Wyden Walks Medicare Policy Tight Rope

His Medicare reform white paper co-authored with GOP presidential running mate Paul Ryan has Democratic Oregon Senator Ron Wyden in the political crosshairs of just about everybody.Democratic Oregon Senator Ron Wyden, who isn't even on the ballot this fall, nevertheless finds himself in the middle of a hard-fought, negative presidential campaign. And he isn't happy about it.

Wyden co-authored a provocative white paper on Medicare reform options earlier this year along with House Budget Chair and now GOP presidential running mate Paul Ryan. The Mitt Romney-Ryan campaign seized on the white paper — and Wyden — as evidence of bipartisan support for their approach to Medicare reform.

Wyden has gone to great pains, including a speech this week to the Portland Rotary, to say ‘no dice.’

Defending the white paper and his collaboration with Ryan, Wyden says what Romney has endorsed and House Republicans have passed is not consistent with the white paper's approach to "preserve the Medicare guarantee."

In an interview with Ezra Klein of The Washington Post, Wyden said the major differences between his views and those of Romney involve the Affordable Care Act and Medicaid. Romney and Ryan favor repeal of the Affordable Care Act and Wyden doesn't. The Ryan-inspired House budget would give states more freedom to run their Medicaid programs for low-income citizens, but also provide less money. Wyden says that will harm lower-income seniors who qualify for both Medicare and Medicaid.

Political debates usually occur several decibel levels above the on-the-ground realities of complex issues. Nowhere is that more true than in health care.

While there are plenty of legitimate perspectives, Wyden says Medicare reform cannot occur in a vacuum. He told Klein, "I've found more and more Americans are coming around to this head-scratching exercise where they ask, shouldn't we do the same things for people over 65 that we're doing for people under 65? Can't we start the march to an integrated system?"

The Wyden-Ryan white paper talks about a Medicare system with more private-sector choices, but Wyden says those choices are predicated on health care delivery reforms embedded in the Affordable Care Act, such as more coordinated care to hold down costs, emphasize preventive care and improve medical outcomes.

"If you don't accept those, and Governor Romney says just rip up the Affordable Care Act, you'll never have any of these reforms," Wyden says.

When Wyden and Ryan unveiled their white paper, Wyden took flak from his Democratic colleagues. At the time, Wyden accepted the political brickbats as the price you pay for daring to explore bipartisan approaches to third-rail political issues like Medicare. Now that spirit of bipartisanship has come back to bite Wyden.

While he couldn't have predicted Ryan would wind up as Romney's choice as his vice presidential running mate, Wyden might well have foreseen that Ryan's budget, including its elements dealing with Medicare and Medicaid, would emerge as a major theme in a presidential contest increasingly pitting two very distinct economic and political viewpoints.

Wyden's frustration has flashed on several occasions as he tries to distance himself from Romney and his policies. "There is ideological bedlam. You have Republicans saying that what they're so strongly opposed to in the Affordable Care Act is exactly what they'd like done in Medicare," Wyden said in his interview with Klein.

Oregon's senior senator is no stranger to major health care debates, which he has engaged in since arriving in Congress in 1981. He also has a political legacy of looking for bipartisan approaches — often with the most improbable political partners — to thorny issues, including health care. The flap he now finds himself in only proves the maxim that no good deed goes unpunished.