Talk to the end users
by digby
Hank Aaron, one of the original proposers of "premium support" back in the 90s weighs in on Paul Ryan's phony adoption of the term and then explains why he's subsequently come to believe that even his proposal will not work:
In brief, current proposals are not premium support as Reischauer and I used the term. In addition, I now believe that even with the protections we set forth, vouchers have serious shortcomings. Only systemic health care reform holds out real promise of slowing the growth of Medicare spending. Predicted savings from vouchers or premium support are speculative. Cost shifting to the elderly, disabled, and poor and to states is not. Medicare’s size confers power, so far largely untapped, that no private plan can match to promote the systemic change that can improve quality and reduce cost. The advantages of choice in health care relate less to choice of insurance plan than to choice of provider, which traditional Medicare now provides and which many private plans restrict as a management tool. Finally, the success of premium support depends on sustained and rigorous regulation of plan offerings and marketing that the current Congress shows no disposition to establish and maintain.
There was a lot of thinking along those lines back in the 90s when everybody was enthralled with the New Democrat ideas about using market forces for liberal ends. The power of money, the nature of modern conservative ideology, the fact that capitalism will always concentrate wealth if you don't restrain monopoly power have shown in the intervening years that social welfare simply cannot rely on the markets.
Aaron points out that Medicare already has 24 "choices" for seniors to choose from and 75% of them choose traditional Medicare. There is no greater example of democratic endorsement than that. They like it, they want to keep it, and nobody knows how this stuff works better than the people who use it. That's the starting point for any "reforms."
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