Search Results for 'Ryan'

Ryan and Wyden Reform Medicare

Representative Paul Ryan and Senator Ron Wyden have proposed a reform of Medicare that is similar to many other proposals that have been made of late, but with considerably more detail. They explain their plan in a Wall Street Journal editorial  and in a white paper. Austin Frakt has a summary. Avik Roy has a discussion of some of the issues as well as commentary on what other bloggers (left and right) are saying.

Basically:

  • Medicare would be redesigned: Parts A and B would be combined to produce a single plan with catastrophic coverage (no need for Medigap).
  • Seniors would be able to choose among competing private plans, just as they do today under Medicare Advantage, and the regulations would be more flexible.
  • There would be competitive bidding by the private plans.
  • The growth of Medicare (and presumably of the government’s premium support for private plans) would be restricted to real GDP growth plus 1 %.

I like this plan. It is similar to the NCPA approach. But like other eat-your-spinach reforms, this plan shifts a burden to young people without giving them new tools to be able to manage that burden. Workers need to be able to save in tax free accounts in order to replace the lower level of spending by government in future years. About 4% of payroll would do the trick.

Dec 16, 2011 | 8 comments | by

Paul Ryan Proposes Universal Health Coverage via Tax Credits

Ryan proposed a variation of John Goodman and Mark Pauly’s proposal to provide universal coverage through a refundable tax credit: “Patient-centered reform means replacing the inefficient tax treatment of employer-provided health care with a portable, refundable tax credit that you can take with you from job to job, allowing you to hang onto your insurance even during those tough times when a job might be hard to find.”

Portable health insurance also solves the pre-existing condition problem that is an artifact of our employer-sponsored system. “Instead of top-down price controls imposed by 15 bureaucrats at IPAB, let’s try bottom-up competition driven by 300 million consumers.”

Avik Roy column.

Sep 29, 2011 | 8 comments | by

Capretta Responds to Ezra On Ryan Care

[W]hen Rep. Paul Ryan proposed a broader reform of Medicare that is modeled on the Part D success story … Washington Post blogger Ezra Klein … argued: (a) that spending on prescription drugs throughout the health-care system (that is, not just in Medicare) is also far below previous expectations, which proves that Part D’s market-based design had nothing to do with costs’ coming in under budget; (b) that, regardless of what has happened to date, future Part D spending is expected to rise rapidly, thus undermining claims of cost discipline; and (c) that Part D premiums are 57 percent higher in 2011 than in 2006.

Unfortunately for Klein, each of these criticisms is easily dismissed.

See full James Capretta piece.

Jun 22, 2011 | 5 comments | by

Ryan’s Plan

Rep. Paul Ryan (R-WI) has proposed a Medicare reform plan that is being contrasted with the approach adopted by the Patient Protection and Affordable Care Act (PPACA), what some people call ObamaCare. Even though Republicans are backing away from the plan, it is the centerpiece of the House Republican budget. It’s also attracting a lot of criticism from the Obama administration and from left-of-center commentators. For example, Health and Human Services Secretary Kathleen Sebelius says it will cause seniors to “die sooner.”

Both ObamaCare and Paul Ryan propose very large cuts in Medicare spending — cuts that will continue indefinitely into the future. As I said in a previous post, neither plan has a serious proposal to slow the rate of growth of health care spending overall. So under both plans, the amount that the federal government will spend on care for the elderly and the disabled will fall further and further behind what everybody else is spending. (See the spending charts here.)

httpv://www.youtube.com/watch?v=HXGz8i0I2L0

Someday We’ll Be Together

May 09, 2011 | 23 comments | by

Obama, Ryan and You

Both parties are being disingenuous about Medicare reform. So let me be the first to open Pandora’s box and reveal three unpleasant truths.

First, health care spending is growing at twice the rate of growth of our income — clearly an unsustainable and undesirable spending path.

Second, any plan to reduce the growth rate of federal spending on health care without doing something about health care spending as a whole will necessarily shift costs — to the elderly, to the poor, to state governments, and to anybody other than the federal government.

Third, neither party is offering a serious plan to control health care spending as a whole.

Let’s start with President Obama, since his plan is already law. The administration calls it the Patient Protection and Affordable Care Act (PPACA). Other people call it ObamaCare. Whatever you call it, if you are confused about what it means, that’s understandable.

So tired of the straight line, and everywhere you turn
There’s vultures and thieves at your back
The storm keeps on twisting, you keep on building the lies
That you make up for all that you lack

May 02, 2011 | 36 comments | by

Obama: Ryan’s Ideas Are Too Radical Unless They’re Also My Ideas

What is it about the [Paul] Ryan plan that liberals find so appalling and unacceptable? Well, according to the president’s speech — and columns by Alan Blinder, Paul Krugman, and Ezra Klein — it’s the fact that the Medicare “premium-support credits” could be used only for private insurance, and that the credits themselves would be indexed on an annual basis to consumer inflation, not health costs. They argue that, as the years go by, the credits will fall farther behind the actual cost of insurance, and leave seniors with larger and larger premium bills.

But, wait a second, there’s something vaguely familiar about how the Ryan Medicare plan is supposed to work … In the new state-based “exchanges” erected by Obamacare, persons with incomes between 133 and 400 percent of the federal poverty line will be eligible for new, federally financed “premium credits” — dare we say “vouchers”? These vouchers can be used only to purchase the private health-insurance plans that are offered in the exchanges … growth in the government’s contribution will be limited, first to the rise in average incomes and then the CPI.

That’s right: Obamacare’s new health-entitlement vouchers are indexed to general consumer inflation too. So if Ryan’s Medicare plan is “cruel” and “inhumane” because the credits supposedly fall behind rising costs, then the exact same criticism can be leveled against Obamacare.

Full editorial by James Capretta at National Review Online is worth reading.

Apr 21, 2011 | 6 comments | by

Ryan on Ryan

Three principles of entitlement spending:

  • No amount of taxes can keep pace with the amount of money government is projected to spend on health care in the coming years. Medicare and Medicaid are growing twice as fast as the economy — and taxes cannot rise that fast without a devastating impact on jobs and growth.
  • If you believe that spending on these programs can be controlled by restricting what doctors and hospitals are paid, know this: Medicare is on track to pay doctors less than Medicaid pays, and Medicaid already pays so little that many doctors refuse to see Medicaid patients. These arbitrary cuts not only fail to control costs, they also leave our most vulnerable citizens with fewer health-care choices and reduced access to care.
  • And if you believe that we must eliminate waste, fraud and abuse in these programs, know this: Eliminating inefficient spending is critical, but the only way to do so is to reward providers who deliver high-quality, low-cost health care, while punishing those who don’t. Time and again, the federal government has proved incapable of doing that.

Full editorial at The Washington Post.

Apr 15, 2011 | 10 comments | by

Posner: Details of Ryan Plan Don’t Matter

The significance of the plan lies not in its details, or indeed in any of its proposals, but rather in the willingness of a major politician to challenge entitlements spending. This is only part of the plan but it has great symbolic significance, displays political courage, may open a productive dialogue, and challenges President Obama to propose his own plan for limiting such spending, which he has thus far been too timid (or politically realistic!) to do…

Perhaps some politician will be bold enough to advocate that all entitlements programs, including social security as well as Medicare, be means-tested, as Medicaid is. There is no reason why people who can afford to provide for their retirement should be subsidized by the government, which is to say by the taxpayer.

Full Richard Posner post at the Becker/Posner blog. See Gary Becker’s post here.

Apr 11, 2011 | 8 comments | by

Paul Ryan’s Medicare Reform Falls Short

The Medicare part of Paul Ryan’s budget proposal, Path to Prosperity, is superior to the status quo, or anything proposed by President Obama. Unfortunately, it falls short of the high standard he set himself last year, in Roadmap for America’s Future.

The Roadmap contained a very precise Medicare “payment” (in Mr. Ryan’s words) of $11,000, to be adjusted for future inflation by a factor combining changes in the Consumer Price Index and changes in medical prices, for future Medicare beneficiaries who are now under 55 years of age. Path to Prosperity, however, eliminates the “payment” in favor of the woolier “premium support.” Nor does it even report how it would calculate this premium support, beyond asserting that “wealthier beneficiaries would receive a lower subsidy” (p. 46).

Under the previous Roadmap, you could have taken the “payment” and used it to “to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market” (p. 51).  In other words, you had the freedom to buy a Medicare Advantage plan, or to pay your employer for a retiree health plan, or buy an individual plan regulated by your state’s Insurance Commissioner.

Not any more: Under the current proposal, we’d be forced to choose a plan from a federal “tightly regulated exchange” (p. 47). We need to put this talk of “exchanges” to bed until we finally get rid of ObamaCare.  People rightly associate an exchange with a limited choice of plans selected by a politically appointed board, offering benefits determined by bureaucrats’ whims.  This is what motivates those who are currently blocking states from implementing ObamaCare’s Health Benefits Exchanges, or preventing Dr. Donald Berwick — an outspoken champion of medical rationing as practiced by Britain’s National Health Services — from taking over the Centers for Medicare & Medicaid Services.

Apr 08, 2011 | 15 comments | by

The Ryan/Rivlin Plan

Congressman Paul Ryan (R-WI) and Alice Rivlin, former director of the Congressional Budget Office (CBO), have proposed an entitlement spending reform plan that is striking both for its boldness and its left-right-coming-together origins. There are a number of interesting parts, but I want to focus on the three most important:

  • Medicare would, for the first time, be transformed into rational insurance. Beginning in 2013, all enrollees would be protected by a $6,000 cap on out-of-pocket expenses; in return they would pay for more small expenses on their own.
  • After a decade, people newly eligible for Medicare would receive a voucher to purchase private insurance instead. The value of the voucher would grow at the rate of growth of GDP plus 1% (note: for the past four decades, health care spending per capita nationwide has been growing at about GDP growth plus 2%).
  • Medicaid would be turned into annual block grants to the states. The value of the block grants would also grow at GDP growth plus 1%.

Bottom line verdict: This is a good proposal that deserves serious attention. To guarantee its success, however, more needs to be done to (1) allow the private sector to control costs through economic incentives, competition and entrepreneurship and (2) allow young people to save for the growing share of expenses they will be expected to bear.

Nov 29, 2010 | 18 comments | by
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