To believe that Paul Ryan’s plan to eliminate Medicare and replace it with a voucher system is anything but a disaster waiting to happen, you have to imagine that it’s possible to run a functional individual market in health insurance for seniors. This is obvious fantasy. The health insurance market for non-retirees kinda sorta works because health insurance comes bundled with employment. That limits the extent of “adverse selection”: healthy people opting out of insurance. But it obviously won’t work for retirees.
The health care costs faced by older people are not only higher, but much more variable, than those faced by younger people. So even ignoring the fact that under the Ryan plan people who retire after low-wage careers would wind up spending about 2/3 of their retirement income on Medicare-equivalent health insurance – and that’s before we even get to the stuff Medicare doesn’t cover – the proposal is simply incoherent.
If the Obamacare principles of guaranteed issue, community rating, and full coverage for pre-existing conditions apply, the only rational strategy for non-rich seniors will be to “go naked” until they get expensively sick and then buy insurance. If they don’t apply, then sick elders won’t be able to get any health insurance at all.
“Intellectually serious”? Not in this space-time continuum.