• Paul Ryan’s new Medicare plan

    This post has an unfair title. I’m writing this to say that I’m not going to be writing about Paul Ryan’s new plan for Medicare, which is to be released as part of the House GOP budget today at 10AM. I have five papers in process (i.e., too much paid work to do), so I have no time to write new blog posts.

    However, we can crowd source this. If you see analysis and commentary on the plan, feel free to drop links in the comments. I might be able to swing back later or tomorrow and pull them into the following list. Just to get us started, here are some background materials:


    • So far at least it is impossible to comment on the plan, because there are not enough details.

      Assuming the plan is basically the same as has been previously proposed, it is one that destroys the concept of health care insurance access for those 65 and over. The reason is that by replacing Medicare with private insurance will allow private insurance to “cherry pick” senior, offering good coverage at low premiums for the young and healthy senior, and leaving the older senior who have health problems with either very high unaffordable premiums or leaving them on Medicare which will simply not have the funds to provide for their care.

      The single payer plan works for Medicare because it creates the largest possible pool, spreading risk over the largest possible base. This is basic insurance 101, but insurance principles seem to be totally misunderstood by people in politics talking about Medicare.

      And yes, you didn’t ask but the issue with Medicaid is block grants, with insufficient funding. This will shift the blame from the federal government onto the states, who will not be able to make up the shortfall. Changing Medicaid to block grants has only one purpose, cutting funding.

    • Okay, we now do have the CBO analysis, which confirms the earlier comment that we really don’t have enough detail to make an intelligent observation, but the likely outcome is this.

      “The implications of that substantial cut in spending relative to the other policy scenarios are unclear, because they would depend on both the specific policies that were implemented to generate that spending amount and the ways in which the nation’s health care and health insurance systems reacted to those policies.

      Possible consequences include the same kinds of effects noted for the baseline and alternative fiscal scenarios—reduced access to health care; diminished quality of care; increased efficiency of health care delivery; less investment in new, high-cost technologies; or some combination of those outcomes. In addition, beneficiaries might face higher costs, which could in turn reinforce some of the other effects.

      At least some of those effects would of necessity be a great deal stronger than under the baseline scenario or alternative fiscal scenario because spending would be so much lower. However, as with the other scenarios, CBO does not have the capability at this time to estimate such effects for the specified path of Medicare spending.”


      And yes, if you look at their charts on Medicare and Medicaid it confirms the earliest post. These programs are devasted.

    • Well, the problem we are having even in a state as historically progressive as Washington State is that the State Congress and Senate are contemplating a budget which will cut state health care spending to the point where it sacrifices Medicaid dollars for mental health matching spending in the process.
      This is relatively unprecedented in Washington where we a surplus of Federal and private/public matching funds have met any lack since the birth of unions. Oh, unions, that is what all of that is what all of this health care for the masses is based on in the US. It comes from the Blue Cross/Blue Shield insurance plans from unionized railroad workers.
      I am not in primary care, but I still would like to know, who is going to do do the “wet work” of medicine? The long hours, the low pay, the hostile patients, the high liability, and the endless paperwork ? I have had enough of that as a splash back in my low paid specialty to drive me crazy..