Are We Entering an Era of Political Cooperation on Medicare?

There’s a chance that we’re starting to see a convergence of opinion on Medicare among Democrats and Republicans on Capitol Hill. I know the recent bickering makes this seem like an odd contention, but consider the following:

  • In recent decades Republicans have done a great job of tarring Democrats with the “tax and spend” label while being fiscally irresponsible themselves. Republicans criticized Carter era deficits, and then proceeded to run up much more startling deficits under President Reagan. Bill Clinton had us looking at surpluses(!) as far as the eye could see until W came in and sent the red ink soaring –partly through tax cuts but largely by boosting spending. When Republicans continued brandishing the “tax and spend” cudgel, Democrats figured they were suckers to go the Clinton route of fiscal responsibility and get no credit for it
  • We’re now at the point where the size of the national debt actually matters. The only way to bring it under control is to bring deficits down. This is something on which Republicans and Democrats can agree. So now you’ve got both parties committed to the idea of deficit reduction; that just hasn’t been the case before.
  • There are still big differences on how to do it, but approaches –at least on Medicare– are likely to converge once the challenge is faced in a serious way, i.e., with an eye toward solving the problem rather than pandering to one group or another. In the case of Medicare, Republicans are likely to move toward the Democrats’ position over time.
  • The Ryan budget proposal is the beginning of this convergence. Rather than cynically trying to scare seniors by claiming Democrats are taking away Medicare (as his colleagues have been doing up til now), Ryan is explicitly acknowledging that Medicare spending can’t continue on its current path. His frank talk is now earning some serious backlash in “town hall meetings” –the same venues where opponents of the Patient Protection and Affordable Care Act (PPACA) took out their wrath on Democrats in the run-up to health reform’s passage. It’s actually good that Republicans are getting a taste of the same medicine they were dishing out  –maybe it will make the GOP think twice about starting up those tactics in the future.
  • Once Republicans decide to think seriously about Medicare costs, they’ll find that the Ryan plan isn’t going to do the trick. A loosely regulated private health insurance industry like Ryan envisions can’t and won’t deal with societal priorities like enrolling sick people for premiums they can afford. At a minimum that’s going to lead Republicans toward similar insurance industry reforms as PPACA (e.g., guaranteed issue, limitations on medical underwriting) in order to preserve Medicare’s universal coverage of the elderly
  • If well-informed, constructive parties –including the Congressional Budget Office, the media, policy wonks, and maybe even presidential candidates– engage on these issues they may yet get toward a national consensus. One reason I’d like to see Mitt Romney get the Republican nomination is it might actually engender a productive debate about Medicare. (Then again Mitt has disappointed in the past.)

I’m getting ahead of myself, but I also think it’s possible that in about 10 years we’ll see significant support among Democrats and Republicans for a single payer system. But that will have to be the topic for a future post.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

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