The political risks on Medicare have been clear all along: Now it's time for jittery Republicans to answer three questions about where they stand on reform

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Politico reported as news yesterday that House Republicans “raced through political red lights” in their effort to include Medicare reform in the GOP’s April budget. The story recounts the dissension within the GOP ranks about Ryan’s plan before the budget vote, and how signs from pollsters signaled big political risks.

Anyone who thinks GOP leadership was ignoring “political red lights” is rewriting the past. The risks were well-known back in February and March as Republican members debated whether and how to push forward on reforms to Medicare in the House budget.

For instance, in light of numerous reports of GOP nervousness about entitlement reform in February, a number of us said such obvious things as “[reforming entitlements] will be difficult. [House Republicans] will need the courage to withstand the political blowback they will get.” Courage was in order because, as Matthew Continetti wrote in the Weekly Standard, plenty of conservatives were ready to bail: “Opinion polls and the political dangers that accompany any discussion of entitlements have persuaded some conservatives that the GOP can afford to wait another two (four? six?) years to reveal its plans for Social Security, Medicare, and Medicaid.” Because of political fears, many in Washington, including a lot of jittery Republicans, were in Reihan Salam’s words, “pretenders, not cutters” on entitlement reform.

The point is this: a debate within the GOP about the political risks of reforming entitlements was practically taking place in the open air before the April budget, and Republican leadership decided to propose serious reforms to Medicare anyway.

They were certainly under grassroots pressure (the Politico story makes it sound as if the tea party was the reason Boehner and Co. went after entitlements), but they were also acting on a series of well-documented claims – especially after Obama’s neglect of the deficit in his State of the Union – that our nation is in fiscal trouble, and that Medicare is a major reason why.

However, even though political demagoguery was expected and predicted, many in the GOP are getting cold feet about the reforms. The polling, the special election in New York, the constant barrage in the media – it all might prove to be too much stress for those who place politics over principle. To capitalize on this nervousness, Harry Reid will hold a purely political Senate vote on the Ryan budget on Thursday to force Republicans to show where they stand. Politico covers it this morning here.

Republicans have to decide where they stand on 3 important questions, which we can formulate as either-or dichotomies:

Either you can shape public opinion, or you can respond to it. Paul Ryan said on Meet the Press last Sunday that leaders shape the polls, not the other way around. He's right, even though most elected leaders seem to forget this - if they ever learned it. Caving to predictable political pressures would be an unforgivable act of political cowardice. Of course you might lose an election by being bold. That's what politics is. The goal is to prevent that from happening by winning the argument.

Either you’re for limiting how much we contribute to Medicare beneficiaries each year, or you’re for the unsustainable status quo. As the WSJ editors pointed out yesterday, this is where we are. To dodge the Ryan plan forces you to say what you would do about Medicare instead. And so far, all other ideas keep the burgeoning, economy-killing trajectory of Medicare intact.

Either you’re for reform now, or raising taxes soon. “We have time” is a common expression by those who punt on Medicare reform. Theoretically, they’re right. We don’t have to reform Medicare tomorrow. But “political time” is different than real time, so in actuality, the hourglass is likely to hit empty before we have achieved real reform. And if we don’t keep advancing a reform agenda, then tax hikes will simply happen. It won't be a question of whether, but when.

The Republicans’ Medicare proposal was not an act of courage that ended when the budget was voted on. The vote was only the beginning.

Comments

[Ricardo's Ghost]

Ryan,

you're overlooking a lot of things.

1) If the GOP is going to defend Paul Ryan's plans it needs to have a reply to Krugman's critique: limiting coverage to a voucher that won't cover the insurance premium is never going to be politically acceptable and therefore will never actually happen.

2) The choice is not between Ryan reform and doing nothing. The choice is between doing things to contain healthcare costs (Obama's ideas for example), and accepting healthcare costs are where they are and will go where they go, and instead switch the question to how much of the bill the government will cover and how much will be left to seniors to cover themselves.

3) If Medicare's cost increases are economically crippling, they will still be economically crippling if the government managed somehow to shift the responsibility for paying those costs onto seniors. The economy would still be devoting enormous sums to healthcare for seniors. The only way this isn't true is if you somehow do something to contain costs or you actually think that when healthcare costs are shifted on to seniors they won't buy something as good or comprehensive as Medicare.