I saw this WaPo piece courtesy of Dean Baker's Beat the Press blog and the illogic was so extreme I couldn't even get past the first few paragraphs of the fictional exchange between “Barack” and “Paul” (Gee, I wonder who those two names could be representing? /snark)
Paul: Okay, you guys won the first round. Congratulations on that New York House seat. But “Medicare as we know it” can’t continue.
Okay, “Paul” admits that, yes indeed, the New York District 26 election was all about Ryan's plan to do away with Medicare. Can Medicare “as we know it” continue? Well, health care as we know it certainly can't continue. President Obama made that quite clear In the speech that kicked off the push to get the Affordable Care Act passed.
But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day.
[snip]
Then there's the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers -- especially small businesses -- are forcing their employees to pay more for insurance, or are dropping their coverage entirely.
So, it's not like anybody back in mid-2009 disputed that American health care was (and still is) quite a mess.
Seniors now have little incentive to control costs, and providers, paid by the procedure, have every reason to ramp them up.
Uh, wait a sec, how does “We spend one and a half times more per person on health care than any other country” square with the idea that private, for-profit health care insurance companies are just throwing money at the problem of health care, seemingly without a care in the world? I thought conservatives, Republicans and right-wingers have been claiming for decades that it's government that spends wildly and freely and doesn't really care about costs. Let's look at another paragraph from Obama's speech:
One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.
Notice that Obama is citing cases from private, for-profit health care insurance companies. He's not talking about government agencies. Where on Earth does “Paul” get the odd notion that American seniors are driving up costs via unreasonable demands when other countries with government (i.e., not for-profit) health care have done a much better job of restraining costs? That doesn't sound like any private capitalist institution I've ever heard of. The important point to remember here is that Medicare administrative costs are about a fifth of private health insurance costs (The study by the Council for Affordable Health Insurance calculates administrative costs for Medicare as being 3.3% of total expenses, private health care costs are at 16.7%). Medicare is not the problem when we're discussing the state of our health care system.
Medicare costs were 8.5 percent of the federal budget in 1990 — they’ll be 17.4 percent by 2020.
I have no reason to doubt this, but the problem is far bigger than just Medicare.
Barack: The current system can’t go on. I wouldn’t say this publicly, but my party’s wrong to pretend it can.
Umm, see the above. No one on either side of the aisle disagreed with Obama's position that health care was a mess and had to be reformed. I haven't the vaguest clue as to where the WaPo reporter is getting this from. Now, if this was a piece from a random blogger, the problem here would apply to just that one person. But this is a traditional media piece and these people pride themselves on having editors and research assistants and fact-checkers. An oversight like this isn't just the fault of one person, it's the fault of a whole group of people. This merits extra condemnation on our part.
Still, your approach goes way too far. Seniors would get help to buy private insurance but would pay a lot more than they do now.
And over time, because the vouchers rise only with inflation, not with medical costs, beneficiaries would have to pay even more. They’re not going to be able to afford it, not with median incomes of less than $21,000. And why should they? You’re forced to make deep cuts in Medicare because you won’t agree to raise taxes and that’s the only other way to get to balance.
This sounds entirely accurate to me.
Paul: Look, I could maybe support higher taxes as part of an overall deal.
That's a nice idea in theory, but there's no evidence that Republicans are willing to raise taxes for any reason. Remember, the whole idea popularized by President Reagan and today pushed very strongly by Grover Norquist is “Starve the beast.” “The beast” being the parts of the government budget that serve the people of the middle and working classes, the government programs that do not directly support the military-industrial complex. So does “Paul” really mean to say “I just can’t admit that” or is he not “admitting” it because he has no intention of ever doing so? Sorry, I can't go along with the WaPo reporter's mind-reading here and refuse to credit “Paul” with the realism necessary to agree to raise taxes.
On costs, my plan gives extra subsidies to the poorest, sickest and oldest seniors. If those aren’t big enough, we could talk.
No. Again, this is a combination of wishful thinking and mind-reading. Ryan simply put out a plan wherein costs would keep up with inflation, not with medical costs and medical costs are increasing a good deal faster than inflation. As Baker points out:
And the comparison of the cost of the Ryan plan to the existing Medicare plan is not a hypothetical. The additional $34 trillion cost that CBO projected for buying Medicare equivalent policies is based on the actual history with Medicare Plus Choice and Medicare Advantage. How many times must this experiment be repeated before its results are accepted?
Ryan has not withdrawn any elements of his plan upon being informed that the cost would be an additional $34 trillion. This idea that he would be flexible and reasonable and would negotiate parts of his plan is sheer wishful thinking.
One statement “Barack” makes strikes me as very true.
Otherwise, costs just get shifted elsewhere.
Precisely! The whole idea of the Ryan plan is to simply shift costs from those most able to pay them (The government, large insurance companies) to seniors, people who are just getting by on Social Security and savings and pensions and who really don't have the spare cash to just toss into “the game.” Having “skin the game” is a rilly kewl-sounding phrase, but seniors spent their lives contributing to a system that they then expected would be there for them when they got to the point of really needing it. I saw a survey many years ago that said our maximum earning years are between 45 and 52. After that, memory and energy take a hit and our capacity for work begins to decline. It is cruel beyond any human decency to expect any typical baby boomer (Somebody born in 1947 would be 64 now) to suddenly have to deal with radical changes to their health care system. As I pointed out above, a person of that age will be living from hand to mouth with very little cushion to deal with radical changes. Such people simply don't have the resources to go out onto the market and negotiate whole new deals for themselves.
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