I was quoted in Monday’s New York Times story on the success private plans are having in Medicare, pointing out the similarities between RomneyCare, ObamaCare, and RyanCare — Paul Ryan’s proposal for Medicare reform, now receiving unprecedented scrutiny following his selection as Vice Presidential candidate. When you remove the distortion of election-year politics, it’s easy to see the three approaches share the same DNA.
Only in an election year could you see a conservative advance a proposal for Medicare reform with a liberal pedigree and get demagogued for it. The same could be said for Obama — a liberal advancing health reform with conservative concepts. Consider:
- RyanCare’s premium support or vouchers resemble the subsidies of Romney’s Massachusetts’ health reform and Obama’s Affordable Care Act. All three proposals have roots extending to President Clinton’s and subsequent bipartisan entitlement reform commissions, as well as to conservative think tanks like the American Enterprise Institute and the Heritage Foundation.
- All three feature a government-regulated insurance exchange, modeled after Medicare Advantage and Part D, as the central marketplace where consumers will choose the coverage that fits best.
- All three feature critical insurance reforms and foster regulated competition among payers and providers at their core. To be clear, Ryan’s second Medicare proposal with Senator Ron Wyden (D-OR) features much stronger consumer protections.
Medicare really wasn’t a leading issue in the election; now it is with Ryan’s selection, especially in senior-heavy swing states like Florida and Pennsylvania. Both camps are jockeying to define the other, with Ryan the Democrat’s poster boy for “Medi-Scare” or “Medagoguery” tactics. An honest debate over Medicare is delusional in an election year — but will be unavoidable in 2013 as the “fiscal cliff” looms and the deficit debate comes to the fore again.
My concern is that Democrats and Republicans will stake out positions during the election cycle that prevent them from having the thoughtful discussion the country needs about Medicare’s future next year. We must first agree that Medicare in its current form is unsustainable. The most recent Medicare Trustee’s report stated the Part A Trust Fund will be bankrupt in 2024 under a rosy outlook, and we know the program is a major contributor to deficit projections. We can’t go on this way.
Ryan-Wyden lays out a carefully considered approach shown to be successful in Medicare Advantage and Part D. Without Ryan-Wyden’s kind of structural reform, we have no hope of getting our debt under control. Ryan-Wyden was a significant improvement over “Ryan 1″ — his first, draconian Medicare reform proposal two years ago — and it shows Wyden’s liberal, former Gray Panthers fingerprints. It keeps traditional Medicare as an option, with heavily-regulated competition at its core. Ryan-Wyden is adequately funded whereas Ryan 1 pegged subsidy growth to inflation, which would result in a huge cost shift to beneficiaries. Ryan-Wyden’s subsidies are pegged to the second-lowest bid or traditional Medicare, whichever is cheaper. Seniors who choose a plan above the benchmark would pay the difference, just like in Part D. It calls for the formation of a Medicare exchange modeled after www.Medicare.gov, and even adds a new catastrophic benefit, also like in Part D. It is inextricably related to both RomneyCare and ObamaCare.
The fundamental difference between the parties is what we’d do with the savings, and that’s what elections are for. My hope is that it doesn’t get so nasty that battle lines harden and Ryan-Wyden doesn’t get its moment.
This blog was originally posted on blog.gormanhealthgroup.com
John Gorman: Under John’s leadership, Gorman Health Group has become the leading professional services and solutions firm for government-sponsored health care, providing thought leadership and expert strategic, operational, and technology-based solutions. Read more
