Entitlements

Paul Ryan and the Real Enemy of Medicare

It's easy to improve health care if cost is no object. It's easy to reduce costs if you can tolerate worse health outcomes.

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If you are on a pleasant walk and someone comes out of nowhere to demand that you stop and turn around, you may regard him as an unwelcome interloper. Until, that is, you learn that he's saving you from going over a cliff. In that case, you might realize that a real friend is someone who tells you the truth even when it isn't welcome.

That's the position of Paul Ryan as he undergoes a frenzy of flagellation from Democrats outraged by his Medicare plan. President Barack Obama's campaign has a new ad accusing Ryan and Mitt Romney of a scheme "ending Medicare as we know it." But the real enemy of Medicare "as we know it" is not Ryan. It's arithmetic.

Medicare is the second biggest item in the entire federal budget and one of the fastest growing. Over the past 30 years, its cost has doubled as a share of our gross domestic product, and over the next 30, it's on track to double again.

But the revenues that pay for it are not keeping pace. The Medicare Hospital Insurance trust fund is expected to run out of money by 2024.

At the rate we're going, Medicare, Medicaid, Social Security, and interest payments will consume the entire federal budget by 2025—leaving nothing for defense, law enforcement, national parks, highways, food stamps and all the other responsibilities the government is supposed to handle. Either drastic spending cuts or staggering tax increases would be needed.

To insist that Medicare can and should remain just as it is today is either delusional or dishonest, and Obama, at least, is not delusional. His own Simpson-Bowles commission called for a variety of measures to slow its galloping growth, some of which could inconvenience seniors.

Ryan's plan, contrary to what critics like to pretend, would not mean draconian cuts for people already on Medicare or about to be. The only people subject to most of the changes are those under age 55.

His chief reform is to shift from a defined-benefit program, which obligates the government to cover all costs, to a defined-contribution approach, which commits the government to provide a fixed amount of money for each recipient. Over time, seniors would have to pay a bigger share of the expenses, but benefits would keep up with inflation.

The overhaul would not mean abandoning Grandma on an ice floe. The Ryan plan approved by the House would set up insurance exchanges where the elderly could choose among plans to suit their needs.

"Health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare's sickest and highest-cost beneficiaries receive coverage," says the committee's report.

Among those favoring such changes is Alice Rivlin of the Brookings Institution, who was President Bill Clinton's budget director. The premium support model embraced by Ryan, she testified before Congress in April, "seeks to combine the tools of market competition and cost-effective regulation in hopes of maximizing the chances of improving health care for seniors at a sustainable cost."

It's easy to improve health care if cost is no object. It's easy to reduce costs if you can tolerate worse health outcomes. The trick is to balance the two needs. The Ryan plan is a credible attempt.

Not that he has a stellar record in this or other areas of the budget. In the past, he's been the fiscal equivalent of a chicken hawk: tough until it's time to put his own survival on the line.

He voted for President George W. Bush's plan to furnish prescription drug coverage to seniors, adding $8 trillion to the government's unfunded obligations. He voted to bail out General Motors. He voted for TARP.

He did more than his share to help Bush add $5 trillion to the national debt. But if the prodigal son wants to redeem himself with a politically dangerous blueprint to make Medicare affordable, more power to him.

Democrats have a point in saying what Ryan offers is not as good as the current version of Medicare. It's also not as good as the Big Rock Candy Mountain, the pot of gold at the end of the rainbow or the valley of Shangri-La.

His option does, however, have the virtue of a connection to the real world. It's a place his critics can't avoid forever.

NEXT: Former Dem Congressman: I Know What Joe Biden Was Doing

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  1. Scariest. photo. ever!

    1. What is that behind Nancy’s left shoulder?

      1. Pretty much 100% certain that’s Ronnie Wood. Why he was visiting Congrefs, I have no idea.

      2. I don’t know. And it says something that Nancy isn’t the most frightening component of the assembly.

      3. We keep debating that. It is either Perry Ferrell or Ron Wood.

        1. It’s alive? I thought it was the mummified remains of a Zuni chieftain, c. 1560 or so.

          1. Maybe it is the mummy they found in Peru back in the 1990s.

          2. It’s the elusively-photographed Blair Witch.

        2. Well it’s Bill Wyman in front, so I’m going with this was taken at a Stones party when they were all in drag for old time’s sake.

          1. I think this was right after Brian Jones died. You should see how old they look NOW.

            1. I don’t think so. I prefer to not be made of stone (obviously until I die, at which time I would like a statue of me, wearing only my monocle, reposing on a chaise lounge to be placed in the yard of the largest orphanage-coal mine to inspire the child-laborers.)

      4. They’ve got a cave troll!

      5. Photobombed by Gollum, I think.

  2. I am going to get rid of facebook. The Ryan pick is the last straw. The parade of stupid is just too much. I hadn’t logged on in a few days. My God.

    Did you know Paul Ryan wants to murder women by letting hospitals not perform abortions?

    Did you know that he is friends with Scott Walker who destroyed the middle class and education in Wisconsin?

    Did you know that Ryan wants to cut Pell Grants and give the money to oil companies?

    I can’t take it anymore. So much stupid.

    1. Ryan’s all for those things? Wow, my esteem for him just went up a few notches. I’m hoping he next comes out for zero taxes on millionaires and billionaires, and ending education for all kids with an IQ of less than 130.

      1. I come on here and Ryan is the kind of the big spending Republicans. A corrupt monster who plans to spend trillions and trillions more on his naferious schemes.

        I go on factbook and Ryan is a monster who plans to grind up poor people as seasoning for rich oil Barron’s food.

        I think we are on pace to equal the stupid put out in the 2008 election.

        1. I think we are on pace to equal the stupid put out in the 2008 election.

          Of this I have no doubt. I think we’re headed to Peak Stupid.

          Well, till the next election, of course. Peak Srupid To Date may be a better way to say it.

          I can’t WAIT!

          1. By stating that there can be a “peak stupid,” you imply there’s a limited supply of stupid. There is not.

            1. So true. We will never run out of stupid. As the supply begins to run out, prices will rise and alternative types of idiocy will be discovered.

        2. Hey, you don’t like it, move to Russia.

        3. Here’s the thing John: While your view of the Reason portrayal of Ryan may be a little exaggerated (though I don’t actually think anyone has said that – we’ve just been honest about his record, which bothers you because you’ve turned into Red Tony), it is A LOT closer to the truth than the left facebook narrative. And you know it

    2. Haha! I’m right with you. “Timeline” was the second-to-last straw. The REALLY stupid, more-than-usual stoopid about the election put me over. I can’t take it any more.

      I’m off shortly. I’ll have to make The Twitters and The LinkedIn work somehow.

      PS Another wonderment – how my wife and I accumulated SO many friends who are Team Blue. A couple Team Red, but why the VAST majority Team Blue? Makes no sense. Oh well – buh bye!

      1. I wouldn’t care so much if all of them wouldn’t immediately post whatever the talking point of the day was on their feed. I don’t post political stuff generally. It is just not the place for it. But the election has really brought them out in force.

        My favorite are the people who always say “I am not trying to start a political fight but..” And the it is always followed by “but how can my conservative friends agree with Ryan wanting to murder young college students?”

        1. Learn to unfriend. Or just call them out as stupid.

        2. I guess I’m just lucky. Some of my friends occasionally post political stuff but for the most part stick to personal friend-type stuff.

          1. A lot of people figured out quick that if you want to keep your “friends,” you don’t get involved in political debates on Facebook.

            “The personal is political” is going to be noted in history as a significant factor in the destruction of whatever social bonds existed in the pre-Internet days.

    3. WARNING
      You are about to terminate your Facebook! Terminating your Facebook will terminate your Friends. Your Friends have no cash value and are nontransferable.

      Are you sure you want to terminate your Facebook?

      1. Your Friends have no cash value

        You should get better (or at least more marketable) friends

        1. I felt a great disturbance in the Facebook…as if millions of voices suddenly cried out in terror and were suddenly silenced. I fear something terrible has happened.

          1. I hope you clicked with extreme prejudice.

            1. Yup. I felt like Himmler.

    4. my wife has been posting this onion piece

      http://www.theonion.com/articl…..-do,29160/

      1. +1. That’s actually kinda brilliant.

      2. my compliments on your wife’s taste!

      3. That piece… Hilarious.

        I’m pretty surprised; I haven’t read TheOnion in a while because of their generally liberal bias.

      4. And if we’re having trouble getting Pennsylvania on board, just wait until I absolutely wipe the floor with Joe Biden in the vice presidential debates. Don’t think for a second that I don’t know you’re terrified of us facing off, because in the back of your mind you know it could be a bloodbath up there.

        This is hilarious, because I said almost the exact same thing to my nephew a few days before Ryan was picked, except I said there was no doubt Ryan will crush Biden. Their debate will be by far the highlight of the campaign.

    5. I’ve already had to unsubscribe a couple of friends who keep posting this shit. Nothing of substance, just the latest Team Blue smears. One of the folks was an old army buddy that I had lost touch with nearly twenty years ago. The one thing I liked about Facebook – the easy searches for lost friends turned around and bit me in the ass. Now I’ve come to regret ever looking some of those very people up. Sad really.

  3. This economy will be driven into the ground, backed over multiple times, and long buried before our political betters realize it’s too late to fix it. They have no incentive to do anything other than continue the pillaging.

    1. Term limits!

      1. Term Inator! “Are you John Boehner?”

        Or is that teh ELIMUNASHUNIST RHETORICKSZOMFG!!11one!!?

        Sorry.

        1. You’re not Almanian’s Evil Twin – you’re O3’s

      2. All term limits do is incentivize politicians to carry out their shake downs faster.

        1. NOT if you combine them with votes of confidence. You can boot them whenever you want.

          We gotta dis-incentivize the fucking career politician. When getting reelected is more important than the truth, there is no chance.

          1. The best way to dis-incentivize career politicianary is to cut their pay. I propose that no politician should make more than the median of the area they represent, but that may be too high. I envision a land where people go to be politicians for a few weeks a year and hate it because it takes them away from their real job (yes it’s like people dreaming of winning the lottery). Unfortunately, the only people who can change what they get paid are the politicians, and they never vote against their livelihood.

            1. The problem is normal people have no desire to become politicians. Chasing out the old crooks at every election will only sweep in a new band of crooks.

              1. The problem is normal people have no desire to become politicians.

                Some say power corrupts. I say corrupt people are attracted to power.

                That’s why “throw the bums out” never works.

                1. The little town where I live has a 5-member city council, and (surprise!) they’re a bunch of corrupt douchebags. There is a small movement to get rid of 3 of them who are coming up for reelection, but there’s literally only one person in town who’s willing to run for one of the three seats. I can’t imagine why anyone would be willing to put their career on hold for a few years so they can play a frustrating game of politics with a set of scumbags. The only people interested in this job are other scumbags who want to make this their career.

            2. Politicians don’t get rich off their salaries.
              They get rich by virtue of the fact that laws don’t apply to them. They commit fraud, insider trading, extortion, and a host of other crimes without consequence.
              Their salaries are a pittance when compared to their legal racketeering.

            3. The best way to dis-incentivize career politicianary is to cut their pay.

              Can’t be done, in any real way. They get most of their “income” from their political careers off the books. Crony deals, insider trading, revolving door, etc.

              1. Sorry, I thought the standard libertarian argument of taking away their power over business, i.e. returning to constitutional limits, that would solve most of the kickback, revolving-door, lobbyist problems was implied.

      3. We have term limits. They’re called “elections”.

        1. So you vote for one fucking liar over another fucking liar. They won’t tell you where they actually stand because they are too fucking concerned about getting re-elected. They don’t do what rational humans would do because they might offend one of their constituents AND NOT GET FUCKING REELECTED! They don’t vote their conscience because…

          1. This. It was never meant to be a career.

          2. Here’s a hint: It’s -good- for them to be scared about being re-elected. Otherwise, they’d just do whatever gets them the biggest kickback.

            Not saying it’s without flaws, but having some kind of market feedback mechanism is actually a good thing.

            1. It’s -good- for them to be scared about being re-elected.

              Couldn’t agree more. I propose a single term (8 year senator, 4 year rep), BUT with votes of confidence every two years, where a 2/3 majority could terminate them early. They would only be running against their record. No campaigning, no money, no lying. (Okay, lying…but maybe less of it.)

    2. I understand where you are coming from, but no more lamentations for a dead nation destroyed by the excesses (actually it is all excess) of progressive policies for me. I assume I’m in the wastelands guarding from the raider hordes at this point. I’m just hoping they have decent loot to salvage.

  4. Did anyone see Maureen Dowd’s column where she told Ryan to wipe that smile off his face because it is inappropriate to smile when you are set on hurting people? Bitch is stupid nuts.

    1. Holy hell she is still alive? Now we know what they did with Keith Richards’ stem cells.

    2. But making jokes about using drones to kill is just fine, I guess.

      1. obama, our nobel peace prize winner did this

        1. “The nobel peace prize; you didn’t win that”

    3. She went over over the edge for the good when Michael Douglas dumped her for Catherine Zeta-Jones.

  5. Pelosi is a scumbag of the highest order. I cannot understand how she continues to exist in our political system. The woman breathes lies.

    1. i cannot understand why pelosi doesnt commit ritualistic disembowelment knowing ur feelings

    2. Pelosi is a scumbag of the highest order. I cannot understand how she continues to exist in our political system. The woman breathes lies.

      Her district is San Francisco.

  6. All term limits do is incentivize politicians to carry out their shake downs faster.

    That may be true, but it takes time to learn how to really work the system. And, if the payoff isn’t continuous re-election, some of the worst power seekers might look for another line of work.

    1. Here’s my forseeable consequence: Ex-politicians become lobbyists and spend their time showing their replacements how to milk the cow.

      1. Easily solved:

        (1) No elected official may work in government after they leave office, or receive any pay for communicating with elected or appointed officials.

        (2) No US Attorney may advance in grade without first successfully prosecuting a former elected offical for violating (1).

    2. Lottery. You pick the government at random from eligible voters in the district/state/nation. Can’t be any worse than what we have now.

      1. I’d rather entrust the government of the United States to the first 400 people listed in the Boston telephone directory than to the faculty of Harvard University.

        William F. Buckley, Jr.

      2. It would be substantially better. No more gerrymandering. Effectively builds in single term limits. No more whining over campaign finance. Might not eliminate the revolving door, but would reduce it. Much easier to catch some types of fraud, since you just have to check the people that get picked. More representative sample of society in Congress. No more legacy candidates. Etc.

  7. Ex-politicians become lobbyists and spend their time showing their replacements how to milk the cow.

    Probably, but with any luck the turnover increases overhead and reduces the expected returns from lobbying.

    1. I don’t think we’ll be that lucky. Politicians are in the game for power. If you reduce the amount of time they can wield it, they’ll find a substitute. That substitute will absolutely be lobbying, because the new crop of politicians will need quite a bit of hand-holding to navigate the political maze. As a result, the only types who will run will be even more for sale than the previous generation.

  8. The premium support model embraced by Ryan, she testified before Congress in April, “seeks to combine the tools of market competition and cost-effective regulation in hopes of maximizing the chances of improving health care for seniors at a sustainable cost.”

    Most of the “tools” of market competition don’t apply to companies scrambling for government cheese. Imagine the AARP and the insurance companies lobbying together: that’s how well the deceleration of costs will pan out.

    1. True enough, Jersey. Does it also work, say, here:

      Most of the “tools” of market competition scientific inquiry don’t apply to companies researchers scrambling for government cheese.

      1. Obviously not Dean.

        I mean the science is settled for Gaia’s sake.

        Also CONSENSUS!!!

        Also also fried chicken.

  9. Medicare is the second biggest item in the entire federal budget and one of the fastest growing. Over http://www.ceinturesenfr.com/c…..-c-26.html the past 30 years, its cost has doubled as a share of our gross domestic product, and over the next 30, it’s on track to double again.

  10. which commits the government to provide a fixed amount of money for each recipient. Over time, seniors would have to pay a bigger share of the expenses, but benefits would keep up with inflation.

  11. I am taking it as a political attack i am not believing in it, these things happen in the election times.

  12. Medicare is the second biggest item in the entire federal budget and one of the fastest growing. Over the past 30 years, its cost has doubled as a share of our gross domestic product, and over the next 30, it’s on track to double again.

    But the revenues that pay for it are not keeping pace. The Medicare Hospital Insurance trust fund is expected to run out of money by 2024.

  13. To insist that Medicare can and should remain just as it http://www.airmaxsalle.com/fem…..-c-12.html is today is either delusional or dishonest, and Obama, at least, is not delusional. His own Simpson-Bowles commission called for a variety of measures to slow its galloping growth, some of which could inconvenience seniors.

  14. Medicare is the second biggest item in the entire federal budget and one of the fastest growing. Over the past 30 years, its cost has doubled as a share of our gross domestic product, and over the next 30, it’s on track to double again.

  15. To insist that Medicare can and should remain just as it is today is either delusional or dishonest, and Obama, at least, is not delusional. His own Simpson-Bowles commission called for a variety of measures to slow its galloping growth, some of which could inconvenience seniors.

  16. Medicare, and all compulsory, generational transfers of wealth, are immoral in their conception. Given that both Ryan and Romney are prone to unprincipled compromises, if Republicans can’t hold the House and capture the Senate, the window for real reform within our current system may close forever.

    http://whatdirectdemocracymigh…..mon-sense/

  17. I would like to say that this Medicare bill is the real enemy of politicians this bill brings so much criticism in Obama government and now it’s on the opposition.

  18. Paul Ryan and the Real Enemy of Medicare

  19. “At the rate we’re going, Medicare, Medicaid, Social Security, and interest payments will consume the entire federal budget by 2025?leaving nothing for defense, law enforcement, national parks, highways, food stamps and all the other responsibilities the government is supposed to handle.”

    Food stamps and parks are something the government is “supposed to handle”? Steve really chaps my ass.

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