Republican Party unity on the issue of a massive restructuring of Medicare and Medicaid (if there is such a thing) ended this weekend. Presidential candidate and former House Speaker Newt Gingrich said on NBC’s Meet the Press that he opposed the House budget proposal designed by Rep. Paul Ryan, R-Wisconsin.
“I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change,” Gingrich said. “I don’t think right-wing social engineering is any more desirable than left-wing social engineering. I don’t think imposing radical change from the right or the left is a very good way for a free society to operate.”
(Gingrich has since tried to retract his comments, going so far as to personally apologize to Ryan and claim that the apology makes any mention of the criticism out of bounds to Democrats. Talking Points Memo reports that Gingrich's fellow Republicans are terrified of his comments being used against them in advertisements.)
I take issue with the notion that the Affordable Care Act is “left-wing” social engineering. To my way of thinking, it’s just a baby step toward the type of reforms that are required by the country’s changing demographics. A radical left-wing solution would be single-payer health care system, not one where private doctors and insurance companies are guaranteed profits from the individual mandate.
But the country also needs a real debate about the hard reality of demographics — there are more seniors than ever, plus we all live longer — and it’s those facts that call for some sort of radical restructuring of Medicare. At least Ryan’s plan does that, even though I disagree with it. His idea is to essentially protect current seniors, shifting the burden to people my age (just under 55) and to younger workers. But this a really tough issue and there ought to be a consensus solution.
The Medicare Trustees report that the "financial outlook for the Medicare program is substantially improved as a result of the changes in the Affordable Care Act. In the long range, however, much of this improvement depends on the feasibility of the ACA's downward adjustments to future increases in Medicare prices for most categories of health care providers."
In other words, at some point, some point soon, we actually have to actually stop medical inflation. We have to find ways to make the current Medicare program less expensive.
The Trustees say that Medicare’s finances are deteriorating rapidly. We need the cost-saving measures that the Affordable Care Act calls for sooner, not later. Unless the assumptions change, Medicare will be broke by 2024 (five years earlier than the projection from just a year ago). The Trustees say, “the sooner solutions are enacted, the more flexible and gradual they can be.”
But those type of changes are difficult right now because they will be unpopular. Gingrich is a good example of that. He wants seniors to be content with what they have, safe from any radical restructuring.
If Medicare is a favorite subject for pandering to voters, Medicaid is far more complicated and difficult to defend. The popular perception of Medicaid is that it's the health care insurance for poor people, a program largely paid for by the federal government but operated by the states. That is true ... but Medicaid is also a senior program because it pays for long-term care for those that cannot afford such services. That means that shifting Medicaid to block grants will require states to choose between paying insurance for poor people or funding long-term care. (It's impossible to kick elderly or disabled out of nursing homes, so it's likely the majority of state cuts will be for those who cannot afford any other health insurance).
Indian Country would take a disproportionate share of these type of budget cuts because the Affordable Care Act uses Medicaid as a key funding source for the Indian Health System. Already some states are more generous with Medicaid than others — resulting in uneven health benefits. Block grants would only make that inequality worse.
Newt Gingrich might have provided one service in the Medicare and Medicaid debate. If there is no unity on the Republican side, perhaps, just perhaps, there is an opening for a larger conversation about what would really work in terms of a radical restructuring of Medicare and Medicaid that’s both fair and sustainable.