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No doubt, Wisconsin Republican Congressman Paul Ryan's dashing good looks make the Washington chattering classes weak at the knees.  But his policy proposals make most Americans - including most of his party leadership - sick to their stomachs.  After all, the past week highlighted how Ryan's supposedly budget-balancing Roadmap for America's Future would instead produce $4 trillion in red ink. And now, Rep. Ryan is doubling down on his plan to ration Medicare.

Hoping to lead the party that tried to block Medicare in the 1960's and gut it in the 1990's, Paul Ryan now proposes curing what ails the health insurance system for 46 million American seniors by killing it.  In a Washington Post op-ed ("A Roadmap to Saving Medicare") that mentions neither the word "voucher" nor "privatization," Congressman Ryan intends to do apply both to address the long-term financial issues facing the system:

Future Medicare beneficiaries would receive a payment to apply to a list of Medicare-certified coverage options. The Medicare payment would grow every year, with additional support for those who have low incomes and higher health costs, and less government support for high-income beneficiaries. The most vulnerable seniors would also receive supplemental Medicaid coverage and continue to be eligible for Medicaid's long-term care benefit.

The only alternative, he insists, "is the European-style death spiral of the welfare state":

Kick the can down the road as our debt explodes. Under an ever-expansive, all-consuming central government, costs will be contained with Washington's heavy hand imposing price controls, slashing benefits and arbitrarily rationing seniors' care.

Of course, Paul Ryan is the only one proposing rationing Medicare.  And, as it turns out, he has admitted as much.

When Ryan unveiled his Roadmap back in February, as Ezra Klein, Matthew Yglesias and TPM all noted, privatization of Medicare was the centerpiece.  But because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage.  The Washington Post's Klein described the inexorable Republican rationing of Medicare which would then ensue:

The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.

It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.

Ryan acknowledged as much.  Sadly for the Republican brain trust, he failed to follow the script that only Democratic reforms lead to "health care denied, delayed and rationed."

"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

Of course, Ryan left out the real culprit - the private insurance market.  But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60% of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today."

But the Republican plan to "slash and privatize" hardly ends there.  Despite insistence by the Republican leadership that the party is not officially advocating it, the Ryan alternative budget follows Rep. Jeb Hensarling's announced desire to privatize Medicare.  As TPM documented:

Rep. Paul Ryan, (R-WI) the ranking Republican on the budget committee, recently detailed the Republican plan for Social Security that preserves the existing program for those 55 or older. For younger people the plan "offers the option of investing over one-third of their current Social Security taxes into personal retirement accounts, similar to the Thrift Savings Plan available to federal employees."

If that sounds vaguely familiar, it should.  After all, George W. Bush's disastrous drive to privatize Social Security helped undermine his presidency.  Now, in the wake of a Wall Street meltdown that evaporated the retirement savings for countless thousands of Americans, the Republican wunderkind Ryan is calling for an encore.

Which, in the run-up to the midterm elections in November, is making the Republican leadership queasy.  Because while most no doubt agree in principle, they are terrified of saying so on the record.

In February, House Minority Leader John Boehner distanced himself from Ryan's Roadmap, saying, "it's his."  In July, Boehner grumbled, "There are parts of it that are well done," adding, "Other parts I have some doubts about, in terms of how good the policy is."  And with good reason.  With its draconian spending cuts, Medicare rationing, tax cuts for the rich and Social Security privatization, a GOP platform based on Ryan's Roadmap would about as popular as the Ebola virus.  As the Washington Post put it:

Many Republican colleagues, who, even as they praise Ryan for his doggedness, privately consider the Roadmap a path to electoral disaster...

The discomfort some Republicans feel for Ryan's proposals goes beyond November. If Republicans were to take control of Congress next year, Ryan will rise to chairman of the Budget Committee. He could use the position to hold colleagues accountable for runaway budget deficits and make it more difficult for fellow Republicans -- and Democrats -- to stuff bills with expensive projects that add to the problem.

For his part, Ryan has acknowledged the GOP's allergic reaction to his Roadmap.  "While I am proud to have 13 House Republicans co-sponsor the legislation, and have been overwhelmed by the support outside the Beltway," he claimed, "my plan is not the Republican Party's platform and was never intended to be."

And yet, the privatization of Medicare remains the love that dare not speak its name among GOP leaders like Boehner, Mitch McConnell and Michael Steele.  Other Republicans have not been so shy.

Last year, 137 House Republicans voted to convert the Medicare program that provides 46 million Americans with health insurance into a system of vouchers.  In September, Sarah Palin penned a Wall Street Journal op-ed which similarly called for "providing Medicare recipients with vouchers that allow them to purchase their own coverage."  The next month, Georgia Rep. Paul Broun proposed legislation that would roll back the Medicare system and replace it with a system of vouchers that seniors could use to purchase private insurance or put into tax-free medical savings accounts.

And that's just the beginning.  Michele Bachmann (R-MN) echoed Marsha Blackburn (R-TN) by insisting "what we have to do is wean everybody" off Medicare and Social Security. Last Friday, Missouri Senator Kit Bond similarly argued that Medicare enrollees should be given a voucher to buy health insurance on their own. And on Tuesday, Broun's Georgia GOP colleague Jack Kingston told Fox Business:

"We need to go in, and we need to cut duplicate programs, programs that are inefficient, programs that are expanding the entitlement mentality. I think we should go back to Social Security, take it off budget, dedicate the funds, put personal accounts on it. On Medicare, I think something like vouchers, where people actually have an incentive to save money."

But killing the patient in order to save it isn't going to win the Paul Ryan and the Republican Party any popularity contests when it comes to Medicare.  Besides, accusing the other party of rationing, as Mitch McConnell repeatedly does, is the Republicans' only prescription for health care.

** Crossposted at Perrspectives **

Originally posted to Jon Perr on Fri Aug 13, 2010 at 12:53 PM PDT.

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