He called for rationing Medicare, replacing it with an underfunded voucher system that would dramatically shift costs to elderly Americans. He proposed repealing the Affordable Care Act, slashing Medicaid by $1.4 trillion over the next decade and turning what's left over to the states as block grants. By 2021, his budget would leave up to 44 million more Americans without health insurance. His budget, one which garnered the votes of 235 House Republicans and 40 GOP Senators, would in turn use the savings to deliver $4.2 trillion in tax cuts, most of them to the richest Americans who need them least.
He is Wisconsin Representative Paul Ryan. And he is Politico's Health Care Policymaker of the Year.
As Politico revealed Tuesday, decimating the U.S. health care system and gutting the American social safety net apparently deserves praise, not scorn. For Politico, the catastrophic impact of Paul Ryan's draconian and dishonest budget matters far less than the fact that people are talking about it:
When House Budget Committee Chairman Paul Ryan released his budget plan in April, the Wisconsin Republican instantly changed the conversation about health care in America. It wasn't always a polite conversation. And it gave way to new Democratic charges that Republicans want to "end Medicare."
But Ryan got everyone talking about ways to get health care entitlements under control -- and he gave Republicans the most detailed illustration to date of how market forces could be used to do that. He has influenced how Republican presidential candidates such as Mitt Romney talk about health care, as they use variations of his Medicare plan in their campaigns. And if Republicans gain power after the 2012 elections, his blueprint is sure to be the starting point for their future health care policies.
As it turns out, Ryan didn't "instantly" change the conversation. Most Republicans, including his party's leadership, refused to endorse his 2010 Roadmap for America's Future until after the November mid-terms were safely won. And Ryan's goal to "end Medicare" is only the beginning of the unraveling of the safety net he would undertake.
To be sure, Ryan's voucher scheme would end Medicare as we know it. As Ezra Klein, Matthew Yglesias and TPM (among others) noted, Ryan's Republican deficit reduction gambit would inevitably lead to the rationing of Medicare.
Because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage. The Washington Post's Klein described the inexorable Republican rationing of Medicare which would then ensue:
The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.
It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.
Last year, Ryan acknowledged as much.
"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"
Of course, Ryan left out the real culprit - the private insurance market. But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60 percent of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today."
As Paul Krugman explained using the chart above:
Medicare actually does a better job of controlling costs than private insurers -- not remotely good enough, but better...
If Medicare costs had risen as fast as private insurance premiums, it would cost around 40 percent more than it does. If private insurers had done as well as Medicare at controlling costs, insurance would be a lot cheaper.
But you don't have to take Paul Krugman's or Ezra Klein's word for it that "the GOP outsources Medicare to private insurers and gives senior citizens checks that cover less and less of the cost of insurance every year." In words and pictures, the nonpartisan Congressional Budget Office issued the same dire warning (see chart at top).
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