What color is the sky on Jacob Weisberg’s planet?

Paul Ryan’s plan to voucherize health insurance for the elderly isn’t just heartless: it’s brainless.

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.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

11 thoughts on “What color is the sky on Jacob Weisberg’s planet?”

  1. Mark, thank you so much for writing this!!! I couldn’t believe my eyes either.

    But, I must say, that nice planet he lives on, where everyone is rich and happy (Palo Alto, maybe?) must be very nice. I can see why the Bubble People like to stay in it so much.

    Btw: the market for non-retirees does *NOT* work for anyone who has ever been sick or is over 25. Try getting into Kaiser as an individual. Can’t be done. I was a green-tea-drinking, exercising, non-smoking semi-vegetarian in my 30s, and they weren’t having any (twice).

  2. This is the battle to be fought. Too many so-called “pundits” like Weisberg aren’t bothering to really think about the proposal. It’s too easy to accept the conventional wisdom that we are in dire circumstances and this is some sort of bold stroke to get us out. It’s not, but unless we can convince the Weisberg class – who are regrettably either innumerate or not inclined to analyze too closely – we lose.

  3. I was wondering if it was time to give Slate another look, aside from the occasional article by Dahlia Lithwick. Nope. And I say this as someone who actually PAID for access to Slate back in the day. It’s still true that Weisberg is a tool, in his 36-inch waist Dockers (the only thing I can remember of/about his writing). Alas

    Bruce? The key in Die Schweiz is that the plan covers EVERYONE, from cradle to grave, and insurers cannot make a profit except on supplemental insurance and the like. Sounds like something right up the GOP alley, all right.

  4. KLG,

    I’m aware of the differences — of which I’m fond. My point’s just that single-payer plans are not the only way to ensure a country’s people have adequate health care when they need it.

  5. Bruce, there are basically four models out there: (1) single-provider, (2) single-payer, (3) some version of the ACA, (4) and some combination of insecurity and price gouging.
    When I say “some version of the ACA” I don’t mean that it’s the exemplar of that third class, that it’s the first or the best of that class, it’s just that I don’t have a really good shorthand for naming that class. But what I mean there is that everyone is required to obtain private insurance, with subsidies available for those who need them, and in turn the private insurers are regulated in a number of ways: they can’t turn you down for pre-existing conditions, they can’t terminate your policy should you have the effrontery to require medical care, and they have to charge you according to some form of community rating, rather than selling their most expensive policyholders a vastly more expensive policy. Switzerland falls in this class (with, obviously, some local variations and the noted rule about profits); so, if I recall correctly, does Germany. Pending the implementation of the ACA, the US remains a weird hybrid: those with large, non-Dickensian employers are already in the third class, seniors are in the second class, and everyone else is at the mercy of the fourth class.

  6. Agreed. Now, how is the previous post on this very blog (Matthew Kahn’s “Zasloff vs. Ryan”) any better or more reality-based than Weisberg’s vacuous contrarianism?

  7. To add to Warren Terra’s excellent post, members of the US military are in his first class. His third class might be called: “private insurers as regulated utilities.”

  8. I don’t think there is any question but that there could be an individual market for those over 65, the real question is what percentage of seniors could afford it. A tiny market is still a functional market. To say that a market is not “functional” if it does not cover a sufficient number of people is to say that today’s insurance market is not functional.

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