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Menachem Rosensaft

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Ron Wyden: Forging Common Ground on Medicare Reform

Posted: 12/19/11 09:08 AM ET

When Democratic Senator Ron Wyden of Oregon partnered with Representative Paul Ryan, Republican of Wisconsin, to propose Medicare reform, Wyden was promptly denounced by New York Times columnist and Nobel Economics laureate Paul Krugman as a "useful idiot" who did "a bad, bad thing." Senator Sherrod Brown, Democrat of Ohio, dismissed the initiative as "lipstick on the pig," and Representative Pete Stark (D-California) hyperventilated that the new proposal "ends Medicare as we know it, plain and simple."

Not to be outdone, Dean Clancy, a Tea Party health policy analyst, wrote that, "I fear it's not the brainy Ryan who has pulled off a coup, but rather the wily Wyden, a dyed-in-the-wool progressive who makes no secret of wanting single-payer, government-run health care."

In contrast, Mitt Romney, who knows something about health care legislation, welcomed the Ryan-Wyden proposal, which is not too far removed from a Medicare reform plan the former Massachusetts Governor had put forward earlier, as "an enormous achievement."

The Ryan-Wyden plan would offer seniors, beginning in 2022, the option of choosing from Medicare-approved private plans in addition to the existing, traditional Medicare plan. Under Ryan-Wyden, wealthier seniors would eventually receive less government assistance, but participating plans would be prohibited from denying coverage based on pre-existing conditions or from charging discriminatory rates based on a senior's medical condition.

As it happens, Wyden is no conservative Democrat like Senators Ben Nelson of Nebraska and Mary Landrieu of Louisiana, who have often broken ranks to vote with Republicans. Wyden is an independent-minded political centrist with a long and strong pro-business, consumer-oriented track record and solid credentials in the arena of health care reform who has authored over 150 bipartisan pieces of legislation since entering the Senate in 1996. He has received a 100% rating from NARAL Pro-Choice America for his stance on reproductive rights, and was one of only 14 Senators to vote against the Defense of Marriage Act. In September 2005 he voted to confirm John Roberts as Chief Justice of the U.S. Supreme Court, but four months later voted against confirming Samuel Alito as Associate Justice.

Wyden is the son of two Jewish refugees from Nazi Germany. Before being elected to Congress in 1980, he founded and headed the Oregon chapter of Gray Panthers, an advocacy group for seniors and retirees, and was director of the Oregon Legal Services Center for the Elderly. In the past, he proposed a health care plan, the Healthy Americans Act, which, according to Time Magazine's Joe Klein, "would have moved us past our clunky and decrepit employer-based system, was more radical than Obamacare, but would have liberated U.S. businesses from the burden of providing health care for their employees while providing a universal progressive voucher system."

(In the interest of full disclosure, I have met Senator Wyden several times, and contributed to his 2010 reelection campaign.)

Wyden is adamant that "Medicare is the most important fiber in the social safety net. I would never do anything to shred it, weaken it or harm it in any way. Our proposal places traditional Medicare, long supported by progressives, alongside a menu of private alternatives that provide the choice and competition long supported by conservatives."

Perhaps the most serious problem with the contemporary American political landscape is that far too many prominent Democrats and Republicans alike seem to have devolved in counter-Darwinian fashion to cliché-ridden sound-bite spouting exponents of unimaginative insipid dogma. My way or the high way has become the safe option, ensuring both continued grid-lock and a refusal to even consider original ideas that do not conform to or promote a pre-set political agenda, whether from the right or the left.

President Obama has called for "a spirit of common cause" by members of "both parties," but political compromise, a coming together in the interest of a greater good, has become an anachronism. Never mind that Ronald Reagan and House Speaker Tip O'Neill found ways to work together, or that some of the major successes of the Clinton administration were the result of substantive give-and-take on both sides of the aisle. Gone are most moderates like Senator Evan Bayh (D-Indiana) and Representative Chris Shays (R.-Conn.) who could forge alliances across party lines. In this environment, the Senate vote to extend the payroll tax cut for two months, without any assurance that the House will follow suit, is considered a major bipartisan accomplishment.

I do not claim to be a health care authority. The Ryan-Wyden Medicare reform plan may well be less than perfect. But we know that all or nothing will in the end get us nothing. Ron Wyden and Paul Ryan deserve praise, not scorn, for at least trying to chart a path out of the quagmire.

Menachem Z. Rosensaft is Adjunct Professor of Law at Cornell Law School, Lecturer in Law at Columbia Law School, and Distinguished Visiting Lecturer at Syracuse University College of Law

 
 
 
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HUFFPOST SUPER USER
Anne Rutherford
07:44 PM on 12/21/2011
In the current political climate, given the debacle over the payroll tax reduction, Medicare reform seems impossible. It seems disingenuous to suggest that only by dismantling the defined benefit and moving strickly to premium support is a viable choice for Medicare. It will devolve into the "younger healthier" seniors getting price support, while those seniors with chronic illness will maintain the defined benefit plan - and see the benefits of that plan routinely cut by Congress. What is suggested here is still the either/or of a polarized Congress.
12:41 PM on 12/21/2011
The USA is the last holdout with market-priced medical because as the wealthiest nation that ever existed we are the last ones who can afford it.

The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand is inelastic if a percentage increase in price results in a smaller decrease in the quantity demanded. Economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA the only exception.

Except for health care, the prices of all goods and services facing inelastic demand in the USA are regulated by government. Retail electricity service providers face inelastic demand. Consequently, their prices are strictly controlled by all governments worldwide, including the USA.

Most goods and services are price elastic. That includes non-medically necessary cosmetic and lasik surgery whose prices have actually relatively decreased over time. Medical care in the USA is the only instance in any developed country where any product facing inelastic demand is not substantially price regulated.
10:55 AM on 12/21/2011
Since the Ryan–Wyden proposal is based on working principles, there are still many policy questions to resolve. For example, it is silent on the future of Obamacare. Make no mistake: Structural Medicare reform should begin after full repeal of Obamacare. Furthermore, given the depths of our fiscal crisis, the proposal is slow to take effect. The Heritage proposal (http://eng.am/vXRGCN) transitions to premium support beginning in 2016; Ryan–Wyden does not begin until 2022, the same date embodied in the House budget resolution.

Nonetheless, Ryan–Wyden continues the conversation about the need for fundamental structural Medicare reform. Trying to save Medicare through more government price controls will not do. Converting the outdated Medicare program into a premium-support model is the best and more honest way forward (http://eng.am/v8wSp9).
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Anne Rutherford
07:38 PM on 12/21/2011
Without prohibitions currently contained in "Obamacare" that prohibit insurance companies from barring folks for "pre-existing conditions" - exactly how will price supports help the majority of seniors purchase anything meaningful? Price support for something you can't purchase doesn't help much. In my state we currently have a high risk pool - and insurance for an individual in this pool runs approximately $800 + per month. Not very affordable, considering the cost shifting and deductibles that are now common. Private insurance administrative expenses run approximately 20-31% of premium dollars, while Medicare runs 3-5% for administrative cost. I fail to see any savings in going to premium support and no defined benefit.
08:46 AM on 12/21/2011
Could it be possible, at least in part, that our seniors arrive on Medicare in worse health because of a lack of health care insurance in their pre-Medicare days? How many people put off needed health care until they can make it to the "golden city in the sky" that Medicare is for some people? If we had Medicare for all, could we do a better job of keeping our citizens in better health throughout life? This is going to be a growing problem as fewer people have access to health insurance in their younger years. Employers are dumping insurance due to such high costs. There are consequences of delaying care for health issues.
08:03 PM on 12/20/2011
The moment you started lauding Bayh, I got the message.
Democrats who are to the right of Gerald Ford and Richard Nixon are good people
Wyden screwed up and hopefully will pay the price in 2016
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HUFFPOST SUPER USER
snesich
07:41 PM on 12/20/2011
No disrespect intended, Mr. Rosensaft, but this is quite an apology and rationalization for an absolutely horrible decision by Ron Wyden---a man I once respected and admired.

Why he would want to do this---and help a far-right, Ayn Rand zealot like Paul Ryan dismantle Medicare over the long term is bizarre. I just don't get it.

But if Wyden sticks to this, and doesn't hear the voices of his constituents---who I guarantee will not be happy when they understand what he's done---then I'll be forced to turn my back on him and vote for his primary opponent. And don't think there won't be one.
11:22 AM on 12/20/2011
I simply wonder if the people in Paul Ryan's district think he is representing them with his budget proposal or with his grand-standing?
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Paul Abrams
07:48 PM on 12/19/2011
Once one understands the details, the proposal makes no sense. A few facts might help: 2/3 of Medicare expenses are consumed by 10% of the Medicare population. So, if one is in the 90%, there will be very little savings, and very little reason for the Medicare-eligible person to switch to private health insurance, as he has already paid for the coverage he needs, when he needs it. If one is in the 10%, what insurance company will provide coverage for all that care at reasonable prices as the proposal dictates?
The only way this works to save money is for Medicare to reduce benefits, and thus make the private insurance, with more benefits, attractive for those who can afford it. Why would we want to do that?
Senator Wyden has done much better in the past. He introduced "Independence at Home" as part of the Affordable Health Care Act. That can save $150B over 10 years. It addresses the 10% who consume 2/3 of medicare expenses.
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Republicanistan
Ignorance is Strength in Baggerstan
05:17 PM on 12/19/2011
The Ryan-Wyden plan is a scam to fatten the pockets of the Health Insurance industry. They overhead costs of administrator heavy private plans are 15-20% higher than the Federal Government's administration.

It is solely a scam to transfer funds that should be going to Health Care into the pockets of CEOs and shareholders whose sole motivation is to provide as little care as they can bribe Congress to let them provide.

This does not "save" Medicare, it only enables Private Corporations with their massive lobbying power access to the $$$billions$$$ that they are salivating over.

A Reform of Medicare would address why health care COSTS are twice in the USA than they are in every other developed nation, yet they have better outcomes.

Everything that Ryan attaches his name to does nothing about COSTS but instead allows his donors access to the Golden Goose that they can then exploit.
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arachne646
Loving # Growing # Knitting
07:59 PM on 12/19/2011
Why grant private insurance companies an even greater share of the medicare pie? Part D, for presciption medications, is only a sop to pharmaceutical companies, since it ensures that their Brand Name drugs are purchased, not the identical chemicals in the cheaper generic form. Private health insurance must produce a profit as well as healthcare, and is always more expensive than a government plan, especially when you compare the economies of multiple plans vs. one in Medicare. Medicare shouldn't be marginalized, it and Medicaid should be expanded to the whole population of the US--then healthcare would improve and costs would go down.
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HUFFPOST COMMUNITY MODERATOR
Coinyer101
King of Doobiestan
05:11 PM on 12/19/2011
SINGLE-PAYER, NOW!!
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HUFFPOST COMMUNITY MODERATOR
Coinyer101
King of Doobiestan
05:10 PM on 12/19/2011
Wyden should be thrown out of office over this. Vouchers will never get support from the people....,
04:31 PM on 12/19/2011
On this one, Senator Wyden is an absolute disgrace,and not merely because he entertains the idea of reforming Medicare. It's the way he's going about it, considering the situation the country finds itself in, that makes the man such a disgrace.

There's nothing wrong with entertaining the idea, in the abstract or in relation to a complete review of the country's priorities and its tax structure. But for Senator Wyden or President Obama or any other Democrat to entertain what they dare call compromising with the Republicans on Medicare or Social Security without a comprehensive reassessment and determination of the nation's economic and social priorites is nothing less than a hostile act against the American people, amounting to the Democrats' war on the middle class and the poor.

For Wyden or any other politician to swap the totally unnecessary expenditure of tax dollars on bogus defense programs, and even more bogus wars and nation building on the far side of the planet, for the funding of vitally needed social programs like Medicare, Medicaid and Social Security, as if such a swap is reasonable and appropriate is treachery typically demonstrated by the Republicans.

What the Democrats have been doing, and what Wyden does here, is allow the Republicans to intimidate them into the position that this is a reasonable and fair swap, a trade off that is good for the American people, when it's nothing of the kind. It's simply the cowardly Democrat's way. Shame on you, Senator Wyden. Shame.
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04:23 PM on 12/19/2011
66 million baby boomer voters started to retire and go on Medicare in 2010. The last wave to sign up for Medicare will be in 15 years. After that these 66 million voters will live about 20-30 more years. If Congress thinks it can ignore their needs Congress is wrong.
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Republicanistan
Ignorance is Strength in Baggerstan
05:19 PM on 12/19/2011
Congress needs to control costs, not shift profit to the private sector in a de facto transfer of wealth.
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TRex86
Enjoying life in West Ohio
04:14 PM on 12/19/2011
Medicare is stupendously efficient compared to private health care, 95% efficiency. It's problem, quite simply, is the epidemic of Old Age. No one anticipated the proliferation of longevity of the last 50 years. Consequently, its funding is inadequate. Part A (HI) is funded with a sliver of payroll tax. The rest are funded with premiums and INCOME TAX. The latter is the rub. The plutocrats that own the Republicans (and rent the Democrats) don't want to support "useless feeders."

The best solution is to allow all Americans into Medicare (if they wish). This would save hundreds of billions of current spending. The system can be made more fair by means-adjusting premiums based on income and NET WORTH. This is in part the case now as all but part A have adjustments based on income. In addition, some elderly are "asset rich; liquidity poor." Their estates should be charged a premium at the death of the surviving spouse.

The actuarial projections of the Medicare population are solid through 2060. Insofar as the affluent-wealthy elderly will be charged proportionately more it makes no sense to tax labor for part A. Thus the payroll tax shoud be ended and the system supported with income taxes and premiums ad infinitum--like our European friends do--at half the cost of our bloated system. Social justice will make a comeback.
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HUFFPOST PUNDIT
peacekitten
primum non nocere.
04:02 PM on 12/19/2011
i hope senator wyden comes to his senses.  his capitulation was a shocking disappointment.

there is absolutely NOTHING in ryan's so called "economic" plans that benefit ANYONE but the wealthy and powerful.  enabling this kind of thing is absolutely inexcusable.