Ryan-Rivlin Plan for Medicare & Medicaid Reform

[rescueme]

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.

+1...

I continue to be amazed that most folks don't recognize this simple fact.

"On January 31, 1940, the first monthly retirement check was issued to Ida May Fuller of Ludlow, Vermont, in the amount of $22.54. Miss Fuller, a Legal Secretary, retired in November 1939. She started collecting benefits in January 1940 at age 65 and lived to be 100 years old, dying in 1975."

She certainly did not contribute to her own benefit. Another generation (or two) did over her retirement years, and that continues to this day.

Heck, DW/me went through several "revisions" of these programs, both in increase of taxes, amount of income taxed, along with the increase in full retirement benefit age and the reduction in age 62 SS benefits.

Sure, "the kids" will have to contribute more over time. That's the way it's always been. They are younger, will probably make more than us over time, and will live longer (along with a longer period of contributions).

We "kids" had to make adjustments over time, during our wo*king years. Ours will have to do the same. Nothing new under the sun...

 

[samclem]

We have ample history in the US that the combination of hospitals, insurance companies and poorly informed consumers of a vital (literally) service is a recipe for uncontrolled costs.

We don't have any history of this. The plan is to help educate consumers (make it possible to get solid information), reduce barriers to competition, and let market forces work while also accomplishing social goals (insuring the sick and poor). We don't have anything like an efficient market today.

We know that Medicare as now structured is unsustainable--that the available services will need to be cut and that the number of health care providers willing to see Medicare patients will continue to decline. I'm at a loss to explain how this is uncritically accepted as the "compassionate" approach to helping the poor. Well-off people will be able to buy private insurance or pay out of pocket, but the poor and the sick will be left aboard the sinking ship. Ryan's plan isn't perfect, but it has the potential to reduce prices and enhance quality in ways that aren't possible with cost caps--as we've now seen for 45 years with Medicare. There is ample history of that.

 

[FinanceDude]

Why are we worried about Medicare when potentially the largest entitlement program of all time (Obamacare) will in short order destroy any beenfit we would get restructuring Medicare/Medicaid and SS. I guess that was the real reason to delay implementation until 2014..............

 

[donheff]

What plan should we compare it against? We all await a plan from the other side of the aisle. Still. It is supposed to be coming soon ("You go first!" "No, you go first!") Maybe it will come when Speaker Pelosi finishes the 2011 budget.

I agree that somebody has to go first and Ryan is taking a risk in stepping forward. But remember, Dick Durban supported the deficit panel's report and is willing to talk to serious people on the other side of the aisle so it isn't one sided. From my viewpoint there is no good answer to the Medicare problem under discussion. I would prefer a single payer system top to bottom so we could all plan our futures without the specter of health cost ruin. But that is not going to happen. So, if we stick to a private insurance model we have to look at how best to deal with Medicare - maybe integration with the rest of us is an answer. But, as long as the GOP is refusing to back any sort of universal health insurance I think they are leading us down the wrong path. Privatize Medicare in conjunction with eviscerating health care reform? -- disaster.

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.

I seem to remember a huge SS surplus that fills the gap through 2037 (a lot of us will be dead by then). Seems we did pay a substantial portion ahead of time. Viewing the trust fund as spent money is a reprehensible way to impose a massive retroactive income tax on the $100K and less crowd. Lets make it more fun by dropping the marginal rates on the $250K+ crowd once again. Great plan

 

[explanade]

I paid and am paying for something. A lot of deductions for social security and medicare taxes.

Just try and change the rules of the game after I played by the rules for decades.

 

[DallasGuy]

The actual bill is to be introduced next week. The Congressional Budget Office did a preliminary analysis last November. I suspect there may be some political interest in the bill, so I'm starting this thread here rather than let it run amuck in the Health & Early Retirement Forum.

www.cbo.gov/doc.cfm?index=11966 (6 page PDF document)
Key Features of the Proposal
MEDICARE
People who turn 65 in 2021 or later years would not enroll in the current Medicare program but instead would receive a voucher with which to purchase private health insurance.

This is a quote from the "The Path to Security" document that was put out by Paul Ryan:

Starting in 2022, new Medicare beneficiaries will be enrolled in the same kind of health care program that
members of Congress enjoy. Future Medicare recipients will be able to choose from a list of guaranteed coverage
options, and they will be given the ability to choose a plan that works best for them. This is not a voucher
program, but rather a premium-support model. A Medicare premium-support payment would be paid, by​

Medicare, to the plan chosen by the beneficiary, subsidizing its cost.

I turn 55 in 2021, so whether this new medicare plan starts in 2021 or 2022 is a big deal to me. My initial reaction is that I don't want the "new plan" and have to deal with insurance companies for my retirement health insurance coverage because my experience with buying individual insurance on the open market has not been good. I feel like insurance companies will always try to find a way to screw the customer. As I've said in the past, I find it somewhat bizarre that insurance companies are "for profit" anyway. When they're in the business of trying to make money by denying or reducing coverage, they will probably end up denying or reducing coverage.

Anyway, does anyone know if this plan actually starts in 2021 or 2022 (for someone turning 65 during that year)? If it starts in 2022, it appears as though I'd be covered under the "old/existing" plan.

NOTE: I realize that all of this could change based on whether any of this plan ever passes or not...so 2021 or 2022 is probably something that will change anyway.

 

[donheff]

From my viewpoint there is no good answer to the Medicare problem under discussion. I would prefer a single payer system top to bottom so we could all plan our futures without the specter of health cost ruin. But that is not going to happen. So, if we stick to a private insurance model we have to look at how best to deal with Medicare - maybe integration with the rest of us is an answer. But, as long as the GOP is refusing to back any sort of universal health insurance I think they are leading us down the wrong path. Privatize Medicare in conjunction with eviscerating health care reform? -- disaster.

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.

 

[nun]

The Ryancare plan is extremist, but it starts the ball rolling to shift Medicare costs from tax payers to retirees. Given the abysmal level of retirement savings this added retirement expense will definitely cause hardship. Will the Government vouchers/subsidies be means tested? I assume there will be no mandate to buy this health care so I can see many old people living without insurance and I worry about the costs of those uninsured.

I increasingly see the US becoming a third world country, but I'm lucky as I can move around easier than most being a dual UK/US citizen so I can organize my retirement to take advantage of the best country to live in. Right now I have no problem staying in the US as my work is rewarding both intellectually and financially and I have good health insurance. At 55 I can retire form my job and continue my health insurance for the same premium as if I was working and that will take me up to 65. Beyond that I would have to go on Medicare, so if the Ryancare were to replace Medicare I'd definitely be looking to move abroad to find better care at a lower cost. UK and France are top of my list.

 

[haha]

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.

Count me in. But I am afraid it makes too much sense for either party to offer it.

Ha

 

[nun]

Count me in. But I am afraid it makes too much sense for either party to offer it.

Ha

Sounds like a plan.....oh wait, mandate, public option. DOA however sensible it might be

 

[fisherman]

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.

+1

A good constructive opinion

 

[nun]

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.

I agree that this would be a good plan. Employers would like it as it would remove the connection between employment and health insurance (which has always seemed strange to me) thus reducing their costs. However, it would result in 3, 4 or 5 fold increase in the cost of premiums to the consumer if they had to pay for the entire premium.

 

[Gone4Good]

I have no problem cutting benefits. But why does the Ryan plan that is being sold as necessary to reduce the deficit also reduce revenue?

"Hi Honey, we have to turn off the lights because we can't afford the electric bill. Oh, and I'm quitting my job, too."

 

[nun]

I have no problem cutting benefits. But why does a plan that is being sold as necessary to reduce the deficit also reduce revenue?

"Hi Honey, we have to turn off the lights because we can't afford the electric bill. Oh, and I'm quitting my job, too."

I reduces the top tax rate form 35% to 25%.....that will obviously increase revenue as it will spur entrepreneurs to invest in small businesses creating jobs and.....oh sorry my own sarcasm just got to me, I just can't keep this up.

Cut costs, increase revenue base ie taxation and we will be out from under the deficit

 

[donheff]

I agree that this would be a good plan. Employers would like it as it would remove the connection between employment and health insurance (which has always seemed strange to me) thus reducing their costs. However, it would result in 3, 4 or 5 fold increase in the cost of premiums to the consumer if they had to pay for the entire premium.

Probably although maybe not to that degree. Employer plans would still exist until the companies abandoned them. As they did so they would have to decide whether to pass on some or all of the savings to employee salary increases. But what the hey -- let the market determine. If, absent the current governmental interference (tax breaks and employer mandates), employers wouldn't pay employees to match then the workers could decide whether they prefer to pay their full, transparent, premiums to insurers or petition the Government to handle it all with a tax based single payer system.

 

[nun]

Probably although maybe not to that degree. Employer plans would still exist until the companies abandoned them. As they did so they would have to decide whether to pass on some or all of the savings to employee salary increases.

Just like employers gave salary increases when pension plans were replaced by 401ks.....I won't hold my breath

 

[FinanceDude]

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.

Uh, the Republicans believe in choice, so I doubt they are in favor of a total govt takeover of healthcare..........

 

[FinanceDude]

The Ryancare plan is extremist,

Really? What workable plan have the Dems come up with?

 

[M Paquette]

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.

The Medicaid block grant idea would be good to see. The current Medicaid system has all sorts of preconditions on how states have to operate the programs, that come down to being unfunded mandates. (These are contributing to California's current budget problem, as a relatively minor item.)

 

[rescueme]

Just like employers gave salary increases when pension plans were replaced by 401ks

Been there - lived that...

 

[rescueme]

Really? What workable plan have the Dems come up with?

+1

Don’t' criticize unless you offer an alternative plan to be considered.

The Republicans have been labeled “the party of no”. Now they offer a plan (good or not) and are ravished by the opposite party.

Can we label the Dem’s in the same manner, e.g. “the party of no?”

Oh wait - I remember. It’s Bush’s fault ...

 

[haha]

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 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.

It may come to pass that America's pets will get better medical care than it's seniors.

The whole world's medical systems are going to crash if we can't come up with some sort of halt to the strong rise in diabetes cases. Many people given a diabetes diagnosis just go right on eating Baby Ruth Bars, under the old system this was bullish for dialysis centers, in the new world order this is very bearish for the elderly who might find themselves in disadvantaged pools. See what this physician who has treated the fit and the unfit all over the world has to say.

http://www.npr.org/2011/03/24/132745785/how-western-diets-are-making-the-world-sick

Ha

 

[FinanceDude]

+1

Don’t' criticize unless you offer an alternative plan to be considered.

The Republicans have been labeled “the party of no”. Now they offer a plan (good or not) and are ravished by the opposite party.

Can we label the Dem’s in the same manner, e.g. “the party of no?”

Oh wait - I remember. It’s Bush’s fault ...

The Dem talking heads in Washington have said "this is a good day for Dems", because they feel they can attack the GOP on this plan. So much for "reaching across the aisle"..........

 

[haha]

The Dem talking heads in Washington have said "this is a good day for Dems", because they feel they can attack the GOP on this plan. So much for "reaching across the aisle"..........

This plan ought to be attacked, it is stupid.

Ha

 

[FinanceDude]

This plan ought to be atacked, it is stupid.
Ha

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