Ryan-Rivlin Plan for Medicare & Medicaid Reform

[FinanceDude]

I have trouble calling the Ryan-Rivlin Medicare plan 'extreme', since is is really just the Federal Employee Retirement System medical coverage opened up to everyone. About the only really questionable item is the way the cost adjustment for the government's part of the program is done, and I'm pretty sure Congress won't be able to resist fiddling with that.

I don't think Congress wants FERS medical opened up to everyone. Much like no govt employee wants TSP available to the average worker.........

 

[BLS53]

This will be a very polarizing debate.

It is funny our economy just went through a near death experience (for the middle class mainly). Caused by the the elite (taking advantage of a lax system). Now GOP wants to kill the middle class programs that were paid for with dedicated funding.

I think they are securing Obama's reelection.

Forgive me... but here is my rant!

It just shows how disconnected they are from average people. That tea party rhetoric will end when many of those same people understand how they will be impacted.

Bottom line: The middle class will continue to pay high taxes. There will be no reduction... not matter what happens... The Middle Class funds most of it.


The GOP has a number of followers that are not their primary constituents. Those people are swayed by emotional issues such as Abortion, Guns, or divisiveness about certain social programs for the poor (e.g., I have to work... why don't they). The shame of it is that those people don't know they are being manipulated like pawns.

I am an independent. IMO certain social programs should be cut and certain spending. But I draw the line at our pension and our retirement health care (that we paid for)! I find it particularly insulting that they try to recast it as welfare (like we did not pay for it)! It is a level of arrogance, self-serving and serves such a few (their contributors)... the only word that come to mind is "Outrageous"!

It is funny how the GOP always wants cut things that are intend to protect or are for the well being of our general population.

The GOP approach to whipping up the faithful is going to be largely neutralized when many people realize that the real plan is: We will not make good on the retirement programs you have funded all of your life!

+1

There was a time when welfare meant unwed mothers having babies on the government dime. Now it seems anyone receiving a cent from the government (even government employees), is seen as a bum and a drag on society

 

[FinanceDude]

There was a time when welfare meant unwed mothers having babies on the government dime. Now it seems anyone receiving a cent from the government (even government employees), is seen as a bum and a drag on society

I could not disagree more. And I live in Wisconsin, so I have heard plenty from both sides........

 

[M Paquette]

I think the whole program, cost adjustment and all would be excellent- but only if it were society wide, not just oldsters who will be discrininated against, herded off into pools with poor experience, and gradually lose access to services available to other groups.

Good point. I don't see anything in the legislation that would prohibit slicing and dicing the insured into the usual tranches. It does make Medicare participation voluntary, so there is some risk of the Medicare private insurance plans becoming the plans of last resort.

As participation in the plan is voluntary, we also have the potential consequences of the uninsured elderly landing in hospital, and the charges going to Medicaid or hospital charity care eventually billed back to Medicaid and similar programs. Bear in mind that Ryan's plan repeals the Affordable Care Act, so the elderly are not required to carry insurance. Some portion of the elderly may find insurance unaffordable even with the Medicare voucher. For example, one local HMO has a high deductible/HSA plan for elders in good health. For all non-Medicare members age 65 and older this plan costs $1208/month. That's well over twice the proposed voucher amount in current dollars.

There will be a rise in the uninsured elderly seeking medical care, so we should expect a reversion to something like the pre-1965 situation for some medical care for the elderly. Naturally, Rugged Individualists will be unaffected, as they have plenty of funds saved up, and they are immune to all illness due to good, clean living. The rest of us need to be careful.

 

[nun]

Ok, Ha, you're a sharp guy, what is the WORKABLE alternative plan you would support?

All health systems are dealing with issues, but some are so far ahead of the US when you look at cost and results that it's amazing the US stands for the system it has. Just look to France or the UK.....better healthcare, people live longer, fewer babies die and the amount spent per capita is half of US expenditure. The systems are out there, the US just doesn't choose to look. I'll wait for the indignant responses.

 

[haha]

Ok, Ha, you're a sharp guy, what is the WORKABLE alternative plan you would support?

First, thank you for the compliment. While I don't consider myself a healthcare expert, my best ideas are in a post right above referring to Ryan-Rivlin-

I think the whole program, cost adjustment and all would be excellent- but only if it were society wide, not just oldsters who will be discrininated against, herded off into pools with poor experience, and gradually lose access to services available to other groups.

We don't have to re-invent the wheel, rather just look at what Europe and Japan are currently doing, and to control cost escalation, add a GNP tie like Ryan-Rivlin advocates for seniors to any increase in overall spending. All the money payments would be controlled by the central government. Who might pay into this health fund (individuals, taxpayers, corporations) is a detail that could be solved. Essentailly the governemt would collect and disburse payments, and set the rules and overall limits on spending.[/quote]

IMO, nothing else could work as well as this, and still get control of costs. In fact, it is so simple that I cannot think of reasons other than perceived self interest for opposing it.

But we will almost have to be facing a final abrupt fall into 3rd world status before something this sane might win out over attempts for various groups to gain favor at the expense of other groups. But this may actually come about sooner than I would have thought.

Ha

 

[samclem]

All health systems are dealing with issues, but some are so far ahead of the US when you look at cost and results that it's amazing the US stands for the system it has. Just look to France or the UK.....better healthcare, people live longer, fewer babies die and the amount spent per capita is half of US expenditure. The systems are out there, the US just doesn't choose to look. I'll wait for the indignant responses.

Strawman argument. Please show me any quote on this board from someone who thinks our present (non) system (e.g. pre-reform act) is the best way to go. The present "system" is not a Democrat system or a Republican system--it's just the sum of 60 years of patchwork steps and half-baked "good ideas." There are plenty of ways to improve it.

 

[samclem]

Actually I can see a way out. A solution could be a comprehensive Medicare/"Obamacare" overhaul with mandatory participation in a nationwide pool covering all of us. Insurers could offer any plan they like as long as certain minimum benefits were offered, no preexisting conditions, blah, blah. Do away with the employer plan deduction from income (i.e. move toward no employer based coverage). Include a public option. Lets see the GOP offer us something along those lines and I am onboard.

While this isn't my first choice, I could support it with two provisions:

"Mandatory": If the SCOTUS says no, then we need a backup plan. I think that's do-able through a strong set of incentives and "sticks" that are not directly through the legal system or tax code. I won't bore anyone with that again.

"Public option:" I'm very confident that private insurers can offer better products than public insurers IF the playing field is truly level and guaranteed to stay that way. That means no support (money, in-kind donations from other branches of the government, publicity, automatic enrollment of government workers, etc, etc) whatsoever for the public option except for the voucher payments (or "premium support" payments, whatever) of the patients they attract. We have a very bad track record of "helping out" govt pseudo-private entities (USPS, AMTRACK, Fanny Mae/Freddy Mac, etc), so I think it's fair to demand a bulletproof mechanism to stop any attempts to throw money over the fence. If such a credible guarantee of non-interference can be fashioned, I'd love to see a publicly-administered plan (paying GS/GG wages and benefits) try to compete with a private insurance plan. It would be a great experiment that might prove a lot to the few bitter-enders who cling to the promises of enhanced effectiveness through government involvement. (Or, maybe I'd be proven wrong!)

The hitch: I have no idea how such a binding guarantee might be created. Constitutional amendment? Some tied-together requirement for a supermajority of 90% to change the rules? Extralegal extraditions of violators? Hostages?

 

[nun]

Strawman argument. Please show me any quote on this board from someone who thinks our present (non) system (e.g. pre-reform act) is the best way to go. The present "system" is not a Democratic system or a Republican system--it's just the sum of 60 years of patchwork steps and half-baked "good ideas." There are plenty of ways to improve it.

Agreed, the current laissez faire US system has developed organically and has staggering inefficiencies in health care services and administration. But the US has gone with it again and again. So when Ryancare just perpetuates the the current system of private insurance and shifts costs onto those least able to afford them I wonder at the lack of imagination and engagement with the fundamental problems.

 

[chinaco]

Do you qualify for SS and Medicare? Are they anything to you or are you on some government employee based pension?

You didn't pay for it, the next generation is paying for it. Seems like a lot of people don't realize that. SS and Medicare for you are paid for by the generation after you, not funded by your own money. The kids are always paying for the parents.

Yes technically that is how it works.... because it is fund by our earnings while we work and the benefit occurs when we retire (retirement age).

If you have some point make it... just stating the mechanics doesn't mean much. Other than how the funds are collected.

There is a program that we are enrolled in... not implied, but by law!

SS is NOT a pension, which is exactly what's wrong with the thinking in this country. Do you think it's ok for your generation to reap the rewards of SS/Medicare if it means the next generation has to increase their taxes to pay for it, and the next generation's kids have to increase their taxes even more to pay for that generation, and so on? How's that fair to those being born today?

I have to assume you are jerking my chain for a reaction. This is another statement of fact.... other than the dangling how fair izat!

Frankly when I read this... I am wondering what the hades are you thinking?

They are paying for themselves! You understand that people pay if they participate in the benefit... right.

They will pay and many of them will be thankful they did... but those that doubt it will only know what it means to them when they reach their 50's. Do you want to know why? Because most people do not prepare for retirement adequately and it keeps them off the streets in old age.


But even if you discount that... people have made their plans around it. It is too late to change it for many because of age. If it were changed.... that taxes would still be collected to pay for those that are counting on it. That my friend... will not change!

Ryan is being floated as a GOP test balloon for president. Guess what just happened to him? He just lost a huge number of supporters. He will not get the nomination and certainly will not be elected. He will not get my vote. Watch and see what happens!

I can only assume that you apparently do not consider those program to be of any value (or at least to you). I can only assume it means nothing to you because you are not in the program... or you somehow believe it will not be there when you retire.

 

[explanade]

Mitch McConnell said we have the best health care system in the world. McCain and some others too.

Oh and bringing up other countries' systems will only be met with responses about rationing, delayed or denied care (as if we didn't have insurance denials of coverage) and accusations of socialism.

 

[donheff]

Strawman argument. Please show me any quote on this board from someone who thinks our present (non) system (e.g. pre-reform act) is the best way to go. The present "system" is not a Democrat system or a Republican system--it's just the sum of 60 years of patchwork steps and half-baked "good ideas." There are plenty of ways to improve it.

We had a survey on that. 75% would work forward from Obamacare rather than go back.

 

[donheff]

Oh and bringing up other countries' systems will only be met with responses about rationing, delayed or denied care (as if we didn't have insurance denials of coverage) and accusations of socialism.

And denials of procedures even with top flight coverage.

 

[M Paquette]

The Plan has unemployment at 2.8% in 2021.
...
Even better, he has unemployment at 6.4% in 2012, and 4% in 2015. That's over a million new jobs created in 2012 with a 0.2% improvement in GDP, also from his figures.

My, my. The sales brochures have been updated with new figures already. The Big Picture folks noticed the revisions:



These numbers look more achievable than yesterdays figures. Oddly, Heritage says they didn't change their methodology. Must be math errors. Yeah, that's the ticket! Math errors!

 

[explanade]

So this is a Heritage plan, more or less?

"Obamacare" was also based on ideas generated by think tanks in the '90s.

Of course Republicans, especially Romney, ran away from the ideas on which it's based once the Democrats adopted the same ideas.

 

[nun]

.....and accusations of socialism.

I don't understand the use of "accusation" with "socialism", it implies that there's something wrong with socialism. Remember I wasn't brainwashed by growing up in the good ol' USofA so I'm proud of being a libertarian socialist.

So to follow that up why don't we solve the health care funding issue by applying some libertarian thinking and devolve it down to the states. Get the federal government out of SS and medicare completely. Federal workers and the military could keep their plans and not be subject to the states' rules, but everyone else would get their insurance through whatever method their state required. Given that the attitudes for particular solutions probably break down along geographical lines as mush as political we'd end up with solutions that most people could live with. Some states would have single payer, some highly regulated private insurance and health care with mandates and others with laissez faire private insurance and zero mandates.

This would wipe out a load of obligations from the federal government.....but it might cause the municipal bond market to crash.

 

[explanade]

That's how the Canadians got nationalized system. One by one, the provinces passed what they now have and eventually all the provinces ended up ratifying it.

One of the NE states had a vote in their legislature to try some kind of single-payer system.

 

[nun]

And denials of procedures even with top flight coverage.

The statistics show that people in the UK live longer and are healthier than in the US, its just a year or so in longevity, but the cost is half as much per capita.

My personal experiences with UK's socialized medicine have been excellent and my 85 year old mother has just had laser oblation and cataract surgery. She had to wait 2 months from her diagnosis, but of course hasn't paid a penny out of pocket. She's also on the usual cocktail of blood pressure, vaso dilators, and diabetes medications for an overweight older woman. But again no out of pocket cost. I visited her last Nov and noticed a small cut on her lower leg that she said wasn't healing. This is dangerous of someone with mild diabetes so I insisted she call the doctor. He came to the house that morning and the district nurse came over after lunch to treat and dress the cut. She visited everyother day for 2 weeks to make sure it healed.....and no out of pocket cost to my mum. So I feel the standard of care is better in the UK than my mum would get in the US and she never worries about insurance or how to pay. No system is perfect and there are waiting times in the UK for some procedures and the outcomes for others are not as good as in the USA, prostate cancer being one.....but all in all I think the UK system is better and the statistics and costs support my opinion.

 

[nun]

That's how the Canadians got nationalized system. One by one, the provinces passed what they now have and eventually all the provinces ended up ratifying it.

One of the NE states had a vote in their legislature to try some kind of single-payer system.

VT is looking into it.

 

[M Paquette]

So this is a Heritage plan, more or less?

I don't think so. Rep. Ryan and friends obviously ran it past them, and they liked the flavor. Not a big surprise. The Heritage Foundation has done reviews of Ryan's various Path to Prosperity plans for a few years now.

I trust the numbers from the upcoming Congressional Budget Office far more than I'll trust Heritage's numbers, either yesterdays, this mornings, or the most recent version.

 

[Peter]

My parents' experiences with the NHS have been similar to those described by nun. Hard to understand why some have such a strong negative reaction to the idea of 'socialized medicine'.

Peter

My personal experiences with UK's socialized medicine have been excellent and my 85 year old mother has just had laser oblation and cataract surgery. She had to wait 2 months from her diagnosis, but of course hasn't paid a penny out of pocket. She's also on the usual cocktail of blood pressure, vaso dilators, and diabetes medications for an overweight older woman. But again no out of pocket cost. I visited her last Nov and noticed a small cut on her lower leg that she said wasn't healing. This is dangerous of someone with mild diabetes so I insisted she call the doctor. He came to the house that morning and the district nurse came over after lunch to treat and dress the cut. She visited everyother day for 2 weeks to make sure it healed.....and no out of pocket cost to my mum. So I feel the standard of care is better in the UK than my mum would get in the US and she never worries about insurance or how to pay. No system is perfect and there are waiting times in the UK for some procedures and the outcomes for others are not as good as in the USA, prostate cancer being one.....but all in all I think the UK system is better and the statistics and costs support my opinion.

 

[M Paquette]

My parents' experiences with the NHS have been similar to those described by nun. Hard to understand why some have such a strong negative reaction to the idea of 'socialized medicine'.

'Socialized' implies 'socialism', which has generally been considered the Boogeyman in the United States since the 1940s. Social-anything tends to trigger a funny sort of knee-jerk reaction in a substantial part of the population.

One of the most pointed pieces I think I've ever read on why 'Socialized Medicine is Bad for America' was this gem. Read it carefully, and see how he handled his medical expenses. I found his approach interesting, and would like to know how we all can use this approach. There may be a scaling problem...

 

[GregLee]

... so I insisted she call the doctor. He came to the house that morning ...

A doctor came to her house? Ye gods!

 

[Tadpole]

The boomers will grow old and die. The bills will be paid or not paid. There is always "death panels" for "putting them down" or "legal euthanasia" or both and a law mandating they choose.

Or, 80 years old, homeless, and feeling bad?- armed robbery and a plea bargain for a 20 year sentence where you can get the same health and long term care given prisoners, not the best perhaps but better than law abiding citizens will get if this thread is any indicator. Wikipedia says it is only about $100/day for aging prisoners, 3x the average.

The affordability thing is silly, IMO, since single payer became single shamer.

 

[nun]

'Socialized' implies 'socialism', which has generally been considered the Boogeyman in the United States since the 1940s. Social-anything tends to trigger a funny sort of knee-jerk reaction in a substantial part of the population.

One of the most pointed pieces I think I've ever read on why 'Socialized Medicine is Bad for America' was this gem. Read it carefully, and see how he handled his medical expenses. I found his approach interesting, and would like to know how we all can use this approach. There may be a scaling problem...

Interesting link.....I think I'll go with socialized medicine rather than "gift from God". I love it when people talk about freedom and religion in the same context, as being told what to think and the notion of faith always struck me as the opposite of freedom. I support socialism in health care, but not in thought....nobody tells me what to think man or god......small "g" to include all deities. Many religions (particularly the "fundamentalist" ones) are like celestial North Koreas where you are told what to think without the opportunity to question it.....Jesuits are an exception, they are always doubting and questioning.