Can there be a constructive entitlement debate?

Something must be done about entitlements – specifically Medicare and Medicaid. Smart, informed, forward looking people like David Walker, former comptroller general of the United States, have been sounding the alarm for years. It took the shock of trillion-dollar deficits (ironically almost entirely unrelated to entitlement spending) for their calls to be heeded.

Unfortunately for America, the calls are being heeded at a time of unprecedented partisan bickering and gridlock, meaning the potential for a constructive debate about what to do to rein entitlement spending is somewhere between slim and none.

This was driven home while I was reading a post by Ross Douthat on his New York Times blog last week discussing the dicey politics of the Republican plan. As Douthat said, “the constituency most resistant to Paul Ryan’s Medicare reforms seems to be conservative-leaning blue collar voters — what the Pew Research Center, in a recent report, calls the ‘Disaffecteds.’ ”

Losing this segment of the populace could cost the Republicans dearly. Douthat noted there are essentially two ways to deal with this political problem:

One is what you might call the cynical Sam’s Club strategy, which involves attacking the Democrats as big-government socialists from one corner of their mouths while promising to defend entitlements (the real driver of government’s growth, of course) to the death from the other corner. This was the Republican approach during the health care debate, and it’s a reasonably effective strategy — so long as you don’t actually care about limited government or the looming fiscal dégringolade.

Douthat said the better, less cynical, more productive approach “is to champion entitlement reform in a way that reassures blue-collar voters, and addresses their (entirely valid) economic concerns.” As Douthat said, the Ryan budget – “packaging a sweeping Medicare reform together with something that looks like just another supply-side tax cut, with a repeal-but-don’t-replace health care bill thrown in for good measure” – probably doesn’t fit that bill. He then pointed to a David Brooks column and an earlier column of his own that both suggested a different sort of plan, one that spread the pain more evenly while still adhering to conservative, small-government principles.

A budget more completely informed by small-government egalitarianism might try to make the recent payroll tax cut permanent, rather than just cutting income tax rates. It might attack handouts for oil and natural gas companies as well as those for alternative energy, and slash agricultural subsidies more dramatically than the Ryan budget does. While thinning out the maze of tax deductions, it might expand the earned-income tax credit and the child tax credit, both of which make it easier to earn a decent living and form a stable family. While trying to repeal Barack Obama’s health care plan, it would insist on replacing it with the kind of universal tax credit that Ryan himself has previously championed.

That’s when it struck me: The Republican Party today is far, far more likely to engage in the “cynical Sam’s Club strategy” – however hypocritical and ineffective – than it is to offer up genuinely constructive solutions of the type outlined by Douthat, especially if those genuinely constructive solutions might be portrayed by Tea Party radicals in any way, shape or form as tax hikes.

Today’s Republican Party is no more concerned about fiscal responsibility than the party that nearly doubled the federal debt during the last period it controlled both Congress and the White House. Indeed, Dick Cheney’s “deficits don’t matter” seems to remain the governing mantra. Deficits don’t matter; only cutting social spending does. The Pentagon remains sacrosanct. Utterly failed tax cuts for the wealthy must be preserved. For Republicans, the cause is spending they don’t like, not deficits.

And, America, it doesn’t take a genius to realize that, the shameless “we’ll save Medicare” pandering of the 2010 election cycle aside, Republicans don’t like Medicare spending.

America needs have a grown-up discussion about what to do about Medicare costs – which, unless you want to throw granny to the wolves, means having a grown-up discussion about how to curtail health care inflation. So far, Republicans are absent from that discussion. President Obama has proposed the Independent Payment Advisory Board, which grown-ups who actually know quite a lot about health care policy think will make a difference. The GOP has proposed vouchers for seniors to buy private insurance – vouchers that would cover less than the cost of care – with no mechanism beyond the vaunted “private marketplace,” which has proven less than adequate at restraining health care inflation, to actually lower prices.

You can only have a grown-up debate when both sides are acting like grown-ups.

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