Glenn Kessler, the Washington Post's fact checker, dished out the maximum four pinocchios in reference to ads by Democratic pacs criticizing Arkansas Representative Tom Cotton over his support of the Republican Medicare plan. This is not the first time such ads have drawn four pinocchios from Kessler or comparable criticism from PolitiFact and FactCheck.Org, the other major media political fact checking sites. 

The essence of the criticism is that the ad cites complaints against an earlier Medicare plan that was passed by Congress in 2011. The specific allegations in the ad, that the plan "essentially ends Medicare and costs seniors $6,000 a year," are not accurate in describing the revised plan supported Cotton.

Kessler is correct on this point, but is carrying his case too far. The revised plan would allow seniors to continue to buy into a Medicare-type program, but it provides no guarantee that the size of the voucher (Republicans prefer the term "premium support," but readers are more likely to know what a "voucher" is, hence my use of the word) would be sufficient to pay for the cost of the Medicare plan. The gap could easily be many thousands of dollars a year.

Furthermore, as Kessler notes, depending on the rules set up for structuring enrollment in the various plans, the Medicare option could easily be the victim of adverse selection. This would  mean that only sicker beneficiaries sign up for the Medicare plan, which would raise average costs. This would force the plan to charge a higher premium, which would in turn chase out the more healthy beneficiaries, meaning that the average remaining Medicare enrollee is even sicker. This raises the cost of the plan even further.

This process ends with a collapse of the market for traditional Medicare since no one will be able to afford the plan. While this outcome is certainly not a guaranteed outcome of the Republican plan it is a very real possibility, especially if the program was administered by Republicans who are quite openly hostile to the traditional Medicare plan.

Given that this sort of collapse of Medicare is a very plausible outcome of the Republican plan (if any fact checkers care to dispute this claim, I promise a blogpost of whatever length you like), are Democratic politicians wrong to warn of this risk to one of the country's most important and popular social programs?

Since there is a long lead time between the passage of the plan and the implementation of the new program, voters could find themselves locking in a program in the next few years that they find very much to their disliking 10 years or so down the road. In this context, it seems entirely appropriate that opponents of the plan should warn of the possible outcomes in as clear terms as possible.

Ideally, they would be careful to focus on the latest plan that the Republicans are now touting and not the prior version, but that seems the less important point. There is a very real risk that Republican plan will end Medicare as we know it. It might be worth a pinocchio or two that these ads get some important facts wrong, but on the big point that would likely get everyone's attention, they are largely on the mark.



Politifact and also criticized the ad.