CNN’s exit poll Saturday told us that abortion, the budget deficit, the economy, and illegal immigration were the top voter concerns of voters in the South Carolina primary. But there’s plenty of room for health care, including possible changes to Medicare, to swish around in those economy and deficit buckets. Republicans said last week they would try again to enact Wisconsin congressman Paul Ryan’s proposal to privatize Medicare by giving seniors a voucher to help them buy health coverage from commercial insurance companies. That plan would shift some of the rising costs of medical care from the government budget to individuals.
The Republican drive to push the Ryan plan is all the more reason for journos to keep some context about the candidate’s positions on health care in their hip pockets, and sprinkle it into their stories when the need arises. David Frum, writing for The Daily Beast, has helped out here, giving a short history of how Mitt Romney’s position on vouchers for Medicare, often called premium support, came to be. It’s good stuff for anyone writing about Medicare during the campaign.
Says Frum: “Mitt Romney has been typecast as a dangerously out-of-touch Richie Rich. So why has he gone along with Paul Ryan’s horribly unpopular plan to gut Medicare?” Frum argues that Romney’s problem is not his own wealth but “his apparent lack of concern for others’ nonwealth.” So shifting more costs to seniors, millions of whom have little or no wealth, is puzzling, but makes sense in the political context.
In developing his argument, Frum noted that at first Romney kept his distance after Ryan announced his proposal last spring. “I appreciate what Paul Ryan has done,” Romney said, promising his own plan. He refused to say whether he would sign Ryan’s plan into law, reasoning “that’s the kind of speculation that is getting the cart ahead of the horse.” A week later the horse was out in front. Now the candidate was more definite, saying he would sign a Ryan plan—but, he repeated, he would also have his own plan.
Frum reported that, throughout the fall, pressure from congressional Republicans pushed Romney more toward Ryan’s vision for the future of Medicare. Finally, in November, he released is own plan. Romney’s plan was similar to Ryan’s, though he did not specify how large the voucher should be to help seniors buy private coverage. When Newt Gingrich began to rise in the polls, in December, Frum reported Romney expressed “unequivocal support for the Ryan Plan—-and the end of the Medicare coverage guarantee for those now under 55.” This all etches a picture of a candidate swaying with the political winds.
As Medicare expert Henry Aaron, a senior fellow at the Brookings Institution, pointed out in a conversation with me, the size of the voucher or premium support is crucial. Whatever the size is, it’s likely to become the status quo, which Aaron said is hard to change. If the voucher is set too low, seniors will get too little help to buy adequate coverage. It’s not customary for such details to be part of the campaign rhetoric, and it’s not likely political reporters following the candidates have much knowledge of the intricacies of a premium support. But when the talk turns to the economy and the budget deficit, which it surely will, such money details will be super important.