If I told you that the chairman of the Republican senators’ reelection committee wanted to phase out the existing Medicare system and slowly replace it with Obamacare, would you believe me? No major caveats, no clever tricks. Just a slow transition from Medicare as we know it to the same health care law Republicans have sued and attempted to repeal — but for seniors only.
You probably wouldn’t. But you’d be wrong.
The long-term Republican budget plan proposed by House Budget Committee Chairman Paul Ryan (R-WI) phases out Medicare as a guaranteed, universal, single-payer system and replaces it with a government-subsidized private insurance program. If that sounds familiar, it should.
“It’s exactly like Obamacare,” said NRSC chairman Sen. John Cornyn (R-TX) in the Capitol Thursday. “It is. It’s exactly like it. Which strikes me as bizarre that you’re seeing so much pushback [from Democrats].”
This is admirable candor — Cornyn was the only legislator I could find, Republican or Democrat, who would acknowledge this obvious truth. Indeed Cornyn didn’t even let me finish my question before excitedly volunteering that the House Republican budget would turn Medicare into a plan that mimics the key aspects of President Obama’s health care law.
What explains the irony? If you think of the health care system as a highway with unbridled free market private insurance on one end and universal single payer on the other end, then two parties are now approaching each other from opposite directions. Democrats pushed ObamaCare for working-aged people as a move away from unrestrained private insurance, toward a universal program. In trying to dismantle Medicare, Republicans are seeking to rollback a successful example of single payer toward freer market.
They’ve now awkwardly encountered each other in the middle. The similarities between the two policies creates a dilemma for Republicans who have smeared the health care law as an existential threat to the United States and for Democrats who’ve attacked the GOP plan as a corporate giveaway and dangerous for seniors.
Thus, most of them deny the chance encounter on the health care highway is even taking place
“I don’t think that there are that many similarities, the way you suggest, as far as our proposals to reform Medicare and ObamaCare,” said House Majority Leader Eric Cantor (R-VA).
The GOP plan, as suggested above, would put future Medicare beneficiaries into an exchange — a pooled marketplace of private health insurance — and subsidize those policies with federal revenues. That’s the very same principle underlying “Obamacare.” But don’t take my word for it. Here’s Cornyn.
“Basically people who lose their employer-provided insurance, right, under Obamacare, go into the exchanges and then are provided with a taxpayer subsidy to help them buy private insurance,” he said. “That’s exactly what the premiums support plan that Paul Ryan is proposing.”
Correct! Yet Cornyn supports one and vilifies the other. “[ObamaCare] was 2,700 pages long, and I did oppose it for a multitude of reasons,” he said.
If you present members with the notion that the two plans are similar in anyway, you get obfuscation, or word salad, or both.
“I’m curious as to how,” said freshman Rep. Bill Huizenga (R-MI). “A lot of people believe that’s going to be a system that’s a little more similar to what we have as federal employees, too.”
“What we do, is what the President has called for and so many of our friends on the other side and that is, don’t you think that seniors ought to have the same kind of health coverage as Members of Congress?” said Rep. Tom Price (R-GA), chairman of the Republican Policy Committee. “The program we would put in place is one that essentially mirrors the federal employee health benefits program and a series of premium assistance for seniors who are not able to have the financial wherewithal.”
This is a common refrain from Republicans. One problem with it, though is that Obama’s health care reform law also provided uninsured people with benefits similar to those members of Congress have.
“Are there better structures? Could be, but we’ve also gotta make sure that we have the art of the possible,” said Huizenga when confronted with this fact.
There are important differences, of course. For instance, Republicans say their plan offers seniors “premium support,” but the policy experts who designed premium support disagree. Premium support would keep pace with the growth of health care costs — this is how the health care law works, and how the federal government’s contribution to employee health benefits works. The GOP, by contrast, would give seniors vouchers. Likewise, there’s a fundamental difference between putting working adults into an insurance pool and trying to set up the same system for sick, old people. The latter is much riskier, and therefore more expensive.
On the political flipside, the GOP plan automatically enrolls seniors in the private system, while the health care law ensnares people with mandates. These are relatively small details compared to the broader policy prescription. Yet Democrats and Republicans alike largely refuse to acknowledge it.
“I don’t believe there is [any overlap] simply because what the President is proposing is to relegate virtually every American into a system where their employees either mandated to provide coverage, or they’re mandated to purchase coverage,” said Rep. Mike Pence (R-IN).
Sen. Ron Wyden (D-OR) ducked the question three times. Sen. Jay Rockefeller (D-WV) joked, “If you just say Paul Ryan, I assume that there’s something bad going on.”
In a way it’s no surprise that Republicans and Democrats have such similar approaches. The health care law is based on an old Republican policy idea — one they quickly abandoned when Barack Obama adopted it. But if the parties happen to be proposing similar policies — albeit for very different reasons — could they come together and tweak the health care law in ways that would appease both parties, without throwing the whole thing out? Cornyn’s candor surprises again:
“I’m open to it,” Cornyn admitted. “If we can afford it.”
Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. He can be reached at firstname.lastname@example.org.