Mitt Romney’s Double Medicare Contradiction

There are two key contradictions in Mitt Romney's messaging on Medicare reform.

First, Romney says Medicare is "unsustainable" in current form. So why has he pledged to delay any Medicare reforms until 2022 and even repeal Medicare cuts contained within the Patient Protection and Affordable Care Act, at a cost of $716 billion over ten years? Doesn't that make Medicare even less sustainable?

Second, Romney says that his premium-support based Medicare reform, to be implemented in 2022, will be "an improved program" and everyone will get benefits "at least comparable to what Medicare provides today." If premium support is an improved program, why is there any need to delay implementation? Romney says his plan "honors commitments to current seniors" by waiting until 2022, but if his proposed benefit is as good as Medicare, why wouldn't it count as honoring those commitments?

Avik Roy has harumphed at my post from Wednesday arguing that the campaign is incoherent on Medicare, contending that I just don't understand the program very well and that:

Romney’s decision to not preserve Obamacare’s Medicare cuts discards a law that has dubious policy merit, in order to ensure that he is in a position to enact far superior structural reforms to the Medicare program down the road.

I don't see how this could possibly be the case (emphasis mine). By saying we don't need any cuts for ten years and can even rescind those contained in PPACA, Romney signals that Medicare's cost crisis isn't so dire. We can even afford to spend $700 billion more on it than the President wants to! This will undermine the case for reform in the future, not bolster it; seniors will believe (reasonably) that if they make enough noise, they can simply get politicians to pay the tab for the rising Medicare bill, and that changes are unnecessary.

This shows the risks of the "reform later" strategy. Just look at what has happened to PPACA. A four-year implementation delay left opponents a long window to attack the law before anybody actually gets to see how it works. They might even succeed in blocking its implementation.

Now Romney wants to do this with Medicare, but with a ten-year window instead of four, and with a grandfathering structure that strongly implies the new benefit will be inferior to the old one. (Again, if the new benefit is so great, why not just implement it now?) Even if passed, his reform is likely to be politically vulnerable until implementation.

Every reform strategy has its political risks. But given the tenuousness of "reform later," it is irresponsible to make the case (as Romney and Roy do) that reform later absolves you of the need to cut Medicare spending now. Romney's long-range Medicare reform plan is more likely to serve as an excuse to do nothing on Medicare than as a way to actually fix the program's problems.

(Josh Barro is lead writer for the Ticker. E-mail him and follow him on Twitter.)

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