More than six years into the Obama administration, Medicare remains the great unsolved question of American public policy. With baby boomers retiring by the thousands, and life expectancy reaching for years into the future, the program providing health care for older Americans is facing a severe test that neither the president nor Congress has the stomach to confront.
In his 2008 campaign for the White House, President Obama promised he would deal with the problem of entitlements – mainly Medicare and Social Security – but with barely 22 months left in his administration, he has ignored Social Security and attended to Medicare only insofar as it affected the Affordable Care Act.
That intersection is about to provide more ammunition for partisan sniping over health care and almost certainly without anyone bothering to help shore up a program that is critical to the health of more than 15 million Americans.
The Affordable Care Act requires cuts to the popular Medicare Advantage program to bring it into alignment with traditional Medicare programs. Early next month, the Centers for Medicare and Medicaid Services is expected to announce how much it will cut those payments in 2016.
Cue the snipers.
The problem isn’t the criticism. A large, expensive government program is certainly grounds for legitimate debate or criticism. The problem is that no one – not Democrats, not Republicans – is making a serious effort to secure the program. Many Republicans just don’t like it and some won’t hear of spending more, if that’s necessary, to keep older Americans healthy. Democrats, meanwhile, seem content to bide their time, which may be politically smart but doesn’t remotely describe good public policy.
Of the two programs, Social Security is the easier one to fix than Medicare. There are several avenues toward fiscal stability, the most obvious – and perhaps most controversial – being an increase in the maximum amount of income that is taxed for the program. It would be useful for Congress to fix this now, but members are too timid even for that.
Medicare is far more complex. The rising cost of health care needs to be factored in, as does the increasing number of subscribers requiring different levels of care over ever-lengthening lifetimes.
But difficult doesn’t mean unmanageable and it certainly doesn’t mean unimportant. Rather than using the inevitable problems of a large program for target practice, Congress and the president should follow the example set more than 30 years ago by President Ronald Reagan and a contentious Congress that was willing, nonetheless, to work together. They touched the third rail of politics – Social Security – and they survived, stabilizing the program for years to come.
This is no impossible task, but it requires leaders who are willing to lead. So far, at least, Obama and congressional Democrats prefer to do nothing while Republicans in Congress throw rocks.
It’s not their finest hour.