Voucherizing Medicare Is a Death Ride for Republicans

Are Republicans really going to start off the 115th Congress by mucking around with Medicare?

For nearly six years, Speaker Paul D. Ryan has championed the new approach, denounced by Democrats as “voucherizing” Medicare. Representative Tom Price of Georgia, the House Budget Committee chairman and a leading candidate to be Mr. Trump’s secretary of health and human services, has also embraced the idea, known as premium support.

....Democrats say that premium support would privatize Medicare, replacing the current government guarantee with skimpy vouchers — “coupon care for seniors.” The fear is that the healthiest seniors would choose private insurance, lured by offers of free health club memberships and other wellness programs, leaving traditional Medicare with sicker, more expensive patients and higher premiums.

....Republicans say their proposal would apply to future beneficiaries, not to those in or near retirement. But the mere possibility of big changes is causing trepidation among some older Americans.

....“I’m scared to death,” said [Charles] Drapeau, who has multiple myeloma, a type of blood cancer, and takes a drug that costs more than $10,000 a month. “We don’t know exactly how it will work, but just the fact that they are talking about messing with Medicare, it’s frightening to me.”

Just for the record, that drug is actually $10,500 every four weeks. So Mr. Drapeau should be 14 percent more scared to death than he already is.

But back to Medicare vouchers premium support. It's pretty plain that it would be worse for seniors than the current Medicare system. After all, if it were better, Ryan wouldn't feel like he has to exempt current Medicare recipients. But everyone currently on Medicare is keenly aware of how their benefits would be affected by Ryan's vouchers, and if they aren't, AARP will tell them in no uncertain terms. So they'll fight Ryan's cuts tooth and nail.

So why is Ryan doing this, anyway? I suppose because it's one of the few ways to open up a significant amount of budget room for his gigantic tax cuts. If you want big tax cuts, after all, you need big spending cuts too, and that means cutting big programs. Unfortunately for Ryan, there really aren't all that many big spending programs, especially once you take defense off the table. So he has little choice but to chop away at Medicare if those top marginal rates are going to come down.

And yet, why now? In one sense, I suppose doing it right at the start, when political capital is highest, makes sense. You do the hard stuff when you have the biggest majorities and everyone is eager for change. That's why Obama went after health care first. At the same time, this would be a huge, messy battle that would almost certainly be wildly unpopular. Medicare is probably even more beloved than Social Security, after all. A battle like this could easily up in an epic defeat, and wipe out whatever goodwill the new Congress has.

So it's a bit of a mystery. I don't think Ryan can win this battle unless he offers up a plan that doesn't really save much money. That's possible, of course: just take a look at the difference between Ryan 2011 and Ryan 2014. But if you don't save much money, what's the point?

I dunno. If it were me, I'd do the popular stuff first. Cut taxes, build the wall, repair some bridges, bomb the shit out of ISIS, etc. More to the point, if I were Donald Trump, that's what I'd do. Trump wants to be adored by the masses, not hated by them. Voucherizing Medicare is very definitely not the way to get there.