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If Republicans are going to succeed in 2012 in both the White House and congressional races, they are going to have to deal with Medicare head-on. In the wake of last week’s special election in New York, many think the opposite is true.
The reality is that Medicare already is an issue since House Republicans included it in their budget and all but four voted for it. And the fact that a “truth-teller” like Tim Pawlenty has to define his forthcoming Medicare plan in light of the Ryan plan shows just how much the House Medicare plan will be central to the White House debate.
There’s no escaping this reality: Republican favor limiting how much the federal government pays up front for Medicare each year, and the Democrats favor limiting how much the government pays on the back end. It’s a part of the debate, like it or not.
So the question becomes how we handle the debate.
The best perspective on this to date came in Karl Rove’s Wall Street Journal column last week:
Next year, Republicans must describe their Medicare reforms plainly, set the record straight vigorously when Democrats demagogue, and go on the attack. Congressional Republicans—especially in the House—need a political war college that schools incumbents and challengers in the best way to explain, defend and attack on the issue of Medicare reform. They have to become as comfortable talking about Medicare in the coming year as they did in talking about health-care reform last year.
And the best set of basic talking points on how to talk about Medicare came in Yuval Levin’s NRO post Sunday evening:
- The Ryan plan would not leave future seniors to find insurance on their own in the private market, and it wouldn’t allow insurance companies to deny coverage or drop people for pre-existing conditions.
- Seniors would be given a menu of approved options to choose from, all of which would be required to accept all Medicare recipients, to offer a plan with at least the level of coverage required by the Federal Employee Health Benefit Plan, and to charge all seniors of the same age the same rates.
- The premium support benefit that seniors get would be adjusted based on their age, their health, and their wealth (and the lowest-income seniors would get an additional pre-funded Medical Savings Account to cover remaining out-of-pocket costs).
- insurers would have the freedom to design these plans (and work with providers to design new approaches to delivering medical services) in ways that would make the plans most attractive to consumers—i.e. in ways that would better provide what seniors want at lower costs.
We can distill these points into three main rejoinders all Republicans should be able to deploy against their Democratic counterparts:
- You’ll have fewer options for good care under the Democratic plan. The Dems just plan on cutting benefits as their cost control system.
- The quality of care will drop. Setting prices will drive doctors away from Medicare patients and result in the entirely predictable and unavoidable reality of lower quality.
- Under the Democrats’ plan, our children and grandchildren will have insufferably high taxes in order to pay for…you. Where the Dems don’t have the heart to cut Medicare as much as their actuaries say they’ll need to, they’ll advocate taxing young workers more. If you are okay with taking more from those who have less just because it benefits you, your conscience – and not some Republican bogeyman – is the real problem.