Nocera is unimpressed by Ryan's plan. But he also says:
Yet I found myself disheartened as I read about the Democrats’ gleeful reaction to the victory in New York. They had a strategy now: bash the Republicans into submission over the Ryan plan. In the Senate, the Democratic leadership forced a vote over Ryan’s budget purely to force Republicans to cast a vote “against” Medicare. Clearly, the Democrats are going to make hay over the very idea that Republicans were trying to mess with Medicare, the most sacrosanct federal program of them all.
Nocera thinks that Democrats should treat the Ryan plan as a launching pad for a serious debate about how to reduce health care spending and secure the future of medicare.
It just seems so reasonable! And Democrats have been arguing for years that we'll need to bring down overall health spending as a matter of priority.
Now I'm all confused. If we agree about so much about the proposed end goal, despite our differences in approach, why exactly is it that we can't have a serious debate about medicare reform?
Oh, that's right. NOW I remember. Do you?
Do you remember when Obama talked about the importance of bending the cost curve on medicare expendiature? Remember how one of the ideas he included within the Affordable Care Act was that the government would pay for end of life counseling in which a patient would sit down with their doctor and tell their doctor how THEY wish to be cared for in the case of serious medical breakdown? Remember how this optional but compassionate option was designed so that those people who do want extraordinary measures to save their lives could make this wish clear, with the benefit of expert medical opinion, and those for whom the idea of living indefinitely as a vegetable, or dying in hospital away from their loved ones was abhorent could work with their physician to understand what level of care was right for them - would they want a focus on pain reduction and being comfortable? Who would they want to make decisions about their care if they were unable to do so themselves? Remember that this policy, a modest change to medicare's coverage options, was seen by geriatric specialists and end of life counselors as a way of eliminating UNWANTED medical spending and preventing people from being forced into heroic measures that they themselves would have seen as tortuous and undignified?
Do you remember? Would it jog your memory if I said:
Democrats put forward a reasonable compromise solution aimed at comprehensively reforming the existing health care system to both reduce costs and expend access to care. We pointed out that America spends more per capita on public health care alone than any other country in the world without even covering our entire population. We pointed out that medicare costs alone were skyrocketing beyond what the federal budget could sustain in the long term, and that if we made a serious effort to reform the system now, which might include modest additional tax revenue on a targetted basis, we could bend that cost curve and expand care. But that it would involve some people having to modestly trim the benefits they could expect and some others having to pay a bit more.
The Republicans acted as if we wanted to kill their grandmothers. Indeed, they outright SAID that we wanted to kill their grandmothers.
We can't have a serious debate about medicare because Republicans don't want one. They want a debate about how to reduce government spending. That's why they tried to privatise Social Security during the Bush administration. That's why Paul Ryan's plan isn't about improving the delivery of Medicare but scrapping it and replacing it with private vouchers. But when Democrats suggest that maybe there could be modest revisions to the way that Medicare operates to direct more of its expenditure towards care and less towards, for example, the profits of the private sector suppliers who have benefited from George W. Bush's medicare reform boondoggle, Democrats are demonised by Republicans for supposedly wanting cut to the program! Even though Republicans want to scrap the program entirely! Even thought Medicare itself is a Democratic policy, and one of the party's proudest achievements! It's enough to make your head explode. We're supposed to reach out to Republicans in the hope of creating a serious debate? We're supposed to use Ryan's utterly unserious proposals as the launch pad for such a discussion? It's not possible for Paul Ryan to start a debate about these issues when Democrats have been shouting into the wilderness for years.
But if you want a serious set of policies aimed at improving Medicare, Democrats have many such policies. One form of said serious policies, which, while imperfect, does in fact reduce the deficit and expand care is called the Affordable Care Act. Perhaps Paul Ryan may have heard of it?