The theory that persistent marketing can make people yearn for that which they formerly feared is about to get its supreme test, the selling of the Republican deficit blueprint and the scuttling of Medicare, the most beloved government program in history.
Only a year ago — no, make that last weekend — Republicans were telling seniors and those approaching Medicare eligibility that the Affordable Care Act, which Republicans call "Obamacare," will take away Medicare benefits and bring about "rationing," the dreaded concept that caused nearly every voter in Frank Luntz's 2009 surveys for the GOP to recoil in horror.
Never mind that the health reform act takes away no benefits and instead expands prescription-drug coverage, provides free preventative care and annual physical exams and gives a bonus to primary-care doctors who treat seniors. A national poll last month showed that 61 percent of seniors still believed that the law weakened Medicare for them even though most of them intended to take advantage of the screenings and physical exams. If you take seniors out of the polls, Americans consistently favor the health-insurance law.
If everyone stays on message — Republicans do, to the last man and woman — negative marketing sure enough works.
So what happens with us oldsters when all but five Republicans unite to do all the things that seniors said in the polls they feared Obamacare was doing? We are about to find out, although the 2012 elections will be the certain test.
Rep. Paul Ryan, the author of the Republican blueprint that passed the House of Representatives on a party-line vote Friday, proclaimed that the Republicans had voted to save Medicare. Our new congressman, Karl Rove acolyte Tim Griffin, joined the national refrain. He said he had voted with Ryan to keep "the status quo" for Medicare recipients.
Not quite, even for current Medicare recipients, and most certainly not for everyone who follows in 2021 and beyond. For them, the status quo would disappear entirely. Seniors and the disabled then would have to buy hospital and doctor coverage from insurance companies just like younger people who are uninsured will have to do under the Affordable Care Act, except the seniors' coverage would not be guaranteed. The government would give vouchers to seniors to help pay for the insurance but, if future congresses follow the Ryan plan, seniors would have to pay for most of their medical bills themselves, through higher premiums, copays and diminished coverage. That is how the Republican Medicare plan expects to save that $4 trillion.
The House blueprint would repeal the Affordable Care Act, including the new drug and screening benefits for Medicare recipients and all the other steps that increased Medicare's life expectancy until 2028 (the year when the Medicare hospital trust fund runs out and benefits will have to be cut) and maybe much later if the pilot projects and reimbursement reforms in the 2009 law are actually carried out. The Republican plan would move the bankruptcy date back to about 2018.
The key to the Republican marketing strategy is to exempt current Medicare beneficiaries and everyone who becomes eligible over the next 10 years. Those are the people who now care about Medicare; no one else even thinks about it. If it were a dream plan as Ryan, Griffin, and Congressmen Steve Womack and Rick Crawford say it is, why not implement all of it next year? You know why.
The proponents of torpedoing Medicare spread out on the political gab shows to explain why privatizing Medicare would save it. See, insurance companies will run it more economically than the federal government and will wring out inefficiencies and stop the program's growth. On the PBS show The McLaughlin Group, Rich Lowry of the National Review said the privatization would work because it would be based on the privately run Medicare Part D and the private Medicare Advantage plans, the 2003 overhauls that sped Medicare toward early bankruptcy.
Although it is not what people have been led to believe, the administrative overhead of Medicare is about 2 percent. Even a study commissioned by the insurance industry in 2006 concluded that industry administrative costs ran about 9 percent without considering commissions and profits. When those are figured in, the administrative percentage doubles. The experience with the Medicare drug program and Medicare Advantage actually verifies it. Since the Medicare private plans were instituted in 2005, taxpayers have been paying about 14 percent more for them so that the companies can cover their administrative costs and make a profit. The Affordable Care Act will make big savings by slashing that subsidy to the insurers. As you might guess, the Republican plan would restore the industry subsidy.
The basic Republican premise at least is right: Medicare is going to gobble up an increasing share of the treasury, partly because of its success keeping people living longer and using more treatment, partly because the post-World War II generation hits Medicare starting this year while fewer and fewer people go into the workforce to pay social-welfare taxes, and partly because of the wasteful prescription-drug program of George W. Bush, but mainly because medical costs for everyone in the United States are growing much faster than inflation or the economy.
How do you bend down the curve? The Affordable Care Act makes a stab at it but no one can reliably predict how successful it will be at turning down the medical reimbursement index (neither Democrats nor Republicans want to make surgeons and other medical specialists mad) or reforming treatment and payment strategies. The Ryan plan doesn't try. It does nothing about general doctor, hospital or medicine costs or long-term care. It just transfers a rapidly rising part of those costs for the elderly, disabled, and poor children to the sick themselves and to the state governments.
If you can persuade the American people that this a good solution, you can sell them anything. I'm not saying you can't.