How likely will a fight to restructure Medicare from its single-payer model to a premium-support system take place in 2017? The New York Times’ Robert Pear predicts a showdown between Paul Ryan and Nancy Pelosi almost as soon as the seats in the House of Representatives fill up after the new year, based on what House Republicans are supposedly promising. There’s only one thing missing from Pear’s report, however:
Donald J. Trump once declared that campaigning for “substantial” changes to Medicare would be a political death wish.
But with Election Day behind them, emboldened House Republicans say they will move forward on a years-old effort to shift Medicare away from its open-ended commitment to pay for medical services and toward a fixed government contribution for each beneficiary.
The idea rarely came up during Mr. Trump’s march toward the White House, but a battle over the future of Medicare could roil Washington during his first year in office, whether he wants it or not.
Who are these “emboldened House Republicans” saying they’ll prioritize Medicare reform in 2017 and fight Donald Trump to get it? It’s difficult to say, because Pear doesn’t quote a single one in his report. Pear does manage to find quotes from Democrats begging for such a fight, such as Joe Donnelly in the Senate and Pelosi in the House. Pear also quotes a consultant opposed to the House GOP proposal, a “health lawyer” from an advocacy group, and two seniors who are “terrified” and “scared to death” of Republicans.
However, Pear oddly cannot find one “emboldened” Republican to quote. All Pear manages is a few verses of the “Republicans Say” ditty. That’s enough to make a sensible reader go Hmmmmmmmm. Democrats would love Republicans to push forward on Medicare reform so they can spread the irrational terror and fear in order to rebound from yet another devastating electoral loss in which terror and fear didn’t quite suffice. Pear seems to be wishcasting for that fight, too.
Republicans may be able to claim mandates after this election on a few specific policies — ObamaCare repeal, certainly — but Medicare reform isn’t one of them. They don’t have the numbers in the Senate, and they don’t have a president willing to take it on. They had a better hand in 2005 with a smaller reform of Social Security, and still blew their political capital on a failure. Instead, as I predict in my column for The Fiscal Times, get ready for some can-kicking over the next two years — at least:
A decade ago, conservatives had built a good public case for entitlement reform and had a president who wanted to accomplish it. In 2017, however, they will have a president who openly dismissed talk of restructuring entitlement programs, insisting that he can make it work by putting his superior business acumen to work on it. The populists who lifted Trump to the White House have little taste for revamping Medicare or Social Security. …
The Trump administration will spend its first months working on its campaign promises and other goals. If Trump does anything significant with Medicare, it’s likely to be addressing the “waste, fraud, and abuse” that he and other politicians from both parties insist are the real problems in the entitlement system.
Perhaps by the midterms in 2018, Trump will have learned that those issues only nibble at the edges of the coming debt nightmare of Medicare, and will be willing to act more boldly. By that time, Republicans have a fair chance of achieving a nearly filibuster-proof majority in the Senate that could push Democrats into a sense of fiscal reality as debt continues to spiral out of control.
There are plenty of other issues on which fiscal conservatives and populists can find some common ground — regulatory reform, tax reform, rebuilding the military, and so on. With a 52-seat majority in the Senate, it’s almost certain that Mitch McConnell would shelve a fight over a Medicare overhaul in favor of priorities that he could actually get through the upper chamber, and which interest Donald Trump.
That’s not to say that Medicare reform is dead; in fact, the need will get more acute and the reality of the unfunded liabilities will make the single-payer crisis more clear in the years ahead. Until conservatives get more strength in the Senate and convince the president of the need to act boldly, though, there’s no point in taking the political damage when nothing will come of it anyway. If they’re smart, House conservatives will play for time and try to use larger Republican majorities and two more years of failed “waste, fraud, abuse” abatement to make the final sale.