The lack of presidential leadership was once again on full display in December 2011 when Republican Paul Ryan and a leading Democrat, Senator Ron Wyden of Oregon, introduced a version of the premium support approach to fundamentally reforming the Medicare program. Ryan, as part of his far-reaching plan for solving the deficit crisis, had included a less generous version of premium support that was viewed by many Democrats as putting seniors at too much risk for increased out-of-pocket payments for their medical care.
Nonetheless, if viewed as an opening bid in a negotiation over Medicare funding, the original Ryan Medicare proposal could be seen as having potential for bipartisan negotiations. Alice Rivlin of Brookings, a leading Democratic budget expert, agrees with the basic approach of the Ryan proposal, although she opposed his original version. However, the version Ryan and Wyden released in December seems nearly identical to the proposal supported by the influential Bipartisan Policy Center and written by Rivlin and former Republican head of the Senate Budget Committee Pete Domenici. Both the Washington Post and the New York Times have written editorials arguing that the premium support approach to controlling Medicare costs deserves consideration and careful scrutiny. In short, a series of developments in Washington opened an opportunity to consider a reform that CBO has scored as reducing the growth rate of Medicare spending.