In a shocking move, Ron Wyden (D-OR) joined forces with Paul Ryan (R-WI) last week to propose a reorganization of Medicare. Democrats - especially Oregon Democrats - have gone ballistic: he's consorted with the most heartless knee-jerk anti-government sociopath in the enemy flanks. (Or would that be Eric Cantor?...) And they're confused: Ron Wyden has been devoted to the protection of seniors for 35 years, long before he was ever in the Senate. How could one of America's greatest defenders of the elderly throw them out of their hover-round scooters, and simultaneously defang of one of Democrat's strong campaign planks for 2012?
I got out my Team Wyden basketball, preparing to stick a fork in it and send it back. But I decided to give Ron the benefit of reserved judgement, in honor of his many years of making me proud. I wanted to be sure I had a clear understanding before I threw a tantrum.
Well, Maybe. In today's Oregonian, there is an article by Matt Miller, host of NPR's "Left, Right, and Center" and a columnist for WaPo, that points out that Wyden may have gotten Ryan to buy into the Affordable Care Act.
What Matt Says
- Wyden-Ryan lets firms with less than 100 employees (accounting for 1/3 of America's total employment) pay employees to get health insurance from exchanges instead of just offering them a single choice. It's a fantastic expansion of access, and begins to move America off the archaic employer-provided-insurance system.
- Ryan has signed onto the idea of subsidizing people to buy coverage from regulated exchanges that must take all comers and charge them similar premiums.
- Wyden-Ryan preserves traditional medicare as an option, effectively turning it into a public option.
- Wyden-Ryan permits costs to rise at inflation plus 1% annually; the original Ryan plan capped increases at inflation. Miller thinks that adds $50 T in costs over the next 40 years, costs Ryan's budget doesn't include, and that Miller thinks will force tax increases.
In summary, Miller says:
But Wyden has put Ryan in a box where he can be forced to admit there's no way to get our long-term fiscal house in order without higher taxes as boomers age.
...
If the media are smart and persistent enough to force this question of Ryan's endless debt, Wyden will have set in motion a Republican "uncle" on taxes that could fundamentally alter policy debate in the years ahead.
Am I satisfied? No. But I'll keep listening. The core question for ACA/Medicare/Medicaid/Tri-care/SCHIP/ad infinitum is:
Can Americans get health care they need at a price they can afford?
That has to be the ultimate measure of any scheme. Republicans never address this question at all; they only worry about cutting the flow of government checks. (Checks to people at least. Checks to the corporations that pay their dues don't seem to be a problem.) I have yet to see a good explanation of how Wyden-Ryan meets this test. But it clearly has some good things in it, unlike Ryan's original right-wing dream plan.
Me and Medicare
I'm 66 now, starting my second year on Medicare. When I was younger, I foolishly thought that when I turned 65, I'd have free medical care. Well, not quite. There are a million options to choose from, and they aren't free. Last month, during Medicare "churn" period where you can change policies, I had about 6 inches of paper in front of me, a thick book of options published by Medicare and piles of stuff that came in the mail from companies offering me options. Fees were rising for the plan on was on last year, and I wanted to review my options.
Medicare has multiple "parts". Everyone gets Part A, which covers hospitalization with lots of deductibles and limits. You buy Part B for around $100/month, which covers doctors visits. You can get Part C, usually called "Medicare Advantage" plans, for anywhere from 0 to $150/month, and you sign up for part D, prescription drugs, which may be included in your Medicare Advantage.
In short, it is not simple, and not free. I pay around $180 in premiums, plus $20 co-pay for doctor visits, plus 15-20% of any lab tests and equipment and stuff, and would pay about $1200 if I went in the hospital for a few days.
My point is that using vouchers toward private insurance is not necessarily less than what we have now. I effectively can pay thousands of dollars for healthcare, even under the fairly good Medicare Advantage plan I have. The key test must always be "is it affordable for the individual that needs it?", not "is medical care free?"