Where does the road end?

This is a repost/update of my last piece on Rep. Ryan’s “Roadmap” from my old blog.  Still relevant:

Rep. Ryan is disappointing me. He has a defense of his “Roadmap” up. Specifically, he wants to talk about how his plan will affect Medicare. In his own words:

We do not have a choice as to whether Medicare will change from its current structure. It is being driven to insolvency. An honest debate requires a serious discussion of how Medicare will avert its collapse and be made sustainable. Unfortunately, but not surprisingly, the Democrats’ political machine has attacked my contribution to this debate, making the false claim that the only solution put forward to save Medicare would “end Medicare as we know it.”

The CBO has said that my reform plan, “A Roadmap for America’s Future,” would put Medicare on a sustainable path. The plan protects and preserves Medicare for those enrolled now and for those who will become eligible in the next 10 years, while reforming the program to ensure it will be there for younger generations. Future seniors would have access to the same coverage I enjoy as a congressman.

OK. First of all, no one is arguing against the fact that Medicare might have to change from its current path to be sustainable. But part of the reason that path was made worse was because of the huge unpaid for addition of Medicare Part D, which was not passed by the Democratic machine. ARGH. Look, he’s made me make a partisan argument. Unforgivable. Deep breath.

Rep. Ryan, your plan for Medicare is not crazy. It’s not corrupt. It’s not morally wrong. But I’m sorry, it absolutely would end Medicare as we know it.

Medicare right now is a defined benefit plan. Everyone knows exactly what they are going to get from the government and that’s what happens. Every year, the government (CMS) figures out how much it will cost to give those defined benefits, and it pays the bills. There are pros and cons to such a plan, but that’s Medicare as we know it.

You would like to change Medicare to a defined contribution plan. In that plan, everyone knows how much money (in a voucher) they are going to get every year, and then they go out and buy insurance. Every year, the government sets how much it is willing to pay, and gives out the vouchers.

A defined contribution plan is NOTHING like a defined benefit plan. Going to a voucher system, is a total change from Medicare. It’s the “end of Medicare as we know it”.

Medicare right now is the equivalent of Canada’s single payer health care system. You want to end that; you want to privatize it. It’s a radical change. Own it. Deal with it.

Your proposal would be a much greater disruption of Medicare than anything in passed in health care reform recently. Yet many of your colleagues have said that any cuts to Medicare would be horrible. Did you share this view with them earlier this year? I ask, because I’ve always felt that the demagoguery about cuts to Medicare was foolish. I’m not sure you’ve always been consistent. A wonk would clarify that.

The irony is that you keep talking about the CBO as if they were the gold standard of knowledge in terms of how reform will affect the budget in the future. Did you share this feeling with your colleagues when they were debating health care reform earlier this year? I ask, because I’ve always felt the CBO was credible. I’m not sure you’ve always been consistent. A wonk would clarify that.

Another irony is that what you are proposing, giving people money or vouchers to buy private insurance, sounds much like the exchanges recently passed in the PPACA. Right? How is it different? Did you share your feelings on the value of this type of setup with your colleagues when they were debating health care reform earlier this year? I ask, because I’ve always felt the exchanges seemed like something conservatives would support. I’m not sure you’ve always been consistent.

A wonk would clarify that.

UPDATE: Paul Krugman clarifies a point I’ve been trying to make.  A true conservative wonk would answer the challenge of ending Medicare as we know it with, “Yes, and we should.”  There are arguments to be made by serious people who think that a voucher/defined contribution system would be superior.  I have not yet been convinced those arguments are correct, but there are people I respect who continue to make them.  What I don’t respect are people who don’t appear to understand those arguments, and think that somehow you could take Medicare, turn it over to private insurance, give people vouchers that may not be enough to cover premiums in the future, and claim with a straight face that it’s still “Medicare as we know it.”  Come on.

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