Friday, April 15, 2011


Today the House of Representatives actually voted to abolish Medicare as we know it, over the next ten years. Wow. The audacity of that move is breathtaking, though perhaps understandable as a symbolic gesture, since the House Republicans know that their plan to scrap the current system has no chance of being enacted any time soon. If the House Republicans thought they were proposing something that might become law, it would be hard to put together a coherent picture of where they think they are heading with this idea. It's not about the deficit, because if they were serious about the deficit, they wouldn't be proposing huge tax cuts at the same time. It might not even be about spending per se either, for these same Republicans voted only a few years ago to dramatically expand Medicare coverage for prescription drugs. Republicans say it's not even about hostility toward Medicare or seniors either, since these same Republicans were screaming loudly about death panels and Medicare cuts when the Democrats passed comprehensive health care reform last year. So how did we get from hearing the Republicans try to scare people into thinking that Obama wanted to cut people's Medicare benefits, to Republicans passing a bill in the House sharply curtailing Medicare benefits over a number of years to the point where there would be no guarantee that the vouchers they propose handing out to seniors would be sufficient to cover their needs?

I have to assume the House Republicans do not have a death wish. Therefore, the only way I can tie all these actions together is by noting that they all favor private insurance companies and health care providers. The Medicare Part D prescription drug benefit turned out to be a boondoggle for pharmaceutical companies (and it hugely impacted the deficit), since Medicare is not allowed to use its tremendous purchasing power to obtain better prices for drugs. Opposition to the Affordable Care Act seemed prompted to a large extent by concern that private insurance companies would find themselves unable to compete with a proposed or potential public plan. And now the House bill to replace traditional Medicare with a voucher program opens up the possibility of greatly expanding the market for private health insurance companies. Under the Republican plan, this market would open up to them whether or not they are able to deliver better services for a cheaper price, because spending on Medicare would be held constant or decrease regardless of whether insurance was available for the voucher price. Those who can afford it will pay more out of pocket, and those who cannot will do without. Those who advocate market-based solutions should be upfront about the fact that that is how markets regulate supply and demand.

This solicitude may spring from the power of lobbyists and campaign contributors, or it may represent an ideological preference for the free market regardless of whether or not the market can actually deliver a better product for a cheaper price. Whatever is driving the House Republicans, it's a blind obsession, because it doesn't seem very smart politically, and it doesn't seem likely to represent a good deal for most of the people who will be eligible for Medicare. This is going to be a tough sell, and deservedly so.


  1. Cheers. Somebody is finally suggesting we reform Medicare. Lets get something done. We know it won't be close to the specific plan laid out; but even if it is as bad as health care reform -- it will be landmark. And, like health care reform, we can improve on it in coming years.

    We are so close to the bus leaving the highway and crashing through the guard rail.

  2. Real reform of Medicare started with the Affordable Care Act, which the Republicans attacked on the ground that it would lead to savings in Medicare spending. That is a fact.

    The Ryan plan is not reform of Medicare. It is anti-Medicare. It does away with the whole concept of Medicare.

  3. I agree. I'm not entirely sure how they think this is going to be a good thing. I mean, I get that it's going to shift a ton of the cost onto seniors and thus cut the deficit, but this seems like it's a bit much.

    I'm not so sure their plan will work the way they think it will.

  4. I'm not entirely sure it will work as it is written either. But as I said above: as it is written is not what will be done. Lets get the process started. We know it won't be close to Ryan's specific plan. There will have to be much compromise from both sides.

    Joe, you have reminded me on several occassions that Medicare was not perfect when it got done originally and was improved over years time. You reminded me of that when I pointed out the weaknesses in the Affordable Care Act; and so have many others. I have repeatedly heard that it will improve over years time. Recall how frustrated you were at the far right that said no to health care reform.

  5. I understand why many people don't call the Affordable Care Act by it's name. It's hard to see where any part of medicine is more affordable after it passed. Having said that, I am hopeful we can add to it and take away from it in ways that are helpful. You are likely hopeful it leads to a single payor system. I understand.

    Understand, I am not backing Ryan's plan. I am backing reform and he is starting the discussion that is going to have to be answered. We are going to find an answer to reform soon -- or we are going to find answers when republicans gain additional control.

  6. The Democrats seem to have figured out the answer already. The Republicans want to cut seniors' benefits so that they give more money back to the wealthiest Americans. The Democrats want to increase taxes on the wealthiest Americans so that we can maintain reasonable levels of services. Guess who I think is going to win that argument?

    I do think there are bi-partisan solutions to many budget issues. But on Medicare, the Democrats have to draw some lines in the sand. One of them is that they can never agree to allow it to become a voucher program. When Obama said that will never happen while he is president, he was taking a stand that he must take as a Democrat. Politically and as a matter of principle, it is the only position he can take.

  7. We are nearly in agreement. I agree with most everything you said except the sweeping statement in your second sentence. Not all Republicans want to srew old people and give to the wealthy. That's not true, Joe.

    I would be equally unreasonable if I said something like this: if you read the health care reform bill you will clearly see that Obama and Democrats want to take money from the middle class like me and give it to wealthy Insurance companies, while giving exemptions to thousands of unions and millions of union workers. That is what it does, so that must be what the mean old President and Democrats want.

  8. I don't think I said that all Republicans want to screw the elderly so they can give more back to the wealthy. I said that was the Democrats' answer to the Ryan plan. My point is that the Ryan plan might turn out politically to be a gigantic gift to the Democrats. The reason it is a gift is that the Democrats are already starting to characterize the Ryan plan as a giveaway to the rich at the expense of the poor and the elderly. The Republicans probably thought, and might still think, that their plan will be popular because it is all about cutting spending and cutting taxes, and everybody says that are for that. The Republicans' miscalculation is that when they start messing around with Medicare, their plan is not going to be so popular anymore.

  9. The Ryan plan isn't going to be put into law; anymore than the single payor health care system was going to fly or Prop 13 will be repealed in California. It is what it is. Lets slow down.

    Both parties will find a way to seek a path that is both more acceptable and workable to everyone. Unless Dems want to wait until the Repubs have controll of the Congress and Presidency. That would be a mistake. Recall, the majority of people in America were not content with health care reform.