Paul Ryan (R-WI) finds himself at the center of a firestorm.
RyanCare, or the Ryan Plan, represents a very significant society changing plan that is part of the Republicans’ partial repeal and replacement of ObamaCare.
In large part RyanCare focuses on reforming Medicare, although major and very significant changes have already been made to bolster Medicare’s future. The only way that RyanCare can be successful would be the repeal and replacement of major portions of ObamaCare, aka the Affordable Care Act (ACA).
I support the core ideas behind RyanCare — our nation faces major debt; Medicare is not only deeply in debt and unsustainable but to keep it functioning to serve those coming under its coverage over the next decade or two will require trillions of dollars — but it will have to make its way on its own merits.
Selling Ryan Care will be tough. The mathematical problem aside, the larger question is whether RyanCare is ethical?
Is it ethical to create a system which effectively ends Medicare? Medicare came about because the good old days were not good for the aged and infirm. The good old days were actually very miserable.
>> I purposely do not say that RyanCare kills Medicare, although any number of both his supporters and detractors believe exactly that. You have to worry when supporters of a plan make repeated statements that reinforce your worst fears.
>> RyanCare and the basics of its coverage are not so different than ObamaCare per a comparison provided by the New England Journal of Medicine. The greatest difference is that short of catastrophic illness the RyanCare plans pushes unaffordable medical costs on the average (median and lower income) individual American. This leads to very credible charges that RyanCare effectively ends Medicare for those that need it the most and that probably could not get health coverage, or get affordable health coverage. The Congressional Budget Office (CBO) estimates that RyanCare will double out-of-pocket expenses, roughly equal to somewhere near $8,000-9,450 per year. RyanCare in 2022 would provide a premium subsidy/voucher for approximately $8,000 but this is to cover the government’s share of Medicare, not out-of-pocket expense — so please don’t confuse the two.
On the question of ethics, any attack or scaremongering against RyanCare also faces an ethical dilemma: How can you support an approach to healthcare where the system will collapse soon enough due to its own overwhelming failure to be either properly funded or administered in such a way that Medicare is means tested and those that can pay greater costs actually do?
>> From the 2011 Medicare Trust Fund’s Board of Trustees report: “…the HI (hospital insurance) trust fund is now estimated to be exhausted in 2024, 5 years earlier than shown in last year’s report (2010), and the fund is not adequately financed over the next 10 years.”
>> The Medicare Trustees in their 2011 report also outlined Medicare’s future as dependence upon the Affordable Care Act (Obamacare) being successful: “The Affordable Care Act introduced important changes to the Medicare program that are designed to reduce costs, increase revenues, expand the scope of benefits, and encourage the development of new systems of health care delivery that will improve health outcomes and cost efficiency. The financial projections in this report indicate a need for additional steps to address Medicare’s remaining financial challenges. Consideration of further reforms should occur in the near future.”
What I would like to see:
>> I would like to see some mature adult conversation. “The enemy isn’t conservatism. The enemy isn’t liberalism. The enemy is bullshit.” —Lars-Erik Nelson. Politifact notes that most partisan critics of the opposing view are often not only wrong, but they strongly mistate the other side’s actual position, or even their own position — this includes President Obama himself. Too many folks that should know better are just big fat flaming liars in this debate.
>> Universal availability of coverage. No preexisting condition discrimination. This doesn’t mean unlimited health care until the last breath. Rationing has always existed, whether by panel, policy or by income. Let’s not pretend otherwise. Conservative criticism of ObamaCare’s ‘death panels’ is probably much more exaggerated than the impact of RyanCare’s individual responsibility to fund more of your own care — with RyanCare’s level of personal responsibility being an approximate doubling of out-of-pocket expenses that come close to 35-40 percent of individual income for those at or below median income. Rationing of health care has and will always exist. Let’s acknowledge that rationing exists and decide upon what kind and how much of health care we will fund as a society.
>> We cannot fund everything, yet neither does our system encourage self-responsibility. Talk of self-responsibility is very irresponsible when it come to the aged and infirm that would live without the possibility of independent affordable coverage. The average net worth of Americans ages 44 and under is not even enough to pay for a heart attack + surgery + care. Older Americans have an average net worth of $181-232,000 but for most this includes the equity in their home. ‘Personal responsibility’ is a great campaign phrase but let’s not pretend that it is anything more … or not too much more than another way of saying ‘your problems are your problems, not mine’.
>> Let’s not talk about free markets but responsible markets. There hasn’t been a free market in health care since HMOs were first founded in the 1920s and Blue Cross Blue Shield expanded on that in the early 1930s. A responsible market would segment tests and procedures to reduce costs. For example, an annual physical consists usually of a battery of very standardized tests. Is there any reason that you couldn’t go to a pharmacy and get those same tests done? Doctors and hospitals need to stop hiding costs by providing itemized bills that represent actual charges — not charges plus subsidized costs averaged across items and procedures. A tooth brush or an aspirin should not cost $70-80 in a hospital stay, or you get charged for things that were never used. Let’s acknowledge the money game by insisting on responsible accounting that reveals the shell game that is going on.
About Paul Ryan and that firestorm — Republicans publicly trashed Obamacare in 2010 and turned the Medicare argument into Mediscare. Much of their criticism was with merit but the way they went about it was over the top, beyond misleading and played on emotion: we were supposedly on the verge of death panels and rationed care.
In 2012 the Republicans are offering death panels by income affordability and rationed care because few may be able to afford RyanCare. That will be the campaign theme of the Democrats — and much of their criticism will be with much merit. Yet they will predictably go over the top, be beyond misleading and play on emotion.
We know who decides most elections: those over the ages of 45. Mediscare worked in 2010 and it will work in 2012, just for the other party.
Seniors may well vote against the GOP. While the GOP works hard to assure them that they will be unaffected by RyanCare, American seniors are old enough to remember the good ol’days and that they weren’t.
I have concerns. I want change. I want responsible change. I want balanced budgets and I want to see a sense of ethics that balances individuals with the reality of the greater society that we live in. You affect my healthcare choices. I affect yours. So can we work this out?