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What Do Republicans Do Next On Medicare?

The political fight over Medicare is over. Paul Ryan lost. Jane Corwin is fleeing the Ryan plan and trying to outflank her Democratic opponent from the left. Even third-party candidate Jack Davis is promising not to touch Medicare. It seems pretty clear that the political market has no demand for what Paul Ryan is selling.

So what comes next for Republicans? Greg Sargent and Peter Suderman say it's back to 2009-10 for the GOP, attacking Democrats for taking away your Medicare. I agree, but it's also worth delving a little further into how Republicans approach this issue. Democrats have an unfair advantage in the fight over Ryancare because they are able to defend the status quo, just as Republicans did in the health care debate, when in reality the alternative scenario requires some measures to restrain spending and/or increase revenue. The Republican approach to this problem has been to imagine the worst possible alternative and insist it's the Democratic plan. Here's the Republican message, per Eric Cantor and passed along by National Review's Andrew Stiles:

“Republicans have offered a plan to guarantee benefits for seniors and those approaching retirement while ensuring that this important safety-net exists for Americans under 54 years of age,” he continued. “In stark contrast, the current Democratic plan for Medicare — endorsed by President Obama, Leader Reid, and Leader Pelosi — is the rationing of care, elimination of benefits, and bankruptcy of the popular program.”

So apparently the GOP's plan involves preserving benefits for everybody over 54 and no other changes of note, while the Democratic plan involves benefit cuts, rationing, and letting the program go bankrupt -- quite a tricky combination to pull off.

Of course, there are different ways to cut benefits. The liberal method is to try to get Medicare to stop paying for ineffective procedures, and to encourage measures of results rather than simply incentivize more spending. Conservatives have decided that any measure seeking to root out waste in Medicare amounts to "rationing" and is unacceptable. They prefer to put beneficiaries into private insurance, and then slowly reduce the subsidy for that insurance, so that customers can shop for cheaper plans.

Conservatives may have convinced themselves that their public opinion success in the health care debate amounted to the public embracing their market-oriented vision of health care, when in fact it was the public simply reacting against any changes in Medicare at all. Their embrace of the Ryan budget reflects, in part, a kind of self-delusion -- a reluctance to admit to themselves that their strongest weapon against the Affordable Care Act was outflanking Democrats to the left.