Romney-Ryan Want It Both Ways on Medicare

The Romney-Ryan campaign has a problem. It is hammering President Barack Obama for cutting $716 billion out of Medicare over the next decade. But Paul Ryan's budget, approved this year by the Republican-controlled House of Representatives, includes those same cuts.

Conservatives are protesting that Ryan's plan to cut Medicare is different from the president's. They're right -- Ryan would actually cut $205 billion more out of Medicare over the next ten years than Obama would. You can see that on page 91 of his Fiscal Year 2013 budget proposal.

How does Ryan plan to achieve Medicare cuts that are deeper than the president's? Well, he doesn't say. Ryan wants to repeal the mechanisms in the Patient Protection and Affordable Care Act that are supposed to control Medicare spending, particularly the Independent Payment Advisory Board, which Ryan calls a "rationing board." He doesn't indicate what he would replace them with.

We do know one means of generating Medicare savings over the next decade that Ryan is not proposing: premium support, his signature proposal to have traditional Medicare bid against private plans. Ryan does not propose to implement premium support until 2022, meaning that it cannot be responsible for any Medicare savings he expects during the next decade.

So it's a problem when Avik Roy defends Ryan on Medicare by saying his plan "preserves the Obamacare targets for future Medicare spending, but employs an entirely different mechanism: premium support and competitive bidding." That's not true with regard to the next ten years.

Similarly, Jim Capretta writes, "Ryan’s budget allows the substitution of sensible ways of saving money in Medicare for the arbitrary and harmful cuts contained in Obamacare." Maybe it allows for that, but it doesn't say what those "sensible ways" of saving money in Medicare are. All we know is that, for the next decade, premium support isn't one of them.

Cutting more than $700 billion out of Medicare over 10 years is hard. Ryan's position is that he will make those cuts, but they won't be through an IPAB or an IPAB-like mechanism. And they won't be through premium support.  And they won't hurt seniors. But we don't get to know how they will work. It is no surprise that defenses of this position fail.

The other defense, offered by both Capretta and Roy, is that even though Ryan favors big Medicare cuts over 10 years, Romney doesn't, and Romney is at the top of the ticket. There are two problems with this. The first is that, in March, Romney said he was "very supportive of the Ryan budget plan," which includes the Medicare cuts.

Let's say Romney has changed his position -- it's happened before -- and now he wants to restore all the Medicare cuts from PPACA through 2022. That would mean Medicare spending would grow from $560 billion in 2011 to $1.17 trillion in 2022. Allowing Medicare spending to double in eleven years is a position that conservatives should attack, not defend.

Capretta writes that Ryan should argue that, if elected, he and Romney "will be in a position to find even greater savings elsewhere that will allow cancellation of the entirety of the Medicare cuts without raising the deficit." This is ridiculous.

Romney has committed to grow defense spending relative to the CBO baseline. His campaign has said any changes to Social Security "will not affect today’s seniors or those nearing retirement." I assume he intends to continue paying interest on the national debt. Now he wants to take Medicare off the table all the way through the two terms he might serve as president?

Together, those four areas account for 66 percent of all projected federal spending over the next 10 years. Romney wants to exclude all of them from cuts, actually grow the defense budget and be taken seriously as a deficit reducer?

What Romney and Ryan are up to is simple: They want to have it both ways on Medicare. They are for Medicare cuts, because Medicare is expensive and the federal budget needs to be controlled. And they are against Medicare cuts, because Medicare cuts are unpopular.

The political impulses behind this strategy are clear. Why any policy experts would try to offer a substantive defense of it is not.

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

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