Sunday morning on Meet the Press, former House speaker Newt Gingrich ripped the Medicare reform proposed by Paul Ryan and supported by almost all House Republicans as "radical" and "right-wing social engineering."
"I don't think right-wing social engineering is any more desirable than left-wing social engineering," Gingrich said when asked about the Republican plan to transform Medicare into a premium support system for future beneficiaries who are currently 54 years old and younger. "I don't think imposing radical change from the right or the left is a very good way for a free society to operate."
Gingrich, who announced last week he's seeking the Republican presidential nomination, went on to say that "we need a national conversation to get to a better Medicare system with more choices for seniors." As for specific changes to Medicare, Gingrich mentioned eliminating fraud. "Between Medicare and Medicaid, we pay between $70 billion and $120 billion a year to crooks. And IBM has agreed to help solve it, American Express has agreed to help solve it, Visa's agreed to help solve it. You can't get anybody in this town to look at it. That's, that's almost $1 trillion over a decade."
"But not what Paul Ryan is suggesting, which is completely changing Medicare," said Meet the Press host David Gregory.
"I think that that is too big a jump," Gingrich replied. "I think what you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options, not one where you suddenly impose upon the--I don't want to--I'm against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change."
Gingrich's disavowal of Ryan's Medicare reform comes just a few weeks after he told Time's Jay Newton-Small that he would have voted for it:
The former speaker sang Ryan’s praises for being a “brave” “man of ideas,” like Gingrich himself.
“But would you have voted for Ryan’s plan?” I pressed.
“Sure,” Gingrich replied.
“Do you think it would actually save the health care system?”
“No, I think it’s the first step,” Gingrich said. “You need an entirely new set of solutions.”
But hours after Gingrich said on April 20 that he would have voted for Ryan's plan, he wrote in a Facebook post that he's interested in making a significant tweak to Ryan's Medicare reform: "allow seniors to choose, on a voluntary basis, a more personal system with greater options for better care."
The Wall Street Journal interpreted Gingrich's post as support for the Rivlin-Domenici plan, which changes Medicare to a premium support system but gives seniors the choice of using their subsidies to purchase private insurance plans sold in a regulated Medicare exchange or putting the subsidies toward the traditional government-run Medicare program.
Paul Ryan told me in an interview on April 27 that that option is a "fine idea worth considering. [Bill Clinton's budget director] Alice Rivlin and I have talked about that in the past.... [I]t wouldn’t be an open-ended fee for service system, like the current one for the under-55 plan. They would get a set amount of money to go toward the traditional fee for service and then, like current Medicare they’d probably buy coverage to supplement it. I would think a person would prefer a comprehensive plan like Medicare Advantage is today, but you can do this in a way that doesn’t have a budgetary effect, that it doesn’t bankrupt the program."
So does Gingrich actually support switching to a premium support system like Ryan's, but to one that would allow beneficiaries to choose either the government-run program or private insurance?
"He has supported such a model," Gingrich spokesman Rick Tyler wrote in an email to THE WEEKLY STANDARD.
I pointed out that Paul Ryan doesn't see much difference between his plan and what Gingrich was calling for on April 20, and Gingrich's spokesman agreed. "There is little daylight between Ryan and Gingrich," he wrote. "But look how it gets reported. Newt would fully support Ryan if it were not compulsory. We need to design a better system that people will voluntarily move to. That is a major difference in design but not substance."
But if there's "little daylight" between the two, why did Gingrich call Ryan's plan "radical" and "social engineering"?
"Radical means that politically you can't get to what Ryan wants from where we are," wrote Tyler. "It will be demagogued to death. Right wing social engineer refers simply to compelling people to participate without giving them a choice. That is a political mistake."
While Tyler made clear that Gingrich wasn't endorsing the Rivlin-Domenici plan in total, there are some ways in which Rivlin-Domenici amounts to a more radical change than Ryan's proposal. For example, Ryan's plan doesn't touch the current Medicare fee-for-service system for those now retired or 10 years away from retirement. Under Rivlin-Domenici, both current and incoming beneficiaries must start participating in a premium-support system in six years.
As Yuval Levin has written in THE WEEKLY STANDARD, the most radical aspect of Ryan's plan is its gradualism.