Nanny State

Why RyanCare Will Fail

Paul Ryan's budget embraces a fatal premise of the Nanny State

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President Obama last week criticized the Medicare vouchers that are part of RyanCare, the health care reform plan in the budget proposal by Rep. Paul Ryan, R-Wis., because they would allegedly balance the budget on the backs of seniors. But his fellow liberals have been criticizing vouchers for the opposite reason: They will cost too much and won't control Medicare spending. They are right.

However, the reason is not GOP economics, but liberal politics that Rep. Ryan has bowed to.

The basic idea behind Ryan's reform is simple: Medicare, the government-funded health care program for seniors, is a slowly tightening noose around this country's fiscal neck. Health care costs have been growing at twice the rate of the economy. But seniors have little incentive to curb their medical consumption because they don't pay for it—taxpayers do. Indeed, according to the president's Council of Economic Advisers, 30 percent of Medicare spending produces no medical benefits.

Ryan wants to squeeze out such waste by turning Medicare from a defined-benefit plan to a defined-contribution plan. This means that instead of paying for a limitless array of medical services for every senior, as is the case now, the government will give seniors a fixed annual sum to use toward their health coverage. If they want coverage more generous than the government's contribution will buy, they will have to use their own funds. This is how most private companies handle pension and health care benefits for retirees, and it works out well for everyone. The companies get to cap their liabilities, and retirees get to control their pension funds.

But not all private-sector ideas can be successfully applied to government programs. 

For starters, private defined-contribution plans are near-inviolable contractual agreements between a company and its workers. Companies can't renege on their obligations—and retirees can't demand bigger packages. But government programs are always vulnerable to lobbying by groups seeking more. 

RyanCare's supporters, such as Cato Institute's Michael Cannon, argue that vouchers will diminish the lobbying game. Right now, a pincer movement of patients and providers combats every cut that affects either group, he argues, but under RyanCare, providers will have less incentive to lobby for bigger vouchers, because they won't necessarily get the additional money. That's true. However, insurance companies selling coverage to seniors will have a bigger incentive to lobby harder, since the money will go to them.

Still, a properly constructed voucher would control costs by prodding patients to consume fewer medical services and shop around for those that they do. And Rep. Ryan's original plan in his Roadmap for America's Future would have done something like that. Under it, every senior would be handed a minimum of about $11,000 in inflation-adjusted dollars and would have great flexibility in deciding which insurance plan to buy. (Sick and poor seniors would get a bigger voucher than healthy and rich ones.) Because the voucher amount would be lower than the cost of most Cadillac plans, seniors would shop around for lower-priced, high-deductible plans with built-in disincentives against overusing routine care for minor illnesses.

But Ryan's current plan does not offer vouchers in a traditional sense, it offers—to use its own words—"premium support." This means that seniors won't actually get any money in their hands. Rather, the government would apply its share, means-tested according to the income and health status of patients, to an insurance plan that seniors pick from a "tightly regulated federal exchange." It is politically inconceivable that this exchange would allow plans that are not larded with every benefit under the sun. Witness all the state patient bills of rights requiring that plans cover everything from "hair prostheses" to in-vitro fertilization (although it is hoped that most seniors won't be needing the latter). 

This will mean two things, both of which will undermine cost containment: One, the greater the gap between what seniors can afford and what is available on the exchange, the more intensely they will lobby for additional funds. Indeed, RyanCare will replace the "patient-provider pincer" with the "patient-insurer pincer." Two, if seniors' shopping options are restricted to bureaucratically sanctioned plans with a standard set of benefits, insurance companies won't have room to fully compete on prices, eviscerating the market mechanism that is key to cost-containment in vouchers. 

But why did Rep. Ryan back away from his original voucher scheme? The reason is politics, or, more specifically, liberal politics. If he simply handed seniors a voucher to do what they please, some would, no doubt, make poor choices and find themselves without adequate coverage when they need it. This would contradict the entire liberal Nanny State project, whose whole goal is to save people from themselves.

However, unless liberals abandon this missionary mentality and let people face the consequences of their choices—especially after society has taken extraordinary steps to give them the means to insure themselves—there will be no end to what society will be on the hook for. At some point, individuals have to be allowed to take responsibility for their own medical destiny.

This is the fundamental cost-containment dilemma. But instead of confronting it, Rep. Ryan has decided to play on the Nanny State's turf. That's why, regardless of the outcome of this battle, in the long run, RyanCare will lose.

Shikha Dalmia is a senior analyst at Reason Foundation and a columnist at The Daily, America's first iPad newspaper, where this column originally appeared.

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  1. Government-funded healthcare is not creating the cost problem. Healthcare is. Government-funded means of access to healthcare are cheaper than private alternatives. The problem is healthcare costs. Putting old people at the mercy of the private insurance market will not change that underlying issue, and will only make it worse in addition to greatly adding to the misery in the world.

    1. I say it’s a spoof, and I say A+! Well done. REALLY top notch work!

      1. Almanian, do you actually think that private insurance companies will not fuck over old and sick people?

        1. Nowhere did I say that.

          1. Why do you still listen to it?

            1. I think that deep down, Almanian hates himself.

              1. No fair, I hated him first. He’s copying me, that dirty fucker.

                1. *runs crying from the room*

        2. I think private companies will do what makes them a profit.

          I think politicians will do the same.

          And if I want to stop a private company from screwing me over, I’ll stop giving them my money. If I want a politician to stop screwing me over, I’ll have to wait til the end of his term, try to get enough people to agree with me, vote him out of office, and get someone else who wants to screw me over in a completely different way.

          I think I’ll stick with the free market, thank you.

          1. Insurance will never be a free-market-RICO will never apply

        3. EOM

        4. “do you actually think that private insurance companies will not fuck over old and sick people?”

          You mean, fuck them harder than the government.

          Uncle Sam will be writing the one writing the “premium support” check out to the insurance providers. Maybe they care about the person receiving benefits, maybe they don’t. Either way, they will care about the customer, and the customer is the one writing the check.

          1. Uncle Sam will be writing the one writing the “premium support” check out to the insurance providers.

            True, and it will be interesting to see how private pay will develop because businesses are trending toward not purchasing insurance directly for employees

            1. I like the idea of employers giving the option of employer based insurance, or a bigger pay check. Two earner households make out, because if the families insurance is through one earners employer, the other doesn’t lose out on compensation. Their is also a benefit to using the additional salary, and purchasing your own individual plan. Not only can you right fit your health insurance based on your family needs; if you find a plan you like, you’re not dependent on anyone, or job, to have continued access to that plan.

              Loyalty has it’s privileges.

              1. Unfortunately, enough of us are not taking part in this pioneering process. Libertarians should be leading the way, and not waiting for libertopia to materialize.

      2. Yeah, the guy that wrote it has that stupid fuck id down pat.

    2. Hmm, government-funded access to healthcare is indeed cheaper for the individuals receiving it (ignoring all the unintended consequences for those individuals), but you cannot honestly say that the government making it easier for people to get every test under the sun doesn’t drive up costs for everyone else. It’s simple supply and demand. Take a look at the wait times for NHS patients. Everything that is scarce (healthcare included) must be rationed in some way. Price allows people to decide their own priorities. If prices are fixed, time will be the means of rationing.

      1. Medicare is relatively lavish compared to some other single-payer plans. It’s also more efficient than the private insurance market. So yes the underlying healthcare costs need to be addressed, and excess care should be looked at (what the GOP were calling death panels if you recall). But if we want the most expensive, lease efficient system, we should look to the libertarian alternative, hand-waving promises about the magical market notwithstanding.

        1. more efficient than the private insurance market

          You sure about that, Tone the Fun Guy? Cause I don’t think so.

          1. Yeah, I’d love to see some proof of that… especially since the Chosen One has spoken about eliminating fraud and waste from medicare to save money…

        2. But if we want the most expensive, lease efficient system, we should look to the libertarian alternative, hand-waving promises about the magical market notwithstanding.

          I didn’t know the Libertarian alternative involved state-sanctioned murder squads roaming the country, gunning down doctors and burning pharmaceutical labs to the ground.

          Come on Tony, the free market has worked wonders in many service industries (hotels, fast food, etc.). Why would it do so poorly with health care? Is it because you insist on treating health care as a right, rather than a service?

          1. Kinda… And the reason for that is health care isn’t just a normal market commodity people can take or leave. Demand for healthcare is based on need alone; you don’t shop around for providers when you have a heart attack. So first of all normal market magic just demonstrably doesn’t work because the same supply and demand factors aren’t at play.

            If you want to treat it as a free market commodity then I think you should be honest about the implications. If you’re too poor to afford healthcare, you should die on the street. Not everyone can afford a yacht, so not everyone gets one. We should treat life-saving surgery or preventive care exactly the same way, right?

            Speaking of preventative care–that’s a good way to reduce costs in the long-term. Lack of access to healthcare drives up inefficiency in this way. If you think about it for more than a few seconds, you can see how making healthcare a universal right isn’t just an abstract moral principle being imposed on you by busybodies. It makes the whole system more efficient. Everyone’s in the same risk pool. There aren’t free riders. Most importantly, it’s been PROVEN that it works at about half the cost per capita in countries with universal systems vs. our own.

            1. It would help though, if we treated medical Insurance as a normal market.

              1. Agreed. Or like car/home insurance. Only pays when shit hits the fan.

            2. …you don’t shop around for providers when you have a heart attack.

              As well as you don’t shop around for new tires just as you’re skidding off of the road and into a ravine.

            3. “If you’re too poor to afford healthcare, you should die on the street”

              How many people were “dying on the street” in all those years of the country’s history before government started interfering in the health care market?

              There were charity hospitals.

            4. If you want to treat it as a free market commodity then I think you should be honest about the implications. If you’re too poor to afford healthcare, you should die on the street.

              They’re in line behind all the people that are too poor to afford food, clothing and shelter.

              1. It’s more of a pile, than a line.

            5. I disagree. Healthcare isn’t solely based on need. If you get the flu you don’t need to go to the ER or even a doctor. You choose how to proceed based on your own cost-benefit analysis. Government interference just screws up that cost-benefit analysis by shifting costs around.

              If you’re too poor to afford healthcare, you should die on the street.

              Agreed, with an addendum. You should die on the street, or in the home of a concerned family member, or in a charity hospital. Do you seriously believe that government is the only effective source of charity? I don’t know your family situation, but I assure you, most people would not let their family members die on the streets.

              Research is undecided on whether preventative care reduces costs in the long term or not. Hit the Googles and you’ll see what I mean.

              1. So Medicare was what, a socialist conspiracy to oppress us? Or perhaps it was invented to respond to a real problem. You can’t say with a straight face that the market will magically cover old or disabled people’s needs in the aggregate the same way Medicare does. So in the process of obeying the commands of the market gods, we are reducing access to healthcare in this country. Just be honest about it. My concerns are not pleasing the market gods, it’s increasing access to healthcare.

                1. Fuck with the market gods at your own peril. The laws of economics are just as strong as the laws of physics. The only way you, Tony, can increase access to healthcare for others is to become a doctor.

                  1. The laws of economics are just as strong as the laws of physics.

                    The problem is libertarians believe that Archimedian physics covers it all.

                2. Sure it was intended to respond to a real problem. It just didn’t fix the problem. The problem was not old people dying in the streets. Do some research into the history of Medicare before you go shooting off your mouth (or in this case your fingers). That’s the trouble with many (if not almost all) government programs. They don’t fix what they are supposed to fix, even though they were passed with all sorts of good intentions. Then we need more programs to fix the problems created by the original program. The cycle repeats.

                  “Just be honest about it. My concerns are not pleasing the market gods, it’s increasing access to healthcare.”

                  You ever try to get a treatment covered by Medicare that Medicare doesn’t want to cover, Tony? Maybe you should…then come talk to me about access to care. We don’t turn away patients who need care, Tony, so your “access” argument is bogus. It’s true that we do eventually expect those persons to pay for the care they receive, but that’s not access. Accessing care and paying for care are not the same.

                3. I never said the old and disabled would be just as well off without Medicare. In fact I said the opposite. I seem to remember something about people “dying in the streets”…

                  While we’re being honest, your concern is increasing access to health care, at someone else’s expense.

                  So why can’t the old cover their own health expenses? Most of them spent their lives working hard. Surely they had ample opportunity to save up for retirement? Why can’t Medicare be limited only to those unable to work due to disability? Is it because Medicare isn’t about helping people, but about controlling the flow of cash in our society?

            6. “And the reason for that is health care isn’t just a normal market commodity people can take or leave.”

              You may be right, but health insurance is a normal market commodity.

              “There aren’t free riders.”

              Then what should we call those who receive more from the government, than what they pay in?

              1. Then what should we call those who receive more from the government, than what they pay in?

                Unlucky? The same principles of insurance applies, it’s just that the risk pool includes everyone. Everyone’s a participant in the same way everyone’s a participant in paying for national defense. Some may not pay taxes, yes, but that’s just progressivity in action–if you want to trade paying taxes for the lifestyle of a person in poverty, you are welcome.

                1. “if you want to trade paying taxes for the lifestyle of a person in poverty, you are welcome.”

                  You cannot be serious.

                2. The bottom 50% pays about two percent of all income tax. I don’t think you can say all of those people are living in poverty. They are just simply living below the median wage level. Not poverty, Tony. Not as well off as others, but not poverty.

                  1. Contrarian that’s because most of the income is concentrated at the top these days. If you factor in all taxes, our system is barely progressive.

                    1. Your post made claims about poverty, Tony. You indicated that everyone pays for our national defense, unless they live in poverty, which just isn’t the case.

                3. “Some may not pay taxes, yes, but that’s just progressivity in action–if you want to trade paying taxes for the lifestyle of a person in poverty, you are welcome.”

                  How is receiving tax payer, subsidized insurance any different than those we currently define as “free riders”? In both circumstances, the cost of covering those who can’t afford insurance, is being absorbed by those who can. The “free rider” argument is a false argument, because under the current system, and the government subsidized system, people will be receiving care at someone else’s expense.

                  1. And actually Tony, I’ve got a better idea. Since your so big on the “social contract”, cash is a little tight this month. Can you post your credit card info so I can knock out a few bills?

                    1. Booze, no matter what system we have I am going to act to minimize by share of the paying for it, as any rational person would do. I’m sorry you’re poor. Perhaps you should try harder. At least in the system I prefer, you would be secure in your access to healthcare so you could spend your time worrying about things that aren’t basic needs. I’m willing to help pay for such a system. I prefer civilization to brutal nature–I even hate camping.

          1. Thanks for this.

        3. Tony has never dealt with a government run system. I don’t think the government has a very good track record when it comes to making things more efficient. In fact I would say it is quite the opposite.

        4. That’s why, according to one study, 1/3 of Medicare spending is wasted on redundancies and inefficient procedures?

      2. Paying 80% is always cheaper than paying the actual cost.

    3. Health care costs are not the problem. Health care opportunities are the problem. There are simply too many new, expensive treatments that extend and enhance life. The fact that health care is a service, not a right, is more apparent now than ever. The problem with Medicare and PPACA is that they try to treat a service like a right. Such attempts are doomed to fail because they invariably infringe upon actual rights.

      1. Lemme guess… the “actual” right not to pay taxes, which is something other than a longstanding western tradition.

        Healthcare costs too much because it is a business. Treat it like a public service and we can get the savings you want. I’m sure the exact same people bitching about government paying too much of its costs won’t complain that we aren’t allowing for the innovation of the private market.

        1. Actually I was thinking of a doctor’s right to not treat someone. If health care is a right, then doctors incur obligations whenever someone is injured or becomes ill. It’s not an actual right if it obligates someone else to act.

          Are you assuming that every industry not treated like a public service is too costly? Or are you assuming that the health care business is fundamentally different from other service industries? Do you believe that making every industry a public service would create savings?

          1. Well, if doctors want to discriminate with regard to who they serve, they should choose another profession. Your beef seems to be with medical ethics.

            And yes, healthcare is fundamentally different from other services, because everyone needs it at some point, as it is related to life-and-death. People do not make “rational” market decisions in healthcare–they need the care they need.

            I believe in making those services that are based on universal needs public. Like national defense, education, basic food and shelter, courts, transportation, etc. What, to you, makes healthcare fundamentally different from these things?

            The real answer is that there is a large extant industry that makes a lot of profit from the status quo. There is nothing else really.

            1. I believe the appropriate response here is:

              “Fuck off, slaver.”

              1. Exactly

            2. And yes, healthcare is fundamentally different from other services, because everyone needs it at some point, as it is related to life-and-death.

              Unlike food, water, clothing and shelter

            3. Tony,

              When you say there is a “right” to healthcare you seem to ignore the fact that healthcare does not grow on trees waiting only to be gathered by those who need it. It must be provided by an individual who also has needs. So what I hear you saying is “Let’s enslave all the doctors so they can provide the healthcare that we have a right to”. It’s either that or “Let’s enslave some of the people so they can pay the doctors to provide healthcare for some other people”.

            4. Are you going to feed, clothe and shelter me? Will you rock me to sleep while you are at it?

            5. Single payer legal care. There’s not one lawyer in this country that does anything worth more than minimum wage.

            6. “”Like national defense, education, basic food and shelter, courts, transportation, etc.”‘

              Defense aside. If you’re poor, you don’t necessarily get quality food, shelter, counsel, or transportation. So by your own agrument, they shouldn’t necessarily get quality healthcare.

              1. You can get food stamps and there is public housing (or homeless shelters). I’m not saying we provide either of those things adequately either.

                1. Aren’t food stamps really food “vouchers”? Doesn’t that mean the greedy grocery store owners will just raise prices, so they can screw the elderly and the poor? Wouldn’t it be more humane, if we created a program that allowed the elderly and the poor to buy all the food they want, then the grocery store can bill the government. We can call it Grocerycare.

            7. What, to you, makes healthcare fundamentally different from these things? The real answer is that there is a large extant industry that makes a lot of profit from the status quo. There is nothing else really.

              Yeah, there’s no profit to be had in any of those other industries. Lockheed Martin works at cost. Private schools and tutoring services don’t exist. There are no rich lawyers. etc.

              I’ll agree that all these industries are pretty much the same. In each case there are many different possible ways to meet a person’s needs. Each person should decide how their needs are met based on their own means and values. Should I go to public school or pay extra for private? Should I take the bus or call a cab (train or airplane)? Should I get a hip replacement or stick with the physical therapy?

            8. “Well, if doctors want to discriminate with regard to who they serve, they should choose another profession.”

              Really? Did I sign a contract somewhere when I enrolled in medical school that I would be obligated to render treatment, even treatment I deem unnecessary, to anyone who shows up, without choice? Am I your slave now, merely because I chose a certain way of earning a living? Maybe all of the physicians who don’t feel like being highly paid slaves would quit such a profession, Tony. We’re smart enough to do other things.

              “I believe in making those services that are based on universal needs public. Like national defense, education, basic food and shelter, courts, transportation, etc. What, to you, makes healthcare fundamentally different from these things?”

              Ah, yes. You’ve just named many things that government has done so poorly. Education. Our government run schools stink. Housing. Ever been to a project, Tony? Transportation. Amtrak. Yes, we have a good military and (somewhat) good courts. But both of these, you’ll notice, are Constitutional functions of government.

              1. Ah so the constitution confers a magical level of quality on the services it sanctions. That is one special piece of paper. Why don’t we just amend it to include healthcare?

                US public schools have their problems but you’d have to compare them to a system without public schools at all. I wonder how well educated we’d be then.

                1. Probably about as healthy as we are.

                2. Finally, some sense out of you. If you wish to amend the Constitution to include healthcare, then do it. That’s why the amendment process is in there. Until then, stop pretending that you get to do anything you wish, when clearly it was a document designed to constrain the power and scope of the federal government. If you want a right to health care so bad, put one in there.

                  By the way, our public schools did as well or better than they do now back before the feds got involved. That’s what we’re talking about here, Tony, federal intervention. States used to run education and it hasn’t gotten better now that the federal government is doing it. In fact, it seems to have gotten worse.

            9. As is food. Should the government assume control over the nation’s entire food supply? Read Cato’s articles on why health care is more expensive in the US, and Sally Pipes (a Canadian) on single-payer systems.

        2. Healthcare costs too much because it is a business of government involvement in every aspect at every level.

        3. Treat it like a public service and we can get the savings you want.

          That’s worked with education.

        4. Tradition? What tradition of not paying taxes are you referring to? Most people in this country do in fact pay taxes.

        5. Treat it like a public service and it will run as poorly as every other public service.

        6. Healthcare costs too much because it is a business.

          Maybe healthcare costs a lot due to scarcity dumb bunny. Any product or service requires labor applied to resources, both of which do not fall out of the freaking sky. So to treat someone who is elderly and as a result their body is failing requires a lot.

          Yeah Tony, if someone is going to die, then let them die, rather than prop them up at the expense of who knows how many others to which that cost is passed to.

          1. You will never understand why your fantastical world in which all the elderly and poor have all their needs taken care of cannot exist, because you don’t understand simple economics.

            You want to accuse drug manufacturers or whoever for not spending enough to cure cancer, when 1) There may not be a cure to cancer, and 2)It is unknowable what really is the best allocation of resources without a free market where the consumer says what he wants. If you really believed what you said you would be devoting all your time to working on behalf of others, but likely you watch TV, go out with friends, or what have you, so you are a flaming hypocrite and one who has no ability to critically think or follow a thought or premise through to its logical conclusion.

            1. So why does healthcare cost 1/2 the US cost per capita in countries with universal government-run systems?

              This is an economic argument as well as a moral one.

              And I love how you guys act morally superior because you don’t bother caring about other people’s well-being.

              1. As I thought, you don’t spend your life laboring on behalf of others and are a flaming hypocrite.

                I do care about other people’s well-being, which is why I hate to see them have the product of their labor stolen and lives ruined through statist economic idiots such as yourself.

                I am morally and intellectually superior….AGAIN you have no idea why scarcity makes your stupid utopia not possible. I’ll help you though; take someone of 70 yrs or so who can no longer work and is dependent on others.

                Now this person needs someone to attend to him as a nurse. So this nurse’s labor must be compensated, and let’s say that it is, so that’s a push. She has labored and received as a result of her labor, but this 70 yr. old is not laboring, not creating wealth, so we have a deficit, or a -1. Now we have someone (multiple someones actually) who has labored to produce a medicine that this person is taking and realistically multiple medicines. Same as the nurse this person is compensated, but again there is a -1. When you continue to add this up it results in negatives, then multiply it over and over and since resources and labor cannot be magically manipulated through an accounting scheme, multiple someones must suffer to benefit this one person.

                Yeah Tony you really care about people.

                1. BTW, I apologize for an overly simplistic example for those who understand economics, but it’s Tony and hopefully this example might get through.

                2. I’m not talking about a utopia, I’m talking about what every other developed country has already figured out. Private healthcare is inefficient. You are saying we shouldn’t even try to emulate a system that works much better than our own because the best we can do is wealth-dependent access. Scarcity of a service is not set in stone. The whole point is that government can increase the supply.

                  1. The whole point is that government can increase the supply.

                    Really? What are they waiting for?

                    1. Really? What are they waiting for?

                      Republicans to gather together and be wiped out by a well-aimed asteroid.

                      If we just had Democrats we’d be only slightly to the right of a proper government coalition, instead of mired in this endless slog of religious radicalism and its associated horrifying power-fellating political beliefs.

        7. Health care in the US costs 50% more than health care in any other country. Ask yourself why this is? Rest of the developed world decided not to allow the health care industry to set prices where it wanted. The reason the health care industry could do this in the first place is that all developed countries have prescription laws, laws regulating every aspect of health care. Difference is that in the rest of the developed world the “problem” was solved via government control, government set prices for services. France for example pays about 2/3rds as much as we do for health care and they cover virtually everyone. France was also rated #1 for health care. The US was #37. So we pay a lot, but we don’t get value for the dollar. What we have a monopoly designed to maximize profits for everyone involved in health care. Government has to enforce all these laws to make the monopoly work. In France the government is on the side of the people, whereas in the US the government is on the opposite side and raises costs for everyone so that those working in the health care field enjoy the world’s highest incomes.

          The Libertarian solution is to take government “out” of health care all the way. No prescription laws, no restrictions upon importing medicine for your own use. Certification instead of licensing. Health care costs go down because there is now a true free market in health care. Something we don’t have now…

      2. Totally. They need to hand seniors a generous wad of CASH, not a voucher, and say “we suggest you use this for health care. You will not receive a penny more”. Any amount they don’t spend on health insurance will go into their pockets. If they don’t buy insurance at all, that’s their business. Health care exepditures would tumble and the price of insurance would come right down with it.

        1. Why not let them keep a percentage of the difference? Of course that won’t keep them for pushing for bigger vouchers.

          1. How about a straight-up health savings account. It is an already existing infrastructure. When combined with high-deductible insurance it makes for a very effective combination.

            For some reason the simple and obvious solution is always shunned.

            I have this combo for my family – it runs close to (but less than) that $11k figure annually if you include my employer’s contribution and assume that I max out my out of pocket expenses at $3k. Our benefits are reasonably generous and I have an incentive to keep costs low in order to hold on to some of my cash – I’m on the hook for the entire first $3,000 of expenses.

            1. “How about a straight-up health savings account”

              I believe Obama calls that “ACME insurance”.

              HSA’s are a great idea. I would much prefer that my employer funds my HSA, from which I could purchase my own insurance, than offer me limited choices on plan options. If we had the option to remain with the same insurance provider, over a long period of time, their would be greater incentive for providers to offer savings.

              Most of the common health care needs are relatively cheap. My local Wal-Mart partnered with a local hospital, and opened a health clinic. They charge $80 for a physical. I recommend anyone look online, and look at the prices of wheelchairs. You can easily find one for the same price as your deductible, if you purchased through your insurance.

    4. Re: Tony,

      Government-funded healthcare is not creating the cost problem.

      Yes it is: By artificially increasing demand.

      Healthcare is.

      Healthcare is just a service. You’re confused.

      Government-funded means of access to healthcare are cheaper than private alternatives.

      That’s not the case. It only means that the cost is spread among more victims, but the cost is actually higher as more people USE IT, which is why many governments resort to RATIONING.

      Putting old people at the mercy of the private insurance market will not change that underlying issue,

      Of course not, provided we agree the underlying issue is the overreliance on a 3rd payer system, whether private or public. One should pay for his or her own healthcare just like one pays for his or her plumbing or electrical intallation service.

      1. Blah blah blah I’m a unique individual anarchist who spews stupid Republican talking points. Rationing? Really? Your fear is that if government subsidizes healthcare, it might have to have maximum payouts? I’m sure there will still be care for those who want to pay.

        One should pay for his or her own healthcare just like one pays for his or her plumbing or electrical intallation service.

        We’ve established that your political philosophy borders on sadistic. Now how are you going to sell it to a democratic populace, which seems to not find social health insurance to be a huge abridgment of freedom over your alternative.

        1. Right, and the slaveowners of the South did find their freedom abridged by having the slaves work for their benefit either. Those slaves might have felt a little constrained in their freedom however.

          When the fuck did a majority, even 999,999 to 1, gain the right to vote away other people’s rights?

          1. correction;

            did find their freedom

            should be

            did not find their freedom

          2. What right are you talking about whose abridgment equates to slavery? The right not to pay taxes? Sorry, not here.

            1. The “right” to health care and/or insurance equates to slavery.

              1. So what you’re saying is you’re an idiot.

                1. Re: Tony,
                  No, he is saying you lack sophistication. Making a service provided by someone else a matter of “right” for you would mean ipso facto the provider is a slave, otherwise it would NOT be a right.

                  The fact that you cannot conclude this from your premise is just one more item in your showcasing of your ignorance.

        2. “Blah blah blah I’m a unique individual anarchist who spews stupid Republican talking points.”

          I’m cool with the GOP hiring OM as a policy advisor. We could only be so lucky.

        3. Re: Tony,

          Rationing? Really? Your fear is that if government subsidizes healthcare, it might have to have maximum payouts?

          No, the economic calculation problem. Central planning ALWAYS leads to rationing, no matter how clever the bureaucrats.

          We’ve established that your political philosophy borders on sadistic.

          Right – paying for your own shit yourself is “sadistic.”

          Up is down.

        4. At least under the Ryan system seniors can decided what they don’t get, rather than the government. Want to make insurance cheaper? Let people buy it across state lines and don’t allow states to require that plans cover things people don’t need, like acupuncture, breast implants (only a necessary item if you have breast cancer), and a bunch of other ridiculous treatments you can find here:http://www.pacificresearch.org/docLib/20081020_Top_Ten_Myths.pdf page 82 of 190 on the PDF.
          and insurance costs will drop. Enormously. And insurers will have no more capacity to screw people over than they do now since people can pick and choose the coverage they want. See: Same document, PDF page 150.

    5. Dalmia is dead wrong about one thing. Medicare is just like the insurance I had when working, except it covers less. I pay a monthly premieum of $90+ a month plus a $80 a month supplimental policy.

      In addition, I paid medicare taxes for the 40 years I worked.

  2. Caption:

    I’M CRUSHING YOUR HEAD!!!

    1. Caption: “This is how big my dick will be when the Democrats kick my pussy ass!”

    2. Nice. +1 Internets to you.

    3. We’re going to shrink the debt by thiiiis much.

      1. Winner!

  3. I think Ryan’s plan is just a re-working of the same problem. Here’s what will happen. If you medical cost for the year are about $5,000, and the government gives you $2,500 to help you pay for those costs, eventually, your costs wil rise to $7,500 (or higher of course), and the demands for more funds will soon follow.

    The only way to bring down costs is to lower demand and the only way to lower demand is to stop government funds from artificially raising demand. (You would think the Keynesians would get this part…)

    I know Ryan is trying for a palatable solution for the average voter, but as long as we’re lying to them anyway, why not just keep the lie we already know? At least most of us can see that this one will fail, we don’t need to create a new one.

    1. True. On the other hand, seniors would also push for things that could lower the cost of the insurance.

    2. False. Medical services and equipment are already inflated. Medicare fraud is huge. Drug companies push drugs out fast and wind up pushing a drug with major side effects every few years and pay billions in lawsuit costs. Old people are afraid of prescription drugs now, and the prices have risen steadily, the actual demand for prescritpion drugs has been decreasing significantly. Why do insurance companies, doctors, drug companies and representatives, equipment makers & etc. make profit consistently? Because they have clients. If you decrease demand for health coverage by 15% you decrease a trillion dollar industry by 15%. You are getting as much as you put into it.

  4. Lady Gaga’s ‘Judas’ music video to be released at Easter

    http://dailycaller.com/#ixzz1JzETHf4d

    I think she should be executed for this. Not because her song/video offends me, but because her marketing strategy is so 1980’s Madonna.

    1. all those Catholic school girls are the same 😉

      1. All alike, pffft. Most Catholic school girls are way hotter than either of those gimpy freaks.

  5. This is way off-topic, but it’s probably too late to post in the morning links. The Chicago Tribune’s website has two peculiar headlines running concurrently right now. Click fast to see them yourself.

    “Brown line derailment tangles trains”

    …and…

    “Forrest Claypool chosen to head CTA”

    http://www.chicagotribune.com/

    How is this significant? Check out what Claypool had to say in an interview some few years ago:

    WCT: What’s something that a lot of people don’t know about you that you want them to know?

    FC: Well, I think the thing that motivates me most is a fundamental belief in the individual. The individual, not the collective and not the state, is what matters. It’s about protecting the rights, dignity and potential of every single human being. In my office, I have two photographs; one is of Martin Luther King and the other is of Ayn Rand. I have those because I believe that both were champions of power and the rights of individuals. I think too often that the state, in the name of religion or something else, tends to dehumanize or minimize or restrain the power of individuals …

    http://www.windycitymediagroup…..?AID=10194

  6. I have to admit, the same fallacy with health-care vouchers exists for education vouchers. The requirements to be a ‘valid’ school present the same incentives to game the system as these health-care vouchers. But unlike education, health-care costs can one day bloom to hundreds of thousands of dollars.

    If altruism is the goal, the sense of a safety-net, then get on the dole. And build a system to accommodate such. Rather than be some Rube Goldberg scheme where everyone is opted in by the signature of existing, make it where you or your advocate (family member, shark, whatever) opt in.

    Who pays for it? Tax dollars. Just like Medicare was skimmed for tax dollars just call a pig a pig and don’t pretend you run an insurance company. You run a hand-out mill, and the only way to get a control on outlays from that perspective is to make it a system where the ‘customer’ calls you when needed. And then you evaluate the need. Then the provider bills the Treasury.

    The chances for corruption and skullduggery that way are obvious and would probably be pretty rampant in that scheme. But it would be a lot of individual corruptions instead of these huge, institutionalized corruptions that Medicare feeds now.

    1. Education costs did balloon to hundreds of thousands of dollars for a K-12 education, per pupil.

  7. It is politically inconceivable that this exchange would allow plans that are not larded with every benefit under the sun.

    That’s the problem, right there.

    Until we get back to catastrophic care insurance, under which the customer has a financial stake in the care they consume, the system will be broken and costs will continue to run until the money is all gone.

    1. i’m afraid first dollar coverage is too ingrained. i don’t know how you get past the idea that health insurance should cover every little ailment or expense.

      1. combine this with “somebody else pays”, where somebody else is either your employer or the government and you’ve got a recipe for out-of-control costs.

  8. I also don’t think you can fix our entitlement problem until you make it perfectly transparent to taxpayers with the Transfer Tax.

    All entitlements (SocSec, Medicare, unemployment, food stamps, you name it) are fully funded every year through a Transfer Tax on income. You can collect it the way SocSec and Medicare taxes are collected now, except you need to get rid of the “invisible” employer portion.

    If the cost of entitlement programs goes up, so do taxes, immediately. If the cost of entitlement programs goes down, so do taxes. Immediately.

    With this system, you have everybody with a stake in entitlements (as a funder or recipient) fully informed about what growth or reductions means, for them, and you can actually have an honest debate about what they should be.

    1. Yes, take the full 15.3% for Fica and medicare right out of the employee’s paycheck. No more “employer’s share.”
      I’d tell the boss to give everyone an
      8% raise, as we’d be saving admin costs.
      Then, throw on top as income, the full cost of their health plans. Once it is all visible, we can easily compare our “tax burden” with those countries of which we are supposedly “undertaxed.”

      1. Yeah, I would say that any employer that adds the employer’s share to the employee’s pay would be excused from having to pay it. Its only fair. Otherwise, maybe require the employer to pay some kind of surtax until they do.

      2. Better yet, everyone should have to sign over a check for each of the tax contributions. That way they’ll see just how much actual money they are spending on these entitlements.

        If you go to pick up your $1,800 check and have to sign over multiple checks in the process, each on the order of a couple hundred bucks… well, you might be a little more inclined to reduce spending by the government.

  9. “Still, a properly constructed voucher would control costs by prodding patients to consume fewer medical services and shop around for those that they do.”

    I am curious where you can find out what a office visit costs for a doctor. Try the experiment (in the Washingto DC area) and tell me what doctors give you a price for a service. I have never had one simply say the price – all doctors’ offices I have encountered say that you have to have insurance and that they won’t give you a price for any service.

    “Witness all the state patient bills of rights requiring that plans cover everything from “hair prostheses” to in-vitro fertilization (although it is hoped that most seniors won’t be needing the latter).”

    I find “health insurance” (or more accurately health COST) problem, by its very nature, akin to the “education crisis” – the very fact that it is discussed makes it something that government should do something about. The government’s education policies can’t educate students, and it can’t make patients wise consumers or even behave in a healthy manner. If wigs are covered by health insurance, obviously there is still spare money.
    It would be nice if health care money was spent wisely and efficiently, but just as I don’t believe “education policy” educates anyone, I don’t believe that “health care policy” makes anyone healthy. Just as with education, the more seminars, blue ribbon panels, education reform, the more money spent that doesn’t change anything.
    I remember Bush’s medicare drug “reform” so I am actually even more cynical (if that is even possible) of republican health care reform than what we got. I say lets have benign neglect.

    1. I’ve never understoond why purchasers of a service like health care are considered to be liable for “whatever the provider thinks he can get away with billing after-the-fact” rather than “whatever was published and/or agreed upon in advance”. Fix that and you’d probably do more to reduce health care costs than any plan in D.C…

      1. Your insurance provider has contracted rates with doctors and hospitals. This is why it is difficult for doctors to tell you the “cost” of a service. YOUR cost, is what ever the contracted rate between your doctor, and your medical provider have agreed too.

    2. It’s very difficult to tell you how much something costs because each insurance company is a different billing quagmire. I can say that I charge a hundred bucks for a routine office visit, but your insurance company may only want to pay seventy. Or eighty. It’s all different. And it all depends on how I document your visit as to how I can bill. Of course it might easily cost me what your insurance company pays to meet my expenses, including the people I’d have to employ to bill insurers, leaving no room for profit for me to take home. That creates a powerful incentive for physicians to try to game whatever system they’re in, just so they can make a good living. Many of us don’t take Medicare anymore because they don’t pay enough to cover expenses, just because they’ve decided they know how much a visit should cost. If you go into a doctors office and say “I’d like a physical exam and I’m paying cash up front” you’ll likely get a very direct answer as to the cost of that service.

  10. “Witness all the state patient bills of rights ….”

    Another part of the problem. Politicians love to elevate commercial transactions to the level of fundamental rights. Patient bill of rights, credit card bill of rights, airline passenger bill of rights, you name it. Imagine if our leaders had some respect for the ACTUAL Bill of Rights.

  11. Is it me or does Reason continually rip on that Eddie Munster looking Ryan guy?

  12. I am curious where you can find out what a office visit costs for a doctor.

    Like any business, it varies. A lot.

  13. if compare with China, you will see we all are in heaven

  14. But Ryan’s current plan does not offer vouchers in a traditional sense, it offers?to use its own words?”premium support.” This means that seniors won’t actually get any money in their hands. Rather, the government would apply its share, means-tested according to the income and health status of patients, to an insurance plan that seniors pick from a “tightly regulated federal exchange.”

    I’m having a feeling of deja vu.

    I mean, we already went through this. Is Reason running out of essays and topics?

    1. Isn’t this the same format as Obamacare and Romney Care?

  15. “But seniors have little incentive to curb their medical consumption because they don’t pay for it?taxpayers do. ”

    This is an arrogant statement and an excuse to promote the libertarian idea that there should be NO PUBLIC safety-net when it comes to our health.

    Conservatives/libertarians have been trying to get rid of all programs that created a healthy middle-class in this country and this is what made this country strong.

    The “un-controlled rise” in healthcare cost that rose twice the growth of the economy is JUST THAT…UNCONTROLLED and UNREGULATED healthcare costs. Doctors can charge whatever and Medicare/Medicaid/AND PRIVATE INSURANCE pays whatever. If people paid, then doctors couldn’t charge whatever.

    The truth is, if you want the free market to control healthcare costs, you must get rid of medicare, medicaid, AND PRIVATE INSURANCE. As long as people (rich, poor, middle-class) don’t pay for the services with their OWN MONEY, it’ll be out of control and there will be abuse, fraud, and waste. So, the ONLY free market solution is make everyone pay for their own healthcare and either offer no healthcare for those who can’t afford it or run low-budget private clinics for the poor and elderly. There is NO OTHER FREE MARKET WAY. This health insurance crap doesn’t work.

    If you want to see how well the free market works in Healthcare, go to the Dominican Republic or Mexico.

    1. Too many caps… didn’t read.

    2. The only thing that really made sense:

      “As long as people (rich, poor, middle-class) don’t pay for the services with their OWN MONEY, it’ll be out of control and there will be abuse, fraud, and waste.”

      Just plain wrong:

      “Conservatives/libertarians have been trying to get rid of all programs that created a healthy middle-class in this country and this is what made this country strong.”

      Those programs didn’t creat a healthy middle class, but I’d love to hear your explanation as to how they did.

      Ready…. Go!

      1. Look, go to any ‘free-market’ third world country like the Dominican Republic or Mexico and see how much disposable income people have when they have to pay for healthcare for not only themselves, but their parents, kids, disabled family members and deal with their own retirement and go with no money in the event of injury and unemployment.

        Don’t wanna get into a big argument about this, but the fact that we’ve had a large and healthy middle-class since the inception of the new deal is self-evident. Safety nets for health, disability, unemployment, and retirements encourages business people and innovators to take a risk.

        1. Don’t want to get in an argument, then stay the bleep out with your nonsense. Neither the DR or Mexico is a free market. Mexico suffers from a very corrupt government, and the DR was under a dictatorship during the 20th century.

          1. Without regulations (which libertarians complain that there is too much of), you’ll end up with corruption.

            What EXACTLY do libertarians mean by ‘less regulation’ and less ‘government intervention’ ?

            1. More power for the government leads to corruption.

              As for your question, I can only speak for myself, but I would like to be able to freely trade with another person without any interference from the government. I don’t want to be told what is good for me, and I don’t want the government in my business. Why do you want government to have so much control over your life?

            2. Huh? Corruption is more government intervention. Is the government protecting people’s ability to voluntarily exchange or interfering with? It’s that simple.

        2. You’re mistaking causation and correlation. The Industrial Revolution and most other developed countries getting the holy horse fuck bombed out of them in WW II had more to do with our large middle class.

          Safety nets don’t encourage innovators. Profits do. The same profits you would take from them at the point of a gun to fund your safety nets.

          Also, if you think the Dominican Republic and Mexico are free markets, you have a horribly skewed view of a free market.

          BTW, if the government wasn’t involved in safety nets, the private sector would take care of it.

          1. retirements encourages business people and innovators to take a risk.

            That must be why so many poor people get involved in selling drugs, the retirement benefits and safety nets. Oh wait maybe it’s the potential money, but this Nixxon here doesn’t seem to get that.

            1. Seriously, people like him are the ones that push me over to Team Red.

    3. “Doctors can charge whatever and Medicare/Medicaid/AND PRIVATE INSURANCE pays whatever.”

      No, they don’t. You are woefully uninformed. It’s very hard to take you seriously when you don’t know what you’re talking about.

      1. You have contracted care agreements but try going to a doctor to pay cash and they think golf club dues

        1. I am a doctor, rather, and I don’t play golf. We’d actually much prefer to deal in cash because it’s much, much easier and more straightforward. I don’t know how much you’ve been quoted, or even if you’ve tried to get a physical exam for cash, but if you go to a physician that does a decent amount of cash work it’s usually about what a deductible would be.

  16. I really didn’t need to read the rest of the piece after:

    “Seniors have little incentive to curb their medical consumption”

    The statement shows the authors complete disconnect from reality and a fundamental misunderstanding to the problem.

  17. Conservatives/libertarians have been trying to get rid of all programs that created a healthy transfer wealth from the middle-class in this country and this is what made this country strong broke.

    I think I have math on my side. What do you have on yours?

    1. oooh, I see what you did there, and I like it.

    2. What made this country broke (at least recently) is a bunch of WARS and the constant tax breaks to the wealthy

      1. OK, I’ll agree with you 100% on the wars, but tax breaks for the wealthy cost absolutely $0. That’s right. Not one dime. It doesn’t cost me anything to allow you to keep the money you earned. Should I thank the potential burglar for skipping my house and allowing me to keep my stuff?

      2. Half-right. The other half makes as much sense as me saying that I’m as broke as I am because I haven’t been hiring thugs to rob people for me.

        That’s the entire political process, though. Hey, I’m naturally extremely lazy, so my life would be easier if even stronger “redistribution” laws were put in place to send money my way. Too bad for me that I realize I’d be scum if I tried to vote that system into creation.

        1. Or you could learn to love it. It’s not like all the money at the top was earned. It could just as well be said that it was taken. Why not?

          1. And the government is what allowed it to be taken. See GM, Goldman Sachs, etc.

            1. You’re right. What do you suppose will alter that policy?

              1. Getting rid of the government altogether?

  18. Insurance companies will do what it takes to keep their ridiculously insanely racist profit margins at a whopping 2.5%

    /sarc

  19. Please don’t argue with the statement “Seniors have little incentive to curb their medical consumption”. I work for a medical equipment company, and we constantly have Medicare patients asking for a wheelchair so they don’t have to walk around at the casino, or their kids’ asking for Medicare to pay for a hospital bed at home and at their summer home. Add to that all of the drugs that they’re told that they need on TV commercials, and you will quickly see that there is little incentive.
    As to Medicare being efficient-please. Medical equipment is 4% of the Medicare budget, but they act like all providers are swindlers. Instead of pre-approving things like private insurances do, they audit after the fact. They use outside companies who are paid a percentage of what they recover. What kind of chance does that give providers? Inefficient, outdated, and wasteful only begin to describe the Medicare program.

  20. Thank you for explaining the different viewpoints on these vouchers, I’ve been very confused about it. Hopefully the debates will lead to better medicare reform.

    http://www.intellectualtakeout…..-1973-2083

  21. “There aren’t free riders.”

    Then what should we call those who receive more from the government, than what they pay in?

    Voters?

    1. I would say anyone who is currently alive and living in the US, not just voters. Happy 4/20 everyone.

  22. When reading some of the “progressives” comments it looks like they want to return to the 1950’s, why they call that progressive is beyond me.

    Saying that someone will take a risk because society is getting free goodies handed to it. Where do these idiots learn these ideas ??? Did Steve Jobs say, hmmm I think I should create the Ipod because of universal health care.

    1. I think u missed my point. I meant that the average joe (not some business genius) wanted to start a business, safety nets may encourage.

      My high-paying job forbids me from taking any risks.

  23. I have NET heard an idea that works for Healthcare.

    From what I hear from the usual suspects on this blog is all the same crap:

    – The free market will fix it
    – No regulations needed
    – Insurance companies will make good on claims if there was no regulatory body making sure they do
    – If an insurance company participates in bad practices, it will go out of business
    – Why should I pay for your healthcare

    That is all a bunch of crap.

    The only way the FREE MARKET would work in Healthcare is the following:

    1. Get rid of the mandate that providers MUST offer emergency medical treatment without taking payment.

    2. Get rid of all public healthcare programs (medicare, medicaid, veterans). If the patient is NOT paying (because and insurance company or the government is paying), the free market will NOT work.

    3. Get rid of private insurance for healthcare. Private plans do the same damage as public plans.

    For the record, I’m not for any of these ideas…I’d rather pay some form of a tax, have public healthcare available, and have the government regulate everything.

    1. Re: Alice Bowie,

      For the record, I’m not for any of these ideas…I’d rather pay some form of a tax, have public healthcare available, and have the government regulate everything.

      We already have that, Alice.

      That is all a bunch of crap.

      Thus spoke the intellectual giant.

    2. You lost me at Step 3. Other than that, I agree with you.

    3. To get the free market to work, it is first necessary to repeal those laws that give doctors monopoly control over the supply of medicine. This requires as a start the repeal of prescription laws that give doctors the monopoly control that they now enjoy. Prior to 1938 these laws did not exist. The patient had the power, not the doctor. Of course the doctor couldn’t make as much money if he didn’t have monopoly control over the supply of medicine. Did you know that there are now prescription laws for pet medications? The only reason is to enhance the incomes of vets. Same principle with human doctors. Repeal prescription laws and patients are in control instead of doctors.

  24. C’mon. Let’s see some real statistics about late-life health care. How many tens or hundreds of thousands of dollars are old codgers racking up in health care expenses for various treatments in their golden years?

    How many actually pay off those mortgage-level expenses before they kick the bucket?

    What happens to the debt? who pays for it? What happens when they can’t?

    I suspect, the health-care industry would be much better off if it ran like a steak house. If you can’t afford to eat here, don’t.

  25. I don’t disagree with Shikha’s analysis, but wonder how relevant it is in the face of two realities:

    1. Few Americans sincerely want to eliminate the welfare state. Changes in societal attitudes on this are likely to happen over decades or generations, not a few election cycles.
    2. The current welfare state structure is a sword of Damocles hanging over our future as an “opportunity society.”

    To many Reason readers “welfare state” and “opportunity society” are mutually exclusive. That’s almost certainly true for the welfare state as currently constituted, but depending on how broad your definition, not necessarily true for every possible form of welfare state.

    Ryan’s plan is a substantive and politically “really might happen” step toward preserving the opportunity society given the reality of public demand for some kind of welfare state.

    Actually enacting an incremental step in our preferred direction demonstrates to the public that this direction is possible and desireable, and so moves the window of political possibility in the right direction.

    That said, to the extent amendments fixing these particular problems are possible, great. If not possible, I still would score adoption of the plan as a major victory.

  26. BTW, another way of getting at these problems is by making the Health Care Compact an optional alternative for states that so choose. Get the best deal possible on the “national” plan, and then if a particular state wants something different: “Here’s your medicaid and medicare money is a no strings attached block grant – you figure it out.”

  27. For all you stupid leftist, I’ll post this example one more time.

    Have you ever heard of St. Jude? It’s funded by private donations only, pays for ALL of your costs, including travel to and from the facility, and not only that, it has the BEST doctors in the field.

    The government doesn’t have anything to do with it. How can you possibly say old people (and remember we’re only talking about “poor” old people that can’t afford health care) wouldn’t be taken care of when children with cancer are?

    You can’t. You’re just stupid!

    1. shut up and get out, logic and reason and evidence and facts and all that other irrelevant shit have no place her!!!!!!!!!11111111111

    2. And it specializes in helping low income families who have children with rare diseases!

  28. No government in health care. Period. No compromise.

  29. first, good article and great comments.

    second, I hate you all.

  30. To control health care costs, the patient, not the doctor must be the decision maker. The doctor wishes to maximize his income. The patient would prefer to spend less money. Currently doctors have monopoly control over the supply of medicine through prescription laws. Remove prescription laws and doctors no longer possess the power to force patients to do as they wish with the threat to with hold medicine if the patient refuses to obey the doctor. Under such conditions, cost control is possible without the government regulating what the doctor can earn. As a member of the Libertarian Party I think this makes a lot more sense than the “solutions” suggested by Republicans.

  31. what makes you think competition will lower costs with seniors when an insurance company is in the way raking off their huge profits? it doesn’t for anyone else. furthermore, i wonder if you have ever been subject to “rationing” by an insurance company? why is that better than a panel of experts with no fiscal interest?

  32. government-funded health care program for seniors, is a slowly tightening noose around this country’s fiscal neck. Health care costs have been growing at twice the rate of the economy. But seniors have little incentive to curb their medical consumption because they don’t pay for it?taxpayers do. Indeed, according to the president’s Council of Economic Advisers, 30 percent of Medicare spending produces no medical benefits

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