Pot and Kettle on Medicare

Romney is deriding Gingrich for criticizing a plan to turn Medicare into a voucher system -- ironic, since Romney holds the same position

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Republican presidential candidates former U.S. House of Representatives Speaker Newt Gingrich speaks as former Massachusetts Governor Mitt Romney listens / Reuters

Mitt Romney's attack on Newt Gingrich today over the former speaker's criticism of the House GOP plan to transform Medicare into a voucher or premium support system is ironic in two respects.

Romney issued a release denouncing the remarks Gingrich made on Meet the Press last May, when he derided Rep. Paul Ryan's plan to restructure Medicare as "right-wing social engineering."  In the assault today, the Romney camp is arguing that Gingrich's comments show that conservatives can't trust him "in the fight to reform government and cut spending," as Romney's communications director Gail Gitcho put it in this morning's release.

But behind the characteristically inflammatory rhetoric, Gingrich actually raised one specific objection to Ryan's plan - and Romney has taken the exact same position on the issue.

The Ryan plan that the House approved earlier this year would replace the current Medicare system, which pays doctors and hospitals directly for the services they provide seniors, with a plan under which government would provide the elderly a fixed sum of money (alternately described as a voucher or premium support) to purchase private insurance. Gingrich's complaint was that Ryan's proposal, unlike other versions of the premium support idea discussed over the years, completely eliminated conventional Medicare and did not maintain it as an option that seniors could buy into with the subsidy they would receive from the government. As Gingrich put it on Meet the Press, "I think what you want to have is a system where people voluntarily migrate to better outcomes...not one where you suddenly impose [the change]."

During his apology tour over the next few days, Gingrich explained his position more clearly in an interview with Glenn Beck. As The Hill newspaper reported it, Gingrich told Beck: "Now, I also, ironically, I would implement the Medicare reforms that Paul Ryan wants, I would implement them next year as an optional choice and I would allow people to have the option to choose premium support and then have freedom to negotiate with their doctor or their hospital in a way that would increase their ability to manage costs without being involved."

Gingrich explained that he differed with Ryan in that he "wouldn't impose it on everybody across the board."  Gingrich, on his campaign web site, explains the difference with Ryan this way: "The one key difference is that under Newt's plan, as outlined in his 21st Century Contract with America, seniors will also have the choice to stay in the current Medicare system or choose a private insurance plan with support from the government to pay the premiums.

Romney's rhetoric has been much more favorable to Ryan, but the former Massachusetts governor has taken the same position as Gingrich. As Romney's campaign put it in a release this morning,  "Unlike the Ryan Plan, Romney's approach keeps traditional Medicare available as one of the insurance plans that seniors can choose among."

That's exactly Gingrich's position as well. Which makes the argument between the two GOP contenders more about style -- Gingrich's tendency toward flame-thrower rhetoric -- than substance. There appear to be other differences in their approach to Medicare - Romney's language implies that he would make it more expensive than Gingrich for seniors to stay in the conventional program - but on this central issue both Romney and Gingrich would modify Ryan in the same way-in effect by creating a public option for seniors. (That's obviously uncomfortable for a party that fiercely opposed creating a public option for the working age uninsured during the debate over health care reform, but that's another story.)

The second irony is that the two leading GOP contenders are engaged in a struggle over who is more deeply committed to a proposal that could be very difficult to sell in a general election -- and will likely be a central point of attack for Democrats. Though results have varied depending on the wording, almost all surveys have found that more Americans oppose than support the idea of converting Medicare from its current defined benefit status into a defined contribution program through premium support; seniors, who have been an increasingly important component of the GOP coalition in recent elections, are especially dubious. If they can't reverse those perceptions, Gingrich and Romney over the next few days may be lashing each other to a ship that's taking on water, if not sinking altogether.

Gingrich, Romney and like-minded Republicans believe that maintaining conventional Medicare as an option in a premium-support system will make the change more palatable.

But critics argue that the way such a system is structured, conventional Medicare could soon grow prohibitively expensive. Romney seemed to acknowledge that possibility in both the release he issued today and his interview yesterday with the editorial board of the conservative Washington Examiner. Regardless of how this fight plays out in the primary, the Republican hope of ending Medicare as we know it looms as a major point of contention in next fall's general election.