RUTHFULLY YOURS

President Obama often claims he wants to cut the budget smartly, using a “scalpel”—not a meat axe, machete, cleaver or chainsaw, to list a few of his favorite metaphors. He’ll need a more inspired term to describe what he’s now doing to Medicare Advantage, perhaps napalm or WMD.

The Affordable Care Act drained $306 billion from this growing version of Medicare that 29% of seniors use to escape the traditional entitlement and obtain modern private insurance, but the Administration is imposing the cuts in ways that are even more harmful than the law requires. The post-election timing is no accident.

In 2012 only 4% of the Medicare Advantage cuts were scheduled under the law, but the folks who run Medicare at the Health and Human Services Department improvised a $3.8 billion nationwide “demonstration project” that paid bonus subsidies to Medicare Advantage insurers to improve quality. The project couldn’t demonstrate anything because the payments went to 90% of insurers regardless of quality, but they did cancel out most of the 2012 cuts. That did the trick for voters in Scottsdale or Boca Raton who might have noticed higher costs or lost the coverage they have and prefer.

Federal auditors suggested the project was illegal, but in any case it is now winding down and HHS is making up for lost time. Even as ObamaCare-mandated cuts of roughly 3.4% hit in 2014, out of nowhere HHS gamed the complex formula to conjure a new 2.2% cut in the fixed payments that insurers receive for each senior they cover under Advantage.

Folding in ObamaCare’s $8 billion tax on insurers next year that is the equivalent of a smaller subsidy, the Medicare Advantage cuts will total anywhere from 6.9% to 7.8%. Thus Advantage will become the only entitlement for which real spending will fall slightly year over year and continue to decline, even as health costs rise and more people join the program. Mr. Obama would never tolerate this in any other area of government, no matter what tool was used.

The cuts translate into lower benefits, higher premiums or both, and the liberal goal is to induce seniors and insurers to flee the program, much as Bill Clinton starved the Advantage forerunner known as Medicare+Choice in the 1990s. Yet for the past several years enrollment has climbed at an 8% to 10% clip annually, versus 3% for normal fee-for-service Medicare.

The Administration can’t abide that Medicare Advantage is stealing customers from government control, while also exposing the failure of traditional Medicare’s cost control. Medicare Advantage shows that more dynamic and efficient private alternatives can generate better health-care value than a room of wise men deciding how the government should pay for tens of thousands of services.

A shelf of academic and industry research shows that the care coordination and disease management in private plans result in higher quality than fee for service, including lower hospital readmission rates and better outcomes for seniors with chronic conditions. No less than the liberal Princeton health economist Uwe Reinhardt recently conceded that “robust empirical evidence” is convincing him that competition among plans creates “powerful incentives to improve the quality of the care they procure for patients.” This is like the Sierra Club conceding that the coal industry has redeeming qualities.

The tragedy is that Medicare Advantage architecture is far from perfect and HHS could save money if it wanted to, in particular by targeting the private fee-for-service plans that mimic all of traditional Medicare’s dysfunctions except with an element of private profit. But that approach conflicts with the Administration’s political goal of strangling Medicare Advantage in the crib.

The new HHS payment cuts will be finalized in a week or so, and even some Democrats are protesting that they are too much too fast—including Senate Finance Chairman Max Baucus, who designed the original cuts. Unfortunately for them and their constituents, Mr. Obama would rather destroy a model for true Medicare reform than let seniors choose.

A version of this article appeared March 21, 2013, on page A14 in the U.S. edition of The Wall Street Journal, with the headline: About That ‘Scalpel’ . . ..

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