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Ryan’s Trojan Horse


As an addendum to yesterday’s post, I think K-Drum is conceding way too much here:

There are plenty of things to dislike about Ryan’s 2013 plan, but the truth is that it’s not that bad. I doubt very much that it would hold down costs without other mechanisms in place, since it relies primarily on competition between insurance companies, and insurance companies simply aren’t the main source of high healthcare costs in the United States.

Saying that voucherizing Medicare merely wouldn’t “hold down costs” is far too charitable. In fact, the evidence is unambiguous that voucherizing Medicare would increase costs all things being equal, since private insurers are clearly less efficient than actually existing Medicare. And, moreover, Ryan/Wyden would place increasing pressure to abandon superior government-provided health care, and the constituencies this would create would put immense pressure on future governments to make New Coke Medicare a better deal for insurers and a worse one for the people it’s supposed to cover. And here’s where Ryan’s 2012 version remains relevant: his goal is the complete dismemberment of Medicare. He presumably believes that his 2013 would be a substantial step in this direction — and I think he’s clearly right about that (and Wyden, whose participation in this con remains utterly mystifying, is wrong.)

In a similar vein, Matt Stoller responds to my point that describing Ryan/Wyden as the “Dem policy” is wrong, for the obvious reason that it is not in fact the Democratic policy in any meaningful sense. Needless to say, Stoller doesn’t provide the evidence he needs — that is, Obama or someone in the Democratic congressional leadership endorsing the voucherization of Medicare. Which isn’t surprising, since if the Democrats wanted something like Ryan 2013, they could have gotten it when they controlled both houses of Congress in 2010. So what is the basis for calling premium support the “Dem policy”?

Jonathan Gruber, the most influential health care policy wonk in the Dem party, supports it.

On its face, this is silly — a policy not supported by the incumbent Democratic administration or the Democratic leadership in either House is “Dem policy” because an “influential wonk” supports it? Right. But it gets worse — what does Gruber actually have to say about whether voucherizing Medicare is the right policy right now in the link Stoller provides?

“I think, ultimately, something like Ryan-Wyden is a good place to be, but not yet,” Gruber said. “In the long run, it’s a very good model. But right now we’re not good enough at risk adjustment and we have a plan that is working for seniors. Why rip that up and start over?”

In other words, even the “influential wonk” doesn’t favor replacing with Medicare with “premium support” as of now. He might support it in the future, apparently, if we realize a (probably over-)optimistic scenario in which the ACA produces a tolerable replication of single-payer with private insurance, like the Swiss system. As with Drum, I think this is conceding too much. But for the time being, even if we assume that “Dem policy” is unilaterally determined by Jonathan Gruber, the Democratic policy is to preserve Medicare. The only reason to say otherwise is if you’re committed enough to blurring huge gulfs between Democrats and Republicans that you’re actually willing to assert that electing the man who put Paul Ryan on the ticket might be “modestly good” because “he’s more liberal than people think.”

UPDATE: Kevin’s follow-up does properly eviscerate Ryan 2013.

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