OP-ED

Paul Ryan Still Doesn’t Get It

Republican House Budget chief Paul Ryan still doesn’t get it. He blames Tuesday’s upset victory of Democrat Kathy Hochul over Republican Jane Corwin to represent New York’s 26th congressional district on Democratic scare tactics.

Hochul had focused like a laser on the Republican plan to turn Medicare into vouchers that would funnel the money to private health insurers. Republicans didn’t exactly take it lying down. The National Republican Congressional Committee poured over $400,000 into the race, and Karl Rove’s American Crossroads provided Corwin an additional $700,000 of support. But the money didn’t work. Even in this traditionally Republican district – represented in the past by such GOP notables as Jack Kemp and William Miller, both of whom would become vice presidential candidates – Hochul’s message hit home.

Ryan calls it “demagoguery,” accusing Hochul and her fellow Democrats of trying to “scare seniors into thinking that their current benefits are being affected.”

Scare tactics? Seniors have every right to be scared. His plan would eviscerate Medicare by privatizing it with vouchers that would fall further and further behind the rising cost of health insurance. And Ryan and the Republicans offer no means of slowing rising health-care costs. To the contrary, they want to repeal every cost-containment measure enacted in last year’s health-reform legislation. The inevitable result: More and more seniors would be priced out of the market for health care.

The Ryan plan has put Republicans in a corner. Some, like Massachusetts Senator Scott Brown and, briefly, presidential hopeful Newt Gingrich, are rejecting the plan altogether. Most, though, are holding on and holding their breath. After all, House Republicans approved it — and voters don’t especially like flip-floppers.

Senate Democrats will bring the Ryan plan for a vote Thursday in order to force Senate Republicans on the record. Watch closely.

Some GOP stalwarts say the Party must clarify its message – a sure sign of panic. Former Republican congressman Rick Lazio says the GOP “must do [a] better job explaining entitlements.”

It’s just possible the public knows exactly what entitlements are – and is getting a clear message about what Republicans are up to.

All this should give the White House and Democratic budget negotiators more confidence – and more bargaining leverage – to put tax cuts on the rich squarely on the table.

And, while they’re at it, turn Medicare into a “Medicare-for-all” system that forces doctors and hospitals to shift from costly tests, drugs, and procedures having little effect, to healthy outcomes.

Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997. He shares many of his thoughts and columns at Robert Reich, where this post first appeared.

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Guest

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Michael Turpin
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Michael Turpin

A basic conundrum: Finite resources, infinite demand. To shrink the pie, one must either: 1) Ration access to patients – especially for non emergency and elective services. BTW, whoever plays the payer ( private insurance or the government ) will wear the black hat with the patient when they deny something based on lack of medical necessity. This includes as the Mad MD shares tough calls on who gets what, when and where. Can someone say, ” hospice”? 2) Reduce unit cost reimbursement to providers – all payer legislation, global budgets, ( oh, and watch a generation of docs retire,… Read more »

Barry Carol
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Barry Carol

Margalit – Even if Medicare were a single payer system that covered the entire population, it would not be any easier to accurately predict healthcare costs a year in advance than it is under the current system. If you had that model and tried to make it work within a fixed budget, what do you think would happen if the money ran out by the end of November? The answer is that there would be a supplemental appropriation because we’re not going to let people go without care just as we won’t let people die on the steps of the… Read more »

Margalit Gur-Arie
Guest

“If physicians are all going to be government contractors can we all look forward to public health center quality care or VA before it became a national scandal?” Why? Every physician that is not operating on a cash only model, which very few do, is currently a contractor with Medicare and with private insurers. Physicians treat members and the payer pays according to contract terms. Medicare has one contract with everybody (although actual fees vary) and private insurers have different contractual fees. The only difference would be that the doctor at Partners and the solo practitioner across the street would… Read more »

Nate Ogden
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Nate Ogden

” we can estimate what national health care expenditures will be next year, inefficiencies included.”

That’s not good enough, government can’t raise taxes effective next month. If they are off 20% then where does the extra money come? What if we are mid recession where does it come from?

Look at Medicare’s history of projections, if private insurance was half as bad as government at projecting cost they would all be out of business.

Barry Carol
Guest
Barry Carol

“It is prepaid medical services. There is really no risk involved in medical care if you look at it at a national level.” Margalit – That’s not true. Medicare is an open ended entitlement. Bills come and taxpayers pay them. It does not operate within a fixed budget determined in advance. Medicaid works similarly though both the federal and state governments share the cost. There is also plenty of risk even at the national level. Practice patterns vary enormously whether it’s managing patients with diabetes, heart disease or asthma. There are regional differences in determining under what circumstances to recommend… Read more »

Nate Ogden
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Nate Ogden

” Which contracts are easier to work with? Which entity allows you more autonomy and has less red tape?” You don’t work with Medicare, you do things the way they tell you or you go to jail or lose access to all their members. If physicians are all going to be government contractors can we all look forward to public health center quality care or VA before it became a national scandal? “What we call health insurance is not insurance. It is prepaid medical services.” Again Margalit, there is so much you don’t know. Again most private insurance is self… Read more »

Margalit Gur-Arie
Guest

“hatred of insurance, I assume you feel the same way about life insurance, auto insurance, homeowners insurance” What we call health insurance is not insurance. It is prepaid medical services. There is really no risk involved in medical care if you look at it at a national level. It’s an expenditure that can be estimated and budgeted just like other budget items (except wars). So eliminating all the little inner pools of insurance, all pretending to assess and manage risk, which only exists because we fragmented the pool into thousands of artificial sub-pools, is illogical. And expensive. The actual medical… Read more »

Margalit Gur-Arie
Guest

‘Until you can reconsile the fact single payor Medicare is more expensive then everything else you should refrain from voting.”

Interesting. I thought that the “private” version of Medicare, i.e. Medicare Advantage is even more expensive.

I wonder how expensive Medicare would be if it included all the healthy people currently paying into private insurance. What was the MA excess? 14%?

Is this the new conservative idea of how to run a democracy “don’t vote because we know better”?

Nate Ogden
Guest
Nate Ogden

“I thought that the “private” version of Medicare, i.e. Medicare Advantage is even more expensive.”

Do you try to be this obviolous to facts or do you really live under a rock? Have you never compared traditonal medicare benefits to Medicare Advantage? Hint, its cost more becuase you get more.

Don’t vote because your ignorant of the basic knowledge you need to make an informed vote.

What’s with you liberals and your apple to orange comparisons?

Margalit Gur-Arie
Guest

So as a tax payer, I am supposed to pay more for each Medicare beneficiary to private corporations because…… ???
We’re looking to cut Medicare expenses, but somehow now I have to pay for memberships in the Silver Sneakers club for active seniors? Does this have anything to do (again) with keeping the same percentage in profit, but from a larger amount?

Nate Ogden
Guest
Nate Ogden

you don’t need health insurance to live, you need healthcare. Health Insurance exist becuase healthcare is so expensive, health insurance didn’t make healthcare prohibitivly expensive. You can thank government for that. You are still ignoring the fact that 80% of private healthinsurance is non profit so your argument based on profit motive is BS. These aren’t assumptions, your making wild and false claims apparently based on a complete lack of comprehension, instead of getting your facts straight you bury your head in the sand chanting falsehoods. Self funded plans don’t have profit motives and they are 50% of all private… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

“you don’t need health insurance to live, you need healthcare.” True, true. All the more reason to get rid of health insurance. Time to change the paradigm. “Health Insurance exist becuase healthcare is so expensive, health insurance didn’t make healthcare prohibitivly expensive. You can thank government for that.” Ultimately, we can thank supply and demand for that. Once again, I argue we should change the paradigm of supply and demand. Also health insurance does its part in jacking up the price of said health care. “You are still ignoring the fact that 80% of private healthinsurance is non profit so… Read more »

Nate Ogden
Guest
Nate Ogden

At least you admit facts and reality have nothing to do with your thought process. Now if only we could take away people like you right to vote the rest of us would be ok.

Curious though, this ilrational hatred of insurance, I assume you feel the same way about life insurance, auto insurance, homeowners insurance? They should all be non profit or not exist at all?

And when is it you propose providers live on civil servant salaries? $50,000 a year and a pension.

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

When you are arguing over assumptions, logical proof has nothing to do with the argument. The current medicopolitical reality is unsustainable and a failure. Time to create a new one.

I don’t hate insurance, I just think it shouldn’t exist or should exist on a (really) non-profit model. And no, this doesn’t apply to other kinds of insurance. We don’t need them to live.

AAMOF, I already live on a civil servant’s salary. I am one, and proud of it.

Barry Carol
Guest
Barry Carol

If providers really think that insurers consume 30% of the premium dollar and provide no value added, there is nothing stopping them from assuming the insurance function. Become an insurer, estimate your claims costs, quote a premium and capture what you think are massive profits currently going to insurers. Oh wait, that’s been tried. It turns out that assuming actuarial risk is not so easy and it’s quite possible to go broke quickly if actual claims costs materially exceed estimated claims costs. Insurers are, in fact, a lot better at assuming actuarial risk than providers are because they have better… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

@Mssrs. Carol and Ogden, I’m a doctor, not an insurer. I do something real with my life, not shuffle other people’s money around, while taking a cut off the top. I don’t need to pull dubious numbers out of my rectumAhem. Which brings me to the point. The Ryan plan is just tinkering with the current system, which is the bastard child of socialism and capitalism. The current system is not working for most people, although it is working for insurance company executives and their shareholders. I am arguing for revolution, not incremental change. No profit motive in medicine for… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

“If providers really think that insurers consume 30% of the premium dollar and provide no value added, there is nothing stopping them from assuming the insurance function.”

First, I’m a physician, not a provider.

Second, yes there is something preventing me from assuming the insurance function: I want to do something real, substantial and honest with my life. I have no desire to get money for nothing.

Nate Ogden
Guest
Nate Ogden

“have done nothing to reduce cost and I would venture a guess that they may have contributed to the rising of costs.” How can you come off as lucid some days then say completly stupid things like this? Nothing really, PPOs don’t reduce billed charges? Utilization review? Bill audits? What’s increased cost is government and clueless liberals making statements like nothing has reduced cost then passing laws based upon that warped view. “There is no one in the medical complex, including private insurers, that would benefit from lowering costs.” Sorry for the bluntness but you managed to raise the bar… Read more »

Margalit Gur-Arie
Guest

Unless you have actual numbers to prove that the cost to insureds has been reduced, all we have is the ever increasing cost curve. Could it be that, as you argued here many times, 5% of more money translates into larger profit? And could it be that all those bureaucratic activities you describe, indeed decrease the portion spent on actual care, but do very little for the overall cost to consumers?

If employers wanted to slash their health care expenditures, they should support single payer.

Nate Ogden
Guest
Nate Ogden

Yes Margalit I have actual numbers. Every time I process a claim with a PPO discount I know for a fact I saved them money. When I audit a hospital bill I know for a fact money has been saved. When I write a new piece of business and reduce their premium 10% I know for a fact I saved them money. You don’t seem to grasp that not all insurance is written by carriers. You also can’t seem to get your head around the concept that it could be far worse then it is now. “If employers wanted to… Read more »

Margalit Gur-Arie
Guest

“..why not wish for Fairy Guardians that keep us healthy with their magic wand?…….. You want individuals to determine what care they will and will not get only with the consultation of their doctor…. you propose to eliminate all cost control.” First of all, all the cost controls that supposedly exist today, have done nothing to reduce cost and I would venture a guess that they may have contributed to the rising of costs. There is no one in the medical complex, including private insurers, that would benefit from lowering costs. Everybody has a nice last resort release valve called… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

Good one.

Margalit Gur-Arie
Guest

“…the cost to run CMS, Congress, Treasury, collection, buildings, and countless other cost”

We have to run those anyway, so might as well use them. It’s called “economies of scale”.
How much does it cost the system just to process claims today? Including all payers, all middlemen, all providers (including time on the phone).
How much goes to marketing? How much goes to benefit design? How much goes to shareholders and other profits (including hospitals)?

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

Which again brings me to my point: how do we justify spending all the money on shareholders, executives, physical plant, staff time and secretaries? Why not just replace them all with a few civil servants and be done with it? If the money is not going to provide actual health care, why is it going in the first place?

Nate Ogden
Guest
Nate Ogden

” how do we justify spending all the money on shareholders, executives, physical plant, staff time and secretaries?”

Because even when paying for shareholders, executives, and everything it is still cheaper then paying civil servants. I’ll point this out to you again, evil private insurance “cost” $360 to $720 per person per year. Medicare cost $700 to $1050.

Civil Servants don’t save money and this has been proven time after time for 30 years.

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

The many socialized health care systems around the world that deliver care at a fraction of the cost of our own argue conclusively against this. The socialized, civil-service systems are much cheaper than our own. Face it. Private insurance in this country is subsidized by Medicare, which takes the oldest, sickest and most costly patients off the books for private insurance. If private insurance took over Medicare patients, the cost of private insurance would sky rocket and the actual care delivered to that population would fall thru the floor. Once again, private health insurance in this country is ultimately parasitic,… Read more »

Nate Ogden
Guest
Nate Ogden

Wow the inteligence on here drops to zero on the weekend. Think through some of these comments….for the first time apparently. “Private insurance in this country is subsidized by Medicare.” ? how, Medicare through cost shifting and administrative complexity increases the cost of private insurance for the population it serves. Now if your saying private insurance premiums are lower then they would be if they covered people over 65 that is true but that is not a subsidy. No Medicare does not take the sickest, how many premature babies are covered by Medicare? What’s with you and margalit making all… Read more »

Nate Ogden
Guest
Nate Ogden

36 million enrolled in traditional Medicare “A four month “Nightline” investigation into Medicare fraud makes one thing perfectly clear: this is a crime that pays and pays and pays. The federal government admits that a staggering $60 billion is stolen from tax payers through Medicare scams every year. Some experts believe the number is more than twice that.” That works out to $1,666.66 per Medicare enrollee per year. Private insurance only cost around $3600 total per year. Private insurance admin at most would be $720. According to ABC news and the government half of what Medicare loses on fraud alone.… Read more »