How Paul Ryan pick by Romney can alter campaign

Paul Ryan was picked by Romney in part for his bold reform plan for Medicare. The plan's key element is more choice in health care – a useful debating point for the presidential campaign.

The Monitor's View

For Americans who vote Nov. 6, the selection of Rep. Paul Ryan as Mitt Romney’s GOP running mate will probably do little to sway them on the top campaign issue: jobs. Mr. Ryan’s expertise is the federal budget, not the economy. And vice-presidential nominees rarely influence an election.

But the Ryan pick could reframe the debate between Mr. Romney and President Obama in a profoundly personal way for voters. The Wisconsin congressman is the leading proponent of more choice for those who rely – or will rely – on government for health care.

Enabling individuals to take charge of their health-care choices lies at the heart of Ryan’s plan to reform Medicare. In its latest version, it would give money to seniors to choose between a range of insurance options with government setting the terms for coverage, much like Medicare coverage of drug prescriptions.

For future retirees – or those under 55 – the Ryan scheme would pay them to buy a government-approved plan whose costs are determined through a competitive bidding system. Those seniors who want more coverage under a more expensive plan would pay more and those who want a lesser plan could pocket the savings. The poorest or sickest seniors would have a special program.

Ryan’s proposal is built on more than his hope to reduce a growing dependency of Americans on government for health needs, or to curb bureaucratic control over medical decisions, or to restore an ethic of self-reliance. Ryan sees more freedom in health-care choices as essential to rein in Medicare’s rising costs – and to save the program.

Those costs are now the leading driver of the federal debt, and may be for decades. The first of 81.5 million baby boomers became eligible for Medicare last year.

Or as Mr. Obama put it: “If you look at the numbers, Medicare in particular will run out of money, and we will not be able to sustain that program no matter how much taxes go up.”

Reform of Medicare is politically difficult, however, as more than half of Americans prefer it as is. Ryan’s political fame relies in large part on his courage to not only call for reform but provide a plan. He even revised the plan after listening to critics.

Ryan’s partial-privatization approach is based on the idea that granting personal freedom in choosing Medicare insurance will reduce costs. That theory is now a prime topic for policy wonks, as it is unclear whether the overhead costs of private insurers would be any less than today’s Medicare program.

Obama claims that Medicare costs can be curbed by new information technologies and a federal body of medical experts who will decide which treatments to allow for seniors. Ryan’s plan even has a backup tactic if costs rise too much: Place a price cap on government spending per beneficiary.

Still, a proposal that would bring more choice into health care, especially when so many Americans are seeking alternatives to traditional medicine, will serve as a useful topic in this presidential campaign. On that point alone, Romney’s pick was a healthy choice.