Ever since House Budget Committee Chairman Paul Ryan put out his proposal for voucherizing Medicare we have seen a steady drumbeat of stories telling us that this is a battle over the size and role of government. This is not true. It is a battle over money.
This point is important because there are very few people in this country who are interested in debates over philosophy. Insofar as they do give it any thought, most people will say that they prefer small government over big government. They want to see government play a less intrusive role in our lives.
There are probably less than a hundred people in the entire country who support "big government" as a matter of principle. Unfortunately, most of them write columns in major national papers.
This is bad news for progressives because insofar as the Ryan plan is seen as being about reducing the size of government, then it could be acceptable to a substantial portion of the electorate. On the other hand, if the public understands that the Ryan plan will transfer tens of trillions of dollars from the middle class to the insurance and health care industries, the plan will become radioactive to politicians seeking reelection.
The basic story is that the Medicare system is far more efficient than the private insurance sector in delivering health care and holding down costs. This has nothing to do with whether we prefer the government or the private sector. It just happens to be true.
We know this because we have tested it. The government first opened up Medicare in a big way to private insurers in the mid-'90s when the Gingrich Congress pushed through Medicare Plus Choice. It turned out that Medicare Plus Choice raised costs. Beneficiaries with comparable histories cost about 10 percent more to treat in the private program than in the traditional Medicare program.
We tested the private-sector route a second time when President Bush pushed through his Medicare Advantage plan along with the Medicare prescription drug benefit in 2003. The nonpartisan Congressional Budget Office (CBO) concluded that Medicare Advantage also raised costs.
This is why the CBO calculated that Representative Ryan's voucher system would raise costs compared with the existing Medicare system. The CBO's projections imply that switching to the Ryan voucher system would raise the cost of buying Medicare equivalent policies by $30 trillion over Medicare's 75-year planning period.
This amount is approximately six times the size of the projected shortfall in Social Security over its 75-year planning period. It comes to almost $100,000 for every man, woman and child in the country. In other words, even in Washington, the burden of the Ryan plan is real money.
It is important to recognize that this $30 trillion figure is simply the increase in the cost to the economy of providing health care. This number does not include the shift in costs from the government to beneficiaries. The $30 trillion represents higher payments that would go to insurers, pharmaceutical companies, medical supply companies, doctors and other health care providers because the private system put in place under Ryan's plan is less efficient than the Medicare program.
This enormous waste, and the resulting transfer of income from taxpayers and beneficiaries to insurers and providers, has absolutely nothing to do with whether our preference is for big or small government. The relevant question is whether we want ordinary workers and retirees to pay tens of trillions more for their health care in the decades ahead in order to enrich the insurers and health care industry.
The answer to that question for the vast majority of voters would be a loud "no." If the public understood what the CBO is telling us -- that the Ryan plan will hugely raise the cost of health care for retirees so that the vast majority will no longer be able to afford plans that are anywhere near the quality provided by Medicare -- then there is no doubt that there would be massive opposition to his proposal.
However, if this massive upward redistribution of income is concealed as a debate over the size and role of government, then those who want to destroy Medicare may get their way. So, just remember, tell the "size and role" folks to shove it. The debate over the Ryan plan is about money; it's that simple.
Rev. Jennifer Butler: Paul Ryan and Ayn Rand: An Unholy Alliance
The article assumes that people will continue to buy "Medicare-equivalent policies." It assumes that each voucher recipient would continue to purchase the same coverage rather than shop for the coverage that best meets their needs for the price. It also ignores any possibility that forcing providers to appeal to consumers could reduce health care costs.
The article thus assumes a priori that the decisions made by Medicare bureacrats in a top down, command-and-control environment would be repeated by consumers in a distributed marketplace, and that providers would therefore continue the same offerings.
Whether this is an accurate assumption is EXACTLY what the philosophical debate is about. If the battle is over money, it is only because the author has assumed the philosophy away.
House lawmakers voted overwhelmingly last night to strip police officers, teachers, and other municipal employees of most of their rights to bargain over health care, saying the change would save millions of dollars for financially strapped cities and towns.The 111-to-42 vote followed tougher measures to broadly eliminate collective bargaining rights for public employees in Ohio, Wisconsin, and other states. But unlike those efforts, the push in Massachusetts was led by Democrats who have traditionally stood with labor to oppose any reduction in workers’ rights.
The few facts he cites aren't even relevant. Medicare Plus is INTENDED to provide more money for care which Medicare alone does not cover, so OF COURSE its going to spend more money, and be more "costly".
Or did that part escape you?
The people receiving Medicare Plus? Of course! They pay more for it.
Did you miss the point I was making? The idea behind Medicare Plus is to BE more costly. It is supposed to cover costs that Medicare alone does not. This tells you nothing about what a fully privatized plan, or even a voucher system would work.
Such attacks do not have any place in civilized debate, something the left seemed to be up in arms about a while back.
However, Baker did cite facts which are highly relevant. The point of Ryan's plan is that he and other Republicans say Medicare is too expensive and the government will run out of money to pay for it. His plan does nothing to alleviate that other than to shift the cost entirely to retirees who could neither afford their care nor negotiate their way through a most likely complicated maze of rules and forms as they get their vouchers and deal with insurance companies while ill or recovering from illness. Medicare Plus provides more money to INSURANCE COMPANIES and NOT for HEALTH CARE which should be its primary focus.
This measure is about trasnferring wealth from the middle-working class to the upper elite levels, and along with it power to control our lives. Social Security and Medicare are programs people and businesses pay into (involuntary payroll taxes) over the course of their working careers. We don't have the choice to opt-out and fund our own retirement benefits, or avoid paying those government-imposed payroll taxes. To claim those programs are entitlements or a government expense is a fabrication.
An individual with an average salary of $50-K over 40 years' (25-to-65), depositing 12.4% of gross into an interest-bearing private account (@ a 4% annual rate, deposited + 1% quarterly interest), would accumulate $747,562. The maximum S.S. benefit is $1200/mo. or $14,400/annually. At that rate, and individual would need to live 51 years to exact that amount from his/her personal fund, or reach the ripe age of 116.9 years. The average life expectancy in the US is 77.8 years, or about 13-14 years of benefits from the system.
We do have additional retirement benefits through 401K's at our companies too. SSI and Medicare is part of our social obligation as Americans, one to another.
I am 58, my wife is 62 and we pay just under $6,000.00 a year with United Health Care, for a very good medical plan, but had to opt for the $10,000.00 deductible and 70/30 coinsurance plan, just to cover us for major medical problems, a catastrophe plan if you will, which adds another $5,000.00 out of pocket before the insurance company pays 100% for our medical care (that is $25,000.00 a year for both of us), but of course that is only true for the remainder of the 12 calender months of the policy.
Then it starts all over again. We will then have to pay another $25,000.00 in deductibles and coinsurance charges before they will cover us totally.
How many seniors will be able to afford the premium difference that the Ryan plan doesn't cover and the deductibles and coinsurance?
This all about money and the Republicans monied interests, who feed the monster.
It seems that The Right is still testing their "message" strategy to fool American people into believing that by hurting themselves (without knowing it yet), they are getting a "city on the hill", that is small government (whatever that means)!
Muddling the whole debate with "freedoms", "small government", "self-reliance", etc. they are patting our backs and robbing our pockets, all at the same time!
Some media pundits have embarked on this Trojan Horse and dancing to the GOP tune!
How in the world are The Right robbing your pockets. That's a hoot. How much are you paying in taxes? I realize the idea that Medicare is unsustainable even if you tax the rich 100% is of little interest to you, since you have already decided that you OWN everyone else's labor.
XYZ hospital in Napa Ca says it costs 500.00 for a simple EKG and more to have it read.
A specialized cardiologist with his own shop did the same procedure for 100.00. You figure it out.
Mark Twain
They stand four-square for the American home--but not for housing.
They are strong for labor--but they are stronger for restricting labor's rights.
They favor minimum wage--the smaller the minimum wage the better.
They endorse educational opportunity for all--but they won't spend money for teachers or for schools.
They think modern medical care and hospitals are fine--for people who can afford them.
They consider electrical power a great blessing--but only when the private power companies get their rake-off.
They think American standard of living is a fine thing--so long as it doesn't spread to all the people.
And they admire of Government of the United States so much that they would like to buy it."
- Harry S. Truman 1947
So the only kinds of jobs that our rich do create are the ones that entail doing work in and around their mansions and caring for their young children and elderly parents. And most of the time they hire illegals to do these kinds of jobs. And what few rich industrialists we do have choose to create jobs oversea rather than here in the US.
Also, back in the 50's and 60's our rich were taxed at a much higher rate than they are today: 80-90% then versus 35-38% now, as I can best recall. So the Republicans are gonna come across as bumbling idiots trying to explain why the jobless rate back then was at an all-time low, roughly 3%.”