Ryan proposes to change that. Beginning in 2022, new (not existing) Medicare beneficiaries would receive a voucher, valued initially at about $8,000. The theory is simple. Suddenly empowered, Medicare beneficiaries would shop for lowest-cost, highest-quality insurance plans providing a required package of benefits. The health-care delivery system would be forced to restructure by reducing costs and improving quality. Doctors, hospitals and clinics would form networks; there would be more “coordination” of care, helped by more investment in information technology; better use of deductibles and co-payments would reduce unnecessary trips to doctors’ offices or clinics.Let's unpack the assumptions in there, shall we? First of all, it doesn't matter in the slightest whether or not existing consumers are affected. When someone who starts receiving Medicare benefits in 2022 looks at those a year older than them and sees them getting the old version of Medicare, there's almost certainly going to be resentment.
Then there's the hope that $8,000 will be enough. Ryan (and his plan's defenders) assume that the invisible hand of the market will ensure that it is. So what is it about this that will ensure that? After all, in that market-driven world, things like high-speed rail are apparently simply not going to work at all, due to economic realities. How is it that the insurance companies are going to be able to provide health care to everyone for less cost?
Well, we bring costs down! ... What's stopping the Medicare we have from doing that? Why does it take Ryancare to affect the health care delivery system so radically? There's no denying that the costs of Medicare have to be brought under control. But there are ways to do that (such as letting Medicare refuse to pay for frivolous medical procedures) without forcing those costs onto seniors, which is what Ryancare would do if its assumptions failed to materialize.
And then there's the kicker: the next paragraph of the argument.
It’s shock therapy. Would it work? No one knows, but two things are clear.That's the best you can give me? "No one knows"? Even I know that if you're going to make an argument, you have to at least pretend to be more confident than that!
(And before you leap down my throat for selective quoting, those two things: that Medicare affects the entire health care system, and that there's wasteful spending as it stands.)
In all seriousness, what that tells me is that Ryancare is a fundamentally uncertain plan that could bring health care costs under control effectively, or could also simply force the excess costs onto beneficiaries, who would then have to pay a great deal more out of pocket... or go without health care, if they couldn't pay.
And that will only be worth it if the underlying assumption, that Medicare as we know it is doomed anyway, is true. I think I'd rather try to fix it before we write it off.