Paul Ryan's Medicare Plan: A Sweet Deal For Seniors?


Kevin Drum, echoing David Leonhardt of The New York Times, notes that Republican Rep. Paul Ryan's Medicare reform plan, which would shift the seniors health insurance program to a premium support system, excludes both current seniors and anyone who is less than ten years away from entering the program. If shared sacrifice is what's necessary, Drum wonders, why aren't seniors included?

This is a point that few people ever make explicitly: today's retirees aren't merely getting benefits that they've paid for their entire lives. They're drawing way, way more from Medicare than they ever put into it…If it's really true that everyone needs to sacrifice, then why should current retirees, who are getting such a sweet deal from the rest of us, be excluded from the pain?

This next song goes out to Paul Ryan.

Good point! Or it would be if Drum weren't being willfully naive about the politics of Medicare reform. The plan doesn't touch seniors' benefits because it would almost certainly make the already difficult job of selling Ryan's overhaul plan totally impossible. Think of this way: Would expanding the reforms to sweep in current beneficiaries actually increase support for the plan? I doubt it. It's safe to say that Drum and Leonhardt wouldn't suddenly sign on. Neither, I am fairly certain, would anyone else who isn't already on board. Changing benefits for seniors already enrolled in the plan would only lead to decreased public support.

As a smart political commentator like Drum has to know, there's a huge amount of built-in political resistance to any attempt to restructure an entitlement benefit. Any politician who wants to overhaul Medicare—and wants his or her plan to have even the slightest chance of actually passing—has little choice but to offer a proposal that makes changes over time, giving potential future enrollees a chance to plan accordingly. So even the slow-moving changes Ryan's Medicare plan calls for are bound to be an extremely tough sell. Why make it tougher? The trick for someone like Ryan, who has been pushing entitlement overhauls for years and is clearly hoping to create legislation that just might actually pass some day, is to design significant long-term reforms that don't unnecessarily poison public support.

Still, I'm glad to see that Drum and Leonhardt have noticed that Ryan's Medicare plan doesn't touch benefits for seniors or anyone set to enroll during the next decade, and I'll look forward to both of them explaining that fact to the Democrats now warning that the Ryan plan balances the budget "on the backs of seniors" and is akin to "war on the elderly." It's really not. As Drum helpfully reminds us, under Ryan's proposal, current retirees get a comparatively "sweet deal."  


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  1. OK, Ryan’s plan doesn’t cut Medicare costs for a decade but its an easier sell? That is your defense of it?

    And those 45-55 get to pay full freight for another decade and then when they turn 65 they get a lousy discount coupon to buy private care?

    Good luck with that.

    1. At current rate, when guy whose 45 today is 65 he will have ‘paid full freight’ for nothing at all. He’ll have to go bug Chang in Shanghai directly for the loan.

      Problem with Medicare is that no one ever paid full freight to begin with. Those bills are coming due. Sucks, but so does entropy. Its going to happen either way.

      1. No, the real courageous thing to do would be to allocate services via cost/benefit immediately (rather than cold-turkey end the program at a future date yet to be determined).

        Its easy for me to say since I don’t have to run for reelection.

        1. I think we’ll just let our creditors handle the “making political unpalatable decisions” for us since we can’t really sit at the fiscal “grown-up” table anymore.

        2. No, the real courageous thing to do would be to allocate services via cost/benefit immediately

          I would suspect the most courageous thing to do is to call a tax a tax, a welfare program a welfare program; stop this charade of calling the current social contraption ‘insurance’ or a ‘benefit.’ Call it what it is, make it what it is, then take old Medicare out behind the barn and put a bullet in it.

          Same deal with the new PPCA scheme. Why do we even call that bizarre construct ‘insurance?’ It is not insurance, its altruism. What a complex convoluted disaster just to hand checks out for somebody’s medical care!

          Why do liberals make their treasured mandated altruisms so hard burying them in hysterical Rube Goldberg social schemes like that?

      2. Entropy is a perfect description for the state of Washington. As someone who is 54 and not thrilled with the cut off date, the fact is that until individuals are made price sensitive enough to shop around for care, costs will go up like a expense account with no limit.

  2. Or they could just make participation in Medicare optional, so people who think it is a raw deal can opt out entirely, and the remaining people can pay the actual costs without being subsidized.

    1. Your proposal is to end Medicare?

    2. I have no problem with letting people opt out now, but that doesn’t solve the problem of paying for people currently retired and in the system. So either you fund that out of some other kind of tax revenue that you don’t call Medicare taxes, or you have the same political problems alluded to in the post.

      1. Its even harder than that. A 50-55er probably won’t opt out now so expenses go out as far as you can see.

        And all the opt-outs drop the revenue base making it less cost attractive.

        1. Its exactly the same problem for ponzi schemes. There’s no way to painlessly unravel them.

          1. Yes, we all agree it sucks. The method Ryan chose– slowly cutting back the subsidies, not affecting people who are already late along– is probably the most acceptable alternative, though the earlier you start the less painful it is.

    3. There’s a piece on this in “Time” today (can’t find the link, but I read it earlier), where this reporter claims that after speaking w/ some of Ryan’s staffers, people actually will be able to opt out.

      Problem being then (according to said reporter), you may get an “insurance death spiral” where only the expensive and unhealthy sign up, increasing premiums, blah blah blah. Again, I’m not vouching for the accuracy of this, just stating it as it was reported.

  3. Paul Ryan must have a lot more patience and a thicker skin than me. He spent a lot of time coming up with an earnest plan that, while not perfect, at least tries to cut spending somewhat. And of course the Dems are accusing him of leaving old people to die in the streets.

    1. Old people dying in the streets? Feature, not a bug!

    2. I’m glad someone here is giving Paul Ryan some credit. There are no perfect plans, people! Paul Ryan has gone way beyond what a typical politician would propose.…

      1. We’ll give that its a start, but it will have to be radically revised to include slashing a whole bunch more from SS and the DOD before it gets us back into the black.

        1. And I wish it were cutting farm subsidies more, entirely even, though the $30B in crop insurance farm subsidy cuts is $30B more than anyone else is proposing.

          1. (Well, “anyone else” is too broad of course, “anyone else in a real position of power” perhaps.)

    3. Were I him, I’d look straight into the camera and say, “I believe we can create 30,000 jobs over the next ten years picking up old people who’ve died in the streets.”

      1. Does “soylent green production” count as a “green job”?

        1. SUSTAINABILITY!!1!

          1. EXTURNALIITIESSZZZ!!11!

            1. DEMAND KURV!11!

    4. While at the same time griping that he isn’t forcing the elderly to take their fair share of sacrifices.

  4. The cost of your diabeetus testin supplies may be covered by Medicare!

    Free meeter!! lol

  5. IT’S A TRAP.
    Lure the old people into picking up their “premium supports” then …

  6. I’m 54 and pissed as hell.

    1. Too bad, you didn’t lobby AARP hard enough for you and your fellow 54 year olds.

  7. “… someone like Ryan, who has been pushing entitlement overhauls for years …”

    He voted for Bush’s prescription drug plan. Was that an “entitlement overhaul”? Strangely enough, Ryan’s “plan” seems to call for generous subsidies for those who voted Republican in 2010 and benefit cuts for those who didn’t.

    1. seems to call for generous subsidies for those who voted Republican in 2010 and benefit cuts for those who didn’t

      *shocked face*

      That sounds SUSPICIOUSLY like “punish our enemies”.

      1. What subsidies? Be specific.

    2. Strangely enough, Ryan’s “plan” seems to call for generous subsidies for those who voted Republican in 2010 and benefit cuts for those who didn’t.

      Farmers voted for Democrats, Vanneman?

  8. I too have wondered why all of these budget plans “spare the seniors”. They’ve been voting for the same crooked politicians longer than I have (or, not bothering to vote at all). They’re the ones who allowed these programs to be horribly mismanaged on their watch. They’re the ones who’ve chosen “lots of free goodies and low taxes forever!” instead of living within their means. And, it’s not like the debt and deficits are stunning new developments. There have been warnings about all this for decades but, the elderly chose to ignore them so they could get their tax-free shiny baubles for free!

    In short seniors, you were the ones who chose a profligate life, you were the ones who chose to accrue a mountain of debt so, you can damn well do a little sacrificing to help pay it off.

    1. Exactly my attitude.

    2. Seniors – “And you and what army are going to make us? Now sit down and do your homework, someone’s got to pay for our lifestyle.”

    3. +1
      To me – and I AMA fairly young person – this is worse than death panels. Death panels favor the young.

  9. Drum’s off-message and it’s confusing me. Am I supposed to be hating the Congress for stealing old people’s medication or should I be hating old people for selfishly sucking benefits away from the productive elements? I’m fine either way, as long as I get to hate somebody instead of fix the budget.

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