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Paul Ryan Balked at Medicare Compromise He Now Backs Paul Ryan Balked at Medicare Compromise He Now Backs

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Paul Ryan Balked at Medicare Compromise He Now Backs


Rep. Paul Ryan, R-Wis., at a campaign rally at the American Helicopter Museum & Education Center on Tuesday in West Chester, Pa.(AP Photo/Matt Rourke)

Correction: An earlier version of this story misstated the final vote on the Simpson-Bowles deficit reduction plan. The vote was 11-7.

Rep. Paul Ryan is known as the man who brought a serious conversation about overhauling Medicare to Washington. The selection of Ryan as running mate to Republican Mitt Romney has given the issue a central role in the campaign for the White House, as he has accused President Obama of failing to save the federal health program for the elderly.


But when Ryan was a member of the fiscal commission in 2010, he showed little willingness to negotiate beyond his original Medicare voucher proposal, even as the commission led by former White House chief of staff Erskine Bowles and former Sen. Alan Simpson debated a plan he would ultimately back one year later with Democratic Sen. Ron Wyden of Oregon.

Ryan was tasked with heading up the fiscal commission’s work to reduce mandatory spending along with Alice Rivlin, the former Office of Management and Budget director for President Clinton. Ryan and Rivlin worked throughout the summer of 2010 to develop a Medicare plan that would move Medicare beneficiaries turning 65 in 2021 onto a voucher system, where they would get a fixed amount of money to buy private insurance, based on what the average Medicare enrollee gets in 2012 times gross domestic product per capita plus 1 percent.

Democrats on the commission balked at the plan, and the phrase “end Medicare as we know it” was born. But the proposal did get members and staff on the fiscal commission talking about where they could find common ground on Medicare reform. In November 2010, members and fiscal-commission staff circulated a plan keeping traditional Medicare as an option for seniors, while offering them subsidies to get coverage from private insurance companies on a Medicare exchange, which would be capped at GDP plus 1 percent.


Sound familiar? That’s because it’s strikingly similar to what Ryan ultimately rolled out with Wyden one year after the commission failed to get enough votes to pass their deficit-reduction plan. But within the context of the fiscal commission—when bipartisan compromise could have actually cleared the way for a fast track toward congressional approval—Ryan wouldn’t budge. The 18-member Bowles-Simpson plan would have needed 14 votes to get fast-track treatment in Congress. Only 11 commission members voted for it and Ryan was one of the seven who opposed it.

Ryan took part in the discussions and played a constructive role in talking through the issues, but he never showed any inclination to support the commission's work, nor did he show an interest in finding a compromise, according to two former commission staffers who declined to be identified given the sensitivity of the negotiations.

The middle-ground Medicare overhaul—which kept traditional Medicare as an option for seniors—did not make it into the final Bowles-Simpson commission report, and it’s impossible to know if it would have passed through the committee if it did.

“There was only one brief discussion on premium support—the bipartisan compromise version with traditional Medicare as the default. It did not get much attention,” Rivlin said in an interview.


But it begs the question of why Ryan wouldn’t get behind this Medicare reform in 2010, only to then back it in another, less-likely-to-pass form in 2011. And on the campaign trail, he has been emphatic about the need to fix Medicare sooner rather than later.

“Medicare was there for our families, for my grandma when we needed it then. Medicare is there for my mom when she needs it now, and we have to keep that guarantee,” Ryan told seniors at a campaign event in Florida on Saturday.  

For all of Ryan’s talk on the campaign trail of Medicare’s need for an immediate fix, the fiscal commission might have been a more effective way to bring about permanent, deficit-reducing changes to the program than introducing a proposal that garnered the support of one Democratic senator but went ultimately nowhere.

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