Our crushing, coming debt crisis cannot be averted unless health care costs are brought under control, and that cannot be done unless the basic structure of the Medicare program is reformed. “Based on his campaign so far,” I wrote in early September, “one senses that Mitt Romney has little heart for entitlement reform, especially Medicare.” For reasons ably laid out by Yuval Levin, David Brooks, and the Wall Street Journal editorial page, that concern has been allayed.
In a major speech on Friday, Romney proposed introducing a premium support system (meaning that seniors are given fixed-amount benefits that they can use to purchase an insurance plan). Less affluent beneficiaries would receive more than more affluent ones. Nothing would change for current seniors or those nearing retirement. And Romney would give seniors the option of staying in the traditional government-run fee-for-service insurance program, with this important caveat: If it costs the government more to provide that service than it costs private plans to offer their versions, the premiums charged by the government will be higher, and seniors will have to pay the difference to enroll in the traditional Medicare option.
All the GOP candidates have now endorsed, at least in some significant measure, some version of the plan laid out by Representative Paul Ryan and/or former Senator Pete Domenici and former Clinton OMB Director Alice Rivlin, with Romney’s being the most specific and detailed. As Levin points out, “It can now be plainly said that the Republican Party is committed to facing up to the problems of Medicare and to a smart and plausible path toward fixing them a path that many centrist Democrats also understand is necessary. On an issue that carries significant political risk, an almost-total consensus of the party’s elected officials and high-office seekers have taken the responsible path rather than the easy one.”
What we can’t know is if any of the GOP candidates would, if elected, put their shoulder to the wheel when it comes to Medicare reform; whether they would make it a top priority rather than simply a campaign hope, a reform wish, a policy box that’s been checked. But at this stage all we can do is judge them by the plans they put forth, and what the former Massachusetts governor has put forward is quite encouraging. More broadly, at a time when politicians are excoriated for their lack of courage and unwillingness to grapple with the most significant problems facing the nation, the Republican Party deserves credit. On entitlement reform, which has historically been politically lethal, the GOP is doing the right thing.
I’ve long believed what Republicans need to do is to position themselves as the party of reform and modernization, of intellectual energy and ideas. That would be appealing in any year; but it’s triply so when set against an administration that is intellectually exhausted, whose agenda has been discredited, and which has nothing to sell but fear and division.