The Thirty Years' War on Medicare

“In this present crisis, government is not the solution to our problem; government is the problem.”—Ronald Reagan, First Inaugural address, Jan. 20, 1981

That line, uttered over 30 years ago, was the first shot in a political war that may be coming to a head.

Ever since Reagan turned the New Deal mentality of the Democrats on its head with that clever statement, the Republican Party has been waging a long battle against the idea that government is necessary to solve problems that the market economy has failed to. 

That is the proper context for Rep. Paul Ryan's budget plan that effectively ends Medicare.  It is not the product of Tea Party demands.  Quite the contrary: the Tea Party is, at least in part, a result of thirty years of relentless Republican insistence that we cannot afford government programs and that taxes must always, but always, be cut.

Ryan talks about "reforming" Medicare.  This needs to be stated plainly, and repeatedly: Ryan is not proposing to reform Medicare.  He means to end it.  Yes, he protects those currently on Medicare and those over 55 who expect to have it.  But everyone else will not get it.  At all.  It will cease to exist. The program that began in 1965, and that pays the medical bills of the elderly, will come to an end, and in the future retired Americans will have to buy private health insurance.

It is worth remembering why LBJ proposed Medicare in the first place.  As he said in his statement to Congress proposing the program, "almost half of the elderly have no health insurance at all," and "the average retired couple cannot afford the cost of adequate health protection under private health insurance."  For 45 years, Medicare has solved that problem.

And now the House Republicans have voted to end that program.

The most ideological Republicans have never reconciled themselves to the existence of Medicare.  In 1964, Ronald Reagan made his national political debut making a speech advocating Barry Goldwater’s candidacy: “we're against forcing all citizens, regardless of need, into a compulsory government program.”

Goldwater lost that election, getting a lower percentage of the popular vote than Herbert Hoover did in 1932.  Undeterred, Reagan issued an LP recording of a speech against the passage of Medicare in 1965.  He famously (and foolishly) concluded that if Medicare were not stopped,

one day . . . we will awake to find that we have so­cialism. And if you don't do this, and if I don't do it, one of these days, you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free.

But Medicare did pass, with large majorities (307-116 in the House and 70-24 in the Senate).  And America is, somehow, still free.

But some Republicans have never given up the fight to do away with it.  Their major problem is the overwhelming popularity of the program.  When Jimmy Carter tried to hit Reagan with his earlier opposition to Medicare during their presidential debate in 1980, Reagan, sensing the danger, brushed it off with a bit of political misdirection:

When I opposed Medicare, there was another piece of legislation meeting the same problem before the Congress. I happened to favor the other piece of legislation and thought that it would be better for the senior citizens and provide better care than the one that was finally passed.

It is true that Republicans tried to thwart the passage of Medicare back in 1965 with an alternative they called "Bettercare."  Historian Robert Dallek has described it as "a voluntary plan providing federal payments of insurance premiums for older persons with low incomes."  In other words, it is similar to Ryan's plan to provide vouchers to buy insurance.  The main difference is that the Republicans in 1965 were not pretending to reform LBJ's proposal—they aimed to prevent it.  (Also, in 1965 they admitted that their plan "would leave most elderly Americans uncovered.")

The true lineage of Ryan’s plan is from Reagan, via Bob Dole and Newt Gingrich in the 1995 budget showdown with Bill Clinton.

In October 1995, then-Senate majority leader Dole boasted about his opposition to Medicare: "I was there, fighting the fight, voting against Medicare" when the plan was passed in 1965, he proudly said.  Gingrich denounced Medicare as "a centralized command bureaucracy."  This is how he explained the fact that Republicans were only calling for cuts in funding rather than abolition: "Now we don’t get rid of it in round one because we don't think that's politically smart…. But we believe it is going to wither on the vine because we think people are going to leave it voluntarily."

That goal has not changed, but in the last decade, Republicans have learned their lessons.  They don’t denounce Medicare and take pride in voting against it, they don’t talk about it withering on the vine. Instead they call their attack "reform."  (When George W. Bush pushed his plan for Social Security privatization in 2005, he too called it “reform,” though it was not significantly different from the basic vision of a voluntary opt-out also proposed in 1964 by Goldwater and Reagan.)

If there is a cause for optimism here, it is that the ideologues pushing this radical abolition of Medicare know that they cannot be honest about what they are doing.  The program is simply too popular. In a recent CBS News/New York Times poll, 76% believe that providing health insurance coverage for the elderly is a responsibility of the federal government, 61% think the costs of Medicare are “worth it,” 57% think there is no need to make any changes to Medicare to help balance the budget, and 56% would rather raise taxes than reduce benefits.

But unless President Obama and the Democrats drive home the essential truth that this “reform” is actually repeal, Reagan’s dream may come true.  In that same poll, a question asking if “changing” Medicare to help people buy insurance would meet their approval, 47% said yes, while 41% said no.  The Republicans can only win their long war against Medicare by stealth.  The defenders of Medicare must make Republicans fight out in the open, or they may lose the war.