Republicans Didn't Make the Case for Medicare Reform


Oh yeah. Powerpoint time.

The conventional wisdom when it comes last night's special election in New York is that it served as an early referendum on Rep. Paul Ryan's Medicare plan. In New York Timesese, "Democrats scored an upset in one of New York's most conservative Congressional districts on Tuesday, dealing a blow to the national Republican Party in a race that largely turned on the party's plan to overhaul Medicare." The national implications of the election are murky, but in the specific case of New York's 26th district, it seems clear enough Democrats won over voters who typically lean Republican by warning them that the GOP was planning to gut Medicare.

Earlier this year, National Review's Ramesh Ponnuru argued that Republicans shouldn't take up entitlement reform this year (with the possible exception of Medicaid). Last night's election is why.

It's not that entitlements don't need reforming; they do. Instead, the problem is that the political groundwork for a Ryan-style overhaul hasn't been laid. Even in the most favorable possible circumstances—say, for example, that Democrats had declined to play the granny card and instead agreed that Medicare needs fixing somehow—no major Medicare overhaul was ever going to get through the Senate this year. And voters were almost certain to be nervous about any plan to substantially alter the system's basic functionality. But House Republicans went ahead and voted for the Ryan plan anyway, thinking that it was their moment, their turn. The sweeping Democratic victory in 2008 had paved the way for ObamaCare. Why couldn't the big Republican win in 2010 pave the way for RyanCare?

Here's the difference: It's true that ObamaCare was partially the product of a big electoral Democratic victory and a moment of liberal policy ascendancy. But it was also a product of years and years of argument and effort, not to mention countless donor dollars spent on think tanks and advocacy groups and polling and an entire well-funded policy infrastructure dedicated to building the case for an exchange-based, mandate/subsidize/regulate health insurance system. Republicans—aside from a few folks like Ryan, who has been diligently hammering away with all manner of Medicare reform explainers—almost totally failed to make any similar effort. Indeed, throughout the '90s and the early '00s, a number of prominent Republican politicians and conservative policy wonks were actively promoting the mandate-driven insurance system that led first to RomneyCare, and then to ObamaCare.

The situaton prior to ObamaCare, then, was that most Republicans generally ignored health care policy except for occasional small battles over things like S-CHIP. And of the few who didn't, some were working on a version of the same plan that ultimately gave their political opponents a major legislative victory. Democrats, on the other hand, spent lots and lots money building institutions that would eventually support and promote their vision of reform.

So when Democrats won big in 2008, they were ready to capitalize on their victory and the legislative power it gave them. They'd laid the foundation for ObamaCare, and it paid off. The big Republican victory in 2010, in contrast, followed a year in which GOP leaders rallied voters against ObamaCare because it cut Medicare, refused to discuss specifics about entitlement reform, and repeatedly distanced themselves from early iterations of Ryan's plan. Is it any surprise that most Republican politicians failed to sell the Ryan budget to the public? It was never clear that most of them actually bought it themselves.

Rep. Ryan, meanwhile, is still plugging away: