The Mediscare Boomerang

ObamaCare gives Republicans a chance to win the Medicare debate.

President Obama all but called Paul Ryan's Medicare reform un-American in 2011, and Democrats have since spent 16 months running their familiar Mediscare campaign. But all of a sudden liberals and their media bodyguards claim to be scandalized because Mitt Romney has the nerve to defend himself by describing Mr. Obama's own "Medicare cuts." How dare he?
The double standard is predictable, but the furor is also instructive. For the first time in memory, voters this year may have a choice between two very different philosophies about how Medicare ought to evolve. The political class is spitting nails because, thanks largely to ObamaCare, a reform agenda might finally get a fair hearing.

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"You paid in to Medicare for years, every paycheck," the voiceover runs in a new Romney TV commercial. "Now, when you need it, Obama has cut $716 billion from Medicare. Why? To pay for ObamaCare. So now the money you paid for your guaranteed health care is going to a massive new government program that's not for you."

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WSJ Editorial Board Member Joe Rago says Mitt's new Medicare ad is exactly what Republicans need to do if they want to capture the White House. Photos: Associated Press

If this horror show sounds familiar, perhaps that's because the Romney ad is a variation on classic Democratic media buys not merely in the Tea Party era but the 2000s, the 1990s, the 1980s, the 1970s, if not to the very creation of Medicare in 1965. Any time Republicans so much as suggest that the entitlement state has a problem, and even if they don't, Mediscare becomes a main election theme.

According to the usual Beltway rules, the Washington potentates call for an honest debate even as they defend or excuse the rank Democratic falsehoods in order to defeat even the modest reform that they will then claim we need, if only there had been an honest debate. The Republicans are supposed to act like Quakers amid the pummeling and are only allowed to appeal to columnists and wonks with their boring old budget charts and obscure details. And then lose elections.
Well, now we're learning that the same tactics can be used against Democrats too. The difference this time is that the Romney-Ryan ticket is trying to create a political shock absorber against Mediscare so voters can consider the substance of a genuine reform alternative that modernizes the entitlement state, rather than simply expanding it.
For the record, President Obama's $716 billion is a "cut" only in the sense of slowing the rate of spending growth over 10 years, which is the baseline Democrats always use. Medicare spending will continue to rise rapidly. The Obama "cuts" come by cranking down Medicare's price controls for hospitals and by gutting Medicare Advantage.
The real term for this familiar Beltway ploy should be Medicare austerity—i.e., keep the status quo, only less of it—rather than reducing costs over time through the structural change the program needs. But it is factually correct to say that Democrats took money from Medicare and then used the "cuts" to hide ObamaCare's true 13-figure cost.

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Getty Images Either Mr. Obama's apologists can defend raiding one insolvent entitlement to finance another one and own the cuts. Or they can say these Medicare cuts don't really count as cuts, as the media fact checkers are suddenly finding ways to do. In which case it means repudiating Mr. Obama's repeated claims that the Affordable Care Act reduces the deficit and that "I have strengthened Medicare," as he put it in Dubuque on Wednesday.
The larger reality is that Medicare cannot and will not continue as it is, as the President used to admit. A sampler of his rhetoric from the town-hall summer of 2009: "Mark my words," he declared in Grand Junction, Colorado, "Medicare in about eight to nine years goes into the red. . . . It is going broke." He added in Portsmouth, New Hampshire, that "What is truly scary—what is truly risky—is if we do nothing" because Medicare is "unsustainable" and "running out of money." In Belgrade, Montana, he said the program must be reformed "to be there for the next generation, not just for this generation."
What he rarely mentions is how he plans to fix Medicare under ObamaCare. First the government will do things like arbitrarily commanding providers to deliver the exact same benefits except for $716 billion less. When that doesn't work, as it surely won't, the feds will take control of the case-by-case decisions currently made between patients and doctors and substitute the judgment of technocrats. (See what's already happening in Massachusetts, "RomneyCare 2.0," August 6.)
ObamaCare does this by empowering an unelected 15-member panel to rule over medicine and tell doctors how to practice, with no legislative or judicial review. Before he decided to fire up Mediscare again, Mr. Obama used to concede that this form of rationing by elites was inevitable. In a 2009 interview with David Leonhardt, he mused whether his own grandmother's hip replacement after a terminal cancer diagnosis represented "a sustainable model" for society.

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Paul Ryan and Mitt Romney are proposing an alternative to protect Medicare patients from this government-run future, and nothing in the GOP Mediscare counterattack is remotely as misleading as the attacks that Mr. Obama has been making against their reform. The Romney-Ryan plan doesn't "end Medicare as we know it," doesn't include vouchers, and doesn't force seniors to shoulder the $6,400 in higher health costs that Mr. Obama mentions at every campaign stop.
Their "premium support" reform explicitly preserves traditional fee-for-service Medicare. Starting in 2023, seniors could either pick traditional Medicare or choose from a menu of regulated private plans. The reform is modeled after the health program that already covers all federal workers, including Members of Congress. The subsidies increase with health costs, so seniors wouldn't bear more risk.
The plan wouldn't kick in for a decade, shielding everyone who is in or near retirement. Our preference would be to start immediately, but the delay is one of many political accommodations to help ease the worries of current retirees.

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In a normal political year, the liberal Mediscare tom-toms might have scared Republicans from this issue, and Mr. Ryan probably would have remained an admired if sidelined Congressman. But Mr. Obama decided via the Affordable Care Act to remake the entire health-care system including Medicare, and thus he also changed the politics.
The destructive policy and unpopularity of ObamaCare have made Paul Ryan's reform politically possible, meaning that voters may be open to hearing the real choice they face between command and control or private competition and more patient choice. Throw in the lousy economy and the Obama spending and debt binges, and the GOP this year has a chance to win a health-care debate if it goes on offense and contrasts its solutions to Mr. Obama's.
That's the real reason liberals and the press corps claim to be so upset by the Romney Medicare ad. By governing so far to the left, Mr. Obama may have neutralized Mediscare and made voters more receptive to center-right solutions. Medicare is already changing because it must. The difference this year is that Republicans have a plan to save it.