GOP Medicare Reforms Need, Deserve Better Marketing

NEW YORK — “Premium support” is at the heart of GOP efforts to modernize Medicare before it evaporates, as soon as 2020. Democrats have mutilated this excellent idea, which also bears a dreadful name. House Budget Chairman Paul Ryan (R – Wisconsin) and his colleagues should re-launch this concept, pronto.

Republicans should remind mewling Democrats that economists in liberal thinks tanks created premium support. The Brookings Institution’s Henry J. Aaron and the Urban Institute’s Robert Reischauer fathered “premium support” in 1995.

Former Senator John Breaux (D – Louisiana) promoted this reform as co-chairman of President Clinton’s bipartisan Medicare overhaul commission.

“I have proposed a premium support Medicare plan modeled after the health care plan serving nearly 10 million federal workers, retirees and their families,” Breaux wrote in March 1999. “Premium support means the government would literally support or pay part of the premium for a defined core package of Medicare benefits,” Breaux explained. “Today, Congress micromanages Medicare and the government uses fee schedules and thousands of pages of regulations to set prices for specific services,” Breaux continued. “My plan combines the best that the private sector has to offer with the government protections we need to maintain the social safety net.”

Former Senator Bob Kerrey (D – Nebraska) echoed Breaux. As he told Reuters in May, 1999: “You’re much better off letting 50 million people make decisions on their own than having [Washington] decide things from the top down.”

Breaux still favors this approach.

“We have to end Medicare as we know it,” Breaux said in last May 25’s Baton Rouge Advocate. “We don’t have to deliver it the same way we did in 1965.”

Unfortunately for this fine policy that Democrats conceived, “premium support” sounds like either an overpriced bridge abutment or a mink jock strap. Only an actuary could love such a cold, sterile phrase. Even worse, nobody outside Washington fathoms this verbiage.

Jim Guirard, long-time chief of staff to the late Senator Russell Long (D – Louisiana), runs the TrueSpeak Institute ( He advises the GOP to market “MediChoice.” Unlike the head scratching that “premium support” inspires, MediChoice signals that Republicans would give seniors choice in medical coverage. Just as the GI Bill helps veterans pay tuition at schools that match their interests, MediChoice would help future Medicare recipients (now 54 or younger) buy coverage that suits their circumstances.

Guirard urges Republicans to call today’s Medicare system “MediCrash.” The Democrats’ policy — snatching $520 billion from Medicare for ObamaCare and pretending that it’s the Platonic form of fiscal health — invites financial catastrophe. By September 30, 2020, the Congressional Budget Office forecasts, Medicare’s Trust Fund will be “exhausted.” Republicans should reiterate that Democrats — not the greedy, granny-killing GOP — perpetrated a half-trillion-dollar heist against Medicare’s coffers to underwrite ObamaCare. Democrats pitifully refuse to do anything to prevent this calamity. What will their negligence yield in just over nine years? CBO predicts: MediCrash.

Republicans also must defeat the Democrats’ repulsive imagery of the GOP literally throwing Grandma to her death. Instead, Ryan & Co. should show Americans what to expect under MediChoice. Rather than run from the voucher concept, why not embrace it? Ryan would have the Treasury send money directly to whichever health insurer a senior selected. To help beneficiaries understand these transfer payments, why not send them physical MediChoice Grant notices equal to their total subsidies? For added comfort, these grants should resemble today’s Social Security checks.

MediChoice advocates should use mock-ups of such a voucher to remind Americans that Ryan and the GOP want to give future seniors something concrete and worthy, not fling them fatally from cliffs.

One high-level GOP congressional aide tells me that Republicans fear that if they unveil a physical voucher, “Democrats will attack it as some kind of discount coupon.” Fine! Far better for Democrats to accuse Republicans of giving Granny a coupon to buy health insurance that she likes, rather than murdering her and selling her wheelchair for caviar money.