Paul Ryan Doubles Down on “You’re-On-Your-Own” Healthcare
Here we go again.
Remember Wisconsin Rep. Paul Ryan and his budget plan that would demolish Medicare under the guise of saving it? (Many of the people in his district sure do.) This week, in a speech at Stanford University, Ryan laid out a vision that would go even further—detonating not only Medicare but the rest of our health care system and leaving everyone on their own in a consumer-unfriendly, costly private insurance market. This expanded version of “Ryancare” is what passes for Ryan’s attempt to propose a replacement for the health care reform bill that passed last year.
As David Dayen puts it, “if you liked getting a coupon instead of your Medicare and being pushed out on your own onto the individual marketplace, you’ll love getting the same coupon for Medicaid and for any coverage you get from an employer.”
Let’s compare and contrast what Ryan is proposing with how Medicare actually works and how the Affordable Care Act will work.
As it exists now—and as the overwhelming political consensus says it should exist—Medicare is a guarantee of coverage for all seniors. Meanwhile, under the Affordable Care Act, those at or close to the poverty line are covered by Medicaid, while everyone else can get insurance through their employer or buy policies in a marketplace with subsidies and strict patient protections. What this means is that nearly everyone gets coverage, and their ability to get care is protected.
Ryan’s plan sweeps all of that away, leaving behind a credit to buy a private insurance plan—a credit that rapidly loses value relative to health care costs. The way it saves money is by covering less and pushing more costs and more risk onto individuals. Under “Ryancare,” the many protections that health care reform put into place would be eliminated, giving free rein to the worst abuses of the insurance industry. If your Ryancare credit can’t cover the cost of a policy, you’ll make up the difference, and if you can’t afford a plan that will actually cover the care you need, you’re out of luck.
The hostility of politicians like Ryan to the power of individuals to band together and bargain for a better deal from corporations is long-standing, so it’s no surprise that it shapes their attitudes towards the insurance market. Ryan’s plan is a mixture of ideological wishful thinking and callous disregard for how a health care system should work.
It’s embarrassing what passes for serious policy proposals in Washington.
Tags: Health Care, Paul Ryan
One problem with this work is the use of votes on actual bills to define ideologies. In the three years of the President’s term, it isn’t easy to find a single bill that would qualify as liberal which has advanced to a vote. That problem is illustrated by the health care bill. There were plenty of liberal ideas for revamping the health care system in a way that would benefit average citizens. These range from some form of single-payer to highly regulated insurance companies as in Germany and Switzerland, to outright nationalization of the system as in England. In the middle, the public option was a moderate position, which some of us stupidly thought was the position of President Obama. Then there was the conservative position, RomneyCare, and further right, the position of Paul Ryan and Ron Paul, moderate and severe versions of you’re on your own. Among Democrats, there was no one espousing the liberal position, and only a few who actively supported the moderate position, which did not include the President.
One arguably liberal bill, cramdown in Chapter 13, passed the House and got a vote in the Senate, presumably after it became clear it wouldn’t win. There were 45 ayes, all Democrats, and 51 nays, including all Republicans and 11 Democrats.* Cramdown was, and remains, an excellent solution to the housing crisis on its own merits. I classify it as liberal because it corrects an unfairness in the system that lets rich people cram down mortgages on their vacation homes in Chapter 11, but denies working people the right to do the same thing for their homes in Chapter 13. It would have made a significant difference in the housing disaster, because it gave homeowners power in dealing with thug banksters and their fraudulent servicing operations.
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