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Congressional Budget Office Looks At “RyanCare” Rationing And It Ain’t Pretty

The Congressional Budget Office has released its preliminary analysis (PDF) of House Budget Committee Chairman Paul Ryan’s budget, and I wouldn’t say it’s pretty. According to the CBO, Medicare beneficiaries will be left paying more for less. The CBO goes about this in a bit of a confusing way, setting a “benchmark” that corresponds to the cost of purchasing a private plan equivalent to Medicare, and then seeing how much more that plan would cost than Medicare under two different scenarios. Compared with either scenario, RyanCare costs a lot more than Medicare:

Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, the CBO estimated the beneficiary’s spending on premiums and out-of-pocket expenditures as a share of a benchmark: what total health-care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary’s spending would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.

If Medicare’s beneficiaries are getting less for more, Medicaid’s are simply getting less, period:

Federal payments for Medicaid under the proposal would be substantially smaller than currently projected amounts. States would have additional flexibility to design and manage their Medicaid programs, and they might achieve greater efficiencies in the delivery of care than under current law. Even with additional flexibility, however, the large projected reduction in payments would probably require states to decrease payments to Medicaid providers, reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more themselves than would be the case under current law.

As the CBO recognizes, a lot of what Ryan is doing isn’t saving money so much as shifting costs. Poor people and seniors don’t need less health care because Medicare and Medicaid are providing less health care. They just have to pay for more of it on their own. And as the CBO says, it’s hard to imagine Congress simply ignoring their pleas for help:

Under the proposal analyzed here, debt would eventually shrink relative to the size of the economy — but the gradually increasing number of Medicare beneficiaries participating in the new premium support program would bear a much larger share of their health care costs than they would under the current program; payments to physicians and other providers for services provided under the traditional Medicare program would be restrained (as under the two scenarios); states would have to pay substantially more for their Medicaid programs or tightly constrain spending for those programs; and spending for federal programs other than Social Security and the major health care programs would be reduced far below historical levels relative to GDP. It is unclear whether and how future lawmakers would address the pressures resulting from the long-term scenarios or the proposal analyzed here.

By: Ezra Klein, The Washington Post, April 5, 2011

April 5, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Consumers, Economy, Federal Budget, GOP, Health Care Costs, Medicaid, Medicare, Politics, Rep Paul Ryan, Republicans, States | , , , , , , , , , , | Leave a comment

Implosion: Paul Ryan’s Radical, Ridiculous, Rip-Off Roadmap

While the process of crafting a budget plan for this fiscal year implodes under the weight of GOP intransigence, today also happens to be the day next year’s budget fight begins in earnest. And if you think the current fight is a mess, prepare to have Republicans take your breath away.

And if you’re a disabled senior on Medicaid, relying on an oxygen tank, that expression should probably be taken literally.

Today, House Budget Committee Chairman Paul Ryan (R-Wis.) unveils his plan for fiscal year 2012. He promised a truly radical approach to our entire system of government, and he wasn’t lying — Ryan’s budget is based on his radical “roadmap” and effectively rewrites the American social contract.

Medicare would be eliminated and replaced with a voucher system. Medicaid would be gutted and sent to the states as a block grant. The Affordable Care Act would be scrapped, tax rates on corporations and the wealthy would be slashed, and all told, Ryan’s plan intends to slash roughly $6 trillion from the federal budget over the next 10 years.

This is madness.

There’s obviously no way Democrats in the Senate or the White House will even consider such extremism, but House Republicans don’t much care. This is the plan they want; this is the plan they’ll pass; and this is the plan that will set a truly ridiculous benchmark for future negotiations. If a shutdown seems inevitable this week, wait until the House GOP votes to eliminate Medicare as part of their next budget pitch.

Those of us hoping the chattering class will recognize the Republican plan as extremist nonsense are likely to be disappointed. David Brooks gushed today about the radical roadmap.

The country lacked that leadership until today. Today, Paul Ryan, the Republican chairman of the House Budget Committee, is scheduled to release the most comprehensive and most courageous budget reform proposal any of us have seen in our lifetimes. Ryan is expected to leap into the vacuum left by the president’s passivity. The Ryan budget will not be enacted this year, but it will immediately reframe the domestic policy debate.

His proposal will set the standard of seriousness for anybody who wants to play in this discussion…. Paul Ryan has grasped reality with both hands. He’s forcing everybody else to do the same.


Jonathan Zasloff’s point-by-point takedown of the Brooks column is worthwhile, but my biggest fear is that the D.C. establishment will start to assume that Brooks is correct. He’s not. Ryan’s budget plan is stark raving mad.

“Courageous”? To the extent that a major political party and House majority is actually willing to rally behind such extremism — without a hint of shame or trepidation — I’ll gladly give Republicans credit for actually putting their ridiculous wish list on the table.

But in this context, real, meaningful courage requires sound judgment, not just a willingness to fight for millionaires and corporations, while screwing over the elderly, the poor, the disabled, and working families.

By: Steve Benen, Washington Monthly, April5, 2011

April 5, 2011 Posted by | Affordable Care Act, Constitution, Consumers, Corporations, Democrats, Economy, Federal Budget, GOP, Government Shut Down, Medicaid, Medicare, Middle Class, Politics, Rep Paul Ryan, Republicans, Senate, Wealthy | , , , , , | Leave a comment

Wisconsin Waterloo: Where The GOP Sees Demons To Attack, Voters See Themselves

Wisconsin Democrats are filing recall petitions that could result in the Wisconsin Senate being controlled by Democrats. Summer 2011 will bring white-hot midterm elections and a potential Wisconsin Waterloo for the GOP that is spreading to other states and could shift the tectonic plate of American politics.

In Wisconsin, Ohio and other states a powerful backlash is brewing from giant swaths of voters who failed to turn out for Democrats or regret their votes for Republicans in 2010. They feel demonized by GOP attacks and financially threatened by GOP policies. They will be highly motivated to vote.

Wisconsin Democrats could win the three state Senate seats necessary to turn control of the Wisconsin Senate to the Dems, because voters do not want political holy wars against teachers, public workers or anyone else. They do not want fanatics in politics, fiats by government, incendiary partisanship or crusades against collective bargaining, which voters widely believe is a valued part of the American system.

Recently the Polish trade union Solidarity, one of the great voices for freedom in modern history, endorsed the Wisconsin workers and condemned the attacks on them by GOP Gov. Scott Walker. More voters agree with Solidarity than with Wisconsin Republicans.

In Ohio, the widely unpopular Republican governor, John Kasich, who was caught on tape verbally abusing a police officer who gave him a ticket, has now added both police and firefighters to the list of enemies he attacked in legislation. Most Americans view firefighters and police as heroes who risk their lives to save their neighbors, not as demons to attack or targets to have their financial security threatened.

In Washington, the GOP has added the venerable AARP to its enemies list. AARP has long represented tens of millions of seniors with honor. For Republicans to launch a Nixonian attack against them is an act of political stupidity that will not be well-received by senior voters.

Republicans wage holy war against National Public Radio, one of the fairest media in the nation, and one that provides vital service to small-town America and includes many Republicans among its fans.

Republicans threaten to shut down the government to pursue their war against Planned Parenthood, which is supported by many Republican women, while they attack a long list of programs important to mainstream American women. Many Republicans oppose efforts to achieve pay equity for women.

House Republicans even want to cut programs that help homeless veterans, cuts that Sens. Harry Reid (D-Nev.) and Sherrod Brown (D-Ohio) speak eloquently against.

The Texas GOP is likely to attempt to cheat Hispanics out of representation in Congress through a gerrymander similar to that once orchestrated by disgraced former House Republican Leader Tom DeLay. Many Republicans use tactics on immigration that are anathema to many Hispanics.

House Republicans will be widely blamed for any government shutdown or economic collapse from a failure to extend the debt ceiling if they pursue their partisan and ideological vendettas and refuse to accept 50-50 offers from Democrats.

A Wisconsin Waterloo is a real danger to Republicans. Where the GOP sees demons to attack, many voters see themselves. 

By: Brent Budowsky, The Hill, April 4, 2011

April 5, 2011 Posted by | Class Warfare, Collective Bargaining, Elections, GOP, Gov Scott Walker, Governors, Middle Class, Politics, Public Employees, Republicans, States, Voters, Wisconsin, Wisconsin Republicans | , , , , , , , , , | Leave a comment

Cutting Through The Medicare Charade

In his Wall Street Journal op-ed today, House Budget Committee Chairman Paul Ryan (R-Wis.) said the Republican budget plan is focused on “saving Medicare.”

Of course, in this context, this is intended to strip the word “save” of all meaning. Even the Wall Street Journal yesterday noted that the GOP proposal “would essentially end Medicare,” which happens to be true.

Medicare is very easy to understand — it’s a popular system of socialized, single-payer health care for seniors. Beneficiaries love it, and the system works pretty well. The House Republican scheme for Medicare is a little more complicated, but still pretty straightforward — the GOP intends to privatize it. The resulting system would, ironically, look quite a bit like the Affordable Care Act, with seniors entering exchanges, where they would take a subsidy to purchase private insurance.

So, what’s the problem? Republicans intend to rig the game, scrapping the existing system and ending the guarantee of set benefits, while at the same giving beneficiaries a voucher that wouldn’t keep up with costs.

This isn’t “saving Medicare”; it’s ending Medicare and screwing over seniors.

Josh Marshall had a good piece on this yesterday, calling the plan “Medicare Phase-out legislation.”

The Ryan plan is to get rid of Medicare and in place of it give seniors a voucher to buy health care insurance from private insurers. Now, what if you can’t buy as much as insurance or as much care as you need? Well, start saving now or just too bad.

Now, by any reasonable standard, that’s getting rid of Medicare. Abolishing Medicare. Phasing it out. Whatever you want to call it. Medicare is this single payer program that guarantees seniors health care, as noted above. Ryan’s plan pushes seniors into the private markets and give them a voucher. That’s called getting rid of the program. There’s simply no ifs or caveats about. That’s not cuts or slowing of the growth. That’s abolishing the whole program. Saying anything else is a lie.


I’d just add that some folks may have forgotten why Medicare was created in the first place. The nature of the human body is that ailments are more common as we get older, and profit-seeking insurance companies weren’t keen on covering those who cost so much more to cover. On average, folks who’ve lived more than six decades often have pre-existing conditions, and we know all too well what insurers think of those with pre-existing conditions.

Seniors relied on this system for many years, but it didn’t work. We created Medicare because relying on private insurers didn’t work.

And now Republicans want to roll back the clock.

By: Steve Benen, Washington Monthly, Political Animal, April 5, 2011

April 5, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Consumers, Federal Budget, GOP, Health Care, Health Reform, Insurance Companies, Medicare, Middle Class, Politics, Public Health, Rep Paul Ryan, Republicans, Single Payer | , , , , , , , , | Leave a comment

Cutting Medicaid Means Cutting Care For The Poor, Sick And Elderly

The part of Paul Ryan’s budget that’s going to get the most attention is his proposal to privatize and voucherize Medicare. But the part that worries me the most is his effort to slash Medicaid, with no real theory as to how to make up the cuts.

Ryan’s op-ed introducing his budget lists Medicaid under “welfare reform,” reflecting the widespread belief that Medicaid is a program for the poor. That belief is wrong, or at least incomplete. A full two-thirds of Medicaid’s spending goes to seniors and people with disabilities — even though seniors and the disabled are only a quarter of Medicaid’s members. Sharply cutting Medicaid means sharply cutting their benefits, as that’s where the bulk of Medicaid’s money goes. This is not just about the free health care given to some hypothetical class of undeserving and unemployed Medicaid queens.

But perhaps cutting it wouldn’t be so bad if there were a lot of waste in Medicaid. But there isn’t. Medicaid is cheap. Arguably too cheap. Its reimbursements are so low many doctors won’t accept Medicaid patients. Its costs grew less quickly than those of private insurance over the past decade, and at this point, a Medicaid plan is about 20 percent cheaper than an equivalent private-insurance plan. As it happens, I don’t think Medicaid is a great program, and I’d be perfectly happy to see it moved onto the exchanges once health-care reform is up and running. But the reason that’s unlikely to happen isn’t ideology. It’s money. Giving Medicaid members private insurance would cost many billions of dollars.

That’s why it’s well understood that converting Medicaid into block grants means cutting people off from using it, or limiting what they can use it for. You can see CBO director Doug Elmendorf say exactly the same thing here. There’s just not another way to cut costs in the program. You can, of course, work to cut costs outside of the program, either by helping people avoid becoming disabled or making it cheaper to treat patients once they become disabled or sick, but those sorts of health-system reforms are beyond the ambitions of Ryan’s budget.

To get around some of this, Ryan’s op-ed talks about state flexibility, with the implication being that states have some secret Medicaid policies they’ve been dying to try but that the federal government simply hasn’t let them attempt. But the truth is there’s been a tremendous amount of experimentation in Medicaid over recent decades. Indiana converted its Medicaid program into health savings accounts. Tennessee based its program around managed care. Massachusetts folded its Medicaid money into Mitt Romney’s health-care reforms. Oregon tried to rank treatments by value. Some of these reforms have worked well and some haven’t worked at all, but none have solved the basic problem that covering the sick and disabled costs money, and you can’t get around that by trying to redesign their insurance packages. For that reason, block-granting Medicaid ultimately means cutting health-care coverage to the poor, the elderly and the disabled, even as it doesn’t actually address the factors driving costs throughout the health-care system.

By: Ezra Klein, The Washington Post, April 5, 2011

April 5, 2011 Posted by | Affordable Care Act, Class Warfare, Congress, Conservatives, Consumers, Federal Budget, GOP, Government Shut Down, Governors, Health Care Costs, Health Reform, Ideology, Medicaid, Politics, Public Health, Rep Paul Ryan, Republicans, States | , , , , , , , , , | Leave a comment

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