Wednesday, March 13, 2013

If A Case Can Be Made for Ryan's Medicare Vouchers, How About Making It

Sometimes I get a bit tired of how bad analysis can be in a "leading" newspaper. Here's what passes for the work of a "health care correspondent" in the National Journal, on Paul Ryan's latest budget stunt:
The plan would not eliminate traditional Medicare. Democrats have gotten political mileage from accusing Ryan of wanting to “end Medicare as we know it.” That is not the same thing as ending Medicare. Ryan’s plan would give seniors a fixed amount of money that they could use to buy traditional Medicare coverage or a private plan with similar benefits. It would convert the program from a single-payer monolith into a marketplace of competing plans. But unlike his budget of two years ago, it would not remove traditional Medicare from the menu of options. Here’s where the “as we know it” part comes in: Because traditional Medicare would have to compete on price with the private plans, there’s a chance it could become too expensive for every senior who wants it to buy it. The plan, which limits how much the payment can increase each year, could also shift costs to even those seniors who buy the cheapest option in the marketplace.
I think it would be more accurate to say that mediocre reporters have gotten mileage out of snarking at an accurate description of Ryan's Medicare plan which, as any healthcare correspondent should know, has been repeatedly revised due to a recognition that current Medicare recipients would go ballistic if it had been implemented as originally proposed. Seriously, if you buy the conceit that Ryan's privatization plan doesn't change Medicare, but merely gives you ample money to buy full Medicare coverage along with any number of additional private plans, why do you think Ryan continues to be such a coward about the implementation of his plan - pushing off full implementation for a decade? Why wouldn't seniors rejoice at the new choices, rather than being anticipated to recoil with such horror that implementation must be put off into the distant future? If the Ryan plan breaches the promise of Medicare to current recipients, how clueless do you have to be to believe it won't change anything for future recipients? How clueless do you have to be to go along with the pretense that Medicare as we know it could be sustained under his voucher plan?

The author, Margot Sanger-Katz, suggests that under Ryan's voucher plan "there’s a chance [traditional Medicare] could become too expensive for every senior who wants it to buy it". A chance? Could? Is she completely ignorant of the genesis of this plan?

If you believe that the purpose of the Ryan plan is to save money - that Medicare costs too much, and that the voucher plan will significantly curtail spending - how difficult is it to figure out that the savings have to come from somewhere. Ryan and his party engaged in some pretty egregious demagoguery against Obama's cuts to Medicare providers - cuts designed to ensure a consistent level of care for seniors. Those cuts... remain part of Ryan's proposed budget. But that's not enough cutting. From where does Ms. Sanger-Katz believe additional savings will be derived? As should be obvious, Ryan's plan is to ensure that the "fixed amount of money" grows at an artificially capped rate well below the rate of medical inflation.

It's also pretty astonishing that Ms. Sanger-Katz is unaware that the Ryan voucher plan is designed to shift healthier seniors out of Medicare - that is, now that he's willing to allow some form of Medicare to continue to exist. Returning to an earlier point, Ms. Sanger-Katz bashed Democrats for supposedly getting "political mileage from accusing Ryan of wanting to 'end Medicare as we know it.'" If the original plan did not end Medicare as we know it, because his vouchers would happen to be called "Medicare", why is Ms. Sanger-Katz claiming that its the continued ability to buy "traditional Medicare coverage" that keeps Ryan's plan from ending Medicare as we know it? If she believes that to be the case, as is implicit in her argument, then it's time for her to respect the facts and admit that the Democrats were correct

As for the goals of the voucher plan, as should be obvious, healthy seniors with lower healthcare costs are more profitable for private insurers. The sickly, money-losing senior citizens are a population that insurers don't want to serve and have never wanted to serve. Ms. Sanger-Katz would apparently have us believe that she has no comprehension of why Medicare exists in the first place. Seniors who need a lot of medical care will end up on "traditional Medicare" (if they can afford the premium), with the result being that Medicare's per patient costs will rise at a much higher rate than the private plans that are able to cherry-pick from a healthier population. While Ms. Sanger-Katz does not hold herself out as an insurance correspondent, she should still be able to figure out that the operative words are not "chance" an "could".

If Ms. Sanger-Katz knows the basic facts, she should admit them. From there, she could describe the probable impact of Ryan's proposed cuts and voucher plan and, if she nonetheless believes the cuts to be appropriate and a voucher plan to be a reasonable alternative to single payer, lay out the policy case for the Ryan plan. If I give her the benefit of the doubt based upon what she instead wrote, I have to regard her as credulous and lazy - as willing to take at face value representations from hyper-partisan politicians that, if made to a better reporter, would instead inspire a series of probing follow-up questions, or at least the performance of basic research to determine if she's being sold a bill of goods.

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