Medicare is a Battlefield

Kaiser Health News wrote about The Medicare Wars. Regardless of which party is using Medicare as an issue they will likely accuse the other side of a War on Seniors. A better description than “war” would be scaremongering among politicians to frighten senior voters. KHN chief Washington correspondent Julie Rovner reports politicians use Medicare as a scaremongering issue because it works, saying:

In 2010, Republicans turned the tables, using what they described as “Medicare cuts” in the Affordable Care Act to sweep back to power in the House. (Those “cuts” were mostly reductions in payments to providers; beneficiaries actually got extra benefits through the ACA.)

The use of the Medicare cudgel likely reached its zenith in 2012, when Democrats took aim at Medicare privatization proposals offered by Paul Ryan, the House Budget Committee chair and Republican vice presidential candidate. That debate produced the infamous “pushing Granny off the cliff” ad.

President Biden began the latest Medicare battle a few weeks ago in his State of the Union Speech:

The political bomb that went off during President Joe Biden’s State of the Union speech on Feb. 7 had been ticking for weeks. In his speech, Biden threatened to veto any Republican efforts to cut Social Security or Medicare. It was one of only three veto threats he made that night. During a trip to Florida after the speech, he said it more forcefully: “I know a lot of Republicans, their dream is to cut Social Security and Medicare. Well, let me say this: If that’s your dream, I’m your nightmare.”

Biden’s veto threat could be used by any president during any political speech regardless of any current policy debates and it would still be effective. A president could just as easily proclaim he will “fight any internal and external threats against the American people!” However, that would not be as effective as telling seniors his opponents want to destroy Medicare and he’s there to protect them.

There is a pitfall with using elderly entitlements, such as Medicare and Social Security, as a wedge to secure senior votes. Claiming any change to Medicare is a war on seniors precludes any real reform efforts where both parties work together and make tough decisions. Speaking of tough decisions, Congress doesn’t even have the political will to go after the low hanging fruit of Medicare cost-control, such as competitive bidding, reference pricing, aggressive fraud control, etc.

As Rovner reports, Democrats and Republicans have ideological differences that impact their policy objectives, saying:

There are fundamental differences between the parties that can’t be papered over. Many Republicans want Medicare to shift from a “defined benefit” program — in which beneficiaries are guaranteed a certain set of services and the government pays whatever they cost — to a “defined contribution” program, in which beneficiaries would get a certain amount of money to finance as much as they can — and would be on the hook for the rest of their medical expenses.

This would shift the risk of health inflation from the government to the beneficiary. And while it clearly would benefit the taxpayer, it would disadvantage both providers and beneficiaries of the program.

With respect to the last paragraph, defined contribution would also likely reduce medical inflation, since it’s much harder to squeeze a nickel from 67 million seniors than hiring lobbyists to convince congress shovel bushels more nickels to providers.

Throughout history numerous wars have been used to take the public’s attention away from other political problems in an effort to retain power and influence. The War on Medicare is no different.