David Brooks writes today that Medicare is our biggest budget problem going forward (true) and that President Obama deserves some credit for tackling Medicare reform (also true). Still, he says, all Obama has done is “trimmed on the edges” of entitlement spending. Mitt Romney, by contrast, has shown “surprising passion” about reining in Medicare. And for all you non-tea partiers out there, it gets even better:
By picking Paul Ryan as his running mate, Romney has put Medicare at the center of the national debate….When you look at the Medicare reform package Romney and Ryan have proposed, you find yourself a little surprised. You think of them of as free-market purists, but this proposal features heavy government activism, flexibility and rampant pragmatism.
The federal government would define a package of mandatory health benefits. Private insurers and an agency akin to the current public Medicare system would submit bids to provide coverage for those benefits. The government would give senior citizens a payment equal to the second lowest bid in each region to buy insurance.
This system would provide a basic health safety net. It would also unleash a process of discovery. If the current Medicare structure proves most efficient, then it would dominate the market. If private insurers proved more efficient, they would dominate. Either way, we would find the best way to control Medicare costs. Either way, the burden for paying for basic health care would fall on the government, not on older Americans.
How can Brooks write something like this? It just isn’t true. The Romney/Ryan proposal for Medicare is an almost pure free-market plan. Its only cost-control mechanism is competitive bidding, and Romney has very specifically rejected all the cost-control mechanisms currently in the Affordable Care Act. If competitive bidding doesn’t work, there’s no flexibility, no pragmatism, no Plan B at all.
Beyond that, how can he ignore the growth cap in the Romney/Ryan plan?1 Neither man has promised that “the burden for paying for basic health care would fall on the government, not on older Americans.” Quite the opposite, in fact. They have very specifically refused to say who would pay if competitive bidding fails to keep costs below their growth cap. And unless they stand willing to adopt the kind of command-and-control measures they say they reject, the only possible answer is older Americans.
As near as I can tell, the truth is almost exactly the opposite of what Brooks has written. He may not be impressed with Obama’s plan, but that’s not a good excuse for so badly misrepresenting what Romney and Ryan would do.
1I’m assuming that Romney supports the growth cap in Ryan’s plan, since he’s said that his plan is nearly identical to Ryan’s. It’s not really possible to know this for sure, of course, since Romney’s plan is almost laughably thin and he has declined to produce any actual details about it. However, if there isn’t a growth cap, then it’s just a joke in the first place. It’s vanishingly unlikely that competitive bidding on its own will seriously rein in Medicare costs.
POSTSCRIPT: It’s worth repeating my assumption that what we’re really talking about here is Paul Ryan’s Medicare plan. The reason for this assumption is that Mitt Romney, almost literally, doesn’t have a plan of his own. If you read through his description, what you learn is that (a) all seniors will get a voucher to buy health insurance, and (b) that’s it. There are essentially no other details aside from the now pro forma assurance that current seniors won’t be affected. It’s really not even possible to assess this plan, let alone suggest that it shows “surprising passion” about reforming Medicare.
