The liberal Internet has decided to pile on this piece in The New Republic from William Galston of the Brookings Institute. Galston thinks that Democrats ought to lay off Paul Ryan, because demonizing his plans for Medicare might invalidate premium support as an option for keeping the program finances sustainable. I think Paul Krugman says most of what needs to be said here.
What’s wrong with this lament? How about the fact that Romney-Ryan actually is a plan to end Medicare as we know it? (And why the quotation marks? That’s what it is – replacing the system with fixed-value vouchers). It is also a plan for drastic cuts in food stamps and Medicaid, not to mention canceling the expansion of coverage under the Affordable Care Act, which would mean lost insurance for tens of millions of Americans – thousands of whom would, in fact, die as a result.
Yet pointing out these truths is, in the eyes of Very Serious People, “demagoguery.”
But as for invalidating premium support, let me join with Scott Lemieux in saying, “Good.” Medicare holds down costs better than any other health program in America, maybe with the exception of the more radically government-centered Veterans Administration plan. The reason is that it has a large risk pool, can bargain on prices, and bring those savings to the individual. And there are a number of demonstration projects on coordinated care and bundled payments that could work to drive costs down even more. The last thing you want to do in that case is to add another middleman into that process, with them taking their percentage off the top. We don’t have to guess about whether opening up Medicare to “competition” will spur lowered costs. We have a series of good examples of that kind of competition