It's budget time again, and so Paul Ryan is making the rounds of talk shows to pimp the new-and-improved Ryan plan, one he claims has "emerging bipartisan consensus." Thanks to Senator Ron Wyden, it seems to at least have the appearance of
January 30, 2012

It's budget time again, and so Paul Ryan is making the rounds of talk shows to pimp the new-and-improved Ryan plan, one he claims has "emerging bipartisan consensus." Thanks to Senator Ron Wyden, it seems to at least have the appearance of bipartisan consensus but it's really just the old 2011 version with some cosmetic changes.

The Wyden-Ryan Medicare reforms would retain the public version of Medicare as a traditional fee-for-service plan, but instead of automatic enrollment, vouchers would go to seniors who could choose traditional Medicare or a private insurer's plan. It takes the very worst policy in both private and public healthcare plans and makes it the law of the land.

The Affordable Care Act addressed some of the issues around cost containment, which is Medicare's biggest failing. As a fee-for-service plan, Medicare's costs skyrocket because providers are paid based upon seeing and treating patients, rather than prevention or outcomes-based care. As ThinkProgress points out, adopting a plan like this allows private insurers to cherry-pick insureds, leaving the highest-cost and sickest in the public system, ensuring its demise.

Senator Wyden has long been a fan of privatizing Medicare and not just stopping there. In 2008 he introduced the Healthy Americans Act, which would have separated health insurance from employment, and bundled CHIP and FEHBP into the package, with tax deductions for insurance as incentives.

The problem with Senator Wyden's effort to sacrifice the social safety net on the altar of bipartisanship is twofold: It's bad policy and it's terrible politics. Yes, Medicare has problems, some of which were addressed by the ACA. But the problems it has could be remedied without dumping the system itself for one where the bulk of rising medical costs fall onto the shoulders of current and future retirees. Paul Ryan, on the other hand, has no difficulty being as partisan as he'd like, while capitalizing on Senator Wyden's naive and tone-deaf reach across the aisle. Statements like these are just desperate baloney, to quote another Republican in the news right now.

So, the president's law takes half a trillion dollars out of Medicare to spend on Obamacare and now he's putting this new rationing board in place, which will lead to denied care to current seniors. So, if you want to compare plans, our plan to save and shrink the program, not change benefits for anybody 55 and above, and the president's plan to start rationing current seniors while still allowing the program going to bankruptcy, I'm happy to take that debate.

The IPAB is not a "new rationing board", and it's one of the best hopes private AND public insurers have for reining in medical costs. But more than that, it illustrates the policy differences between Ryan and Democrats (excepting Ron Wyden, of course). Ryan and Republicans loathe the IPAB because it forces price controls into Medicare, which means providers can no longer realize huge profits at taxpayers' expense. Think about some of the ads you see today for Medicare-provided supplies: wheelchairs, glucose monitors, and diabetes supplies, for example. Knee and hip replacements are another big ticket Medicare item that these providers spend millions on ads to get the word out to seniors! Pharmaceuticals. Procedures. All of these are currently unrestricted, even if their outcomes do not warrant the treatment. This is because traditional Medicare has, as a result of flawed health policy, not paid attention to outcomes but focused on services and fees for those services.

I have seen this in my own family, where a useless heart monitor was implanted which will not serve the purpose it is intended, because it must be triggered before a fainting spell, and the person faints with no warning. Yet Medicare paid for the device, the procedure to implant it, and the cardiologist to monitor it. A complete waste of money.

Ryan wants the fee-for-service model to live on. Democrats want a more reality-based model free of profit and excessive administrative costs. Nothing illustrates this more starkly than Ryan's rejection of the IPAB as a "rationing board" while pretending handing off Medicare to private insurers with a voucher isn't privatization. Ryan's conservative view seems to be that those of us under age 55 are worth only $6,000/year. If we cost more than that, too damn bad.

Part of the reason we have such a screwy health care system is because it's been demagogued to death in the name of liberty on one side, and social responsibility on the other. By the time anything gets through Congress it's just a hot mess of ideology with very little sane policy underneath it, which is why it's best if Ryan, Wyden, and the others in Congress just step away from Medicare and let it be while the Affordable Care Act provisions start to take place.

I fully expect this to be the centerpiece of the House Republicans' budget. But thanks to Ron Wyden, Democrats won't have quite the same leverage to shape public opinion as they did last April. Let's hope the general public is as tired of the extremes as those of us who actually follow these issues are.

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