The Republicans are making a cynical bet that Americans over 55 really are the "greedy geezers" of conservative ideology, people who care only for themselves and not for their children and subsequent generations.
That calculation is at the center of Rep. Paul Ryan's proposal to replace Medicare with a voucher system, but only for those reaching retirement age in a decade.
Ryan and the Republicans have sought to dilute the political toxicity of their radical plan by grandfathering in people who are currently within the Medicare system and those who are now 55 or older.
Senior citizens vote in higher percentages than other demographic groups and thus could overturn the GOP's House majority if they felt threatened by the transformation of Medicare.
So, Ryan and other advocates of his plan have stressed to seniors at town hall meetings that they will continue to get the system's guaranteed benefits, an explanation that has drawn applause from some of the over-55 set but has prompted questions from others.
For instance, in Elkhorn, Wisconsin, 64-year-old Clarence Cammers hesitantly asked Ryan a question that got to the heart of the matter. After describing himself as a disabled veteran living on Social Security, Cammers said he could stand some cutbacks for himself; that wasn't his concern.
"I will be fine," Cammers said. "I guess what I'm saying is, what are all these changes going to mean for my son?"
Cammers was noting the hard truth that it would be Americans under 55 who would face Ryan's scheme of replacing Medicare with government vouchers (or "premium support" as Ryan insists on calling it). That prospect is certain to be a grim one.
Though Ryan has inserted some pleasant language promising that the sick will get adequate care, the reality is sure to be much different, essentially requiring the elderly -- many with preexisting conditions -- to negotiate with insurance companies that don't want them and their illnesses.
As the Brookings Institute's Henry Aaron explained to the Washington Post's Ezra Klein, "We've all heard about the great proportion of health services used by people in the last year of life. That means if you're an insurer, you want desperately to not enroll those people. "That means you need to try every marketing device you can not to get stuck with the sickies."
Since Ryan's plan also repeals last year's Affordable Care Act, known as "Obamacare," with its prohibitions against insurance companies excluding your preexisting conditions, there can be little doubt that industry sharpies would do all they can to limit their liability for medical treatments.
Finding the "Savings"
Indeed, the dramatic savings that Ryan projects once his "premium support" system takes effect would be derived from the shortfalls between the vouchers and the cost of medical care for seniors, in other words, the money would be taken out of the pockets of the elderly or be saved by them skipping treatments that they otherwise would receive.
Even for current and near-term Medicare beneficiaries, the Republican plan would have that effect for people needing lots of prescription drugs. The Ryan plan would repeal the subsidy for seniors facing the "doughnut hole" gap in drug benefits.
But the hardest impact of the Ryan plan would hit those turning 65 in 2022 and later. Though Ryan's sketchy proposal lacks many of the specifics needed to fully evaluate its effects, a New York Times editorial noted, "there is little doubt that the Republican proposal would sharply reduce federal spending on Medicare by capping what the government would pay at very low levels."
"The Congressional Budget Office estimates that by 2022 new enrollees would have to pay at least $6,400 more out of pocket to buy coverage comparable to traditional Medicare. Huge numbers of Medicare beneficiaries live on modest incomes and are already struggling to pay medical bills that Medicare does not fully cover.
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