When GOP presidential candidate Mitt Romney announced on August 11 that he had selected Paul Ryan as his running mate, the consensus was that he had made a daring choice with a huge risk: being demagogued on Medicare cuts.
Ryan’s reputation rested on his bold proposals as the House Budget Committee chairman to offer seniors “premium support” payments to purchase their own Medicare coverage. Even though the program is facing an astronomical $38 trillion in unfunded liabilities and is the single-largest driver of America’s mounting debt, Medicare reform has historically been a big electoral loser for Republicans. As recently as May 2011, Democrat Kathy Hochul came from behind to win a special congressional election in New York’s 26th—traditionally a GOP seat—after Ryan’s Medicare plans became the key issue in the race. House minority leader Nancy Pelosi began claiming that three issues would help Democrats reclaim a majority in the lower chamber: “Medicare, Medicare, Medicare.”
Naturally, Democrats were giddy when Ryan was added to the GOP ticket. “Democrats seemed just as exuberant with the choice as Republicans,” reported the New York Times. “Mr. Obama’s campaign manager, Jim Messina, argued that the Republican ticket ‘would end Medicare as we know it,’ a preview of the messages that will play out in what will be the most expensive presidential campaign in history.” The Obama campaign soon unleashed a torrent of ads claiming that if Ryan’s Medicare reforms were implemented, “seniors could pay $6,400 more a year,” a talking point Obama and Biden embraced on the stump.
But after months of heated rhetoric and ads savaging the Romney-Ryan ticket, Democrats are finding that their tried and true Mediscare playbook hasn’t worked. An October 8 Pew survey found that 46 percent of voters trusted Obama more on Medicare, compared with 43 percent who trusted Romney-Ryan more—the issue was effectively neutralized. With the presidential election a little over a week away, almost no observers believe Obama is going to carry Florida, where retirees are a dominant electoral force. The issue hasn’t helped Democrats down ballot, either. Earlier this month, Politico ran with the headline “Paul Ryan plan not the weapon House Dems had expected.” Even if Romney and Ryan end up losing, it will be very difficult to argue that it was because of their position on Medicare.
Ryan, an articulate and gifted campaigner, has worked hard to defuse the notion that he didn’t care about the future of the program. He hit the campaign trail with his mother—a Florida retiree on Medicare—to combat the notion he was out to destroy the program. This is a tactic Ryan appeared to borrow from Rep. Mark Amodei, a Nevada Republican who won a special election in September 2011. Amodei parried Democratic Mediscare attacks by addressing the issue in campaign ads with his elderly mother. Amodei’s election was almost a mirror image of the New York special election four months before—the National Republican Congressional Committee circulated a memo and video presentation using the Amodei race as a template for defending the Ryan plan.
Crucially, Amodei won by favorably contrasting the GOP’s Medicare reform plans with Obama-care—another tactic embraced by Romney and Ryan. “Democrats largely disarmed themselves when they gave Republicans that talking point that Democrats took $716 billion out of Medicare to fund a new entitlement,” says Michael F. Cannon, a health care policy expert at the libertarian Cato Institute.
How Medicare interacts with the provisions in the 2,700 page Obama-care law is a complicated matter to explain to voters. To the extent the Obama and Romney campaigns sparred on the issue, it quickly devolved into dueling soundbites—the Obama campaign’s $6,400 question versus the Romney campaign’s claim that Obama-care raided $716 billion from Medicare.
But Republicans had a big advantage over Democrats—their number was correct, and there was no honest basis for the Obama campaign’s figure. Obama’s accusation that Ryan would make seniors pay thousands for Medicare derived from an earlier version of Ryan’s plan. Originally, Ryan pegged the cost of the premium support payments to seniors to inflation. A study done in April 2011 by the left-leaning Center on Budget and Policy Priorities came up with the $6,400 figure by estimating what seniors would have to pay out of pocket to keep up with medical costs, which are rising faster than inflation.
However, Ryan had revised his reform proposal to address this issue long before the Obama campaign unveiled its attack ads. The plan attacked by Obama ads was not the version embraced by the Romney ticket—and for good reason. Ryan’s fixes were ones first proposed by Romney during his primary campaign. The Obama campaign’s Medicare critique was based on a proposal that the top of the GOP ticket had never endorsed and the bottom of the ticket had abandoned.
The GOP’s decision to highlight the $716 billion Obama-care took from Medicare proved very difficult for Democrats to rebut. The Obama campaign’s defensive spin on the matter was transparent and weak. At the first debate, the president tried to claim that money taken from Medicare was a matter of savings. “Seven-hundred-and-sixteen billion we were able to save from the Medicare program by no longer overpaying insurance companies by making sure that we weren’t overpaying providers,” Obama said.
The problem with this argument is that Medicare doesn’t overpay—indeed, it often pays doctors below market rates to treat patients. You can’t lower Medicare costs this way without limiting seniors’ access to care. Romney’s response at the debate was accordingly damning:
On Medicare, for current retirees, he’s cutting $716 billion from the program. . . . That’s not just going after places where there’s abuse. That’s saying we’re cutting the rates. Some 15 percent of hospitals and nursing homes say they won’t take any more Medicare patients under that scenario. We also have 50 percent of doctors who say they won’t take more Medicare patients. . . .
We have four million people on Medicare Advantage that will lose Medicare Advantage because of those $716 billion in cuts.
Ultimately, Obama-care was Rom-ney and Ryan’s biggest weapon. “When seniors hear that Obama-care took $716 billion out of Medicare, they don’t need to know exactly how it did that—they don’t even need to know how the administration and their echo chamber in the media, particularly fact checkers, are wrong when they say, ‘Oh, I took that money away from providers, not beneficiaries,’ ” observes Cannon. “They know that means their subsidies are going to go down, and they don’t like that. It’s more of an intuitive, gut-level reaction that people have.”
As for intuitive, gut-level reactions, Tevi Troy, a former deputy secretary of the Department of Health and Human Services and an adviser to the Romney campaign on health care policy, also attributes the failure of Mediscare to a change in public attitudes.
“The fiscal realities that we are facing have become more apparent,” he says. “When you see countries like Greece and Spain going through what they’re going through, and when you also see the financial collapse we went through just a few years ago, people recognize that you can’t just continue on the current unsustainable path.”
While the public is increasingly cognizant of the threat posed by Medicare’s trillions of debt, Democrats have been thumbing their nose at the public’s fiscal anxiety by impeding Medicare reform for political gain. In an article for Commentary last year, Troy observed that Senator Patty Murray, in her capacities as both head of the Democratic Senatorial Campaign Committee and Democratic co-chair of the deficit reduction supercommittee, was actively blocking efforts to compromise on Medicare. “We shouldn’t be giving away our advantage on Medicare. . . . We should be very careful about giving away the biggest advantage we’ve had as Democrats in some time,” a source close to Murray told the Washington Post.
The New Republic’s Noam Scheiber also reported that the White House blew up the $4 trillion “grand bargain” deficit negotiations, including Medicare reform, to avoid throwing the Republicans a bone on taxes:
“Let me get this right,” [GOP senator Jon] Kyl finally said to [White House aides Jack Lew and Gene Sperling] as the discussion became tense. “You’re saying there are Medicare savings you think would be good policy. But you won’t do them unless we agree to raise taxes?” Lew and Sperling looked back at him stone-faced and simply said: “Yes.” A few days later, on June 23, [GOP House majority leader Eric] Cantor and Kyl withdrew from the negotiations.
By contrast, Troy points out that Ryan was building bridges on the issue. “You’ve had prominent Democrats saying of Ryan’s plan, ‘Hey, this seems to be an appropriate response,’ ” he says. Ryan worked on his proposals with former Democratic Office of Management and Budget director Alice Rivlin, and a version of his premium support plan was endorsed by Democratic senator Ron Wyden. Ryan’s Medicare proposals have also been praised by Erskine Bowles—the co-chair of President Obama’s own National Commission on Fiscal Responsibility and Reform.
Voters appear receptive to the GOP’s message that Medicare reform is urgently needed, even as Democrats fail to offer a serious solution. “If you get up there and say, ‘We’re going to keep Medicare as it is’—that’s the fastest way to destroy Medicare. That is the path to bankruptcy,” says Troy. “What Ryan has been talking about for a long time, and what the Romney-Ryan approach is, is let’s fix Medicare so that we have it for our children and grandchildren.”
Of course, even if the polls show the Republican ticket erasing the Democratic advantage on Medicare, they also show voters aren’t entirely sold on adopting Romney and Ryan’s Medicare reform plans. But the voters aren’t running from Medicare. Cannon thinks that should Romney and Ryan win, “it’s been enough of an issue that they can claim a mandate to put a Paul Ryan-like [plan] in place.” Still, whatever happens on November 6, it’s likely this election will herald the end of an era—the days of Medi-scare attacks might finally be over.
Mark Hemingway is a senior writer at The Weekly Standard.