Medicare needs a makeover before it implodes, and Sen. Ron Wyden (D-Ore.) and House Budget Committee Chairman Paul D. Ryan (R-Wis.) may have just devised a way. If, of course, you're willing to make some concessions.
The unlikely pair, as Wednesday's editorial puts it, have come up with a "bold and politically risky plan that could help slow the rate of growth of premiums and bring more innovation to the health insurance market without dismantling one of the federal government's most popular programs."
Though the plan doesn't dismantle Medicare, it throws in some curveballs. In allowing seniors the option of buying their own insurance, similar to "Obamacare," for example, the Wyden-Ryan plan would create a more competitive marketplace for health insurance. Says the editorial board:
Why bother providing a private alternative, if Medicare works? Because its costs are growing unsustainably. It's already one of Washington's costliest programs, and its burgeoning demand for dollars is draining resources from other priorities. It can't survive on its current trajectory. Although the healthcare reform law took numerous steps to rein in Medicare, including a cap on its budget that increases only slightly faster than the economy grows, it didn't do enough to eliminate the incentives in the system to demand too much care and charge too much for it.
"The proposal isn't a silver bullet," the board writes. But, they continue: "The fact is, the country can't afford Medicare as we know it today, and last year's healthcare reform law started the process of changing it. The Wyden-Ryan plan is a promising addition to that effort."
Readers take a different view, at least those who are writing up rebuttals on our discussion board. Here are a few of their arguments.
Medicare -- with no adjustments -- for all
A few years ago, the Los Angeles Times published an article by Jaime Court entitled "Medicare for All." Following Court's advice and allowing everyone to enroll in Medicare would be the best way to save Medicare.
In addition, Medicare could be allowed to bid for proper pharmaceuticals. We could also attack the causes of Medicare expenses, such as sugary soft drinks, red meat and environmental pollution. Red meat is a known carcinogen; sugary soft drinks cause diabetes; and we permit all sorts of corporations to dump highly toxic chemicals into our air and water.
Your editorial failed to mention who is paying for Wyden's and Ryan's campaign bills -- pharmaceutical companies and for-profit health insurance companies.
Ryan's plan is nothing but a ripoff. We need to save Medicare as we know it rather than end it.
Are the elderly capable of negotiating with insurance companies?
Articles such as this should give lie to the concept of a liberal press. There simply isn't any major city newspaper that supports positions that were mainstream within the Democratic Party just a few years ago and are still mainstream with the American voters.
The reality is that people's mental health declines as they age. Anyone who has worked with the elderly will tell you that a very large percentage of the elderly are simply incapable of negotiating with insurance companies. Free markets only work when both the consumer and the seller are able to act in their interest.
An insurance market whose primary customers are the elderly will quickly become dominated by the interest of the insurers. In a very really sense this is worse than simply reducing Medicare benefits. Because the insurance providers will not be interested in reducing the cost of the program to the taxpayers, but rather simply in capturing more of the tax money spent on Medicare, quickly the insurance companies will become a lobby for more and more Medicare spending, less and less of which will be spent on patients.
Even if this dynamic did not come to pass, healthcare is not a traditional market. HMOs started to fail to contain costs not because of customer complaints or the movie As Good As it Gets but because the hospitals consolidated to control the market.
A conspiracy theory about Ryan
I don't know what Wyden thinks he's going to get from this, but Ryan DOES want to end Medicare, and this is his first step.
A *serious* effort to reduce Medicare costs would include negotiating drug prices, re-importing drugs that have been exported from the US, and putting controls on insurance companies (on both prices and profits). A national plan that included everyone would help. (So would single payer.) You'll notice that NONE of those are being proposed.
A better plan
This editorial seems to back up its approval of Wyden/Ryan with a balanced view of its strengths and weaknesses. However, its dependence on the current Healthcare Reform Act makes it a risky bet in the unfortunate event of a Republican November upset. If the Republicans get control of all three branches, they will favor corporate interests, ensuring that Big Insurance and Big Pharma will prosper at the expense of the public. I would rather see a more comprehensive effort to improve healthcare for everyone, not just seniors. Although it is true that seniors run up big end-of-life medical bills, many costs could be reduced through a system based on lifetime health promotion and access to preventive care for all -- rich and poor alike.
*For clarity purposes, spelling errors in the above comments have been corrected.
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Photo: Protesters are seen on April 26 outside Gateway Technical College in Kenosha, Wis., where Rep. Paul D. Ryan (R-Wis.) was speaking. Credit: Jeffrey Phelps / Associated Press