The Bogus Attack on Paul Ryan's Medicare Plan

It's time to retire the lame cliché about "ending Medicare as we know it."

By putting Paul Ryan on his presidential ticket, Mitt Romney has created an abundance of new fodder for our class of political prognosticators. It's a bold pick that will fortify his flagging support among movement conservatives, some have it. Others call it a giveaway to Democrats that weds Romney to the most politically risky parts of the Ryan fiscal vision and makes him an easy target for ferocious attacks from the left. And so on and so on.

As always, these predictions are pretty much impossible to verify. But one near-certainty about the selection of Paul Ryan as Mitt Romney's running mate is that we will now be subjected to yet more accusations that Ryan (and now Romney) plans to "end Medicare as we know it."

In fact, President Barack Obama and Vice President Joe Biden have already put the quip into heavy rotation on the campaign trail. But long before that, the phrase had become a go-to tile in the dated set of magnetic poetry that pundits and politicians use to cobble together analysis. Even Mitt Romney himself—in an assault on the Affordable Care Act—has made use of the trope. The word mavens over at the AFL-CIO, meanwhile, recently labeled Romney's VP pick "Paul 'End Medicare as We Know It' Ryan."

In a strong field, this is one of the most inane clichés in modern politics. Depending on your reading, it's a doomsaying prophesy of retiree squalor and American decline, or a fact so trivial as to be nearly devoid of meaning. It's a quasi-apocalyptic formulation, from its uncompromising first word "end" to it's REM-evoking final part "as we know it." It is also true by definition of just about any reform of any kind. In fact, it's such a fluid turn of phrase that Bill Clinton famously used it to the opposite effect when touting his 1996 welfare reforms as the "end of welfare as we know it."

And yet, it is more commonly trotted out to smear those who suggest serious changes to any of America's marquee federal programs—no matter how necessary, sensible, and non-ideological—often halting any kind of substantive debate in its tracks. Which is, of course, what it was engineered to do.

Its return to prominence is in itself strong evidence that this year's White House race has little chance of rising above the status quo of our decidedly stodgy, outdated, obscurantist policy conversation.

Let's get a few things straight about Medicare "as we know it." According to the 2012 report from the Medicare's Board of Trustees, the entitlement's trust fund will be exhausted in 2024. Part of the current strategy for dealing with its mounting cost is to cut payments to doctors—a solution so unpalatable that Congress has been putting it off for years.

It is a public policy dinosaur, a Johnson-era program that was flawed in conception nearly half a century ago, and has been so afflicted by our current demographics and growth in health care spending that it can barely stand under the weight of its own unfunded liabilities. To keep funneling money from younger generations to prop up a fiscally doomed edifice that caters exclusively to the old, regardless of their level of need, is at best ill-advised, at worst morally abhorrent. That is the Medicare that we know. And, given its current trajectory, it's going to end one way or another.

But part of the reason that it's considered near-treasonous in some circles to propose any kind of fundamental change to Medicare or any other entrenched program—aside from the indispensability of the over 65 vote—is a destructive tendency by some to worship certain institutions as ends in the themselves. It's precisely the thinking that has made "saving Social Security" a rallying cry instead of "helping the least well off among us." Or "defending public schools," a bumper-sticker-ready tenet, instead of "giving our young people the best chance at a fulfilling, prosperous life."

Such a confusion of priorities is partly what is preyed upon by those who whip up crowds with the "end something-or-other as we know it" rhetoric. It cynically appeals to a pre-rational view of politics.

Fortunately, it runs counter to what many already take as self-evidently true. Indeed, according to a Harris poll from April, 83 percent of respondents understand the necessity of Medicare reform, with 51 percent believing that "a great deal of change" is needed.  As for those age 50 or older, a group that includes seniors, the main target of "Mediscare" tactics, 88 percent agree that it should be strengthened to "provide health coverage in retirement for future generations," according to an AARP poll from last month.

But of course they do. And it's hard to imagine any politician who understands the basic arithmetic of the program not at least stopping to pay lip service to the need to revamp it. In fact, Obama himself has said that "with an aging population and rising health care costs, we are spending too fast to sustain the program. And if we don't gradually reform the system while protecting current beneficiaries, it won't be there when future retirees need it." No kidding.??
Ryan has answered the president's call and proposed an approach to updating the program that attempts to bring its costs under control by exposing it to the market forces that have helped keep prices low and quality high in so many other domains. Scary stuff, no?

Putting aside the relative merits and drawbacks of Ryan's approach, to label this as anything other than an honest attempt to solve a difficult problem is the worst kind of fear-mongering. Which is bad enough. But if they're going to do it, is it too much to ask that they come up with a new turn of phrase every now and then?