• False Equivalencies

    Steven Pearlstein wrote a column about the sad state of the political parties in the US today. Usually, he’d get little argument from me. But this was the crux of his argument, and I take exception to it:

    Unless you’re trained as a lawyer or a Talmudic scholar, it’s hard to see a practical, moral or constitutional distinction between Obamacare (requiring every American to buy health insurance from a regulated exchange or face a tax) and Ryancare (requiring every American to pay a Medicare payroll tax so they can buy health insurance from a regulated exchange at age 65). Both involve an individual mandate. Both involve an exercise of coercive power by government not enumerated in the Constitution. Both envision federal regulation of the marketplace. And both involve a transfer of subsidies from the rich to the poor.

    This intellectual dishonesty is hardly limited to Republicans. Democrats have been equally hysterical in attacking Ryancare as a throw-Grandma-under-the-bus scheme to balance the budget, even as they proudly defend the health reform law for everyone else.

    It seems like no matter how many times we explain this, no one seems to listen. You can absolutely believe that one of these is OK and the other is not. Many, many, many progressives have made peace with the idea that the private insurance industry is going to exist in the United States health care system.* They did so with the understanding that it would be more tightly regulated, and that sufficient subsidies will be available to make insurance affordable to most Americans. That was the crux of the PPACA, and most Democrats supported it.

    Note that they’ve even made peace with the private insurance industry existing within Medicare. Medicare Advantage was not eliminated by the PPACA; some of the over-payments were curtailed. So “that side” is not nearly as rabidly anti-private-insurance as many think.

    The two biggest things that I think are a problem with Rep. Ryan’s proposal are (1) the elimination of traditional Medicare and (2) the level of the vouchers. Why eliminate FFS Medicare when in many markets it’s outperforming private industry? That doesn’t seem wise. And, I’m sorry, but I have concern for grandma when the CBO says that out-of-pocket payments will rise to 68% of health care costs in 2030. There are better ways to involve the private insurance industry; in fact, on this very blog, are many posts that defend premium support and competitive bidding.

    Those are my issues. And I don’t think they’re inconsistent. I know it’s become very common for people to write the “both sides are the same” type of article, but they’re really not. Maybe politicians are, but not those of us less concerned with politics than policy. I wish we could spend more time talking about that, and squaring our differences, than focusing on the how the issues play.

    Now I leave it to others who attack the PPACA and defend Rep. Ryan’s plan to make a similar defense. I have a harder time seeing the consistencies there, but that could be my failure. I look forward forward to reading that, perhaps from one of you in the comments.

    *Yes, some did not. I know. There’s no need to email me.

    • The single biggest difference between conservatives and liberals is not, as Pearlstein clearly assumes, that liberals believe in government health insurance and and conservatives want private insurance. The single biggest difference is that liberals believing that increasing the number of people who have reasonably comprehensive insurance is important enough to justify increased government spending, if you cannot accomplish that by making health care more cost-effective, and conservatives don’t.

      If your priority is, as mine is, to expand coverage, there is no contradiction between supporting a plan that uses the private sector that would increase the number of people with coverage and opposing a different plan that uses the private sector that would decrease coverage.

    • As far as I can tell the Ryan plan simply states that the companies offering insurance on the exchanges must offer insurance regardless of pre-existing conditions. However the insurance companies have made an individual mandate a requirement for offering insurance for those with pre-existing conditions under the ACA. It would seem that a law with no individual mandate like I assume describes the Ryan plan would leave the exchanges devoid of any offerings from insurance companies for those with pre-existing conditions such as being 70 years old at anything like affordable rates under the offered vouchers. I think the Ryan plan is a cruel political joke in disguise.

    • Your concern for Grandma is misplaced. It should be concern for your children and, even more, your grandchildren

      Grandma’s Medicare will continue as is (the cynic in me says Ryan didn’t want today’s seniors jumping down his throat while the realist says that it’s unreasonably harsh to make folks change boats while they’re already in the middle of the stream).

      The inadequate size of the vouchers (the big difference between Obamacare and Ryancare) may hit you if you’re under 55, but it will definitely hurt your children and, even more, your grandchildren if the costs of healthcare continue to rise faster than the rate of inflation.

      • The rising cost of medical care will hurt our country’s children and grandchildren no matter what plan is used. If the price is the same and you use the service, then the cost will be the same. Our children and grandchildren can pay with a medicare tax, their inheritance or their own dollars when their parents/grandparents have been bankrupted by medical bills.

    • Mike from CT: “Grandma’s Medicare will continue as is.”

      Suppose that Grandma is 55 today, and that she lives to see her 90th birthday 35 years from now. At that point in time under Ryancare she will be part of a tiny percentage of Americans who are on Medicare, and her cohort will be outnumbered by younger elderly who are envious and possibly resentful because their health care sucks or is non-existent. Yet you figured that Grandma’s then-lack of political strength won’t cause her Medicare benefits to be trimmed or converted to Ryancare. HOW did you figure that?

      • Sam Brasel : “HOW did you figure that?”

        I didn’t have to. Rep Ryan promised it wouldn’t be and he wouldn’t mislead us, would he? (add extremely sarcastic tone to that, before responding.)

        Yours is, however, an interestig point. As many budget students have noted, Ryan’s plan actually *increases* the deficits in the short haul, with sacrifices made later. Whenever a politician promises dessert now and that you won’t have to eat the spinach until 10 years from now, know you’re being had.

        Remember when Republicans insisted the Bush ytax cuts were less than they were – because they lapsed in 9 years of the ten year budget window. Now these same Republicans are insisting that keeping to what they said then (allowing the cuts to lapse and thereby meeting their projections) is raising taxes and we have to extend the cuts forever. Get used to the desserts. You’ll never have to eat the spinach (and Ryan will never be serious about actually balancing the budget.)

    • While Pearlstein is right in that the end outcome of both proposals are similar, he’s dead wrong in assuming the starting point is the same and thus the paths are equal. For senior citizens we currently have a single payer health care system with universal coverage. The cost of Medicare has grown significantly less than the private market and the private component of Medicare, Medicare Advantage, has been running more costly than Parts A&B while the prescription plan Part D is extremely inneficient.

      Ryan is proposing we take our universal coverage plan that currently is working the best within our system and demolish it for a fully privatized system with insufficiently sized vouchers designed to reduce government expendatures. Obama proposed we regulate our private insurance industry for those of us not yet eligible for Medicare, provided subsidies to entice businesses to provide coverage and a mandate to drive down costs and ensure the insurance industry isn’t only covering people who are sick or middle aged and older. Obama’s objective was to improve health care access, drive down health care costs and in turn drive down government health expendatures over time. Very different objectives.

      Pearlstein is also dead wrong to assume on the politics of these plans. The right wing has fully embraced Ryan’s plan as the be all end all solution to health care costs. The left wanted Medicare for all and didn’t get it. They resolved themselves to a highly regulated system with a public option and didn’t get it. They ultimately got a moderately regulated system with a mandate and no public option which was and still is a tough pill to swallow for many. It got embraced as better than status quo and a good first step, but I don’t hear anybody claiming its the ideal solution.