Chait points out that an important part of the Republican base – "disaffecteds" – more fiercely oppose Medicare cuts than even hardcore liberals. Douthat digests this:
I agree with the conservatives who are arguing that Republicans need to forge ahead on Medicare reform, because they’ll be demagogued on the issue no matter what they do. But forging ahead on entitlements doesn’t require defending every detail of the Ryan budget, or fighting the next election on exactly the same lines that the NY-26 race was fought on. That’s a battle I don’t think conservatives can win.
So what lines? That we need to means-test, ration, increase co-pays and premiums, and raise the retirement age? I can't see how that wins over the disaffecteds, who will rage even more at the feckless establishment. The only hope for the GOP is a Democratic bout of bipartisan fiscal responsibility – the kind that sends Paul Krugman into a foam-speckled rage. After the GOP brutally exploited fears about healthcare last time around, I cannot imagine the Dems are that game.
Ramesh Ponnuru urges the GOP to hang in, and make the case for privatizing Medicare carefully and methodically, and contrasting the actual Democratic alternative:
When you’re talking about Medicare, at those town halls or in interviews, don’t say that the alternative is bankruptcy and that the Democrats want to do nothing. No, the alternative is heavy-handed bureaucratic cost- cutting. The Democratic plan is cutting payment rates so that Medicare becomes as lousy a program as Medicaid, with doctors refusing to participate in it. The Democratic plan is letting an unelected board decide which treatments won’t get funded.
I'd support this if there were any solid evidence that patients can act as effectively as consumers. But there isn't. The idea of individual choice and market competition bringing costs down is very powerful. It's just wrong.
The Dish 