The Ryan Replacement for Medicare

Now I have been spending the greater part of the past two years plus commenting one way or another on the health care policy mess that Washington has created. As of today Rep Ryan has provided a succinct summary of what he proposes in the WSJ.

He states in part:

This starts with saving Medicare. The open-ended, blank-check nature of the Medicare subsidy threatens the solvency of this critical program and creates inexcusable levels of waste.... its reforms will not affect those in or near retirement in any way....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 a plan that works best for them from a list of guaranteed coverage options. 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....In addition, Medicare will provide increased assistance for lower- income beneficiaries and those with greater health risks. Reform that empowers individuals—with more help for the poor and the sick—will guarantee that Medicare can fulfill the promise of health security for America's seniors.

 Now there are a few problems:

1. If you are say near 50, as my children are, you have been paying into this Medicare fund for almost 30 years. Does that mean you will stop, or that you will not see an increase but will see a different benefit.

2. What happens to the pre-existing condition concern. By the time a person reaches 65-70 there may very well be a few pre-existing conditions making the cost for this group quite high. How does he deal with this issue?

3. What about all the restructuring underway under the new health care plans such as ACOs and the like.

4. What price private insurance and what coverage. What is the out of pocket. The new health care plan and the old Medicare drove carriers for retired people out of the market. Who will drive them back in.

The Congressman should be aware of the real issues here:

1. Many people have life style diseases, developed over many years of drinking, smoking, poor health care of their own choice.

2. Yet there are many with just a bad hand of genes. They get prostate, breast, colon, cancers at 60+, not their fault. How do we balance that risk?

3. We always need the 800 pound gorilla, and Medicare was that, at times a bit too heavy and getting worse. Yet we all remember HMOs. They were universally despised.

4. An increase in Medicare tax would cover everything if combined with a life style tax. We worked out the numbers well over a year ago. It would always be better for marginal changes for when there is a massive realignment many fall through the cracks.

5. Catastrophic coverage is essential, and waiting till you are 65+ is not the time to get that. Would the Government do that function, as say they do for flood insurance?

Ryan makes an interesting proposal but it really needs socializing. At least some one is doing something. Now if he can keep it below 2,000+ pages we are possibly moving forward.