Potential presidential candidate Jon Huntsman’s recent Wall Street Journal op-ed was thoroughly predictable, containing lots of the acceptable phrases for GOP discourse: stuff about not underestimating the “seriousness of the responsibility,” the need to “make hard decisions now,” “reforming entitlement programs,” Paul Ryan’s attempt “to save” Medicare, “the inescapable reality that we have too few workers supporting too many retirees.” (I thought that last one had been put to rest.) The candidate presumptive made it clear he was a devotee of Ryan and his now-infamous voucher plan to privatize Medicare. He implied that he was on the side of the angels on this one:
I admire Congressman Paul Ryan’s honest attempt to save Medicare. Those who disagree with his approach incur a moral responsibility to propose reforms that would ensure Medicare’s ability to meet its responsibilities to retirees without imposing an unaffordable tax burden on future generations of Americans.
It seems Huntsman is not interested in raising any taxes that would make Part A—the hospital benefits—ship-shape for years to come. And his op-ed doesn’t talk about cutting payments to providers or rationalizing—not rationing—wasteful, expensive medical care or changing the way care is provided; all of which might, just might, start to bend Medicare’s cost curve. But farmers beware! He does mention ending popular but unaffordable agricultural subsidies. The takeaway from Huntsman’s op-ed is that his Medicare solution apparently rests on cutting benefits, aka making seniors pay more out-of-pocket. That, indeed, would reduce the amount the government would have to pay. To review: the Congressional Budget Office says that under the Ryan plan seniors would be paying, on average, about 68 percent of their medical costs, including copayments, coinsurance, and deductibles, compared to around 39 percent on average today.
Los Angeles Times columnist Michael Hiltzik took up Huntsman’s challenge and offered his readers his own moral approach to Medicare, noting that Ryan’s plan transfers more of Medicare’s expense to Medicare enrollees and places “more of the program in the hands of private insurance companies, which have higher overhead costs than traditional Medicare.” Hiltzik attacks what he calls “one of the basic flaws of Ryan’s plan,” that is, folding in Medicare’s long-term financial woes with the short-term problem of the federal deficit. Writes Hiltzik:
Medicare’s ills are wholly separate, except insofar as ginned-up panic over the current deficit is driving Washington politicos to hack away at the program so they look like they’re doing something.
Medicare’s financial troubles are entwined with the money problems of the entire health care system, Hiltzik writes. Indeed they are, and too often journos miss that fact. They also overlook another point—that Ryan would repeal much of the health reform law and with that the few cost-containment measures it does call for. Take the Independent Payment Advisory Board, or IPAB for short. This independent board of fifteen presidential appointees is tasked with examining Medicare’s costs and recommending reductions if they exceed certain benchmarks. Their elimination would then be subject to an up or down vote in Congress.
Some experts believe the IPAB is the best hope for controlling medical inflation in the Medicare program. But guess what? The stakeholders in the medical-industrial complex aren’t keen on that, and for months they have been working behind the scenes to abolish the board, even though it doesn’t yet exist. Ryan’s plan would wipe out that headache for them in one big stroke.
In some ways who is on which side of the moral argument doesn’t matter at the moment, as long as there’s a robust debate on the merits of Ryan’s plan and any other proposals to change Medicare that arise in the coming months. Ryan seems to be calling for such a discussion, framing it in terms of morality. Hiltzik responded. Let’s hope Hiltzik has set an example for other voices to chime in.
For more from Trudy Lieberman on the ins and outs of Medicare coverage, click here. For a recent interview with Trudy from Reporting on Health, click here.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.