If you're looking for a description of the Ryan/Rivlin Medicare reforms that have gained so many admirers on the right, Matt Yglesias has a good write-up of the idea. But I'd add another way of explaining the proposal: The Ryan-Rivlin plan basically turns Medicare into Obamacare. And in that context, Republicans love the idea behind ObamaCare and think it'll save lots of money.
Under the Ryan-Rivlin plan, the current Medicare program is completely dissolved and replaced by a new Medicare program that "would provide a payment – based on what the average annual per-capita expenditure is in 2021 – to purchase health insurance." You'd get the health insurance from a "Medicare Exchange", and "health plans which choose to participate in the Medicare Exchange must agree to offer insurance to all Medicare beneficiaries, thereby preventing cherry picking and ensuring that Medicare’s sickest and highest cost beneficiaries receive coverage."
Sound familiar?
As Matt says, this doesn't save money. In theory, it actually costs money, as private insurance is more expensive for Medicare -- and that's true both in the private market, and in the quasi-private Medicare Advantage market. What saves money is capping the amount paid to seniors, so they either have to pay more for their care or get less.
But that's not how it's being explained. Matt calls the privatization strategy here "an ideological tic" and says it's unrelated to the cost control, but I'd say it's more of a sleight of hand that's necessary for the cost control. The question seniors will have about this plan is "won't it mean lower benefits?" The privatization idea, by virtue of being a disruptive reform, allows you to say, "no, competition in the private market will make Medicare so much more efficient that it'll be able to deliver more for less!" Or, as Rivlin's original plan (pdf) says, "The expectation is that increased competition among plans fostered by the Medicare Exchange...will keep costs from rising."
I don't know that accusations of hypocrisy are really worth making in American politics, but consider the way this policy and its rationale interacts with the case against ObamaCare. Right now, Medicare is much cheaper than private insurance. If you think that moving Medicare to a model of private insurance sold on exchanges will make it even cheaper, what you're saying is that an ObamaCare model will not only be cheaper than the current private-insurance system, but cheaper than the even-cheaper Medicare system.
If you believe this logic, the Affordable Care Act is a great bill that will save much more money than CBO currently assumes. And yet this is the reform package that's gaining adherents among the group of people who want to repeal the Affordable Care Act and think it a monstrous and unconstitutional piece of legislation with no redeeming features worth mentioning.
Photo credit: Melina Mara/The Washington Post.
If you're looking for a description of the Ryan/Rivlin Medicare reforms that have gained so many admirers on the right, Matt Yglesias has a good write-up of the idea. But I'd add another way of explaining the proposal: The Ryan-Rivlin plan basically turns Medicare into Obamacare. And in that context, Republicans love the idea behind ObamaCare and think it'll save lots of money.
Under the Ryan-Rivlin plan, the current Medicare program is completely dissolved and replaced by a new Medicare program that "would provide a payment – based on what the average annual per-capita expenditure is in 2021 – to purchase health insurance." You'd get the health insurance from a "Medicare Exchange", and "health plans which choose to participate in the Medicare Exchange must agree to offer insurance to all Medicare beneficiaries, thereby preventing cherry picking and ensuring that Medicare’s sickest and highest cost beneficiaries receive coverage."
Sound familiar?
As Matt says, this doesn't save money. In theory, it actually costs money, as private insurance is more expensive for Medicare -- and that's true both in the private market, and in the quasi-private Medicare Advantage market. What saves money is capping the amount paid to seniors, so they either have to pay more for their care or get less.
But that's not how it's being explained. Matt calls the privatization strategy here "an ideological tic" and says it's unrelated to the cost control, but I'd say it's more of a sleight of hand that's necessary for the cost control. The question seniors will have about this plan is "won't it mean lower benefits?" The privatization idea, by virtue of being a disruptive reform, allows you to say, "no, competition in the private market will make Medicare so much more efficient that it'll be able to deliver more for less!" Or, as Rivlin's original plan (pdf) says, "The expectation is that increased competition among plans fostered by the Medicare Exchange...will keep costs from rising."
I don't know that accusations of hypocrisy are really worth making in American politics, but consider the way this policy and its rationale interacts with the case against ObamaCare. Right now, Medicare is much cheaper than private insurance. If you think that moving Medicare to a model of private insurance sold on exchanges will make it even cheaper, what you're saying is that an ObamaCare model will not only be cheaper than the current private-insurance system, but cheaper than the even-cheaper Medicare system.
If you believe this logic, the Affordable Care Act is a great bill that will save much more money than CBO currently assumes. And yet this is the reform package that's gaining adherents among the group of people who want to repeal the Affordable Care Act and think it a monstrous and unconstitutional piece of legislation with no redeeming features worth mentioning.
Photo credit: Melina Mara/The Washington Post.
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