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.