Policy or Politics?

The Wyden-Ryan plan for overhauling Medicare helps Republicans move back toward the center of the political debate

WASHINGTON – The plan to overhaul Medicare introduced by Sen. Ron Wyden (D-Ore.) and Rep. Paul Ryan in mid-December could be considered a ray of bi-partisan light in an era of fiercely partisan squabbles inside the Washington beltway. But it also begs the question: Is it sound policy, or merely a political ploy designed to provide election year cover for Republicans?

By proposing a plan that supports providing premium subsidies for seniors to purchase any of a number of competing Medicare plans including that of traditional fee-for-service Medicare, Wyden-Ryan has moved the debate back to the center. It also may spare Ryan and other Republicans running for office in 2012 significant political fallout from the plan Ryan introduced earlier in the year, which had very little support among older Americans.

And among the Republican presidential contenders, most have plans that more closely resemble the newest proposal.

“(The original Ryan plan) brought the private sector into Medicare in a large-scale way and was seen by many Republicans as a bold move,” said Robert Blendon, professor of health policy and political analysis, Harvard School of Public Health. “But there isn’t a poll that I have seen that indicates anyone over 50 thought this was a good idea.”

While a bill including the Ryan plan passed the House in a party-line vote, it never progressed beyond that point and Democratic lawmakers found fertile political ground by pointing out that the original Ryan plan would put an end to Medicare as we know it.

A late November CNN/ORC Poll found that 57 percent of respondents said Congress should not make major changes in Medicare and Social Security in order to achieve significant reductions in the budget deficit and 62 percent said they were opposed to raising the age for Medicare eligibility.

Amid that backdrop, and with seniors firmly against the best-known Republican Medicare plan out there, Ryan’s shift in direction with Wyden could neutralize Medicare as a significant issue in the election.

“I believe Democrats running for the Senate and the House would like to be running in 2012 with: ‘they are for ending Medicare as it exists today. We are not,’” said Blendon. “From a Democratic point of view, not that it has anything to do with the merits of the idea, you would not have wanted this proposal to be on the table prior to the election since it clouds the issue.”

The proposal may be serving an immediate political purpose in 2012, but Ryan is serious about moving forward with it. “What Ron and I are trying to do is to prepare the ground for a consensus to be accomplished as soon as the politics allow it to happen,” Ryan told Politico in a December interview.

While it is unlikely Wyden-Ryan will come to a vote this year, the proposal should serve as a starting point for renewed debate on how to fix Medicare after the election is over, noted Paul Keckley, director of the Deloitte Center for Health Solutions. As a matter of policy, however, Keckley still feels the proposal misses the mark.

“Until we get to the appropriateness of care, we can’t address the issue of cost in the Medicare system, because we are not addressing demand,” he said. “We can muck around with the pricing and various mechanisms for administering the program and do some public-private options – which are important pieces of the puzzle – but the big pieces are really what we do clinically.”