At a Friday speech in Washington, Mitt Romney complained once again that “President Obama is the only president in history who has cut Medicare for seniors” and promised with a straight face to “Protect Medicare. Improve the program. And keep it sustainable for generations to come.”
His plan to save the program from eventual bankruptcy? As is so often the case with Romney’s policy proposals, the details are still vague. Even still, there’s an easy way to describe the basic framework: It’s ObamaCare for seniors—but with the addition of a government-run “public option,” also known as traditional Medicare.
The plan bears all of the now-familiar hallmarks of a Romney policy proposal. It’s vague. It’s designed for maximum pandering. And Romney was against it before he was for it.
Now, one might point out that Rep. Paul Ryan’s plan to overhaul Medicare also resembled ObamaCare for seniors. That’s true enough. Under both plans, seniors would be able to use a taxpayer-funded premium support payment to subdisize their insurance premiums and then allowed to purchase a plan of their choosing from a regulated exchange—much like the system of subsidies and exchanges ObamaCare uses to expand individual insurance to the middle class. Ryan’s subsidy formula is designed to cap and restrain the growth of Medicare; Romney has yet to say how he'll calculate the subsidies, or even roughly how generous they would be.
But there’s another important difference. Ryan proposed improving the current system by transforming the current system’s essentially unlimited benefit—and thus its ever-expanding cost to taxpayers—into one in which spending is capped per beneficiary. Romney, on the other hand, wants to add a layer of private insurance on top of the existing government-run Medicare insurance system, which would continue to operate alongside the newly subsidized private plans. He not only wants to preserve today’s Medicare system for current seniors, he appears to want to preserve it—and its unlimited benefit—for anyone and everyone going forward.
The political advantages should be obvious. On the one hand, unlike Ryan, he can’t be accused of “ending Medicare as we know it.” He gets to position himself as a protector of Medicare (the entitlement section of his proposal is titled “Preserve Entitlements.”) On the other hand, he gets to talk about Medicare using key GOP buzzwords like “choice,” “competition,” and “private insurance.”
On a policy level, the idea, Romney explains, is to “encourage insurers to lower costs and compete on the quality of their offerings.” But as Ezra Klein has already explained, that was the oft-stated idea behind the liberal proposal to include a government-run “public option” in ObamaCare’s insurance exchanges. What liberal supporters of the public option said less often was that many, including the idea’s designer, hoped it would provide a slow-but-steady path to single-payer, as private insurers slowly dropped out of the market unable to “compete” with a heavily subsidized, artificially low-priced government-run insurance plan. (Read how a public option for property insurance has displaced private offerings in Florida.)
Romney’s plan, limited to seniors, probably wouldn’t lead to nationwide single payer system, except perhaps the one we already have: Medicare. In other words, it might lead to a seniors' health care system once again dominated by a government-run insurance—essentially canceling itself out.
Romney is at least aware of the potential for problems with leaving a government-run insurance in place. He’s defended his own Massachusetts health care overhaul against Republican criticism by insisting that "we don't have a government insurance plan. We rely on private insurers”—the clear implication being that this is a good thing. And in 2009, commenting on the president’s proposed national health reform, he told CNN that "You don't have to have a public option. You don't have to have the government getting into the insurance business to make it work.” With Medicare, the government has been getting into the insurance business for decades. And Romney, under the guise of reform, wouldn’t do a thing to stop it.