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Hullabaloo


Tuesday, April 01, 2014

 
Paul Ryan's long march

by digby

I think people may be surprised that Paul Ryan once again proposed his plan to voucherize Medicare today, knowing that it has no chance of passage and this being an election year and all.

If you aren't familiar with his plan, here's a succinct description from Think Progress:

Ryan’s new Medicare proposal hews to the same basic structure as his previous premium support plans — in essence, a system of insurance vouchers. Under the plan, future Medicare beneficiaries would have the option of choosing between traditional fee-for-service Medicare or a list of private health plans and receive a subsidy to help pay the chosen policy’s premium. Unlike previous Ryan budgets, however, seniors who are currently 55 or younger would be forced into this alternative system, likely breaking a pledge House Republicans made last year promising that current 55-year-olds would be able to stay on traditional Medicare.

Ryan emphasizes that his proposal still gives seniors the choice of remaining in regular Medicare. But what he doesn’t mention is that his plan makes Medicare so expensive that millions of seniors will likely be forced to switch into the private plans. While Ryan employs a different type of bidding system for private health plans under his 2015 blueprint that softens his plan’s topline effect on beneficiaries’ costs, an earlier Congressional Budget Office (CBO) analysis of Medicare premium support systems found that plans such as Ryan’s would increase traditional Medicare premiums by a staggering 50 percent.

Aside from his general misanthropy and dystopian hellcape vision of America, it's not surprising at all that he would reintroduce this. He's playing a long game. Indeed, the GOP, for all its caterwauling and repeal votes of Obamacare, probably understand the way the wind blows on this better than the Democrats. They certainly have a roadmap if Ryan stays at the helm of their budget battleship.

Here's what I'm talking about. Recall what Ezra Klein wrote a couple of years ago:

If Republicans can make their peace with the Affordable Care Act and help figure out how to make the Affordable Care Act's exchanges work to control costs and improve quality, it'd be natural to eventually migrate Medicaid and Medicare into the system. Liberals would like that because it'd mean better care for Medicaid beneficiaries and less fragmentation in the health-care system. Conservatives would like it because it'd break the two largest single-payer health-care systems in America and turn their beneficiaries into consumers. But the implementation and success of the Affordable Care Act is a necessary precondition to any compromise of this sort. You can't transform Medicaid and Medicare until you've proven that what you're transforming them into is better. Only the Affordable Care Act has the potential to do that.

So Bachmann is perhaps right to say that the president is moving us towards a day when ObamaCare -- or, to put it more neutrally, "premium support" -- might come to Medicare. He's seeing whether it works in the private health-care market first and, if it does, there's little doubt that the political pressure to extend it to other groups will be intense. The question is why Bachmann and her party are doing so much to stand in his way? The corollary to Bachmann's accusation that the president has a realistic plan to privatize Medicare is that the Republicans, for all their sound and fury over the Ryan budget, don't.

So in the long run, all the crowing about the success of Obamacare --- regardless of the details --- may be just what Dr Ryan ordered. And, apparently, just what some of the ACA wonks ordered too. Bipartisanship at last.

I think that to the extent that liberals care about "fragmentation" of the market, they would much rather have this go the other way --- move us into a medicare-for-all situation rather than fold Medicare into Obamacare. Regardless of how willing people are to sign on to Obamacare, there are many complications that I think people would rather not have to deal with --- especially old people who need a lot of health care. Our private insurance system, even with the subsidies, is a horrible pain in the neck to deal with. But apparently, we should all want to turn the entire health care system over to it because ... well, I don't honestly know why.

Progressives had better get organized to fight this or it can certainly happen. Might I suggest taking a page from the campaign to raise Social Security benefits and say that now is the time to start agitating again for lowering the Medicare age (or at least allowing a medicare buy-in?) If Democrats want to keep one of their most successful programs healthy, they should probably be thinking about how to expand it to more people because those who are hostile to Medicare will be working overtime to either subsume it into the maze of Obamacare or privatize it altogether. Paul Ryan's playing the long game. Progressives need to do the same.

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