In Thursday's debate, Vice President Joe Biden will almost certainly go after Rep. Paul Ryan's Medicare plan. And why shouldn't he? It's unpopular. But I'd like to make a case for that plan. It's the best thing the Romney-Ryan campaign has going for it.
First, let's define the problem. Today, Medicare costs about $550 billion. By 2020, according to the Congressional Budget Office, it will cost more than $1 trillion, sucking money away from every other government program.
According to the Urban Institute, the average couple in 2010 had paid $109,000 in Medicare taxes during their working years but would be able to receive about $343,000 in benefits. A chunk of that $234,000 gap will be paid for by their grandkids. That should weigh on the conscience of every American over 55.
Basically, there are two ways to reduce Medicare inflation, through the political system or through a market system. Obamacare tries the former. Current budget projections are so bad because almost no one outside the president's employ believes this approach will reduce Medicare costs. The president's primary cost-control instrument is an independent board of experts that Mitt Romney mentioned often in last week's debate. It's supposed to lower payment levels.
There are problems. It's hard for a few people in Washington to centrally rejigger something that complex. Second, the board is not really out of political control.
The history of Medicare is strewed with efforts to control costs by controlling prices. The results are terrible. Providers just increase services, redefine the classification of services or find other ways to get their money back.
The second approach is to replace the fee-for-service system with more normal market incentives. Give recipients a choice among insurance options and have providers compete to offer comprehensive coverage like today's Medicare. This idea has been around for a while, and used to be popular in parts of the Democratic Party.
Paul Ryan wrote his own version a few years ago and has come up with a more moderate version with Sen. Ron Wyden, a Democrat. Whenever you hear a Democrat say that Romney and Ryan would end Medicare or cost seniors $6,000, that is a reference to the original Ryan plan, not anything on offer today. Today's Romney plan would not shift costs to seniors.
There are serious health economists who scoff at market-based strategies. Others just don't know. The leader of the Congressional Budget Office, Doug Elmendorf, candidly admitted at a congressional hearing that his agency doesn't know how behavior would change under this sort of competition.
My bottom line is this: The status quo is cataclysmic. The Democrats' price-control approach has little chance of working.
The Romney-Ryan approach might work. If it doesn't, the federal budget would suffer but seniors wouldn't. At worst, if the market approach flopped, we'd be back to where we started.
If we don't get Medicare right, there's no money for anything else. On this particular policy issue, the Republicans have the edge.
David Brooks is a New York Times columnist.