Instead, House Speaker Paul Ryan is working hard to destroy Medicare and force seniors and people with disabilities into the arms of private, for-profit health insurers. Ryan wants to end Medicare as we know it and, instead, simply give seniors and people with disabilities fixed cash stipends to fend for themselves, unprotected, on the private market.
Ironically, Ryan is proposing to convert Medicare into the very system he is rushing to repeal — the Affordable Care Act (“ACA” or “Obamacare”) — but without its protections, such as the requirement that private insurers cover those with pre-existing conditions.
Ryan claims that the ACA must be killed quickly because “we have to bring relief as fast as possible to people who are struggling under Obamacare.” Out of one side of his mouth, he asserts that young, healthy Americans are struggling to buy private health insurance, even though the government provides them with subsidies to help with the cost and requires that they can’t be turned down because of pre-existing conditions. Out of the other side of his mouth, Ryan claims that seniors and people with disabilities will be just fine with a government provided subsidy in the form of a voucher, and no other protection!
Before the enactment of Medicare, many seniors and people with disabilities couldn’t get health insurance at any price. And those that managed to find an insurance company willing to cover them were charged premiums that would be out of the reach of most seniors even with a government voucher.
To accomplish his goal of ending Medicare as we know it, Ryan and his allies are dusting off the same playbook that they use for Social Security. One play is to falsely claim that the program is in crisis and that the solution, to “save” it from the supposed crisis, is to dismantle it. In a particularly shameless use of this strategy, Ryan is blaming Obamacare for the “need” to cut Medicare — even though the ACA, in truth, improved Medicare’s finances. It also closed the Part D donut hole and added important preventative care benefits to Medicare, all of which will be lost if Republicans go ahead with repealing the ACA.
Another play from the Destroy Social Security Playbook is to claim that those aged 55 and over will not be affected. (This play — and indeed the entire Destroy Social Security Playbook — can be read in an illuminating article, Achieving a Leninist Strategy, which was written in frustration, shortly after President Ronald Reagan signed legislation restoring Social Security to long-range balance, rather than dismantling it, as the authors wanted.)
Consistent with Achieving a Leninist Strategy, Ryan, in a recent town hall, kept reiterating that no one currently on Medicare would be affected by his plan to destroy it. Besides being deeply insulting — assuming that those on Medicare are selfish, caring only about themselves and not about what happens to their children and grandchildren — it is also a lie.
First, Ryan proposes to increase current beneficiaries’ out of pocket costs, limit their access to Medicare supplemental plans, known as Medigap, and restrict their ability to litigate actions in the event of malpractice. But that is just the immediate cuts. Over time, his proposal is likely to destroy Medicare completely, even for those now on it.
By raising the initial age of Medicare eligibility to 67, as he proposes, and providing those younger than age 55 simply with a voucher to purchase health insurance, Ryan would leave traditional Medicare with an aging group of beneficiaries. Currently, Medicare covers the oldest and sickest. Under Ryan’s Medicare, that group would be even older and sicker — and continually shrinking in size.
What protects Medicare is that its beneficiaries are 55 million-strong and rapidly growing in number as the Baby Boom ages. And that large group of Americans are consistent voters. Once Ryan’s voucher plan went into effect, the number of people covered by traditional Medicare would start to shrink, as current beneficiaries die. And those that remain would be older and, likely, in poorer health.
As that number diminished, so would the program’s political clout. Who could trust, as Medicare covered fewer and fewer people who were more and more costly the older and sicker they became, that a future Congress wouldn’t end it? And even if they didn’t end it outright, who can trust that a future Congress wouldn’t save the government money by raising the premiums and other out of pocket costs for those who remained? And who can trust that a future Congress wouldn’t reduce the reimbursement to doctors and hospitals, resulting in fewer and fewer health care providers covering Medicare patients? Indeed, Ryan is proposing to lower those reimbursement rates now.
What Ryan and his fellow Republicans refuse to admit is that Medicare is the best part of the nation’s health care system. This is true despite Medicare covering the most expensive part of the population. Other industrialized nations, which have substantially older populations and less wealth than we do are able to spend half what we spend on health care while providing health care to all their people as a right. Perhaps not surprisingly, they can spend less, cover everyone and still have better health outcomes, like longer average life expectancies. They do it by having what amounts to Medicare for all.
Insurance is most inexpensive and efficient when it has the broadest risk pool possible without what is called adverse selection. That is, insurance is best when everyone is covered under the same plan and everyone must participate, not just opt in when the protection is needed immediately. Only the federal government has the power and the ability to cover everyone, spreading the risk and responsibility as broadly as possible.
No other nation has the crazy patchwork system we have, which includes employer-sponsored private insurance, means-tested insurance, and individual private insurance, in addition to government-run Medicare. Ryan proposes to make the patchwork system even more of a hodgepodge, with less coverage and higher costs. Even insurance companies aren’t clamoring for this — they make their money by covering young and healthy people, not older and sicker ones.
So why is Ryan determined to replace a system that works with one that all evidence says will not? Among his many lies, he has told one truth, which sheds some light on his true motives: ideology and greed.
Ryan accurately states that his plan will save the government a huge amount of money. What he doesn’t state, though it is also true, is that the government saves this money by shifting costs to individuals least able to afford it. Those unable to afford the costs will presumably forego treatment. Either way, the government is off the hook and its costs remain low. What he also doesn’t state is that while the government’s costs are reduced, the nation’s health care costs will increase, because the system will be much less efficient.
So, what is the ideology and what is the greed? Republicans believe, with what amounts to religious fervor, that the private sector is always superior to the government. But there are some things the government does better than the private sector. And Medicare is one of them. It puts the lie to the Republican belief and so, in their eyes, must be destroyed.
A second motive is simple greed, and the related motive of retaining power. They want to balance the unified federal budget on the backs of seniors and people with disabilities to make room for tax cuts for the richest and most powerful. (The unified federal budget is something the law doesn’t even recognize, but that is another story.) They want to shower benefits on millionaires and billionaires – the group that makes up the bulk of GOP campaign donors and is also well represented among the politicians themselves.
Notwithstanding Republican lies to obscure their true motives and fool the American people, the fight over Medicare is a question of values, plain and simple. We are the wealthiest nation in the world at the wealthiest moment in our history. Indeed, we are the wealthiest nation in the history of the world. The question is how we choose to spend that wealth: Do we funnel even more of it up to the richest people in the country, or do we use it to ensure that seniors and Americans with disabilities have access to health care?
That is a debate worth having. It would be an honest debate. But it is one in which not even the Republican base would side with Republican politicians and elites. So instead Ryan and his fellow believers have chosen simply to lie. Senator Al Franken got it right when he chose to title his 2003 bestseller about Social Security privatization and other Republican policy prescriptions, Lies And the Lying Liars Who Tell Them.
An honest debate would be whether we, as a nation, prefer to expand Medicare, cut it, or end it? An honest debate over Social Security raises the same alternatives. That is a debate supporters of Social Security and Medicare relish. But it is a debate opponents will do anything, including lying, to avoid.