Liberals are already lining up to attack Rep. Paul Ryan's budget proposal, even though it won't be released until Tuesday.
But before getting to that, it's worth clarifying a misunderstanding about what he's actually going to propose with regard to Medicare.
Despite press accounts to the contrary, Ryan made clear on Fox News Sunday that his proposal would not include the idea of converting Medicare into a system in which beneficiaries would receive vouchers for the purchase of private insurance, which was included in his "Roadmap" plan. "That's not what we're proposing," Ryan said. "Our reforms are along the line of what I proposed with Alice Rivlin, the Democrat from the Clinton administration in the fiscal commission, which is a premium support system. That's very different from a voucher. Premium support is exactly the system I as a member of Congress and all federal employees have. It works like the Medicare prescription drug benefit, similar to Medicare Advantage today, which means Medicare puts a list of plans out there that compete against each other for your business, and seniors pick the plan of their choosing, and then Medicare subsidizes that plan. It doesn't go to the person, into the marketplace. It goes to the plan. More for the poor, more for people who get sick, and we don't give as much money to people who are wealthy."
Lots of opportunity to discuss this proposal in more detail, but for now, here is Center for American Progress blogger Matt Yglesias on why Ryan's Medicare reforms wouldn’t affect those 55 and older:
The idea here is that today’s old people—a very white group that’s also hostile to gay rights, and thus sort of predisposed to like conservative politicians—will also get to benefit from an extremely generous single-payer health care system. But younger people—a less white group that’s friendly to gay rights and thus predisposed to skepticism about conservative politicians—will get to pay the high taxes to finance old people’s generous single-payer health care system, but then we won’t get to benefit from it. This is in part in order to clear headroom in the budget so as to make gigantic tax cuts for rich people affordable.
It's not surprising that as a liberal, Yglesias would imart racist motives to Ryan. Yet TNR's Jon Cohn gets a bit closer to the truth when he writes, "To be fair, I think the primary impetus for delaying implementation for a decade was a slightly different political calculation: An assessment that taking away Medicare from seniors who have it now would, in fact, kill the plan politically."
That's a fair political assesment, but it's also important to emphasize that the reason why many plans for reforming entitlements exempt those at or near retirement is that older Americans have built their lives around the existing system and don't have the opportunity to adjust to changes, whereas younger workers do. One of the things that Ryan has repeatedly argued is that the reason why we need to address these problems now is that the longer we wait, the harder it will become to protect current retirees from any changes.
It's also important to note that Medicare as we know it won't be around for future generations anyway, because it's financially unsustainable. So the real policy debate we need to having is whether we want to move in the liberal direction, which relies on higher taxes and more centrally-imposed cost controls, or a more free market approach in which taxes are kept low and health care costs are contained by creating a real consumer-driven market for health care. That debate is beyond the scope of this post, but the important point is that Medicare won't survive in its current form no matter what.