presidential candidate Mitt Romney and his vice presidential pick, Rep.
Paul Ryan, at Aug. 13 rally. (Photo credit: mittromney.com)
The newly minted Republican ticket of Mitt Romney and Paul Ryan is
placing a big -- and some might say cynical -- bet that the stereotype of
the "greedy geezer" is real, that Americans now eligible for Medicare or
close to it don't care that the popular health program won't be there
for their children and grandchildren.
In picking Rep. Ryan as his vice presidential running mate, Romney
has taken on Ryan's plan for replacing Medicare for senior citizens with
a voucher program that will end the current fee-for-service program and
shift more of the financial burden for health care onto Americans after
they turn 65.
However, as Romney and Ryan quickly explained in a TV interview, the
Ryan plan wouldn't affect people currently on Medicare. In its current
form, Ryan's plan for turning Medicare into a voucher system (or
"premium support" as Ryan calls it) wouldn't begin until 2022.
Since senior citizens vote in higher percentages than other
demographic groups, Romney and Ryan are trying to split the current
Medicare recipients away from those Americans in later generations. The
reasoning goes: If today's seniors think that they'll still get theirs,
they won't care that their kids and grandkids might be stuck with an
inferior program costing each one more than $6,000 extra.
Last year, when Ryan's was pushing his Medicare overhaul, he and
other advocates specifically stressed to seniors at town hall meetings
that they would continue to get the system's guaranteed benefits, an
explanation that drew applause from some voters in that age group but
prompted concerns 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 younger Americans
who would face Ryan's scheme of replacing Medicare with government
vouchers that would fall short of covering the costs of private
Though Ryan inserted some pleasant language promising that the sick
will get adequate care, the reality is sure to be different, essentially
requiring the elderly -- many who will have preexisting conditions -- to
navigate through a complex system of insurance companies offering
varying levels of coverage. Plus, many insurance companies don't want
anything to do with old and sick people.
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."
Indeed, the projected budget savings from Ryan's "premium support"
system 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 current 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 2011 proposal lacked 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. We should not force
them into private health plans that would charge them a lot more or
provide much skimpier benefits."