Medicare politicking won't fix problem

Democrats may be crowing now about the political damage caused to Republicans for embracing Wisconsin Rep. Paul Ryan's unpopular prescription to heal Medicare, but eventually voters will demand more than just criticism of the Ryan plan.

The House Republican leadership miscalculated in so quickly backing and passing the proposal from Rep. Ryan, chairman of the Budget Committee. The plan would end Medicare as a public entitlement and convert it to a government-subsidized voucher program, with insurance coverage purchased in the private market.

Following their congressional victories in a November election on which most of their candidates campaigned on smaller government and fiscal conservatism, Republicans appeared confident that Americans were ready for radical changes to cut Medicare spending. The largely negative reaction to the Ryan proposal shows they are not. Medicare is for the most part a popular program and one Americans count on to make sure they have adequate medical care in old age. They want it made solvent, not overhauled.

Democrats have sought to exploit this misstep to political advantage, forcing a vote in the Senate knowing the proposal would fail, but wanting to put Republicans on record in favor of the Ryan plan. Five Republicans defected, opposing the House bill.

Rep. Ryan is right that Medicare needs fixing. The latest annual report of the Medicare trustees concludes the program is carrying $24.6 trillion in unfunded liabilities over the next 75 years. No amount of taxation alone can close a gap that wide. A combination of cost reduction, improved efficiency and increased revenues will be necessary.

President Obama's tepid response is a proposal to create a 15-member appointed board to regulate the organization of health care services and to set prices for doctors, hospitals and other providers. Proponents of this model say it will lead to a more rational approach and a standard of care that reduces redundancy and price padding, while stressing preventive medicine.

Critics call it rationing of care.

In truth, however, both approaches will ration care. Republicans would control costs, and effectively ration care, by limiting the value of vouchers and therefore the quantity and quality of health insurance coverage that nonwealthy senior citizens can afford. President Obama would ration care through strong central control.

The reality is Medicare must change. Costs have to be reduced. Any treatment at any price is not a sustainable model. Labeling that rationing of care, or living within one's means, or simply harsh reality makes little difference.

A compromise solution may come from utilizing some form of both models. Traditional Medicare could continue, but within the reality that strict restrictions on cost and care will be necessary as envisioned by the Obama model. Conversely, building on the Medicare Advantage option, senior citizens could opt out and take part in a market-based model closer to the Ryan plan.

In time it would likely become clear which approach offered the best care at the lowest cost.

Finding common ground is probably impossible in the current, pre-presidential election environment. But unless the election places one party squarely in control and provides tacit electoral endorsement for one approach or the other, there should be a post-election opportunity for serious discussion and compromise.

The choice doesn't always have to be this or that. Sometimes it can be a little of both.

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