Premium Randroids

Premium Randroids

by digby

Gosh, for some reason every time some group of political elites get together to deal with the devil deficit the consensus position moves farther and farther to the right:

Though it reached no agreement, the special Congressional committee on deficit reduction built a case for major structural changes in Medicare that would limit the government’s open-ended financial commitment to the program, lawmakers and health policy experts say.

Members of both parties told the panel that Medicare should offer a fixed amount of money to each beneficiary to buy coverage from competing private plans, whose costs and benefits would be tightly regulated by the government.

Republicans have long been enamored of that idea. In the last few weeks, two of the Republican candidates for president, Mitt Romney and Newt Gingrich, have endorsed variations of it.

The idea faces opposition from many Democrats, who say it would shift costs to beneficiaries and eliminate the guarantee of affordable health insurance for older Americans. But some Democrats say that — if carefully designed, with enough protections for beneficiaries — it might work.

The idea is sometimes known as premium support, because Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government...

John C. Rother, president of the National Coalition on Health Care, which represents consumers, employers and providers, said, “The supercommittee may have laid the groundwork for future reductions in the growth of Medicare.”

I don't know who these Democrats are and perhaps they are just speculating that there's bipartisan support. But considering how far to the right we've moved on everything else, I'm guessing a few Dems at least have opened the door on this one too. After all, "premium support" was originally a New Democrat idea back in the 90s.

Today, however, "premium support" will add up to Paul Ryan's vouchers. That's all. It's not complicated. It adds up to elderly people with less money buying sub-standard health care policies (like I have now) that basically force you to wait until you are dying before you get medical care. I'm sure it will save money. After all, many people are going to die much earlier than they otherwise would. Silver lining, I guess.

One of the New Dem experts who originally devised the term "premium support" disavowed the idea earlier this year.

Here's the conclusion:

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 think that last goes without saying.

"Premium support" as we know it is an obvious step to the dismantling of Medicare. There's a reason why Paul Randroid Ryan took up the phrase and doubled down on its premises. And it has the added benefit of making the health care reforms (which need Medicare to be a government cost leverager) unworkable too. A twofer!

I think one of the major lessons from all of this is that, as predicted, the Rube Goldberg contraption of the health care reform is going to be subject to a whole lot of malicious tinkering, any piece of which could bring the whole thing down. That's always been a weakness of such a uselessly complicated, politically restrained program run by special interests. In the grand scheme of things it may turn out to be better than nothing over the long run, but as everyone knows, in the long run we'll all be dead. If this current wrecking crew has its way, we'll be dead a lot sooner than we need to be.


Also too:
In their initial analysis of the Ryan Medicare plan, the non-partisan Congressional Budget Office determined, “Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system… Under the proposal, the gradually increasing number of Medicare beneficiaries participating in the new premium support program would bear a much larger share of their health care costs than they would under the traditional program…That greater burden would require them to reduce their use of health care services, spend less on other goods and services, or save more in advance of retirement than they would under current law.” [CBO, 4/5/11]