Where Barack Obama And Paul Ryan Agree On Medicare

Rep. Paul Ryan’s (R-WI) budget unveiled Tuesday indicates a new, albeit somewhat minor, area of agreement with President Obama on Medicare: How much money it should spend per beneficiary. But they completely disagree on what to cut in order to get there.

Ryan’s budget — which replaces Medicare with subsidized insurance exchange where seniors can buy into a private plan or a public option — limits the value of the subsidies to per-capita GDP+0.5 percent. In other words, it makes cuts on the beneficiary side.

President Obama’s plan, as enacted under the Affordable Care Act, is to let 15 Senate-confirmed experts find the best way to hold down Medicare costs to the same level — but only by cutting reimbursements to providers, without touching benefits. Its existing mandate is GDP+1 percent, but Obama last year supported reducing that to GDP+0.5 percent.

The contrast in broader visions remains stark as ever, however, with Obama and his party wanting to keep Medicare alive as an insurance plan with a coverage guarantee, and Ryan and the GOP pushing to replace that with a “premium support” or voucher system.


Sahil Kapur is TPM's senior congressional reporter and Supreme Court correspondent. His articles have been published in the Huffington Post, The Guardian and The New Republic. Email him at sahil@talkingpointsmemo.com and follow him on Twitter at @sahilkapur.