Although the the new Medicare reform unveiled Thursday by Paul Ryan and Democratic senator Ron Wyden has received some criticism from conservatives in the press, Ryan says he hasn't heard any objections from his Republican colleagues--quite the opposite, in fact. "I've briefed many members on this, and all, to a person, are very excited about it," Ryan told THE WEEKLY STANDARD Thursday afternoon. "I got so many compliments from members just yesterday on the [House] floor for advancing this dialogue, not running away from this issue, grabbing this issue, and showing that this issue is moving into the mainstream," Ryan said. "I was encouraged to do this in the beginning of the budget [discussions] by conservatives."
According to Ryan, conservative stalwart Jeb Hensarling of Texas and other Republicans on the supercommittee supported the exact same framework proposed in Wyden-Ryan plan, but Democrats on the panel wouldn't go along with it. "Most of our [Republican presidential] candidates are already running on this framework," Ryan pointed out. GOP frontrunners Newt Gingrich and Mitt Romney effusively praised the plan during Thursday night's debate.
The new Wyden-Ryan plan is much like the Medicare reform included in the GOP 2012 budget, with two key differences: (1) the subsidies may grow at a faster rate, and (2) seniors may use their subsidy to buy into government-run fee-for-service Medicare. The latter change is of greatest concern to conservatives.
Won't the government stack the deck in favor of the government-run plan? "The plans, including [traditional] Medicare, compete for providers as well. And so providers and seniors will make a decision based on how good or bad the system is," Ryan said. "That's a market force. That's choice and competition." Fewer and fewer providers are willing to accept Medicare as it exists today, so there is certainly room for private insurers to offer more attractive and competitive plans.
"Are we moving Medicare from a command and control government run system to a market based patient centered system? The answer's clearly yes," Ryan said. "We're taking Medicare from a public-only option to a real-private option and a market-based option in a market-based system." Wyden-Ryan would transform Medicare from a single-payer system into a system in which those entering Medicare after 2022 receive a capped subsidy, or premium support, to purchase health insurance on an exchange. "It runs the money through the person rather than through the government. The marketplace, the patients and the doctors, can make a decision," he said. Ryan-Wyden maintains the exact same "risk adjustment" and means-testing provisions that the GOP budget did (i.e. the sick and poor get a larger subsidy, the healthy and wealthy get a smaller one).
But why did he make this change now, and not back in April when he unveiled his budget? According to Ryan, he always intended to include this option. “We literally couldn’t get it all together because of [the Congressional Budget Office],” he said. “My goal was to do this then.... I had about two or three weeks to write a budget. I just didn’t have the time to get the answers from CBO to do it right.” By law, Congress is required to pass budget by April 15.
"The fact that you have an elected Democrat buying into this kind of structure, I think encourages members, and makes them feel more secure in their positions," said Ryan. "What's important for conservatives is that our ideas become mainstream ideas. And those who cling to the unsustainable status quo are increasingly becoming marginalized."