Medicare math…

It’s been interesting to see the Presidential campaign turn into a debate about health policy. Not too long ago, it was assumed that neither candidates would talk about health care much–it has surprised some that the President has talked a lot in his speeches about the Affordable Care Act, and many assumed Governor Romney would want to steer clear of the subject, given his convoluted position of having passed health reform in Massachusetts but pledging to repeal it for the nation.

But here we are, talking about health care–and specifically Medicare. With the pick of Paul Ryan, who is best know for his budget plan that would, as opponents say, “end Medicare as we know it,” Romney has now focused the debate on the future of Medicare.

Virtually every Republican member of the House of Representatives voted on the Ryan budget. Here’s Michael Kinsley back when the plan was introduced.

The Ryan proposal would replace Medicare with a voucher system. The “savings” is actually simply a shift of cost to seniors, as the cost of health care outpaces the worth of the voucher. Seniors would have to pay more and more out-of-pocket–perhaps up to $6,000–to continue to get the same level of coverage.

There’s cogent commentary by Paul Krugman at the New York Times, Jonathan Cohn at the New Republic, Derek Thompson at The Atlantic, Jonathan Chait at New York Magazine, and Ezra Klein at the Washington Post’s Wonkblog.

Romney has endorsed this proposed privatization to Medicare, and highlighted it further by choosing Paul Ryan as his running mate. (Ryan was also a primary author of the effort to privatize Social Security–transforming it into private accounts invested in Wall Street.)

In the last week, Republicans have sought to deflect the attention on the Ryan Medicare voucher proposal by calling attention to the Affordable Care Act, and $700+ million saved out of the program. But there’s three big problems with proposing that:

1) none of those savings are from reducing benefits or increasing cost-sharing for seniors;
2) some of those savings go back into Medicare, to *improve* benefits (free preventative care; more coverage for prescription drugs by closing the infamous “donut hole”) and to extend the life of Medicare by ten years;
3) the savings in the rate of growth over the next ten years were largely agreed to by the health care industry (hospitals, drug companies, etc), in return for the increased business they would get from the other health care expansions. The industry was going to significantly benefit from subsidizing coverage for several million more Americans, and so they agreed to live with a reduced rate of growth of cost in their Medicare payments.

What’s more notable was that the Paul Ryan budget (voted on by every Republican Representative) repealed all the Affordable Care Act benefit improvements and expansions–but kept all the cuts. It hasn’t stopped them from shamelessly attacking these so-called “Obamacare” cuts. One example is Romney surrogate John Sununu, who was thankfully factchecked by CNN’s Soledad O’Brien:

Why did the Ryan plan keep the cuts of “Obamacare”? They needed to pay for their planned tax cuts skewed toward the wealthy. So part of the issue is that after President Obama identified savings, he puts those savings back into Medicare and the health care system, while the Ryan plans uses them to pay for tax cuts–even though the tax cuts are greater, and thus balloon the deficit more. Now Ryan and Romney have backed off of the cuts they voted on in just the last year–but that makes their tax plan increase the deficit even more–to the point of impossibility.

But that raises other troubling questions, as John McDonough points out in his Health Stew blog. As long as Romney and Ryan continue to shift their positions and figure out answers, this campaign will continue to focus on health care…

Health Access California promotes quality, affordable health care for all Californians.
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