In addition to the foolish idea that it would be possible to reach a grand bargain if only the Obama campaign would unilaterally disarm and refuse
to tell the truth about “demagogue” the Ryan/Romney budget, it’s important to ask the question of whether such a grand bargain would actually be desirable. What, exactly, would accurately describing the effects of Ryan/Romney’s budget proposals and trying to win the election prevent us from doing?
A number of Democrats once believed—and some still do—that a well-crafted version of premium support is part of a balanced and sustainable long-term fix for Medicare. If the effect of the Ryan choice is to take not only the Ryan budget’s version of premium support off the table, but also the kinds of approaches that Alice Rivlin and Ron Wyden have proposed, then we’ll be left with far less appealing options for stabilizing Medicare.
So it would stop us from replacing Medicare with “premium supports.” Uh, good? Here’s the thing — Ron Wyden foolishly agreeing to give Paul Ryan cover doesn’t make his proposal a “Democratic” proposal in any meaningful sense; it proves that it’s long past time for Wyden to retire. As Galston implicitly concedes, most Democrats reject Wyden’s kinder, gentler end to Medicare for the obvious reason that it’s a horrible idea. As Medicare Advantage conclusively demonstrates, replacing Medicare with “premium support” (even in the somewhat more generous Wyden version) would result in greater inefficiency, with less money going to the provision of health care and more money going to rentiers. It can “stabilize” Medicare only by denying people medical care and/or greatly increasing costs to individuals. It is the unappealing option.
Alas, I don’t think Galston is right that attacking Ryan ferociously would permanently kill premium support, but I certainly wish he was right.