• Key to Wyden/Ryan is the ACA

    The Wyden/Ryan compromise Medicare reform was announced yesterday. Austin looked at the policy and politics; his series on premium support is required reading. Aaron also had several good posts up right away.

    In policy terms, something like this proposal will likely be adopted one day in Medicare, for both political and policy reasons. I used to call for an end to private insurance options in Medicare. However, having no private insurance option in Medicare is a fantasy of the left, just as having no public option (traditional Medicare) is a fantasy of the right. Given that there will likely be some sort of private insurance option in Medicare along with a public one, I think that some version of premium support based on competitive bidding could be better than our current Medicare Advantage program. And we must do something. The Wyden/Ryan plan continues that part of the conversation.

    It is true that Rep. Ryan moved to the center from his initial Medicare proposal, but that only means he moved away from his fantasy with respect to Medicare, as have I. However, I am unable to give a final grade to the Wyden/Ryan proposal without knowing what we will do to expand coverage (or not) for people under the age of 65, while seeking to slow costs and improve quality. If Wyden/Ryan were a part of a deal that also adopted a compromise to modify and implement the ACA, then maybe (but more details are needed).

    In fairness to Rep. Ryan, he has a replace plan for the under 65 set, the Patients’ Choice Act, introduced before any House committee passed any version of the ACA in 2009, and which he recently re-embraced. I have blogged quite a lot about this bill and as always, the details are important. I see a great more policy overlap between the PCA and the ACA than Rep. Ryan’s rhetoric suggests. However, the big picture is more telling on replace than are the details of any one proposal: no House committee has marked up any sort of comprehensive replace bill  since the Republicans took control of that body. Nothing. It is very easy to say what you are against, but hard to get 218 votes in the House, 60 in the Senate and 1 in the White House.

    Both political parties claim to be interested in a long range sustainable budget. To achieve this will require a health reform plan. The Democratic party passed one, and the ACA was what could pass. It can and needs to be reformed and changed; we will never be done with health reform, and the ACA gives us a place to start. The Republicans need a deal on health reform in the long-run-achieve-a-sustainable-budget-sense more so than do the Democrats; there is no example of the Republican party using political capital to drive any sort of comprehensive health reform, ever. Without a health reform plan, there will never be another balanced budget, or anything close.

    Wyden/Ryan is only a placeholder unless there is to be a fuller discussion about health care reform. Senator Wyden said the key to his relationship with Rep. Ryan was not discussing the ACA. That conversation has to be had, in the Supreme Court and beyond.


    • Under Ryan/Wyden, Medicare will grow at GDP + 1%, while health care generally will grow, say, at GDP + 2%. That means growing access to cae problems in Medicare proper. To avoid rationing by waiting, beneficiaries will turn to the private plans, where the out-of-pocket expenses will grow through time.

      Utimately: (1) the “public” plan will wither on the vine and (2) young people will be unable to afford their co-shares under the private plans unless they save during their working years for post-retirement care.

      To make all this work, we need a long term HSA, call it a Roth HSA. I’ve written about it elsewhere.

    • How does the Republican’s failure to produce comprehenisve legislation to replace the ACA compare to the Senate’s and the Administration’s efforts on the 2012 budget?

    • @Will
      If the Dems had 60 votes in the Senate then their failure to pass a budget might be more comparable to the House not passing a comprehensive replace. However, the Rs made repeal and replace such a big deal in the 2010 election, no movement is quite telling. And you can imagine a Dem Senate budget, but I can’t imagine a comprehensive replace plan getting 218 Republican votes in the House. I am not sure they could even pass one would of Ways and Means or Commerce where the heavy lifting would have to first be done.

    • That might be true except that the Democrats didn’t propose a budget the last time they controlled both houses and the President hasn’t proposed a serious budget since his first one.

      With respect to the Repulbicans offering comprehensive repeal and replace legistlation, Paul Ryan has been working on this in good faith and those who seek bipartisan solutions are met with the following kind of encouragement.

      The Republicans are stereotyped in the media and among fashionable academics as extremeists but the Democratic Party has become an inhospitable place for serious thoughtful moderates — ask Joe Lieberman, Evan Bayh, and Jim Webb, for example. There’s a lot of evidence that the White House never engaged with moderates in its own party and its approach to legislation when it thought it had a permanent supermajority empowered and created extremists on the other side. Erskine Bowles, for example, when he was head of the deficit reduction panel said the following: “I told the people in the White House I had spent more time listening to people in the opposition party than they had done as a whole group.”

      • @Will
        I agree the Congress is dysfunctional, particularly the Senate. That said, if you think back to Simpson-Bowles, 5 of the 6 Senators voted yes and 5 of the 6 House members no (incl Paul Ryan). My hunch is that when the actual big deal comes about, it is started in the Senate (not in this congress). You should read my book It is the policy and political argument case for balanced budget from a progressive perspective.