Posted on 08/12/2012 10:42:36 PM PDT by Praxeologue
The Ryan plan DOES reduce government expenditures by tying the growth of Medicare spending to the consumer price index rather than letting it 'float' with the rising cost of healthcare - a rise that is mostly part of a vicious cycle of limitless government healthcare spending. That's the central element of the plan. It also shifts the plan closer to a private plan and eases the government's involvement as a general healthcare provider to all old people by gradually means-testing people off of it AND by creating cost competition among providers and model competition via block grants to states.
It's as if your analysis was cherry-picked from another planet's cherry bushes.
You’re too vulgar to attempt a discussion with. If you wish to try again, perhaps.
You are telling us what someone else thinks. Have you actually read Ryan’s plan yourself?
Does anyone else’s opinion/explanation count?
http://paulryan.house.gov/news/documentprint.aspx?DocumentID=273106
paulryan.house.gov
Paul Ryan
Contact:
Means, Ends, and Premium Support
Washington, Dec 15 -
By Yuval Levin, National Review
Ezra Klein today once again tries out the peculiar notion that Paul Ryan’s (and now also Ron Wyden’s) idea for Medicare reform is basically the same thing as Obamacare, since both involve a form of premium-support—even though the idea is employed in very different parts of our health-care system for quite different purposes.
The confusion on this point, if it is confusion, is rather telling about how even policy wonks on the left think about health care: It ignores the basic point of the Ryan reform (and of conservative reforms of the rest of our health-care system), which is to move our system in the direction of more market competition to improve its efficiency and reduce the growth of costs. Ryan’s Medicare reform would use a form of premium support to do that while Obamacare’s reforms of the under-65 market would use a form of premium support to push in the opposite direction. Ignoring that crucial difference of ends because the means bear some similarities to one another is an odd way to think about health care.
Our health-care financing system now consists of three large parts and a fourth smaller part. The three large parts are Medicare, Medicaid, and the employer-provided insurance market, and the smaller part is the individual market. The system is composed of these parts because we seem to have come to a rough agreement that the government should very heavily subsidize comprehensive insurance coverage for the elderly, should heavily subsidize a decent insurance benefit for the poor, and should modestly subsidize the purchase of insurance by everyone else. That general agreement is fairly well established, but the system we have for achieving its goals works very poorly because every one of those three elements creates powerful perverse incentives: Medicare’s fee for service system (which utterly dominates the economic logic of our entire health sector) incentivizes volume over efficiency and so inflates costs; Medicaid’s federal-state structure incentivizes overspending (since states decide what to spend but the federal government pays for a large share of it) and so inflates costs; and the tax exemption for employer-provided insurance incentivizes high-premium health insurance, and so inflates costs. It is therefore no surprise that costs are inflated.
The Ryan-type reforms are based on the premise that the solution to these problems is to put in place market incentives for efficiency and lower costs rather than inefficiency and higher costs, and that the way to do that is by creating a competitive insurance market in which consumer pressure moves insurers to provide more appealing and cheaper high-quality options, which in turn would drive providers to organize their work more efficiently. The underlying assumptions about what we want our system to do for the elderly, the poor, and the rest of us are still there, but they would move that entire three-and-a-half-part system in the direction of a competitive market to better achieve those goals. They would transform Medicare from an open-ended, single-payer, fee-for-service insurer into a premium-support system in which insurers compete for customers on a level playing field, which would drive them all to pursue more efficient and appealing means of providing a comprehensive benefit. They would transform Medicaid into a block grant to the states, giving them a powerful incentive to contain costs and more flexibility to experiment with ways of making the system more efficient. And they would turn the tax exclusion for employer-provided coverage into a tax credit for all, so that the people who pay for insurance would be the same as the people who use it and we would move toward a genuine consumer market with sensible economic incentives for all involved. The result would in time be a three-part system, and each part would be far more market-friendly (and therefore, we believe, efficient) than today’s.
The Obamacare reforms are based on the premise that the solution to these problems is to put in place greater centralized control of the entire sector, and that the way to do that is to make the government an even greater buyer and regulator of insurance coverage. They would therefore move the entire three-and-a-half part system in the direction of greater centralized control and thus away from a competitive market to achieve these goals. Today’s employer-provided insurance system and individual market would gradually be turned into a heavily regulated system of heavily subsidized premium-supports, today’s Medicaid system would be vastly expanded but not otherwise changed (giving government purchasing and regulation an even greater role), and today’s Medicare system would remain a single-payer, fee-for-service insurer but its spending would be cut by a board empowered to impose more price controls but not to change the basic payment system. In each case, the move is away from market incentives and toward more regulation and centralized control.
So it’s true that there is a system of heavily regulated and subsidized premium supports in both cases, but in the Republican case it is offered to senior citizens (and is thus a move toward markets in the over-65 insurance sector) and in the Democratic case it is offered to younger people (and is thus a move toward government in the under-65 insurance sector). The fact that similar means are employed in a different part of the system for a different purpose doesn’t really make these two reforms the same. Means have to be understood in relation to ends. Pushing an old lady out of the way of an oncoming bus is not the same thing as pushing an old lady into the way of oncoming bus, even though both involve pushing old ladies and oncoming buses. Using premium support to replace the least market-oriented part of our system as part of a broad move to push the entire system toward market mechanisms is not the same as using premium support to replace the most market-oriented (but still not nearly enough so) part of our system as part of a broad move to push the entire system away from market mechanisms, even though both involve premium support and market mechanisms.
http://www.nationalreview.com/corner/285885/means-ends-and-premium-support-yuval-levin
Thank you for your post. To reiterate:
“The Ryan-type reforms are based on the premise that the solution to these problems is to put in place market incentives for efficiency and lower costs rather than inefficiency and higher costs, and that the way to do that is by creating a competitive insurance market in which consumer pressure moves insurers to provide more appealing and cheaper high-quality options, which in turn would drive providers to organize their work more efficiently.”
I spend evenings and weekends going door-to-door for candidates. I encourage friends to participate and donate. I always support the team and never express doubt. Your comment reminds me of a campaign manager admonishing his volunteers from disputing policy during campaign season.
FR is a different place, however, where we can openly express our views. FR allows me to let off some steam, and speak the truth, in a world where thought-control is pervasive. It is therapeutic. There are many forums for Rockefeller Republicans, but few for those of the Goldwater/Reagan stripe. FR is the biggest of those. If we can't speak frankly here, where else can we do so?
Bottom Line Right There
I don’t think this article does that. I don’t think it is honest. I think it has an obvious agenda and bias - a political one.
Either that or it is ignorant of basic free market principles or inept at anlyzying the two approaches.
Likely some of both. It struck me as anti-discussion, so I slammed it back.
A discussion of how to speed up free market solutions in a new political environment after defeating the marxist regime... perhaps.
To the extent that his March plan was essentially a press release, yes. The Levin article that you posted is from last December and describes Ryan's previous plan, which was scored and which I liked. Levin describes Ryan's current plan in his National Review article of yesterday, which I cited above.
Government approved producers do not make a free market.
I would not look to wenzel as the first or last word on much.
wenzel: http://economicpolicyjournal.com/labels/RobertWenzel.html
“Robert Wenzel has been quoted by the New York Times, the BBC, the Huffingtn Post, Federal Reserve economists and in academic journals, and has also been quoted on many web sites, including LewRockwell.com and Mises.org.”
Oh, happy day!
Don’t we all read those every day to get our thinking points?/s
You choose from ‘government approved producers’ every day in almost every free market decision you make.
Not surprising. Thank you very much for your research and posts on this thread.
How do they differ?
When you put it that way, I'm even more disappointed that Palin's not running.
Aggregate expenditure growth is common to every scored plan, as discussed in yesterday's Levin article:
In order to be scoreable by CBO, the Wyden-Ryan reform also has a kind of backup: a requirement that Medicare’s growth not be faster than 0.5 percent more than GDP growth per year. That is, not by coincidence, the same maximum rate of growth set in President Obama’s budget. Neither maximum rate is really all that meaningful — it’s a scoring convention, not a reform; if it were exceeded, Congress would almost certainly just suspend it, as it has when past maximum growth rates (like the one in place since 1997) have been exceeded. So in this respect, too, if Ryan-Wyden’s competitive system didn’t keep costs down, we would just be in the same place the Democrats want to end up. It is not the maximum growth rate but the mechanism for remaining below it — the bidding process that allows for the transformation of Medicare into a new kind of intensely competitive insurance system with both a defined benefit and a defined contribution at once — that is the real key to the Ryan-Wyden reform.
Of course Levin is discussing the previous Ryan plan, which was co-authored with Democrat Rep. Ron Wyden, who has no part in Ryan's March plan. That plan actually was a market-driven plan.
http://paulryan.house.gov/issues/issue/?IssueID=9978#4
We cannot afford to tinker around the edges of this fundamentally flawed law. Full repeal is a critical step towards true health care reform.
snip
Recognizing the problems facing Medicare, the House Budget Proposal:
•Strengthens health and retirement security by taking power away from government bureaucrats and empowering patients with control over their care.
•Repeals the new health care law’s unaccountable board of bureaucrats empowered to cut Medicare in ways that would jeopardize seniors’ access to care.
•Saves Medicare for current and future generations, with no disruptions for those in and near retirement.
•For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.
•Program growth would be determined by a competitive-bidding process – with choice and competition forcing providers to reduce costs and improve quality for seniors.
•Premium support, competitive bidding, and more assistance for those with lower incomes or greater health care needs will ensure guaranteed affordability for all seniors.
Allowing the federal government to break its promises to current seniors and to future generations is unacceptable. The reforms outlined in the budget passed by the House protect and preserve Medicare for those in and near retirement, while saving and strengthening this critical program so that future generations can count on it to be there when they retire.
Reforming Medicaid in the Path to Prosperity
The Congressional Budget Office estimates that federal spending on Medicaid, a program which provides medical care for the poor, will grow from $276 billion in 2013 to $622 billion by 2022. This translates into an annual growth rate of 9 percent. Should this problem continue to be ignored, Medicaid will continue to overwhelm state and federal budgets and fail the vulnerable people who need it most.
Specifically, the Path to Prosperity:
•Secures the Medicaid benefit by converting the federal share of Medicaid spending into a block grant tailored to meet each state’s needs, indexed for inflation and population growth. This reform ends the misguided one-size-fits-all approach that has tied the hands of so many state governments. States will no longer be shackled by federally determined program requirements and enrollment criteria. Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations.
•Improves the health-care safety net for low-income Americans by giving states the ability to offer their Medicaid populations more options and better access to care. Medicaid recipients, like all Americans, deserve to choose their own doctors and make their own health care decisions, instead of having Washington dictate those decisions for them.
•Saves $810 billion over ten years, contributing to the long-term stabilization of the federal government’s fiscal path and encouraging fiscal responsibility at the state level.
•All Americans will pay more because of this broken Medicaid system – and not just in higher taxes. Because Medicaid’s reimbursement rates have been ratcheted down to below-market levels, the care that Medicaid patients receive is often substandard. Offering states more flexibility for their Medicaid beneficiaries will remove the stigma Medicaid recipients face, and allow them to take advantage of a range of options available. Several of the nation’s governors have made innovative proposals to fix Medicaid. This budget encourages further efforts in this direction.
“Who benefits?”
Not the taxpayer, that’s for sure!
Our government is spending more, primarily on entitlements, than it is taking in as revenue. We cannot afford to pay for everyone’s two hip surgeries and a triple-bypass. The Federal Government, namely We The People, cannot afford to do so.
There is no Constitutional reason for the government to be involved in healthcare. None at all.
Ryan’s plan wouldn’t change a damn thing that needs to be changed.
It is important to do reserch on candidates and get the information out there, period. You do not want to be blindsided later when the politician you thought was a conservative turns into the ultimate Washington insider.
There are a lot of people who did not research Obama’s background and who voted for him in 2008. I know of quite a few conservatives who were sucked in by the post-racial, hope and change mantra.
As for myself, I started reseaching BHO2 in March of 2008, reported on FR what I was finding - namely that he wasn’t born here in the U.S.A. - and experienced my computer being hacked three times prior to the election. It was hacked a fourth time near the inauguration.
I began to answer my front door with a shotgun, either in hand or nearby.
Folks, exactly like you are doing right now, mocked my information on BHO2. Too bad more didn’t look into the information in greater detail. I also said he was communist.
A voter cannot know too much about a candidate before casting a ballot.
I will be voting for the Republican candidates for Prez and VP. Why?
Because if BHO2 gets 4 more years, we are doomed.
If Romney & Ryan win and don’t do what’s necessary, we are doomed.
Since past performance is generaly a good predictor of future actions, Romney & Ryan will probably not turn things around.
One thing I do know is that with BHO2 there is no hope but maybe, just maybe, Romney & Ryan could change.
It’s all I can hope for at this point.
This does not mean, Jessup, that I am changing my admonition about knowing as much as possible about the candidates. And that means checking everything they say.
“IT’S THE SPENDING STUPID! The US must become less a government of men, and more a government of LAW. When people lose everything and have nothing left to lose they lose it.” -Gerald Celente ( He lost a fortune at IMF Global)
That is a never mentioned but germane point.
Yes, much propaganda to bail out bundlers of phony non-collateralized “instruments” as they try to call them.
They’re desperate now.
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