Bipartisan cooperation on Medicare: I'm getting more optimistic

There's been so much acrimony about health care on Capitol Hill that it's easy to conclude that we'll never find a political compromise on key issues. A month ago (Are we entering an era of political cooperation on Medicare?) I took the tack that there was reason for optimism. Until recently, Republicans showed essentially no concern for Medicare's runaway costs, and used defense of the Medicare program's status quo as a cynical way to turn seniors against health reform. Now that Republicans are starting to get real about government spending --mostly thanks to the Tea Party-- their previous defense of leaving Medicare as is is starting to backfire.I'm even more optimistic that I was a month ago that we're going to get somewhere, at least on Medicare, and that Republicans won't continue to make their whole health care policy simply an attack on the Patient Protection and Affordable Care Act. There are a few reasons for my enhanced optimism:

• In an upcoming special election Republicans are quite likely to lose what should be a safe seat in upstate New York, thanks to voter rejection of Paul Ryan's budget plan, which restructures and cuts Medicare. That would be a well-deserved loss. It's waking Republicans up to the fact that if they are serious about cost reductions they can't do it alone. They need some bipartisan cover.
• Congressional Republican leaders including Ryan himself are now talking compromise rather than confrontation. Senate Republican leader Mitch McConnell, for example, said it's time to have "an adult conversation" on health care costs. Ryan has reversed course, and now says he is open to settling things prior to the 2012 election.
• At least a couple Republican Presidential candidates are showing a willingness to discuss health care in serious ways and to disagree with their Congressional counterparts

We really do need an adult conversation about health care costs and especially Medicare. One topic that should be on the table is inter-generational equity. That means we shouldn't start with the idea that everyone currently in Medicare can keep their benefits as they are for life. It's unreasonable that millions of relatively wealthy senior citizens receive highly subsidized Medicare that is partly paid for by lower wage workers who can't afford health insurance themselves.When we're ready for that conversation I'll be excited to participate.