The Republican Death Wish

Forty Senate Republicans have now joined their colleagues in the House to support Paul Ryan’s plan that would turn Medicare into vouchers that funnel money to private health insurers. They thumbed their nose at the special election in upstate New York earlier this week that delivered a victory to Democrat Kathy Hochul, who made the plan the focus of her upset victory.

So now it’s official. The 2012 campaign will be about the future of Medicare. (Yes, it will also be about jobs, but the Republicans haven’t come up with any credible ideas on that front, and the Democrats seem incapable of doing what needs to be done.)

This spells trouble for the GOP. Polls show an overwhelming majority of Americans — even a majority of Republican voters — want to preserve Medicare. They don’t want to turn it over to private insurers.

It would be one thing if Republicans had consistency on their side. At least then they could take the high road and claim their plan is a principled way to achieve the aims of Medicare through market-based mechanisms. (It isn’t, of course. It would end up squeezing seniors because it takes no account of the rising costs of health care.)

But they can’t even claim consistency. Remember, this was the same GOP that attacked the President’s health-reform plan in 2010 by warning it would lead to Medicare cuts.

Former President Bill Clinton counsels Democrats not to say Medicare is fine the way it is. He’s right. But instead of talking about Medicare as a problem to be fixed, Democrats should start talking about it as a potential solution to the challenge of rising health-care costs — as well as to our long-term budget problem.

Can we be clear about that budget problem? It’s not driven by Medicare. It’s driven by the same relentlessly soaring health-care costs that are pushing premiums through the roof and causing middle-class families to shell out more and more money for deductibles and co-payments.

Some features of Obama’s new healthcare law will slow the rise — insurance exchanges, for example, could give consumers clearer comparative information about what they’re getting for their insurance payments — but the law doesn’t go nearly far enough.

That’s why Democrats should be proposing that anyone be allowed to sign up for Medicare. Medicare is cheaper than private insurance because its administrative costs are so much lower, and it has vast economies of scale.

If Medicare were allowed to use its potential bargaining leverage over America’s hospitals, doctors, drug companies, and medical providers, it could drive down costs even further.

Robert ReichAnd it could force the nation’s broken health-care system to do something it must do but has resisted with a vengeance: Focus on healthy outcomes rather on costly inputs. If Medicare paid for results — not tests, procedures, drugs, and hospital stays, but results — it could give Americans better health at lower cost.

Let the GOP go after Medicare. That will do more to elect Democrats in 2012 than anything else. But it would be wise and politically astute for Democrats to go beyond just defending Medicare. Strengthen and build upon it. Use it to reform American health care and, not incidentally, rescue the federal budget.

Robert Reich
Robert Reich’s Blog


  1. says

    Universal single-payer health care!

    All they have to do is open it to all. One insurance pool of 308 million people with no profits eating at cost per person. All in, no charge at the point of care, real modern health care.

  2. Milan Moravec says

    Reich needs to solve the problems at University of California before he solves everyone elses problems. The 10 University of California (UC) campuses, UCOP are not untouchable: Californians fund UC. Californians face foreclosure, unemployment, depressed wages and higher taxes: it’s time Governor Brown, UC Board of Regents Regent Lansing, President Yudof demonstrated leadership by curbing wages, benefits. As a Californian, I don’t care what others earn at private, public universities. If wages better elsewhere, chancellors, vice chancellors, tenured, non tenured faculty, UCOP should apply for the positions. If wages commit employees to UC, leave for better paying position. The sky above UC will not fall.
    California suffers from the greatest deficit modern times. UC wages, benefits must reflect California’s ability to pay, not what others paid elsewhere. Campus chancellors, vice chancellors, tenured & non-tenured faculty, UCOP are replaceable by the more talented.
    UC faculty stop tuition increases:
    No furloughs
    18 percent reduction in UCOP salaries & $50 million cut.
    18 percent prune of campus chancellors’, vice chancellors’ salaries.
    15 percent trim of tenured faculty salaries, increased teaching load
    10 percent decrease in non-tenured faculty salaries, as well as increase research, teaching load
    100% elimination of all Academic Senate, Academic Council costs, wages.

    Rose bushes bloom after pruning.

    Governor Brown, UC Board of Regents Sherry Lansing, President Yudof can bridge the trust gap to public by offering reassurances that salaries reflect depressed wages in California. The sky will not fall on UC

    Californians are reasonable people. Levy no new taxes until an approved balanced budget: let the Governor/Legislature lead – make the tough-minded (not cold hearted) decisions of elected leadership. Afterwards come to public for continuing, specified taxes.

    Thanking you in advance for advocating for California, University of California

  3. Ryder says

    That a democrat candidate would take advantage of the old and try to frighten them to win votes is nothing new. Why paint it as virtuous, Rob? Lame. And yes, SOME Republicans do it too. But what is clear, it is ONLY in the Republican camp where there are at least a few principled people that know the issues well enough to know that the program **********must********** be reigned in. No choice. They are the adults in the debate.

    Everyone knows that ANYONE can add votes by enlarging the program (with no end in sight. ever), but real men and women know thats not reasonable or sustainable… and represents massive and raw consumption. Not productivity. Consumption, on a massive scale on a planet with limited resources. Try thinking about the carbon footprint of medicare… and you might get just ONE view of what that level of consumption means.

    And your words about “funneling” money to private insurance… let’s rephrase that like adults, shall we? Let’s call it what it is. Paying for medical services. As needs to be done. You pay for what you consume, Robert…. or what, are you living by theft? Of course not. Speak plainly my friend. There is nothing wrong for using insurance to pay for unanticipated medical needs. That’s what Obamacare is, after all. That you would differentiate between private and your favored bloated government insurance just shows you to be a statist or a socialist or both.

    Private medicine has given us the astounding medical advances that we no longer we can live without… we live in the age of medical miracles… not created by socialist or statist regimes, but by free trade and a healthy marketplace….

    Your ideas about how the marketplace doesn’t take into account people of limited means, leaves me wondering what planet you hail from. The market place does that better than any mechanism known to man… where only the rich had mobile phones, now the poor of such little means that are on on HUD assistance, foodstamps, WIC, etc. etc… generally have them. Just one example. I can give you THOUSANDS.

    You live in the non productive fantasy land that is the public sector that thinks you can create something for nothing… and invent Ponzi schemes on a massive scale… the likes of which land private individuals in jail.

    Calling Medicare as a means to have a balanced budget is just not sane, my friend. It’s consumption…. of the most massive and crippling kind. We might as well spend three trillion on mansion estates for all government employees… or some other insane spending. Would it help them? Sure. but it’s also stupid. It’s waste.

    Let’s just spend ALL money we have, on medicare. All of it. Helping the elderly to live to 120 years of age, regardless of cost. Every last cent. Do you have ANY idea what that would do the everyone else?

    To the extent that is already true…. that is the exact extent that the rest of us suffer already… with inadequate schools… an embarassment in the world. Huge crime rates. Crumbling infrastructure… highest corporate tax rates in the world… causing businesses and jobs to flee…. it’s already hurting us in a thousand ways, and there are no grown ups left to tell it like it is, and deal with it.

    • Nate says

      I don’t normally reply to silly misinformed posts such as yours. However in your case, I absolutely could not resist.

      You have mistaken both the practice of medicare and the intention of this article. The author does not propose we expand investment in medicare exponentially while limiting its services to its current population. The author is proposing that we expand medicare from simply government funded for elderly, to an option for insurance for any that needs it. The overhead cost of your BCBS or your ODS or you fill in the blank insurance is over 20% of your premiums. Over 20 cents of every dollar they receive goes to paying for their fancy offices or their add campaigns or their CEO’s salary. Medicare is a bit more subtle than that. Not only is medicare’s overhead cost much lower (less than half 10% I believe), but it also pays less per service performed. Because of its massive size, it is able to pay much lower prices for services performed, giving Dr’s and hospitals just slightly over cost per service rendered.

      That would be a step towards universal health, and that would be a good thing. The US spends the most per capita on healthcare costs… we are also 50th in the world for average lifespan (we are in fact below every other 1st world nation, and many third world nations do you know who just surpassed us? Cuba)

      If you want to discuss gross overspending, this is being performed by the private insurances you so proudly supported. Medicare with its sleek performance of dollars per healthy outcome should be the model for the future.


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