Republicans are continuing their gradual pivot away from the Paul Ryan Medicare plan they once voted for overwhelmingly — another tacit admission that the blueprint is too radical to pass. But they haven’t given up on the concept — far from it. In fact, they’re searching for more tactful ways to bring it to fruition.
The latest evidence came Thursday, when Republican Sens. Tom Coburn (OK) and Richard Burr (NC) rolled out a sweeping new plan that would transition Medicare to a subsidized private insurance system while giving seniors the option to remain in the traditional government-run program — think “Obamacare” exchanges with a public option.
Both of the senators voted for the Ryan blueprint that ends traditional Medicare, but they made it clear that their new plan won’t do that. “Unlike other Medicare reform proposals that have been introduced, we’re not eliminating fee-for-service or traditional Medicare,” Burr told reporters. “But what fee-for-service should have to do is it should have to compete with what the private sector can lay on the table also.”
This comes two months after Ryan, the GOP-led House’s point man on budget, himself backed off his Medicare plan somewhat by teaming up with Democratic Sen. Ron Wyden (OR) to unveil a gentler version of his plan — although it still moves in the same direction. He said he stands by his version but wants to find a bipartisan way to move to “premium support,” i.e. vouchers.
Ryan’s plan — which won the votes of nearly every congressional Republican and no Democrat — would have replaced Medicare in 10 years with a private insurance exchange in which seniors’ financial assistance grows much more slowly than medical cost inflation. It was beaten to a pulp by Democrats, who have been relentlessly bludgeoning Republicans with it ever since.
So Republicans are now looking for a politically feasible way to get there, and in the process working hard to create the impression that such a shift is inevitable. But even the Wyden-Ryan or Coburn-Burr renditions of “premium support” would represent a drastic departure from traditional Medicare, partially privatizing the program and setting the stage to phase out the single-payer plan.
That’s what this is ultimately about — finding a way to get Dems on board for that goal. Wyden is already there but Dems are otherwise not biting. The White House objected to Wyden-Ryan about as strongly as it objected to Ryan’s first effort. But that’s to be expected with a major election looming. The drumbeat is nevertheless building — major health care industry groups are pushing hard for it — and Coburn-Burr adds to that.
“What we’re laying out is a blueprint,” Coburn said. “And we’re willing to talk with anybody to get better ideas, to adjust it, to try to build a consensus for our country.”
Even though general concept of Coburn-Burr may be the sort of thing liberals detest, there’s more evidence that they’re trying to win over Dems. The blueprint is sprinkled with some provisions apparently aimed at winning progressive support, including an annual cap on seniors’ out-of-pocket costs, asking millionaires to pay more into the program, and eliminating an incentive for over-utilization among those who have supplementary plans.
Coburn portrayed the road to Medicare’s long-run solvency — experts overwhelmingly agree that it’s on an unsustainable trajectory — as a choice between President Obama’s cost-cutting Independent Payment Advisory Board (which has the authority to limit provider reimbursements) and privatized insurance. There’s growing agreement on both sides that Medicare per-beneficiary spending needs to be held down to per-capita GDP+1 percent. The question is whether to get there by embracing a “defined contribution” plan where the program gives seniors a fixed amount to buy their own private insurance, or to continue with the existing “defined benefit” model and cut costs on the provider side.
That’s where the fundamental divide is — and Coburn made it clear where Republicans stand.
“You can control health care one of two ways,” he said. “You can allocate resources from a bureaucracy, from a government-related planned manner that saves money and actually rations care. Or you can say, even with its defects, market forces might allocate it better.”
Sahil Kapur is a congressional reporter for TPM. He previously covered politics and public policy for numerous publications including The Guardian and The Huffington Post. He can be reached at sahil [at] talkingpointsmemo.com.