ObamaCare and the Ryan Plan: One and the Same?


Two plans enter, one plan leaves.

TPM's Brian Beutler ponders the similarities

If you think of the health care system as a highway with unbridled free market private insurance on one end and universal single payer on the other end, then two parties are now approaching each other from opposite directions. Democrats pushed ObamaCare for working-aged people as a move away from unrestrained private insurance, toward a universal program. In trying to dismantle Medicare, Republicans are seeing to rollback a successful example of single payer toward freer market.

They've now awkwardly encountered each other in the middle. The similarities between the two policies creates a dilemma for Republicans who have smeared the health care law as an existential threat to the United States and for Democrats who've attacked the GOP plan as a corporate giveaway and dangerous for seniors.

Thus, most of them deny the chance encounter on the health care highway is even taking place.

Beutler is right that the plans have a lot in common in terms of basic structure. If anything, they have too much in common: As John Graham explains, the newest version of the plan put forth by Rep. Paul Ryan forces seniors to purchase insurance from highly regulated exchanges, much like ObamaCare:

Under the previous Roadmap [the previous Ryan plan], you could have taken the "payment" and used it to "to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market."…Not any more: Under the current proposal, we'd be forced to choose a plan from a federal "tightly regulated exchange" (p. 47). We need to put this talk of "exchanges" to bed until we finally get rid of ObamaCare.  People rightly associate an exchange with a limited choice of plans selected by a politically appointed board, offering benefits determined by bureaucrats' whims.

It's a closed, government-controlled market, which not only limits choice, but also limits potential gains from competition.

But in its broad strokes, it's still better than the status quo alternative. That's because there's a crucial and obvious difference between Ryan's premium support proposal and ObamaCare's subsidy system: Ryan's plan is a plan to reform and preserve an existing entitlement while capping per-beneficiary spending and adding a small measure of insurer competition to the market; ObamaCare creates a brand new entitlement that, if the Massachusetts plan its based on is any indication, is likely to cost far more than advertised. Medicare has $36 trillion in unfunded liabilities. According to the Congressional Budget Office, it's set to go bankrupt in 2021—even with the supposed savings in ObamaCare. As even Obama has acknolwedged, the program, along with Medicaid, represents the biggest single driver of the federal debt. Its costs are rising so fast, in other words, that it won't last without a major cost-saving fix. Perhaps, as Obama's Medicare director Donald Berwick argues, those savings can be generated by providing smarter, more efficient care designed by new and improved Medicare bureaucrats. But I wouldn't bet on it.

The primary goal for legislators designing health policy should be to bring our unsustainable public spending under control. That's what Ryan's plan is designed, however imperfectly, to do. ObamaCare, on the other, was created first and foremost to expand insurance coverage, with the hope of maybe, just maybe, controlling costs later.

NEXT: Not So Stagnant

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  1. We need to just round-up all the doctors and keep them in a camp while they treat us for free

  2. Should it be surprising to anyone that the plans which are being decried by the other side as dangerous and irresponsible, are essentially the same?

    These fuckers collude with the singular goal of enlarging the scope and size of the state. It doesn’t matter which side “wins”; the results are the same and as planned.

    1. Point taken, but it’s not as contradictory as it sounds. The Democrats are still trying to pull everyone to the left and the Republicans are still trying to pull everyone to the right.

      Medicare is full-blown socialism (all the way to the left) that is going bankrupt. Ryan is trying to pull it to the right by making it a little more free-market-like. Obamacare takes the current healthcare system and pulls it left, closer to full-blown socialism by making it less free-market-like (not that it a very free market to begin with).

    2. Not true. Medicare as it exists only “works” because it floats on top of and is indirectly subsidized by the private insurance system.

      Pulling Medicare further into the private sphere will improve it; Pulling the private system towards Medicare will destroy Medicare as we know it.

  3. Original investigations on Kaiser Permanente, ObamaCare’s model, expose fraud, waste, abuse, and mismanagement from “slush funds.” Posted on YouTube at http://www.youtube.com/watch?v=v0h7tUymj2Y and http://www.hmohardball.com.
    Robert Finney, Ph.D.

    1. PhD in what, from where, out of curiosity? Or just blogwhoring?

      1. PhD *in* blogwhoring.

  4. Original investigations on Kaiser Permanente, ObamaCare’s model, expose fraud, waste, abuse, and mismanagement from “slush funds.” Posted on YouTube at http://www.youtube.com/watch?v=v0h7tUymj2Y and http://www.hmohardball.com.
    Robert Finney, Ph.D.

  5. In trying to dismantle Medicare, Republicans are seeing to rollback a successful example of single payer…

    ROTFL. And crying.

    1. But everyone who is in Medicare lovez it!1!1! Because its FREEEEEEEEE

    2. seeing [sic] to rollback [sic]

      The first error is Hit & Run’s (or else it was corrected by the source after H&R’s quote); the second, the substitution of the noun “rollback” for the verb phrase “roll back” is still in the source.

      Tip your teaching assistant. I’ll be here all weekend.

  6. Here’s a much better idea. Are you ready for it, guys? Your minds will be blown, for you’ve never conceived of anything of such brilliance before –

    Abolish Medicare, Medicaid, and ObamaCare, and stop assuming that the provision of medical services is somehow open to governmental regulation.


    1. fortunately for you, mental healthcare is covered

      1. I work for a living, and I’ll pay for my medical costs myself should I ever need to.

        Smart-ass comments of that sort from parasitic leeches of you ilk really ARE ridiculous.

        1. Mental healthcare is covered by FMLA so take ur time off work. good luck

  7. “In trying to dismantle Medicare, Republicans are see[k]ing to rollback a successful [an unsuccessful] example of single payer toward [a] freer market.”

    It was either a typo, or Beutler is very confused about the definition of successful.

  8. Universal single payer covering cheap basic care (i.e., death panels bitches) is the way to go. Don’t want the death panel deciding when to cut off care? Then you get to buy your own supplemental coverage.

    1. What’s basic care?

      1. like I noted before thats for the death panel to decide. They should be randomly chosen from all left-handed, right-eyed, Baptist Sunday school teachers that are socially functional yet porn-addicted.

    2. What’s basic care?

      1. on 2nd thought, bandaids and aspirin. And good thoughts or a posting of sympathy on facebook.

  9. Republicans are seeing to rollback a successful example of single payer toward freer market.

    I do not think that word means what you think it does.

  10. capping per-beneficiary spending

    Good luck.

  11. Am I mistaken or aren’t you forced to buy into medicare by way of SS premium deduction anyway?

    Not that being forced to buy private insurance is any better but I’m just not sure it functionally changes anything…

  12. What’s with all the libertarian hate for this plan? No, I am not fond of it, either, but it is better than government continuing on its current course. It seems to me that a lot of libertarians are assuming that a crach = libertarian policies.

  13. My biggest question is why are costs rising so fast and, what effect would tort reform have on these rising costs?

    1. This hear website had a post last week that explained clearly that costs are increasing because the government is involved in the market. https://reason.com/blog/2011/04…..ealth-care

  14. Cash everyone out of SS for the amount they have put in plus whatever treasures matured for during that period. Then end the program. It is far from successful.

    Yes, this would be a deficit spike, but not in the long term.

  15. Here I read how liberals are turning on Obama over the budget deal.


    In other places, including Reason, I read where the budget deal is a sham and doesn’t really cut anything. If that is the case, and I think it might be, why are liberals up in arms about it? Are they just insane?

    1. Maybe they’re misinformed? Or just worried about how it looks politically? Probably both.

  16. There’s actually a pretty key difference between the Ryan plan and Obamacare. The Ryan plan pegs increases in the premium subsidies to the rate of overall inflation. The Obamacare insurance premium tax credits are pegged to the cost of insurance plans, so when insurance premiums go up, so do the size of the credits (the credit is calculated by reference to the second lowest cost ‘silver plan’ in the taxpayer’s geographic region, and then adjusted for income and some other factors).

    So the Ryan plan limits the government’s exposure to rising medical care costs. Obamacare exposes the government to those rising costs. Limiting the government’s exposure to medical inflation is really the whole point of Ryan’s proposal, so calling the two exactly the same because they use private insurance companies is pretty damn stupid.

  17. On what fucking planet is Medicare — bankrupt and riven with fraud — “a successful example of single payer”?

    1. Planet Leviathan.

    2. Granny loves it

      1. I have a Ph.D. in something

  18. Any medical system that is federal will always be inherently bloated, inefficiently, and unaccountable. I’d rather have state-by-state single payer than any federal alternative – no matter how supposedly free market.

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