With Election Day finally in sight, the last few weeks have been brimming with slogans, speeches, and sound bites. But while Republicans and Democrats are working from a similar playbook, there’s a gaping chasm between their competing visions of the social safety net, and the future of Medicare hangs in the balance. In short, the Republicans claim their voucher plan would reduce health care costs, but the truth is that the seniors who depend on Medicare would be forced to pay the price.
The policy clash boils down to a single notion: vouchers. Mitt Romney and Paul Ryan are proposing a voucher-based Medicare system—one in which seniors are given vouchers to trade for insurance plans on a national exchange or market. The value of these vouchers is capped at a specific value, with the aim of curbing rising health care costs. And in fact, it is completely true that the Romney-Ryan voucher system will reduce Medicare costs, as promised. But it will do so by pushing those expenses onto Medicare enrollees, by forcing them to pay more out of pocket to cover their medical expenses as health care costs rise. What the GOP is proposing, in other words, is not exactly cost-cutting, but rather cost-shifting from government to seniors. If the yearly national allowance of vouchers has expired and your heart begins to fail, well, at least take solace in the fact that Mr. Ryan’s plan lowers Medicare costs by 20 percent.
If you’re only looking at the arithmetic, voucherizing Medicare is a clear and easy solution to bending the health care cost curve. Unlike, say, prevention and wellness campaigns, it’s not hard to project the level of cuts such vouchers will allow for. But this policy simplicity and straightforwardness mask an equally straightforward truth. Rather than attempt to extract amorphous, messy savings through biomedical innovation, electronic records, waste reduction, comparative effectiveness research, or incentivizing quality of care—in other words, achieving collective savings through progressive reforms—Romney and Ryan propose to gut Medicare and hand senior citizens the entrails. And this is hardly hyperbole; the nonpartisan CBO itself stated that the plan “could lead to reduced access to health care; diminished quality of care for Medicare beneficiaries…[and] less investment in new, high-cost technologies.”
That’s not to say that changes to the structure of Medicare are not needed, or will not require tradeoffs; they will. Real discussions, for instance, will have to be had over such hot-button topics as end-of-life care, or limits on the use of expensive, clinically unproven medical technologies. Refinements to these policies would bring Medicare into the 21st century, making it more nimble and in tune with technological advancement and social change. But they also preserve its central guarantee: that our nation’s retirees, having put in a lifetime of hard work and civic service, will receive quality, affordable health care to support them through their later years.
Fifty years ago, with the creation of Medicare under LBJ, thousands of soon-to-be enrollees—aunts, uncles, professors, my friends’ parents and my own—grew up trusting in this promise. And though, as a student, it will be nearly half a century before I qualify for the program, I recognize all too well the gravity of the decision we now face. It is one, after all, that will be borne most heavily by my peers, since the costs that are shifted to seniors today will be thrust upon us tomorrow as health care costs continue to rise. And young Americans will feel the consequences of voucherization well before we reach the age of eligibility, for the security that Medicare provides allows us to take risks when we're younger, to try to create the next Facebook or Instagram, rather than play it safe for fear that we'll be left destitute or denied care in our later years. To chip away at the heart and soul of our social safety net is, in a sense, to hinder innovation itself.
Ultimately, the choice we face is simple: to uphold this mandate or reject it fundamentally; to maintain the promise of health care access for our elderly or begin chipping away at the coverage we provide in the name of budget-balancing. This debate is about a decades-old American social compact, and its effects will reverberate, shaping the futures of not only my own generation but also the ones to come. For the health of our citizens and our safety net, there is only one right answer.
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