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Mitt Romney Shows Rick Perry How A Stealth Embrace Of Medicare Overhaul Is Done

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WASHINGTON -- Mitt Romney has out-maneuvered Rick Perry in the effort to surreptitiously embrace an overhaul of Medicare reform -- a top goal of conservative elites -- without drawing too much attention or criticism in the Republican presidential primary.

Romney unveiled the outline of his Medicare plan on Thursday and Friday as part of a larger proposal to cut spending and the federal budget deficit. Perry included his Medicare plan a week ago -- which was less detailed than Romney's -- in a rollout that focused on his tax reform plan.

Perry stepped all over his entitlement reforms by emphasizing his optional 20 percent flat tax idea, almost to the exclusion of everything else. His recommendations for Medicare, Social Security and Medicaid got some attention from conservative policy wonks and journalists in the days that followed, but very little otherwise.

It was not even clear that Perry wanted much attention for his entitlement reforms. The Texas governor's highlighting of the tax reform plan was intended to capture some of the enthusiasm over tax simplification that had gathered behind Herman Cain's 9-9-9 plan.

The Romney campaign clearly intended, however, for its Medicare proposal to get some attention. The measure was included among a grab bag of proposals that were by and large fairly pedestrian. Many of the measures had been included in Romney's 160-page jobs plan that he released in early September.

In addition, the former Massachusetts governor dribbled out a piece of his Medicare approach in a USA Today op-ed released Thursday evening. The three-sentence paragraph on the topic was placed near the end of the piece. The Romney campaign then followed up with more details on Friday that made it clear he was embracing what is essentially an optional version of the "premium support" idea of Rep. Paul Ryan (R-Wis.). The basic proposal is that the federal government would give seniors defined benefit amounts to take to insurers, with lower income seniors getting more generous amounts than middle- and high-income seniors.

If seniors found an insurance plan that cost less than the amount of their voucher, they could keep the money to pay for out-of-pocket medical expenses. The intent would be for insurers to compete for customers by offering cheaper plans, placing downward pressure on health care providers to lower prices.

The result of Romney's rollout? The Medicare proposal was immediately seized upon by some in the press late Thursday and early Friday -- including conservative journalists at the Washington Post, Weekly Standard and Washington Examiner -- while most reports focused on the more generic spending cut proposals. There was skepticism from some corners over whether Romney's plan would work, but more importantly he was recognized as finally putting forward a proposal on the issue.

Yuval Levin, a fellow at the Ethics and Public Policy Center who has written about the debate over how to save Medicare, gave Romney high marks for his plan.

"While some important details ... clearly remain to be decided, the general framework Governor Romney presented today is an extremely encouraging and smart proposal," Levin told The Huffington Post by e-mail. "It is exactly the kind of reform that will be necessary to make Medicare more secure and more effective, to save the program (and with it the long-term federal budget) from fiscal collapse, and to help restrain the growth of health-care costs not just for seniors but for everyone."

Romney also met last week with Ryan, the House Budget Committee Chairman, and discussed his plan with the influential Republican. Ryan has been the only member of his party willing over the past few years to propose a comprehensive plan to make Medicare solvent using small government, free market ideas. The two have talked on the phone about the plan as well.

Ryan commented favorably on Romney's plan Friday, declaring himself "very pleased with these kind of entitlement reforms," giving a big boost to Romney among conservative influentials.

No such opinions were sought of Perry's proposals on entitlements last week. That may have also been because Perry did not fully embrace any specific proposals on Medicare, instead saying there were several "reform options" but not wholeheartedly embracing any in particular.

Entitlements, and Medicare, are of crucial concern to conservatism's policy wing for two reasons. One, Medicare is a significant contributor to both runaway health care costs and to the nation's growing long-term debt obligations. And second, if conservatives can overhaul Medicare, they believe they can strike a big blow to the liberal vision of a big government welfare state.

"If it worked, our fiscal prospects would improve dramatically and liberals would have to acknowledge the case for transforming the rest of our welfare state along similar lines," Levin wrote in September. "If it failed, we would need to find other means of addressing our fiscal problems, and conservatives would have to acknowledge that their vision of American government beyond the welfare state requires a profound rethinking."

But Romney, by making the Medicare proposal part of a larger plan, and by making his plan optional, deflected attention in the mainstream press away from his stance on an issue that is not of high concern to the average voter. Many of the preliminary articles on Thursday evening and Friday morning focused on Romney's proposed spending cuts, which polls much higher.

Romney's pollster, Neil Newhouse, said earlier this week that entitlements were not on the minds of women he talked to in focus groups recently.

"I can guarantee, the word entitlements didn't come up in any of the focus groups we did. You know what, I don't think the words Social Security and Medicare came up," Newhouse said. "It really was not an issue."

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