How Republicans Could Still Succeed At Privatizing Medicare

Republicans may be backing off their famously toxic plan by Paul Ryan to privatize Medicare, but they’ve doubled down on the broader concept and are taking strategic steps to get there over time. Democrats currently have the upper hand in their battle to protect traditional Medicare for the future, but unless they thwart the GOP’s drumbeat and build support for their alternate vision, it may not be for long.

There’s little disagreement that Medicare is currently on an unsustainable trajectory, with costs spiraling out of control thanks in part to aging baby boomers. Democrats and Republicans both want to rein in Medicare spending, and the two sides increasingly agree that per-beneficiary outlays should be held down to per-capita GDP plus 1 percent, a substantial reduction from projections. But they strongly disagree on how to get there.

Republicans want to turn Medicare into a subsidized private insurance structure and cut costs on the beneficiary side. This concept — dubbed “premium support” by backers and “vouchers” by critics — would end the coverage guarantee and give seniors a fixed amount to shop for insurance on a private exchange. If the subsidy is too small, tough luck; they’re on their own.