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On Tuesday, House Budget Committee Paul Ryan blasted Obama budget chief Jack Lew over entitlement spending, declaring "why did you duck?"  But for their part, Republicans have yet to offer their own plan for addressing the fiscal health of Medicare, Medicaid and Social Security.  While Majority Leader Eric Cantor promised "a serious document" addressing entitlement reform by "the beginning of April," Speaker John Boehner did some ducking of his own, announcing he would "let Paul Ryan and the Budget Committee do their work."

If so, the big question remains whether Republicans will follow through on their past proposals for the "voucherization" - and inevitable rationing - of the Medicare program serving 46 million American seniors.

As Politico reported yesterday, House Republicans will likely push for "instituting block grants to states for Medicaid."  As for Medicare, Rep. Wally Herger (R-CA) would only offer, "We need competition, which we're not seeing now."  For his part, Paul Ryan criticized President Obama, declaring "we plan to step in the breach and provide that kind of leadership by showing the country how we would do things different."

By "different," many in the same Republican Party which tried to kill Medicare in the 1960's and gut it in the 1990's now mean privatizing the program to death.

As Steve Benen detailed in the Washington Monthly in the fall of 2009:

In April, 137 Republicans voted in support of a GOP alternative budget. It didn't generate a lot of attention, but the plan, drafted by the House Budget Committee's Rep. Paul Ryan (R-Wis.) called for "replacing the traditional Medicare program with subsidies to help retirees enroll in private health care plans."

The AP noted at the time that Republican leaders were "clearly nervous that votes in favor of the GOP alternative have exposed their members to political danger."

Political danger, that is, because the Ryan proposal would necessarily lead to rationing, a delicate proposition for the party which cried "death panels."  As it turns out, Paul Ryan 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 of his deficit reduction vision.  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."

As it turns out, Paul Ryan has a lot of support from his fellow Republicans, if not yet the party's leaders (more on that below).  In September 2009, death panel inventor 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."  In another WSJ op-ed last December, the half term governor offered her full support for Rep. Ryan (R-WI) scheme to privatize Social Security and Medicare.

Among Ryan's House allies, Georgia Rep. Paul Broun also 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. Michele Bachmann (R-MN) echoed Marsha Blackburn (R-TN) by insisting "what we have to do is wean everybody" off Medicare and Social Security.  Broun's Georgia GOP colleague Jack Kingston told Fox Business, "On Medicare, I think [we need] something like vouchers, where people actually have an incentive to save money."

Nevertheless, in the run-up to the midterm elections in November, Ryan's scheme to gut the wildly popular Medicare program made the Republican leadership queasy. Because while most no doubt agree in principle, they were terrified of saying so on the record.

Last February, then House Minority Leader John Boehner began distancing 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 last summer:

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.

Even Ryan's closest political allies feared the blowback from his ideas. Last year, GOP representatives Eric Cantor (R-VA) and Kevin McCarthy (R-CA) joined in Ryan in publishing Young Guns. But even Ryan's co-authors are afraid to back his draconian plans. As ThinkProgress reported last August, Cantor repeatedly refused to endorse Ryan's Roadmap.  Even a month ago, he could only muster, "I'm hopeful that we can get elements of what Paul is aiming for incorporated."  (As for his other co-author, in September McCarthy lied about what was in Ryan's plan - and their book, pretending No one has a proposal up to cut Social Security. It's about protecting it.")

For his part, Ryan has acknowledged the GOP's past 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."

But with the election over, that may be about to change.  As Paul Ryan put it, "rationing happens today."  And if he gets his way with Medicare, millions of elderly Americans will sadly learn that first hand.

* Crossposted at Perrspectives *

Originally posted to Jon Perr on Thu Feb 17, 2011 at 12:15 PM PST.

Also republished by Community Spotlight.

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