I’m speaking of Paul Ryan’s wish to privatize Medicare, or phase it out, depending on how you want to look at it. In an interview last week with Fox News, Ryan made clear that as part of the legislative bacchanal Republicans have planned for Trump’s first months in office, he plans to begin the Medicare phaseout he has long advocated. He seems to want to package it together with the repeal of the Affordable Care Act: “Well, you have to remember, when Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid. If you are going to repeal and replace Obamacare, you have to address those issues as well,” he said. “What people don’t realize is because of Obamacare, Medicare is going broke.”
As part of his strategy, Ryan must convince people that Medicare is all but dead already, so we don’t actually lose much by putting it out of its misery. That’s why he says things like, “Because of Obamacare, Medicare is going broke.” This is not just a lie but the precise opposite of the truth, and Ryan knows full well it is; in fact, the ACA extended the solvency of the Medicare trust fund by over a decade. And be warned: Any time you hear Republicans say the phrase “entitlement reform,” understand that phasing out Medicare is what they’re talking about.
When Democrats say Ryan wants to “privatize” or “phase out” Medicare, Republicans protest that he and they only want to reform it, strengthen it, save it. This is baloney. (I’d use a slightly different word were this not a family paper.) If Ryan gets his way, Medicare as a universal insurance program will cease to exist. It will be replaced by “premium support,” or vouchers which seniors will use to buy private insurance. If you can’t afford any of the available plans with what the voucher is worth, tough luck. The whole point is to transfer the expense from Medicare to the seniors themselves. Half a century after Medicare brought health security to America’s seniors, Republicans would snuff it out, leaving some unknown number without any coverage at all and breaking the fundamental promise the government made.
Understanding just how much senior citizens love this big-government program of single-payer health insurance, Ryan and other Republicans have always tried to sell privatization by telling seniors that they shouldn’t worry because the changes they’re proposing won’t take effect for a while. You’ll still have the Medicare program you love, they say. It’s those who come after you who will be without it. For whatever combination of reasons this argument has never been persuasive; perhaps seniors just don’t trust it, or perhaps they want to make sure their children and grandchildren enjoy the same health security they do. But whenever Republicans have considered making a privatization push, they’ve quickly changed their minds as they contemplated the almost inevitable backlash.
But now they may have the boldness to give it another shot. For Ryan and other Republicans, phasing out Medicare is a high-risk, high-reward game. Getting rid of it is a beautiful dream, because Medicare is a living rebuke to everything Republicans argue about government programs: It’s a gigantic entitlement that has solved a significant societal problem, works efficiently, and is spectacularly popular. If they could privatize it and then begin to shrink it down little by little, they could then do the same to Medicaid, to CHIP, to anything. As Ryan says on his website, “Medicare is the cornerstone on which all other government health care programs rest.”
Ryan knows the political dangers he faces in trying to phase out Medicare, but he also knows that a chance like the one he has now doesn’t come along very often. So he seems determined to move forward, and that gives Democrats a tremendous opportunity.
An effort to phase out Medicare will unite liberals and give them one specific thing to direct their energies toward. It’ll make the consequences of unified Republican rule vivid and concrete. It will also enable them to apply pressure to every member of Congress in a way that the parade of Trump administration horrors may not. A Republican congressman from Alabama doesn’t care if a few of his constituents are appalled that President Trump will have a white nationalist as his senior adviser. But a threat to their Medicare? Hoo boy. Now that’s trouble.
So as much as the 2016 presidential campaign showed the danger of making predictions in politics, I feel comfortable making this one: Ryan’s effort will fail. If he actually tries to move ahead with a privatization plan, there will be a revolt. Even Republican members of Congress who agree with Ryan’s anti-government goals and who would like to see Medicare die will be terrified of their angry constituents and will quickly abandon him. At some point, President Trump — who has no genuine beliefs about any of this and therefore no ideological commitment to privatizing Medicare — will pull the plug.
And Democrats, having beaten back this effort one more time, might begin to see a glimmer of hope. They’re going to lose a lot in the next four years, perhaps more than they can truly understand at this stage. But they won’t lose everything.