Rep. Paul Ryan‘s plan to replace Medicare with a voucher plan was killed by the Senate the otehr day when five GOP Senators voted against Ryan’s idea. On most political occasions, this blow would put an end to Ryan’s fifteen minutes of political fame, except for two things: one, the Democrats will now want to keep reminding voters in the 2012 election that Ryan and the Republicans wanted to take away their Medicare, and two, the Democrats are now going to own the damn problem.
Ryan’s effort is already being blamed for a narrow Democratic victory in a safe Republican seat in upstate New York, notwithstanding the presence of a Tea Party candidate who diverted votes from the Republican candidate. Once the nonpartisan Congressional Budget Office estimated that the Ryan plan would leave seniors paying nearly twice as much for health care—more than $12,510 a year—than they do under today’s Medicare, this plan was dead on arrival. (More and more, it looks like Newt Gingrich‘s attempt to have a Sistah Souljah moment and denounce Ryan’s plan as right-wing social engineering was not wrong but just premature; if he had waited a couple of weeks, he might not have wounded himself so grievously.) Now forty Republican senators and every Republican in the House is going to have to spend 2012 explaining their support of Ryan’s plan, the politics of which is lousy and the reality of which is dead. With Obama facing a non-entity and the Republican Congress now saddled with this stinking albatross of a vote, things at this moment look swell for the Dems. How early does the early balloting begin?
The problem for the Democrats, of course, is that now they own the problem. The Congressional Budget Office didn’t like Ryan’s idea, but they are also pretty clear that Medicare is not sustainable in its current form. As the brilliantly lucid Matt Miller explains in The Washington Post, there are real problems. “As can never be said often enough, the United States spends 17 percent of GDP on health care, while every other advanced nation spends 10 or 11 percent. Those other nations insure everyone, while we still have 50 million neighbors who lack basic coverage. At the same time, the United States doesn’t have better health outcomes to show for all this extra spending, and it experiences huge regional variations in the utilization of procedures and treatments. Observers of all stripes agree that these facts mean our system is radically inefficient. (And given that mighty Singapore spends just 4 percent of GDP with as good or better outcomes than ours, the “radically” is justified).” But here’s where Miller makes a point that will cause the Democrats to double over: “In any other wealthy nation, a Ryan-sized voucher would more than suffice to ensure high-quality health care for seniors. In Singapore, it would be seen as offering an outrageous bonanza for the Medical Industrial Complex.”
In other words, the real answer is doing something about inefficiency is the American medical system. Curing that isn’t a matter of spending money (which usually comes so easy in Washington); it’s making a change, which is harder, because change usually means somebody’s ox is gored. Some people aren’t going to get the care they want, and some people are going to lose their jobs, and some powerful companies are going to lose their profits. And as we all know, pain, or even the fear of pain, can be demagogued.