05/26/2011 05:08 pm ET | Updated Jul 26, 2011

Medicare Fix Rose by any Other Name Still Has Thorns

Political philosophies are like beautiful roses, and when we fall in love with ideals and ideas we tend to imbue them with magic, while overlooking their less agreeable parts.

Republicans love the idea of a small government that gives people freedom to pursue their dreams without interference, believing that the free market can, almost magically, solve any problem. At the same time, Republicans tend to overlook the problems that markets create. It was from this dream that Republicans passed the budget written by Rep. Paul Ryan (R-WI) through the House of Representatives.

The Ryan Budget relies on spending cuts exclusively to achieve deficit reduction -- and in its most controversial and ultimately unpopular provision, it replaces the "Medicare as we know it" guarantee of health insurance for life with a voucher which future seniors can test for value in the free market.

We Democrats love Medicare and want to preserve it, but contrary to the view of our own experts, most of us believe almost magically, that it can be sustained without major changes. It is a core Democratic belief that government has an obligation to preserve the social safety net, and the right to affordable health care for seniors is our party's greatest achievement.

Many Democrats believe Medicare's problems are mostly manufactured by Republicans, and that by reversing the Bush tax cuts and taxing the wealthy, getting rid of subsidies for oil companies, and increasing spending on preventative medicine to keep patients out of emergency rooms, the money could be found to make the system whole.

Medicare is on an unsustainable path
The economics is straightforward and daunting: on average, Americans pay much less into the system during their working years than they use in benefits, mostly when they are old -- and Americans are moving in large numbers from the former category to the latter. The demographic shift and pace of medical cost inflation would be a problem demanding a solution even without the Bush tax cuts and two unpaid for wars.

The public wants more than it can afford
In some sense the politics of Medicare is quite simple. When it comes to Medicare and health care more broadly, the public knows what it wants: greater access to services at a lower cost. The public is particularly clear about what it does NOT want: any "cuts" in the Medicare services people (especially seniors who vote in higher numbers) believe they have already paid for, or payment increases for the costs they will pay in the future.

Preserving Medicare
Democrats can make a strong case that the starting point for reform should be provisions in the Affordable Care Act such as creation of the The Independent Payment Advisory Board. They are in a stronger position to appease the public with tweaks to Medicare in order to preserve it for future generations as compared to the Republicans who seek to dismantle the program altogether. Nevertheless, there are pitfalls ahead for anyone who tells the public that they must accept fewer services and more costs.

Armies of Politicians hurling stones from glass fortresses
This mismatch between what the public wants -- more healthcare for less money -- and what the public can afford -- less care and rising costs -- helps explain why efforts to reform health care, or more narrowly Medicare always garner increasing public opposition. We saw this in 1993 when the Democrats failed to pass "Hillary Care" and again in the 1996 election when Republicans took on Medicare reform and lost to charges they wanted the program to "wither on the vine." We saw this again when the Democrats laboriously passed "Obama Care" only to suffer heavy losses in the 2010 election, and again in 2011, when the Republicans passed a Congressional budget that would in the words of their opponents, "end Medicare as we know it."

Ryan's Budget Is Politically Toxic
Ryan's budget probably never had a chance of passing the Senate and then being signed by President Obama, but now it is so unpopular with the public that Republicans in the Senate, on the presidential trail, and even in the House that voted for it, are doing back-flips to create distance between themselves and the budget bill they just passed last month. And last night the deal was sealed when Democrat Kathy Hochul defeated Republican Jane Corwin and Tea Party candidate Jack Davis for a huge upset in a strongly Republican district, placing Republicans in full retreat on the issue.

Many Democrats, smelling blood, are calling on their party to show resolve in opposing any changes to Medicare until after the 2012 election. It is easy to understand sentiment here given the almost two year Republican "just say 'no'" policy on health reform and how shamelessly the Republicans distorted the Medicare issue in the last election. But when progressives call for a strategy of rejecting any progress for two years on one of the nation's most pressing problems just to maintain a campaign message, we risk getting too far bent out of shape toward tactics over our deeper principles.

We should be looking for real solutions not political points or magical answers. A real solution to the Medicare math problem is going to involve dealing with a lot of thorny issues, so whether you call it "Hillary Care," "wither on the vine," "Ryan Care," "ending Medicare as we know it", "Obama Care" or "Death Panels," decisions have to be made. Medicare is on an unsustainable path and it is as important that this simple fact is as well understood by those (mostly Democrats) who love Medicare and want to preserve it as by those (mostly Republicans) who have never liked Medicare and want to dismantle or replace it.

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