Is Paul Ryan Really Crazy Enough to Take on Medicare?

Maybe Donald Trump isn’t the one who needs restraining.

Speaker of the House Paul Ryan answers questions during a press conference at the U.S. Capitol November 15, 2016 in Washington, DC.
House Speaker Paul Ryan answers questions during a press conference at the Capitol on Nov. 15 in Washington.

Win McNamee/Getty Images

One cannot think of a more tone-deaf political response to the 2016 election than an effort to privatize Medicare. There aren’t that many lessons Republicans need to draw from 2016—they control everything!—but one is that so long as you pledge not to touch Medicare, even a goon like Donald Trump can win the presidency. Yet since the election there has been much chatter that conservatives in Congress, led by House Speaker Paul Ryan, might consider moving forward with his treasured voucherization of Medicare. I had thought that this might be a product of Democratic wish-casting, because there was no way that Ryan would be so stupid.

And yet he keeps … talking about it.

In a postelection interview on Fox News, Ryan floated the idea that Medicare and Medicaid reform would be logrolled into the repeal and replacement of Obamacare. “When Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid, so if you’re going to repeal and replace Obamacare, you have to address those issues as well,” he said two days after the election. He added that Medicare was “going broke” because of Obamacare, which is the opposite of what is happening. “So you have to deal with those issues if you’re going to repeal and replace Obamacare.”

The proper response from the less ideological people around Ryan would have been to gently talk him down from his stack of 1961 Ronald Reagan LPs. They would suggest that he perhaps rethink this plan in light of the Rust Belt coalition Trump had assembled to retake the White House for the GOP. Reporters are swarming the Capitol asking Republican members whether they will support the privatization of Medicare, and many of these Republican members seem less than ecstatic about that. Ryan’s enthusiasm, however, appears not to have dampened. In his Sunday interview with 60 Minutes, Ryan reiterated his interest in overhauling Medicare using the same old scare tactics about how the program is scheduled to go “bankrupt” in a hot minute and that he’s just looking out for the kids’ best interest.

[F]or those of us, you know, the X-generation on down, it won’t be there for us on its current path,” Ryan told Scott Pelley. “So we have to bring reform to this program for the younger generation, so that it’s there for us when we retire and so that we can keep cash flowing to current generations’ commitments. And the more we kick the can down the road, the more we delay, the worse it gets.” Ryan didn’t say overhauling Medicare is his top priority, “but it is an issue that we have to tackle.” He also said that he hadn’t discussed it with Trump yet.

Perhaps Trump will be the one who talks Ryan off the ledge—this is where we are, folks—because pushing to change Medicare from a single-payer system to a voucher system for private insurance would be among the stupider political campaigns of the 21st century.

Democrats, in case Republicans hadn’t noticed, are dead right now, with no clear path forward—unless one is made for them. Republicans who completely misinterpret the world might read this as a “mandate” to effect ideologically conservative change, such as the privatization of Medicare. The election, however, was more a primal scream from folks aggrieved that it’s no longer politic to call their female co-workers “sweetheart” than it was a referendum on whether and how to shore up the Medicare hospital insurance trust fund. It’s not coincidental, either, that Trump was the only major Republican primary candidate to insist that he would not make any changes to Medicare, a position it’s unclear he’ll adhere to.

A Republican effort to privatize Medicare is the most direct prescription for resuscitating the Democratic Party’s immediate political prospects. It would unite the party in opposition to something awful, which is about all an out-party can ask for. Republicans might be able to divvy up the Democratic Party if they look first to infrastructure or tax reform. But Democrats will have little difficulty uniting to protect Medicare, and they will stay on message about it. They killed the privatization of Social Security that way during the Bush administration, after all. Few now speak of privatizing Social Security.

Think of the “gettable” Democrats whom Republicans will be able to work with in the next Congress, the 10 facing re-election next cycle in states that Trump won. They will be right there with Bernie Sanders and Elizabeth Warren resisting a plan like this. West Virginia Sen. Joe Manchin, for example, basically has to dress like Colonel Sanders and beat up hippies with the butt of an AR-15 every hour for the next two years if he wants to win re-election. You could not give him a better gift than a Republican campaign against Medicare.

I doubt Republicans are under the impression that going after Medicare is swell politics. That means they must view the 2017 window as their best chance in the foreseeable future to achieve an ideological goal, consequences be damned. But as Republicans are showing right now in their plan to repeal Obamacare, unilateral efforts to push through an ideological goal, even if successful, may not have much of a lifespan. Even if the privatization of Medicare were to get through the House and the Senate and Ryan were able to trick President Trump into signing it by telling him it’s a bill to send the cast of Saturday Night Live to a re-education camp, its repeal would immediately jump to the top of Democrats’ list of priorities. It would sit there until the great gettin’ up morning when they had the numbers to eliminate it.

Going after Medicare would be political malpractice. I do not know what about the concept of future 90-year-olds using vouchers of withering purchasing power to buy health care plans from Aetna or Cigna makes Ryan so giddy, but it sure does. Maybe he is the recently empowered figure in Washington most in need of restraint from those around him. Maybe he is being enabled by Trump as surely as Trump is being enabled by him.