« How to contact Lowe's and complain about Muslim bigotry | Main | Cranky old man gripes about social networking »

December 14, 2011


Next day update: predictably, the White House is "concerned" about the Wyden-Ryan plan.

Yet Matt Miller persuasively argues in a Washington Post piece that Ryan has just endorsed "Obamacare" and has put himself in a political bind.

Excerpt from Miller:
But there’s more. With this new plan, Ryan has signed onto the idea of subsidizing people to buy coverage from well-regulated health exchanges that must take all comers and charge them similar premiums regardless of health status (provisions that did not exist in Ryan’s previous premium-support plan).

If that framework sounds familiar, it should — it basically describes the dreaded Obamacare! And here’s the kicker: Wyden-Ryan has a public option to boot, because fee-for-service Medicare would remain an option for seniors.

If you’re with me, Ryan is now on record for the Affordable Care Act model, more generously funded than was his previous plan, with a public option. But just for seniors. Oh, and for workers at small firms representing a third of America’s total employment. Paul Ryan is so close to universal coverage he can almost taste it!

Here's another opinion on the broad outlines of the Wyden-Ryan plan from Aaron Carroll, a highly knowledgeable health care policy expert who blogs at The Incidental Economist.

It's a short post, so I'll copy it in its entirety:
I have already answered my 10th email of the morning asking me what I think of the Ryan-Wyden plan for Medicare. The short answer is: it hasn’t been fully released yet, and I can’t comment on something until I’ve had the chance to evaluate it fully.

But here are my gut thoughts based on what I’ve seen so far. I agree that – as described at the moment – this seems like it’s making Medicare more like the ACA in the future, but with a big difference. It sets actuarial minimums, it demands guaranteed issue and community ratings, it sets the subsidies by competitive bidding, and it allows for plan switching. But it’s different than the ACA in that it contains a fee-for-service public option.

I expect that those who are dyed-in-the-wool single payer supporters will oppose this, as it can be seen as the first step towards dismantling traditional Medicare. I expect that those who are dyed-in-the-wool free marketeers will oppose this because it doesn’t do enough to dismantle traditional Medicare. But everyone else is going to be in a bit of a pickle.

I’ve often been snarky towards those who think that a single payer system is American as apple pie if you’re 65, but communism if you’re 64 (I’m looking at you, Congress). But if this proposal picks up steam, it will flip things for many people. It will be hard to argue that the ACA is a viable, progressive solution for universal coverage if you’re 64, but free-market-heartlessness if you’re 65. And many who wholeheartedly supported the ACA will find themselves in that position moving forward. After all, this program even has a public option.

Moreover, with Ryan’s support, many who want to repeal the ACA may soon be in a similar spot. How do you support this plan as a sensible solution for universal healthcare if you’re 65, but believe that it’s tyranny and the end-of-freedom if you’re 64? After all, the ACA doesn’t even have that public option.

Now, if no other Democrats besides Sen. Wyden and no other Republicans besides Rep. Ryan support this, then they’ve just gone out on a limb, and nothing will change. But Ryan is not the most liberal of Republicans, and Wyden is not the most conservative of Democrats. I think it’s likely that others will sign on. When that happens, the whole dynamic of the discussion could change. That is, if the media is paying attention, and can learn to ask good questions.

One concern I rarely see addressed, either in our current patchwork of health care plans, or the ACA, or the Wyden/Ryan Medicare reform plan, is the lack of geographic mobility caused by health care plans that are largely local, and have built in geographic constraints.

As a person taking early retirement, I assumed I would be free to travel around the country, even relocate if I felt the urge. As a fellow Oregonian, I love Oregon, but I like to imagine having other living experiences. Oops. Can't do it unless I want to go without health insurance. At the age of 59 it is impossible to be approved for a new individual policy, and my current policy only covers Oregon.

The ACA will not solve this problem, especially now that the decision has been made to give the states more latitude in determining coverage standards. More patchwork quilt.

So I waited patiently, thinking the age of 65 might bring the possibility of new living adventures. Not if Wyden/Ryan takes hold.

I have been bewildered why this problem is so rarely discussed. It is anathema to the American character of geographic mobility.

Gail, the Wyden-Ryan plan would only apply to people 55 or younger, I'm pretty sure. So you'll be on traditional Medicare no matter what happens. And I thought beginning in 2014 the Affordable Care Act disallows denying insurance based on pre-existing conditions, because at that time everybody is supposed to have insurance.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Your comment could not be posted. Error type:
Your comment has been saved. Comments are moderated and will not appear until approved by the author. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.


Post a comment

Comments are moderated, and will not appear until the author has approved them.

Your Information

(Name is required. Email address will not be displayed with the comment.)

Strange Up Salem

Welcome to HinesSight

  • Salem Political Snark
    My local political rants are now made on this badass blog. Check it out. Dirty politics, outrageous actions, sleaze, backroom deals — we’re on it. 

  • Twitter with me
    Join Twitter and follow my tweets about whatever.
  • Church of the Churchless
    Visit my other weblog, Church of the Churchless, where the gospel of spiritual independence is preached.

  • Welcome to HinesSight. If this is your first visit, click on "About this site--start here" in the Categories section below.