(This column is cross-posted at the Century Foundation’s Taking Note)
More than 190 health policy experts really, really hate the Ryan proposals. This is a pretty distinguished group: Hank Aaron, David Cutler, Judy Feder,, Jacob Hacker, Harold Pollack, Uwe Reinhardt, Theda Skocpol, Paul Starr–you know, people like that. In a letter to congressional leaders, these scholars had this to say about Medicaid:
We write this letter to oppose plans to convert Medicaid to a block grant and to cut Medicaid benefits.
These changes would do nothing to improve quality but would ration care to millions of Americaâ€™s most
Medicaid supports health care for nearly 60 million people, including 30 million children. Two-thirds of Medicaid
expenditures support services for impoverished people who are elderly or who suffer from disabilities. By spreading
the cost of care between federal and state budgets, Medicaid helps state governments maintain services during
Looming budget deficits have led some to propose capping federal spending by converting Medicaid into a blockgrant
program. We recognize the challenges posed by budget deficits. Actions must be taken to close those deficits.
Yet block granting Medicaid is both unfair and unwise. During economic downturns it would expose states to the
full costs of increasing enrollments just when their revenues are falling. The inevitable result would be curtailed
services, reduced eligibility, and increased charges that many low-income patients would be unable to pay, forcing
them to forego care or placing burdens for uncompensated care on hospitals and physicians.
And this to say about Medicare:
Advocates of vouchers seem unwilling to label what they are advocating for what it is, and seek to rechristen their
plan as â€œpremium support.â€ Premium support referred to payment linked to health costs, not a more slowly growing
economic index. It entailed aggressive regulation to promote informed choice by patients. The voucher proposals
now being advanced have none of those protections.
We are particularly concerned by recent Congressional Budget Office analyses, which indicate that current proposals
would link voucher payments to growth in the Consumer Price Index adjusted for population growth. Because
medical care costs are rising much more rapidly than the CPI, this guarantees that the value of the proposed
Medicare vouchers would erode over time. By 2030, the Congressional Budget Office estimates that a typical
65-year-old would pay more than twice as much for health care under the voucher proposal than that individual is
predicted to pay under current law….
In summary, turning Medicare into a voucher program would undermine essential protections for millions of
vulnerable people. It would extinguish the most promising approaches to curb costs and to improve the American
medical care system. We urge responsible members of Congress to reject calls for repealing traditional Medicare
and to support vigorous implementation of the Affordable Care Act.
The Congressional Budget Office has essentially echoed these findings in a devastating analysis. Paul Ryan is an appealing guy. He has produced an extreme and appalling proposal for the future of American social insurance.