Robert Pear’s New York Times piece “Support Builds for a Plan To Rein In Medicare Costs” seemed like a leak. Writing on the Friday after Thanksgiving, usually a slow news day, Pear signaled the D.C. health care cognoscenti’s willingness to convert Medicare into a “premium support” plan—a euphemistic moniker for a voucher system. The piece seemed like a preview of the plan that was being crafted by Democratic Sen. Ron Wyden and Wisconsin Republican Paul Ryan, which would give seniors a fixed amount of money to buy health insurance from commercial carriers.
The idea is to move away from the federal government’s forty-six-year-old commitment to provide senior citizens with health insurance that covers almost all of a person’s hospital care and most of the other medical services they require. Under the Wyden-Ryan proposal, the feds would give seniors a fixed amount of money with which to choose their own combination of coverage. If the policy costs more than the amount of the federal voucher, seniors would have to pay the rest of the cost out of pocket. That would allow the government to shift much of its expense for Medicare to the beneficiaries themselves, especially if the government’s contribution shrunk over time while medical costs increased. Bruce Vladeck, who headed Medicare during the Clinton administration, described such a plan this way: “By controlling the price of the voucher, future governments would be able to shift the risk of increasing health care costs from the community as a whole to individual beneficiaries thus sidling away, without visible fingerprints, from Medicare’s basic commitment to provide access to health care.”
Media coverage echoed the consensus that had been signaled by Pear. Ryan told the Washington Post: “We want to demonstrate that there is an emerging consensus developing on how to preserve Medicare. We want to move that consensus forward.” In an interview with the Milwaukee Journal Sentinel, he said: “The issue has become extremely partisan lately, and what we’re trying to do is rebuild a bipartisan consensus.” Bloomberg News stressed the bipartisan bit, quoting from Ryan’s press conference, where he announced: “What we’re trying to do here is plant the seeds for future bipartisan compromises.”
Some in the blogosphere picked up the “politics-as-strange-bedfellows” theme. Wasn’t it cool that a liberal Democrat who was once a consumer advocate was playing in the sandbox with one of the House’s most conservative members? Some made it sound like the plan—so far without any details—might not be so bad. Kevin Drum, who blogs for Mother Jones, reported the Wyden-Ryan idea should be put in a bucket of plans “that are reasonable starting points for conversation.” He thinks it’s significant that Ryan, given his credibility with the tea party, has put his name on this plan. The Hill, which is read by the cognoscenti, also made Ryan sound so reasonable with its headline “Paul Ryan moves away from controversial Medicare reform plan.” It noted that Ryan was moving away from his original proposal, which would have put everyone in private plans. Now, he has agreed to keep traditional Medicare and offer seniors a choice between that coverage and private insurance.
Absent from most of the reportage was discussion of what such a change means for the 46 million or so people currently on Medicare, and those coming on to the program in the near future. The stories basically were all about politics. Julie Rovner nailed it on a post for the NPR blog: “There’s not much new in the Medicare proposal, so why is it getting so much attention?” The answer: “Politics.”
The idea of letting people stay in the traditional program has been kicked around for years, with many experts fearing that only the oldest and sickest will remain. They will hardly be the choicest customers for Aetna and Cigna, and they will bear the continually escalating costs for their care. Medicare will become something very different than it is today, a point that the AP made in its story.
These stories about consensus-building for Medicare are similar to those the media ran a year ago when Washington elites began planning their new legislative agenda. The Washington Post’s Lori Montgomery then reported that “a surprisingly broad consensus is forming around the actions required to stabilize borrowing and ease fears of a European-style debt crisis in the United States.” That consensus, she wrote, had formed around a package of options for cutting the deficit, which included smaller Social Security checks and higher Medicare premiums. We asked: “A consensus of whom?” Was it Beltway opinion makers, reporters, or ordinary people who said they didn’t like those ideas? The same can be asked about Medicare.
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.