In a passionately argued piece here in Fox News Opinion earlier this week, Michael Reagan, eldest son of President Ronald Reagan, correctly recalls that "The Gipper" opposed the creation of Medicare in 1965, deriding the program as a step toward “socialized medicine.” Half a century later, conservatives and Republicans are still targeting Medicare, but they haven’t gotten very far. So perhaps a new strategy is needed.
The younger Reagan is exactly right about what his father said about Medicare back in the 60s, but it must be remembered that once he became the 40th president, Ronald Reagan made no effort to repeal Medicare.
I know, because I was there, working as a policy and political aide to Ronald Reagan from 1979 to 1985, in his presidential campaigns and also in his White House.
And no leading Republican since has made any effort to repeal Medicare; in 1995, Speaker of the House Newt Gingrich made an effort to cut the growth rate of Medicare, which led to two government shutdowns, totaling about four weeks, in late 1995 and early 1996, but that effort, too, was mostly unsuccessful in curbing the growth of Medicare.
Indeed, in 2003, President George W. Bush and the Republican majorities in Congress voted to expand the Medicare program, adding a prescription drug benefit estimated to cost $500 billion over a decade.
So what does this track record tell us? It tells us either that Medicare is a good idea, or that Medicare is popular. The first point, that Medicare is a good idea, is endlessly debatable. The second point, that Medicare is popular, is not. Medicare is one of the most popular programs there is. We might consider the evidence from a New York Times poll, released in April of this year: According to the poll, 76 percent of Americans think that Medicare, as is, are “worth the cost,” while 62 percent of self-described “tea partiers”--18 percent of the population--support the program.
Some ambitious Republicans are gearing up for another effort at remaking Medicare. Rep. Paul Ryan (R-Wis.), likely to be the new chairman of the House budget committee in the 112th Congress that convenes in January, has released a plan for the profound restructuring of Medicare, involving both cutbacks and voucherization. The Ryan Plan possesses a bracing intellectual clarity, but at last count, it boasts just 12 co-sponsors among House Republicans. No doubt more Republicans will sign on next year, in a more tea-party-ized GOP, but political reality will still put long, long odds on any major restructuring, or shrinking, of Medicare.
So is that the last word? Medicare just keeps going up and up? One point to bear in mind: Medicare, huge program that it might be, is not yet in crisis. Its current budget is about $468 billion a year. That’s a lot of money, but it’s less than a seventh of the federal budget, and less than four percent of gross domestic product (GDP).
And as for the future, yes, the cost of Medicare is rising rapidly, but much of that growth is the aging of the population--and there’s not much to be done about that. Yet even so, Medicare doesn’t even reach six percent of GDP until 2040. Admittedly those are Obama administration projections, based on the proverbial “rosy scenario.” But even if the projected cost of Medicare in 30 years is substantially higher, as many critics assert, the here-and-now reality is that we have time to sort through this crisis.
It would be politically counter-productive, for example, for Republicans to start hacking away at Medicare in 2011 in an attempt to ward off fiscal doomsday in 2040. As we have seen, the poll numbers in support of Medicare are strong--they are not likely to shrink much, if at all, in the next few months. It would be unfortunate, indeed, if the new Republican majority in the House were to “break its pick” on Medicare and see the Democrats returned to power 2012 with a mandate to prop up the status quo.
We do confront a fiscal and economic crisis, as Michael Reagan says, and national health care policy is part of the problem. We do need to do something to reduce the size and scope of the federal government and to get the economy back on track. But at the same time, we must recognize that we face other challenges, too. And so let’s step back for a moment, and take a more comprehensive view of Medicare. Let’s consider some “out of the box” solutions that are, in fact, tried and tested, albeit neglected in recent decades.
We might start by stating the obvious: As our population ages, people develop diseases associated with aging--and those diseases are expensive. That’s not a matter of left or right, or blue or red; that’s a matter of medical reality. And so it stands to reason that the answer is more likely to be medical than it is to be ideological or fiscal.
We are in the middle of an epidemic of Alzheimer’s Disease (AD), the affliction that took Ronald Reagan from us. "The Gipper" fell ill in 1994, and died in 2004--a costly and tragic decade for the Reagan family. And in that one life story, we see much of the challenge we face with Medicare.
And the AD problem is going to get worse--much worse. Currently about 5.3 million Americans suffer from AD,; the cost of their treatment is about $170 billion a year. Meanwhile it is estimated that AD will triple in the next 40 years, and if it does, care will be expensive, whether the care comes from the public or the private sector.
So what to do? One answer is to boldly revamp the argument about federal health policy, away from the idea that Uncle Sam exists to pay for care, and toward the idea that Uncle Sam is wiser to pay for a cure. After all, a cure is cheaper--as well as more compassionate--than care. As retired Supreme Court justice Sandra Day O’Connor, appointed to the court by Ronald Reagan back in 1981, and two co-authors argued last week in The New York Times,“As things stand today, for each penny the National Institutes of Health spends on Alzheimer’s research, we spend more than $3.50 on caring for people with the condition.” So we spend 350 times more on treatment for the disease, after the fact, than we do on research aimed at preventing the disease. Is that smart? Of course not. As an aside, one would almost think that the nursing-home lobby had gained control of our policy on geriatric health issues.
O’Connor and many others think that we could make a real dent in AD over the next decade--if we tried. If, that is, we focused public and private resources, as well as dramatic changes in the legal and regulatory environment. We might ask: Who do we want dominating healthcare policy? Trial lawyers and bean-counting bureaucrats? Or research scientists?
I believe that Ronald Reagan, were he still with us, would approve of this approach. Reagan, born in 1911, grew up amidst the scourge of polio, which crippled and even killed. In 1955, Dr. Jonas Salk, working for the March of Dimes, developed the vaccine, and America was changed. Not only were Americans freed from the terror of a crippling disease, but the national treasury was freed from the burden of paying for wheelchairs and iron lungs. In other words, science came to the rescue and solved a problem that was both medically ruinous and fiscally costly.
And in 1985, from the White House, President Reagan issued a proclamation commemorating the 30th anniversary of the Salk Vaccine. As RR said, recalling the greatness of Salk’s work and the contribution he made:
"One of the greatest challenges to mankind always has been eradicating the presence of debilitating disease. Until just thirty years ago poliomyelitis occurred in the United States and throughout the world in epidemic proportions, striking tens of thousands and killing thousands in our own country each year.
Dr. Jonas E. Salk changed all that. This year we observe the 30th anniversary of the licensing and manufacturing of the vaccine discovered by this great American. Even before another successful vaccine was discovered, Dr. Salk's discovery had reduced polio and its effects by 97 percent. Today, polio is not a familiar disease to younger Americans, and many have difficulty appreciating the magnitude of the disorder that the Salk vaccine virtually wiped from the face of the earth."
We might remember those words: “virtually wiped from the face of the earth.” Reagan was no fan of big government, but he was a fan of science--and oftentimes its science that wins the battle. The battle, that is, not only against disease but against the costs associated with the disease.
Interesting, there was no similar proclamation in 1995, on the 40th anniversary of the Salk Vaccine. Evidently President Bill Clinton did not see the value of cures as a health care strategy; indeed, as we all know, Bill and Hillary Rodham Clinton had a different approach to healthcare--the national health care insurance approach. That approach failed in 1994, of course, only to be revived by President Obama.
Yet as we just saw on Tuesday, “Obamacare” is not particularly popular. People don’t trust the federal government to manage their health care--so Ronald Reagan was right. But as the 40th president also knew, Americans do trust the federal government to help lead the scientific search for medical cures.
If the cure-is-better-than-care approach could be applied to polio, could it be applied to other diseases, starting with, but not limited to, AD? If so, we would be a richer, as well as healthier, nation.
To be sure, we will all die of something, but if we could extend our productive lives, we would generate more income and wealth, as well as happiness. And who knows? We might even be able to extend the retirement age for Medicare--and Social Security. That would save trillions, fulfilling yet another Reaganite goal.
Such a medical victory would be a win-win, both for senior citizens and all the rest of us. And so, healthier and richer, we could move on to solving other urgent problems.
James P. Pinkerton is a writer, Fox News contributor and the editor/founder of SeriousMedicineStrategy.
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