What It Takes to be Considered "Serious" in Washington

The very first post I threw up on this site was about Paul Ryan’s budget.  I have to admit to a kind of horrified fascination with it.  Even in the beginning, when the Beltway cognoscenti were enthusing over how “mature” and “serious” the thing was, I was absolutely taken aback.

And this was for any number of reasons:  it doesn’t really balance the budget, not for decades; it envisions massive tax cuts for the wealthy and for corporations, but doesn’t explain how this lost revenue will be made up (other than by some vague mouthing that unidentified “loopholes” will be closed); its numbers only come close to adding up if the U.S. achieves some never-before-seen unemployment rate of about 2.8%; it anticipates shrinking the federal budget to a portion of GDP not seen since before we had a standing military.  (And do you really think America is going to go back to not having a military?  Having a military is the one thing at which we are indisputably the world’s best).

But above all, the idea that Medicare should be eliminated entirely, and then replaced with $15,000 a year vouchers with which seniors (you know, the poor, the tired, the really sick) can fail to buy can attempt to buy private insurance (although we are still gonna call this bastard spawn of a GOP wet dream “medicare”) . . .   well that is truly revolting.  Not merely because the plan calls for nothing less than throwing our most vulnerable members to the howling wolf of inevitable human decay, which is bad enough, but because its proponents argue that doing so is nothing less than virtuous pragmatism.

The thinking appears to go something like this: 

            (1) providing a minimum social safety net for the most disadvantaged among us is something that the vast, vast majority of people in this country like (“keep the government out of my Medicare!”); but

            (2) increasingly expensive medical costs means that we are either going to have to roll back some of those tax cuts for the wealthy or else get very serious about limiting medical expenses (for example, by using the collective bargaining power of a single-payer system to demand cuts in the prices health care providers charge); but

            (3) both of these ideas are opposed by a small but very wealthy (and thus, very powerful) part of our population, and therefore all Serious People know that these solutions are “off the table”; which means that

            (4) since we aren’t allowed do anything to lower rising medical expenses, and since we aren’t allowed to collect enough money to pay for rising medical expenses, we can no longer afford to maintain that minimum social safety net that is so very popular with the American people; so therefore

            (5) we must get rid of Medicare because (under these self-imposed rules) we can’t pay for it; but since

            (6) Medicare is a very, very popular system – see No. 1, above – any proposal to eliminate it can be counted on to be very, very unpopular; now, therefore,

            CONCLUSION:   Since Paul Ryan has proposed eliminating Medicare in favor of even more tax cuts for the wealthy, he must be considered “politically courageous” and “very serious.”

Only in the bizarro realm that is American politics can an idea that is both inherently revolting and wildly unpopular be considered courageous and serious.  And yet, there it is.  But, to be sure, common sense and rationality must ultimately prevail, right?  Something this evil and ludicrous can’t continue to be taken seriously forever, can it?  I’ve gotta believe that. 

Why Medicare Kicks the Crap Out of Paul Ryan's Voucher Plan

So I was talking with a friend of mine earlier today about health care, Medicare, and the Paul Ryan plan to privatize Medicare. One important point came up that I think should be discussed more because (i) it points out how dangerous the Ryan plan is to everybody, including those already 55 or older, and (ii) it provides a simple illustration why a single-payer system (i.e., "Medicare for All") would actually do more to curb rising health care costs in this country than any other proposed health care reform. And that point is this: Medicare is entirely voluntary, not only for the patients being treated under the program but also for those physicians who provide the treatment.

The way things stand, a lot of health care providers (physicians, private hospitals, HMO's, etc.) don't really look forward to treating patients covered under Medicare. This is because the government has limits on what it is willing to pay for any particular procedure, and these payment limits make treating patients covered by Medicare less lucrative than treating patients who have a private insurance plan. However, many - if not most - of the country's health care providers cover Medicare patients anyway, simply because there are so many people in the country reliant upon Medicare. In other words, the health care providers make less per Medicare patient than they would treating patients covered by private health insurance, but there are so many Medicare patients out there who need treatment that it doesn't make financial sense to turn them away: "How can I sell these [health care services] so cheap? Volume!"

Now as to one reason the Ryan Plan is so bad . . . consider what happens to those currently 55 or older who would still remain eligible to participate in Medicare as it exists today. Everybody else would be forced to purchase private insurance in the market when they turned 65; Ryan's Plan would have the government give you a voucher to help defray the costs of that private insurance, but the voucher would be capped and -- even assuming you could find an insurance company willing to insure you at a rate you could afford after you turned 65 -- the voucher would be worth less and less each year as health care costs went up. Which means that, year after year, seniors would be forced to pay more and more just to have insurance coverage (which would not include co-pays or deductibles, which means the cost of actual health care would increase even more).

But for those 55 and over today . . . eventually, their even older cohort (say, those who are 70 and older right now) would die off. Which means that, with no additional people joining the Medicare ranks, the pool of Medicare patients needing treatment would inevitably shrink. At some point it would not be unreasonable to expect health care providers to refuse Medicare patients outright; they would be too small a pool of patients to justify the lesser charges the health care provider could expect. Which means, of course, that a significant portion of even those the Ryan Plan says could remain with Medicare as it is now can still expect, before they die, not to have access to any entity willing to treat them under that plan.