THE MEDICARE MESS, PART 2: Barack Obama, 'The Truman Strategy' and the Politics of Health Care in 2012

Editor's note: This is the second of a five part series looking at Medicare by Fox News contributor James P. Pinkerton.

On April 13, President Obama delivered a frontal assault on House Budget Committee Chairman Paul Ryan’s “Path to Prosperity” plan, which was about to be the subject of an up or down vote  in the U.S. House of Representatives. Obama zeroed in what he saw as the Ryan plan’s biggest weakness--the massive restructuring of Medicare to begin a decade from now, in 2022. As Obama said of the plan, “Put simply, it ends Medicare as we know it.”

Observers immediately recognized that this was the big fight--Obama vs. Ryan and the House Republicans. As we saw previously, Obama has adopted the strategy of Harry Truman: Run your presidential campaign against the entirety of the Republican-controlled Congress.

In a year or so, the GOP will indeed nominate its presidential candidate, but that nominee will know that the political fight--bigger government vs. smaller government--has already been going fast and furious; the contours of the battle are being set now, in 2011.

The day after Obama’s April 13 speech, this headline the Financial Times summed things up: “Obama fires the opening shots in 2012 campaign.”

In that speech, the president did not mention any Republican by name, but it was clear that he had Ryan and his plan in mind when he criticized “one vision [that] has been presented and championed by Republicans in the House of Representatives.” Conceding that reducing the deficit was a “worthy” goal, Obama--not much known for deficit-reduction heretofore--ripped into the Ryan plan:

But the way this plan achieves those goals would lead to a fundamentally different America than the one we’ve known certainly in my lifetime. In fact, I think it would be fundamentally different than what we’ve known throughout our history.

As an aside, we might note that Obama’s general tone--that he knew best what was truly American or not--provoked Time magazine’s Mark Halperin to declare, “I think if a Republican president called the Democratic proposals on something like this un-American, I think the press would be up in arms.”  But, lamented the fair-minded Halperin, since it’s a Democrat saying it, the media are silent.

After denouncing other Ryan budget cuts--in energy, education, and transportation--Obama then locked in on Medicare:

It’s a vision that says America can’t afford to keep the promise we’ve made to care for our seniors. It says that 10 years from now, if you’re a 65-year-old who’s eligible for Medicare, you should have to pay nearly $6,400 more than you would today. It says instead of guaranteed health care, you will get a voucher. And if that voucher isn’t worth enough to buy the insurance that’s available in the open marketplace, well, tough luck--you’re on your own.

Tough talk from Obama that was, throwing scary numbers and summoning up visions of heartless Republicans throwing Granny into the snow.

Democrats rallied to Obama, forgetting months of their own stinging criticism. Those in politics and in the media had been complaining that he wasn’t tough enough; back in December, for instance, he had agreed to the two-year extension of the Bush-era tax cuts, and his January State of the Union address was regarded as a nothing-burger.

Moreover, his fiscal year 2012 budget had been dismissed by just about everyone as not credible. Obama was doing well enough in the polls, but as a president, he was looking weak--and it’s hard to win the White House if you look weak. Indeed, just the day before the April 13 speech, a headline on had asked, “Is Obama a leader or a follower?” 

But all that changed on his lucky 13th day of April. Finally, in that Ryan-bashing speech, Obama tapped into a main cable of Democratic thinking. After all, the legendary Franklin D. Roosevelt, rousing the nation in his “four freedoms” speech of 1941, had essentially endorsed national health insurance as part of a comprehensive “cradle to grave” welfare state.

World War Two intervened to thwart his liberal domestic agenda, but just a few months after the war ended, his successor, Harry Truman, put forth a proposal for an expansion of the nation’s “compulsory social insurance system,” an expansion that would include health care.

Truman never could get his bill enacted, but two decades later, in 1965, when President Lyndon B. Johnson pushed Medicare through Congress, the 36th president flew to Independence, Missouri, so that he could sign the Medicare bill in the beaming presence of the 33rd president, then in his 80s.

So today’s Democrats are happy Medicare warriors, keeping faith in their past while pummeling Republicans in the present. Sen. Barbara Boxer (D-Calif.), for instance, declared that the Ryan budget would “have us walk away from our commitments to seniors and the most vulnerable.” She continued:

This proposal ends Medicare as we know it, increasing costs and cutting benefits for seniors while abandoning the promise of health care made to Americans who spent a lifetime paying info a system. In fact, under their plan, out of pocket health care costs for seniors 65 years or older could double.

As Rep. Steve Israel (D-N.Y.), chairman of the Democratic Congressional Campaign Committee, the political arm of the House Democrats, announced,

We are going to use the budget to prove to Americans that every time Republicans choose to protect oil company profits while privatizing Medicare for seniors, seniors will chose Democrats.”

In other words, Democrats, by protecting the Medicare status quo, will be the winners.

But are Democrats really so smart to be fired up about defending Medicare? Or are the Republicans the ones who are smarter? After all, it’s a $500 billion program, growing twice as fast as the economy --can we afford that? Is it possible that the American people are thinking that the Ryan-Republican message of fiscal restraint is actually what’s needed?

Yet some Republicans, still bearing scars from previous Medicare battles, have sounded a cautious warning. “I think it is a dangerous political exercise,” former House Speaker Newt Gingrich told The New York Times. Gingrich supports the Ryan plan but adds, “This is not something that Republicans can afford to handle lightly.” Gingrich, of course, had been through the 1995 Republican confrontation with President Bill Clinton over proposed Medicare cuts, which left Clinton victorious and Medicare intact.

A headline in Politico made the same point: “Some in GOP squirm over Paul Ryan budget” as the newspaper explained:

Whether they’re new lawmakers in formerly Democratic seats or House veterans who represent districts with large elderly populations dependent on Medicare, a significant number of Republicans realize that embracing the Ryan plan may be one of the most treacherous votes of the year.

Yet on Friday, April 15, the Republicans voted as a bloc to pass the Ryan plan. Of the 239 House Republicans, just four voted no, joining 189 Democrats. House Speaker John Boehner, a staunch Ryan supporter, nonetheless acknowledged the challenge Republicans faced as they headed home to their districts: “I think it’s important for our members to go home and talk about it, the crisis that we face.” 

So what, exactly, is “the crisis”? Is it the fight over Medicare as it is? Or is it a fight over Medicare as it should be? Or is it over a “tax and spend” government? Or a tax increase? Or the deficit and the debt? Or is it over the larger economy--jobs, growth, and inflation? Or, come to think of it, should we also be debating issues of health itself--that is, not health insurance, but health and medical progress?

Because of its popularity and its size, as well as its potential, Medicare is central to many political and economic debates.

We will take up the shifting politics of Medicare in the next installment, Part 3 on Saturday, April 23 in Fox News Opinion.

James P. Pinkerton is a writer, Fox News contributor and the editor/founder of SeriousMedicineStrategy.