The biggest Washington DC fight of 2017 may not actually have anything to do with Trump at all, but with Paul Ryan and double crusade to end Obamacare and Medicare as we know it. It's something that even the Democrats might be able to turn to their advantage in 2018.
For nearly six years, Speaker Paul D. Ryan has championed the new approach, denounced by Democrats as “voucherizing” Medicare. Representative Tom Price of Georgia, the House Budget Committee chairman and a leading candidate to be Mr. Trump’s secretary of health and human services, has also embraced the idea, known as premium support.
And Democrats are relishing the fight and preparing to defend the program, which was created in 1965 as part of Lyndon B. Johnson’s Great Society. They believe that if Mr. Trump chooses to do battle over Medicare, he would squander political capital, as President George W. Bush did with an effort to add private investment accounts to Social Security after his re-election in 2004.
Democrats will “stand firmly and unified” against Mr. Ryan if he tries to “shatter the sacred guarantee that has protected generations of seniors,” said Representative Nancy Pelosi of California, the Democratic leader.
Republicans have pressed for premium support since Mr. Ryan first included it in a budget blueprint in 2011. As he envisions it, Medicare beneficiaries would buy health insurance from one of a number of competing plans. The traditional fee-for-service Medicare program would compete directly with plans offered by private insurers like Humana, UnitedHealth Group and Blue Cross Blue Shield.
The federal government would contribute the same basic amount toward coverage of each beneficiary in a region. Those who choose more costly options would generally have to pay higher premiums; those who choose plans that cost less than the federal contribution could receive rebates or extra benefits.
Supporters say this approach could save money by stimulating greater price competition among insurers, who would offer plans with lower premiums to attract customers.
Democrats say that premium support would privatize Medicare, replacing the current government guarantee with skimpy vouchers — “coupon care for seniors.” The fear is that the healthiest seniors would choose private insurance, lured by offers of free health club memberships and other wellness programs, leaving traditional Medicare with sicker, more expensive patients and higher premiums.
“Beneficiaries would have to pay much more to stay in traditional fee-for-service Medicare,” said John K. Gorman, a former Medicare official who is now a consultant to many insurers. “Regular Medicare would become the province of affluent beneficiaries who can buy their way out of” private plans.
If all this sounds familiar, that's because Republicans literally want to apply the Obamacare model to Medicare coverage, after spending six years sabotaging that same model for Medicaid recipients and the individual coverage markets. But as Democrats found out the hard way in 2010, if seniors even think you're messing with Medicare, they will end you at the ballot box.
Republicans say their proposal would apply to future beneficiaries, not to those in or near retirement. But the mere possibility of big changes is causing trepidation among some older Americans.
“I am terrified of vouchers,” said Kim Ebb, 92, who lives in a retirement community in Bethesda, Md., and has diabetes, atrial fibrillation and irritable bowel syndrome. “You get a fixed amount of money to draw on for your expenses. Then you are on your own.”
Charles R. Drapeau, 64, of East Waterboro, Me., said he was rattled by the Republican plans.
“I’m scared to death,” said Mr. Drapeau, who has multiple myeloma, a type of blood cancer, and takes a drug that costs more than $10,000 a month. “We don’t know exactly how it will work, but just the fact that they are talking about messing with Medicare, it’s frightening to me.”
These of course are the same folks I'm betting voted for Trump earlier this month. Now that they're finding out what giving total control of the government to the GOP actually means, I'm betting the buyer's remorse factor in 2018 will be sky-high...high enough that even the inept Democratic party can find a way to win some seats back.
Because right now the deck is stacked against the Dems in the next mid-term about as much as it possibly can be. We'll see.