The Republican Pledge to Avoid Doing Anything About Medicare


Avik Roy makes an important point about the recently released Republican Pledge to America: When it comes to entitlements, and specifically health care entitlements, the document has very little to say:

The Pledge says almost nothing about the biggest and most difficult questions in health policy: Medicare and Medicaid reform. It criticizes PPACA's "massive Medicare cuts" without offering an alternative solution for putting the program on stable long-term footing.

By my quick count, the Pledge uses the word "Medicare" eight times. There are references to the Centers for Medicare and Medicaid services as well as to the Medicare Trustees Report. There's also a reference to the fact that the billion dollars a day our country will soon be spending on debt service "won't build roads, fight terrorism, secure our border, or support Medicare for seniors" (a line which tells us a lot about how the GOP thinks taxpayer money ought to be used). And then there are warnings that the new health care law's Medicare cuts will hurt seniors:

  • "The chief actuary at the Obama Administration's Centers for Medicare & Medicaid Services has confirmed that the new law's massive Medicare cuts will fall squarely on the backs of seniors, millions of whom will be forced off their current Medicare coverage." (p. 26)
  • "The new health care law includes…$528.5 billion in Medicare cuts, which will be used to create new programs not related to seniors." (p. 28)

The only reference to long term planning for Medicare and Medicaid comes on page 22, and it's hardly inspiring:

We will make the decisions that are necessary to protect our entitlement programs for today's seniors and future generations. That means requiring a full accounting of Social Security, Medicare, and Medicaid, setting benchmarks for these programs and reviewing them regularly, and preventing the expansion of unfunded liabilities.

They will make decisions! That are necessary! But what might those decisions be? Er, um…look, a blimp!

Combine this with the hedged promise to only roll back spending "with common-sense exceptions for seniors" (as well as veterans and troops) and you have a recipe for total inaction on our unsustainable entitlements. The conservative defense, best expressed by National Review's Kevin Williamson, is that it's unrealistic to expect too much action or specificity from the party given the limited political prospects for large-scale reforms in the coming years. The Pledge is a popular campaign document, after all. Williamson is right that Republicans will struggle to accomplish any of their major initiatives in the near future. But it's tough to trust their fiscal bona fides if they can barely manage to anxiously tip-toe around the subject of entitlement reform.

It's not simply that the GOP leadership isn't specific enough. It's that  even when directly pressed, GOP leadership won't take even the smallest of stands when it comes to entitlemen

t spending. The party's House Minority Leader, John Boehner, certainly doesn't have any answers—or if he does, he's not telling anyone:

House Minority Leader John Boehner (R-Ohio) on Thursday said he doesn't have the answer to solving Medicare's spending crisis. To solve those problems, Boehner said, Congress will first have to initiate "an adult conversation" with voters, who will then decide what fixes to apply.

"It's time for us as Americans to have an adult conversation with each other about the serious challenges that face our country," Boehner said Thursday, responding directly to a question about entitlement solutions during the unveiling of the GOP "Pledge." "I don't have all the solutions. But I believe that if we work with the American people, the American people will want to work with us to come to grips with these challenges that face our country.

If Boehner, one of the most powerful politicans in the Republican party, wants to have an "adult conversation" with voters, shouldn't he be willing to start that conversation by talking about the actual policy changes he and his party believe will be necessary to turn Medicare into a sustainable program? Democrats at least cloaked their health care overhaul in the CBO-certified veneer of fiscal responsibility; Boehner and many of the Republicans behind the Pledge can't even be bothered to take a passing stab at the specifics of entitlement reform. And it's not as if Boehner and the rest of the GOP leadership haven't had the opportunity to sign onto a broad and relatively slow-moving plan to deal with the country's long-term deficit and rising entitlement costs—Paul Ryan's Roadmap. But instead of signing on as supporters, many top Republicans (including Boehner) responded with something to the effect of "that's really, uh, interesting" and tried to change the subject. The GOP clearly wants to be the party of fiscal responsibility. But if it hopes to claim that title, it's first going to have to introduce a plan to be fiscally responsible.

More on Medicaid reform here. More on the GOP's Pledge here, here, and here.