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Bush's Brain in the Wall Street Journal:
What the country most needs—and what the GOP must now advocate—is a fundamentally new approach to containing health-care costs.
The most promising model for Medicare comes from Clinton Budget Director Alice Rivlin and House Budget Committee Chairman Paul Ryan (R., Wis.). Under their plan, starting in 2021 those turning 65 and going on Medicare would get a fixed contribution to use to purchase insurance, allowing them in many instances to keep their existing coverage. Consumers will be in charge.
Annual support would grow at the same yearly rate as the economy plus 1%. Medicare payments would be adjusted by income, geography and health risk. Poor seniors would get extra help for out-of-pocket expenses.
Under Rove's plan, Medicare as we know it would be eliminated and the benefits provided by its replacement would be dramatically curtailed.
Instead of automatically being covered by Medicare, seniors would be given a subsidy for purchasing private coverage on a health insurance exchange. If that sounds familiar, it's because that's the way health care reform delivers insurance in individual market. The difference is while health care reform delivers universal coverage to a market that doesn't currently have it, eliminating Medicare and replacing it with private insurance would actually cause costs to skyrocket because private insurance costs rise much more quickly than Medicare.
So how would the Rove plan save money? Simple: by capping the size of the subsidy. Of course, that doesn't mean health care costs won't continue to rise. It just means if they rise faster than subsidy (which they will), then you won't be able to afford health care insurance. Oh well, tough luck for you. But hey, at least now we can afford to cut the Koch brother's taxes.
There's another feature of the plan that Rove glosses over. He says the benefits of his proposal would begin at age 65, but the plan actually calls for the eligibility age to be raised to 69. That's a pretty big deal, but hey, what's four years to Karl Rove, right?
The real way to bring down Medicare costs is by doing things like eliminating subsidies for programs that don't offer any tangible benefit, but Rove starts out his column by attacking Democrats for having done just that in health care reform. The real way to bring down health care costs is doing things like empowering Medicare to negotiate on drug prices and, yes, making Medicare available to every American.
But to Karl Rove, the best way to reduce Medicare costs is to eliminate the program entirely and replace it with a voucher, even though the voucher won't be enough to purchase equivalent care. It's hard to imagine a less popular proposal, yet this is the plan he wants Republicans to embrace in 2012. Well, bring it on. It would be a political gift for the ages.