Premium support con
by digby
TPMs Sahil Kapur has published a characteristically smart analysis of the GOPs latest strategy for destroying Medicare in the wake of their Ryan Plan debacle. It's absolutely correct --- "premium support" is the new watchword. It's especially potent because it was originally developed by Democrats and has been recently joined by one high profile health reformer Ron Wyden (who is evidently doing it because he's miffed at having his pet plan shelved in the health care debate. Seriously.) They have good reason to think they'll get a few more Dems on board with this as well.
Kapur's piece gives a good overview of the problems with it, but I thought I'd add this important analysis from one of the men who came up with the original concept:
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.
I assume that once the election is over we'll have another attack of deficit fever and this issue will be back on the agenda. It's good to be armed with all the information now and get prepared. We know what the Republicans are going to do and there's not much we can do to stop it short of defeating a few of them. But it may be useful to corner some of the Democrats now, during the election, and get them to publicly disavow premium support. That's hardly a guarantee, of course, but it might put them on notice that they won't get away with trying to pass it off as some sort of legitimate bipartisan reform effort.
It's not much, I know. The Democrats will undoubtedly be almost as anxious to gut Medicare as the Republicans are, especially once the Health care lobby brings the hammer down on provider cuts. But they are slightly less gleeful about it, so perhaps there's an opening.
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