Ryan, Wyden, and the health care reform debate

I have already answered my 10th email of the morning asking me what I think of the Ryan-Wyden plan for Medicare. The short answer is: it hasn’t been fully released yet, and I can’t comment on something until I’ve had the chance to evaluate it fully.

But here are my gut thoughts based on what I’ve seen so far. I agree that – as described at the moment – this seems like it’s making Medicare more like the ACA in the future, but with a big difference. It sets actuarial minimums, it demands guaranteed issue and community ratings, it sets the subsidies by competitive bidding, and it allows for plan switching. But it’s different than the ACA in that it contains a fee-for-service public option.

I expect that those who are dyed-in-the-wool single payer supporters will oppose this, as it can be seen as the first step towards dismantling traditional Medicare. I expect that those who are dyed-in-the-wool free marketeers will oppose this because it doesn’t do enough to dismantle traditional Medicare. But everyone else is going to be in a bit of a pickle.

I’ve often been snarky towards those who think that a single payer system is American as apple pie if you’re 65, but communism if you’re 64 (I’m looking at you, Congress). But if this proposal picks up steam, it will flip things for many people. It will be hard to argue that the ACA is a viable, progressive solution for universal coverage if you’re 64, but free-market-heartlessness if you’re 65. And many who wholeheartedly supported the ACA will find themselves in that position moving forward. After all, this program even has a public option.

Moreover, with Ryan’s support, many who want to repeal the ACA may soon be in a similar spot. How do you support this plan as a sensible solution for universal healthcare if you’re 65, but believe that it’s tyranny and the end-of-freedom if you’re 64? After all, the ACA doesn’t even have that public option.

Now, if no other Democrats besides Sen. Wyden and no other Republicans besides Rep. Ryan support this, then they’ve just gone out on a limb, and nothing will change. But Ryan is not the most liberal of Republicans, and Wyden is not the most conservative of Democrats. I think it’s likely that others will sign on. When that happens, the whole dynamic of the discussion could change. That is, if the media is paying attention, and can learn to ask good questions.


Note from Austin: My post on the Wyden-Ryan plan will appear at noon. Many questions will be answered and many asked.

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