Some random thoughts on Medicare

1. It's not the "Ryan plan," it's the Republican plan. The Medicare privatization plan has been endorsed by the Republican party. Overwhelming majorities of Republicans in the House and Senate voted to make it law. Every Republican presidential candidate has come out in support of it - except Newt Gingrich, and that didn't turn out so well for him. Every Republican candidate should be forced to spend the next two years on the hustings with that plan stapled to their chest like a big ol' scarlet A.

2. I think most Americans would say that the Medicare problem is, how do we ensure that retirees have decent healthcare at a cost that doesn't bankrupt us. That problem has no easy answers. Any reasonable proposal ends up with panels of experts, bending of curves, and other pieces of impenetrable jargon. The Republicans, however, have managed to come up with a simple solution: transform the Medicare program into a voucher system. How have they done this? Simple: their plan is a solution to a different problem. For Republicans, the problem is not how to provide good health care at a reasonable cost, it's how to have the government spend less money on health care. And so the solution is a simple one - just spend less. But the plan does not actually address the problem that most Americans have in mind when they think of the challenges facing Medicare.

3. Under the Republican plan, are retirees required to buy the insurance that the government is going to subsidize or is participation voluntary? If participation is voluntary, then if the plan is implemented large numbers of retirees are not going to have health insurance for the first time since 1965. That's a pretty big deal. If buying insurance is mandatory, then is the plan constitutional? I thought that this was the kind of thing (no, this is exactly the thing) that Republicans thought the 10th Amendment forbade.

[Update: It appears that under Ryan's plan the purchase of health insurance is voluntary. I say "appears" because the Ryan plan actually does not exist as a concrete legislative proposal. The budget resolution that contains the proposal, which the House passed and the Senate did not, describes the changes to Medicare in broad terms. The Congressional Budget Office analyzed the plan. For the purpose of making its cost estimates it assumed that everyone eligible for the premium support would purchase health insurance. There's no good reason that I can think of for this assumption - the CBO ought to be able to estimate the price elasticity of demand for health insurance and come up with an estimate of the number of senior citizens who would go without. This number would probably be large: the average recipient would pay 2/3 of his/her health care costs under the Ryan plan compared to 20-25 percent now. It's therefore fair to say that under Ryan's plan, X percent of people who now are depending on Medicare will lose their health insurance coverage. X to be determined.]