Rep. Paul Ryan, R-Wisc., presents a Republican budget plan to overhaul Medicare benefits for the elderly. J. Scott Applewhite/AP
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I’m sitting by the hospital bed of a grateful Medicare beneficiary — my mother. She seems to be making progress in her battle against pneumonia, and she doesn’t have the worry that many other patients here have about how they are going to pay their medical bills. Because private insurance companies and employers have shifted so many Americans into high-deductible plans, many of the younger patients here will soon find out that they are terribly underinsured and thus will be on the hook for thousands of dollars not covered by their policies.

Earlier today I went to the gift shop to buy Mom a brush. Amid the Christmas candy, cards and cheap do-dads near the cash register was a basketful of something that brought back a painful holiday memory: little lacquered lumps of coal.

Several years ago, a friend who had been in the habit of giving me a biography of some long-dead politician or literary figure surprised me by giving me instead a Christmas stocking with nothing but a lump of coal in it. In her opinion, I had been such a jerk during the year I didn’t deserve anything else.

That lump of coal was probably the best present I’ve ever received. I was so wounded I resolved to be a better, more thoughtful person. I’m still working on that.

So knowing from personal experience how beneficial lumps of coal can be at the holidays, I have decided to give out a few lumps of my own to folks whose recent actions make them deserving recipients.

The first one goes to President Obama and his health care team for wimping out on one of the most important provisions of health care reform. The law specifies that starting in 2014, all private health insurance plans must cover a set of “essential benefits,” ranging from doctor, hospital and prescription drug coverage to mental health and rehabilitative services. Congress instructed the executive branch to work out the details. Insurance companies and other special interests immediately began lobbying the administration to make the essential benefits package as limited as possible. To do otherwise, they claimed, would make insurance unaffordable for many people — as if it isn’t already, thanks largely to them.

Consumer advocates warned the administration that if it took such a bare bones approach, more and more Americans would find themselves in plans that would not come close to meeting their coverage needs.

So what did Obama’s Department of Health and Human Services do? It abdicated its responsibility by punting the decision to the states, which, for all practical purposes, means it caved to the pressure from insurers and employers. What we had thought was a federal health care reform law is increasingly looking like something that lets the states continue do whatever they want to do. That might seem like the safest course for the White House politically, but it represents a squandered opportunity for the administration to show some backbone.

The second lump of coal goes to Sen. Ron Wyden, the Oregon Democrat, who also deserves a “dupe of the year” award for teaming up with Republican Rep. Paul Ryan in trying to pretty much hand the Medicare program over to private insurance companies.

When Ryan unveiled his plan to privatize Medicare earlier this year, it was so unpopular even his GOP colleagues were hesitant to embrace it. That’s because it would replace the program as it has existed since its inception with a voucher program. Instead of continuing to operate the program, the federal government instead would dispense vouchers worth a few thousand dollars to Medicare-eligible Americans who would use them to pay private insurance companies for coverage. This has been a dream of the insurance industry for decades.

Ryan’s plan was panned in part because the vouchers over a few years would become increasingly inadequate to buy decent insurance. It was a surefire way for elderly Americans, most of them retired and on fixed incomes, to be forced into the ranks of the underinsured.

When Wyden and Ryan announced their so-called “bipartisan” plan, they said it would contain some safeguards Ryan’s original plan didn’t, and would allow people to stay in traditional Medicare plan if they wanted. But it would still be a voucher plan, and it most certainly would lead to the destruction of the Medicare program as we know it, despite their claims.

Wyden and Ryan said their plan of encouraging more involvement by private insurers in Medicare would make the program more nimble and efficient and that the additional choices would lead to lower costs.

What have these guys been smoking? Are they not aware that the government has been paying private insurers 13 percent more to cover Medicare beneficiaries in the Medicare Advantage plans (operated by private insurers) than the government spends to cover people enrolled in traditional Medicare? And have they failed to notice that private insurance premiums have skyrocketed over the past several years because insurers have done such a dismal job of controlling medical costs and have administrative expenses that are far higher than traditional Medicare?

Here’s a suggestion for Sen. Wyden: put a big lump of coal in the stocking of the aide who talked you into your unholy alliance with Rep. Ryan.

My last lump of coal goes not to a politician but to the folks at the St. Petersburg Times whose PolitiFact website has been, until now, a highly respected fact checker. It routinely monitors what politicians are saying and alerts us when they’ve been less than honest with us. The worst liars get a “Pants on Fire” rating.

At this time every year, PolitiFact chooses a “Lie of the Year.” Two years ago it was the lie that reform would be a “government takeover of health care.” Last year it was that the reform law would create “death panels” in the Medicare program. Both were indeed whoppers.

This year, though, apparently feeling they needed to appear more bipartisan or, even better, nonpartisan, the PolitiFact folks decided that the assertion by most Democrats and liberals that Ryan’s privatization plan would mean the end of Medicare deserved this year’s Lie of the Year award.

There undoubtedly were plenty of lies told by Democrats in Washington during the year, but that wasn’t one of them. Ryan and his colleagues would not get rid of the word Medicare, but they would get rid of the program that has been a lifeline for millions of people since it was created in 1965.

Shakespeare had Juliet utter the immortal truth that a rose by any other name would smell as sweet. He did not, for good reason, have her say that calling stinkweed a rose would make it smell better.

The truth is that Ryan and Wyden would indeed end Medicare by turning it over to greedy private insurers. Keeping the name Medicare would not make that less true. Medicare can be fixed–and there are provisions of the health care reform law that begin to do that. But Ryan and Wyden’s stinky plan would take us in the worst possible direction.

Come to think of it, PolitiFact deserves two lumps of coal.

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