Health policy experts really, really dislike the Ryan plans

More than 190 health policy experts really, really hate the Ryan proposals….

(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 America’s most
vulnerable citizens.

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
economic downturns.

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 “premium support.” 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.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

12 thoughts on “Health policy experts really, really dislike the Ryan plans”

  1. Well of course they don’t like it. The Ryan program distributes administrative control of the programs. The elitists like central command, especially when they get to dominate the decision making. One fatal flaw in their logic is to assume that health care costs must continue to rise at a rate faster than inflation. That assumption, as a self-fulfilling prophecy, assumes the system is doomed, regardless of the approach chosen, including continuing as is.

  2. If the Medicare voucher plan were to become policy, the (insufficient) “premium support” would decline year by year, until finally there would be nothing there.

    I think the real goal of this plan is to incite generational conflict, because instead of arguing against the plan on its (lack of) merits, too many people argue against it as being unfair to the below-55’s. This is just a way to get the under-55’s lined up to institute the plan for everyone, just like how those who had their private pensions stolen from them are now arguing that public pensions should also be stolen.

    Paul Ryan et al. know very well that the way to win the (class) war is to have the victims all fighting against each other, until all the scraps are gone.

  3. Cutting to the chase, aka, the Crux of the Problem

    If we can imagine a good faith, informed discussion/debate on this issue then Ryan’s “plan” is as much a “serious” proposal as would be an IED on a Sunday drive, i.e. it should be rejected out of hand, immediately.

    Almost all discussion boards offer hundreds and hundreds of plausible solutions to our numerous, and varied, problems. And many of them are certainly doable. So, when the author of a blog gives us a topic, the responses come fast and furious; “we should do this, they should do that,” etc. As I said, finding solutions is easy, but this is politics, and that makes implementation (almost) impossible.

    Having worked in management for a fortune 500 company (once a Dow Jones Co,) for 35 years, the last 10 as their senior negotiator, its beyond obvious that the problem isn’t being on the right side of the issue; the problem is that one side knows how to win, and the other does not.

    What has made these past couple of years so damn perplexing is that we know one side’s goal, and we’re playing amateur psychoanalysts trying to figure out the others’. All we know about President Obama is that he wants bipartisanship. But, what his core beliefs are, or what policies he wants, we draw a blank.

    Make no mistake about it, the “other side’ wants nothing less than the total destruction of our country as most Americans have come to believe it should be. Unless we have Leadership as committed as theirs,’ we’re doomed.

  4. Pro-tip: any reference to “experts” will be countered by referencing “elitists”. Have you been asleep since for the last 50 years?

  5. Redwave72,

    One fatal flaw in their logic is to assume that health care costs must continue to rise at a rate faster than inflation.

    Well, PPACA takes some steps to slow the rate of growth. The GOP doesn’t seem to like that. Maybe you should address your complaints elsewhere.

  6. Sadly, negotiations on the Ryan Plan are going to hold the debt limit debate hostage. The equally unworkable McCaskill plan (limits medical spending to GDP levels below 2008 will then be trumpeted as the credible alternative). Once adopted, the only way to meet the McCaskill goals will be to adopt Ryan-like cuts to Medicare. This is going to be a very dangerous negotiation and the Republican hostage takers will be in full force with no evidence whatsoever that the Democrats have learned how to deal with that.

  7. its beyond obvious that the problem isn’t being on the right side of the issue; the problem is that one side knows how to win, and the other does not.

    What has made these past couple of years so damn perplexing is that we know one side’s goal, and we’re playing amateur psychoanalysts trying to figure out the others’. All we know about President Obama is that he wants bipartisanship. But, what his core beliefs are, or what policies he wants, we draw a blank.

    Make no mistake about it, the “other side’ wants nothing less than the total destruction of our country as most Americans have come to believe it should be. Unless we have Leadership as committed as theirs,’ we’re doomed.

    This is how I see it as well, altho not certain about the ‘total destruction of our country’ part. But yes, it should be easy to be a successful opposition party in this country at this moment – just sack up. That’s it. Nothing else is required.

  8. One of the big problems here is the notion that “Paul Ryan is an appealing guy”. It really makes you think that a certain country would own much of central and eastern europe if only they hadn’t insisted on their public face being a guy with such a funny mustache.

  9. I was surprised and disappointed to see a Brookings staffer among the signatories. Brookings, in association with the Urban Institute and the Committee for Economic Development, published Vouchers and the Provision of Public Services, which ranges over a variety of voucher and voucher-like programs for a variety of services. The whole book rewards attention. Although several authors contributed, the editors composed a systematic development which the introductory chapters support. The difference between Medicare’s voucher-like programs and explicit medical treatment vouchers is the cap on individual subsidies. This forces people to face inevitable death and the trade-offs we must accept, individually in an unsubsidized market for medical services or collectively in a subsidized environment, to forestall it.

    No surprise to see Michael Meeropol among the signatories, or Harold Pollack rubbing shoulders with him.

  10. When Mr Redwave used the word “elitists”, I knew I didn’t have to read the rest of his post. Goodwins law lite.

  11. By definition any educated or specially trained sub group can be considered an elite. Bus drivers, plumbers, soldiers, economists and so all are members of an elite.

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