The Vagaries of Medicare Reform

A weird article from The New York Times purports to reveal a growing consensus among lawmakers, born from the failed Super Committee, in favor of eliminating Medicare as we know it in favor of vouchers:

Though it reached no agreement, the special Congressional committee on deficit reduction built a case for major structural changes in Medicare that would limit the government’s open-ended financial commitment to the program, lawmakers and health policy experts say.

Members of both parties told the panel that Medicare should offer a fixed amount of money to each beneficiary to buy coverage from competing private plans, whose costs and benefits would be tightly regulated by the government.

Republicans have long been enamored of that idea. In the last few weeks, two of the Republican candidates for president, Mitt Romney and Newt Gingrich, have endorsed variations of it.

The idea faces opposition from many Democrats, who say it would shift costs to beneficiaries and eliminate the guarantee of affordable health insurance for older Americans. But some Democrats say that — if carefully designed, with enough protections for beneficiaries — it might work.

If you read through the rest of the piece, you’ll find that the “some Democrats” mentioned above are never identified, on background or otherwise. Besides their brief appearance here in the article’s beginning, Democrats interested in supporting a vision of Medicare reform that, until very recently (perhaps until this article’s publication) had been roundly and forcefully rejected by the Party for years are only mentioned, not presented.

Similarly, the following bit concerning Paul Ryan’s plan glides by the reader without substantiating what is an obviously empirical claim:

A report on that proposal by the Congressional Budget Office provided ammunition to [Ryan’s] critics. “Under the proposal,” the report says, “most elderly people would pay more for their health care than they would pay under the current Medicare system,” and some would choose not to buy coverage, so “the number of older Americans without health insurance would be higher.”

Health policy experts said these problems resulted from specific features of the House Republican plan and were not necessarily inherent in the idea of “premium support.” Medicare, they said, could move toward “premium support” without destroying the individual entitlement at the heart of the program.

I’m not saying the Times is full of it. I’m sure there are some Democrats who’d like to turn Medicare into a voucher system; and I’m sure there are some policy wonks who argue that this can be done without turning Medicare into a Potemkin program. But instead of relying on my powers of imagination, I’d like the Times to, y’know, prove it.

I’m skeptical that something this thin would be printed by the Times if it took a different political line. The degree of vitally important stuff — like how exactly the federal government would regulate these Medicare exchanges so as to ensure prices don’t get out of control — the piece leaves essentially TK is somewhat remarkable. It reminds me a bit of the Times‘s reporting in the run-up to the Iraq War: A lot of handwaving towards Experts and Reasonable People On Both Sides, the avoidance of asking and asking again the difficult to solve questions, the focus on the event (be it invasion or premiumization) rather than the aftermath (occupation or functionality).

If nothing else, the article serves as a reminder of how important the Occupy Movement has been, and how necessary it was to shift the public conversation away from the deficit and toward jobs and inequality. The ideological and political apparatus to cut Medicare is well-established and will likely never have a more propitious political climate.