How Would the Ryan-Wyden Plan Work Out?

Since Paul Ryan’s nomination as VP, his proposals to reform Medicare have come under increased scrutiny and criticism. However his current proposal does offer traditional Medicare as an option and worked out with Senator Ron Wyden, a Democrat is as follows

So can this work in controlling costs or not?

I would very strongly support such a measure on a national scale for everyone (not just for Medicare), assuming the lowest bidders were required (and strongly regulated!) to meet or exceed the coverage offered by the government.

I’m hoping the reality isn’t just a sneaky way to stick seniors with shitty medical coverage that promises something with no real penalty for not delivering. If there’s one thing we know about medical care, it’s that the private sector just can’t compete with the government when it comes to price. Every government funded health care system in the world costs less per capita than the American free market health care system. Ryan seems to think this isn’t the case, and is clumsily holding on to the settled, proven-false notion that the free market is more efficient with health care.

If there is a republican or bipartisan solution to the fact that health care costs are growing far faster than inflation, then that is good.

The affordable care act had the Independent Payment Advisory Board (mentioned toward the end of the article) which is designed to slow the rate of medicare growth. So to claim as the article does that Obama is ignoring the problem is not true. That isn’t the debate, but it bears mentioning. As does the fact that state exchanges seem to be designed to accomplish the same thing, force insurers to provide high quality care at a low cost.

As far as private insurance, it was my understanding that the reimbursement rate of medicare is far lower than private insurance. Can private insurance compete effectively with medicare?

Wyden doesn’t like being part of the Ryan-Wyden plan:


Interestingly, Ron Wyden got his political start working with an Oregon chapter of the Grey Panthers, an elderly advocacy group. The Grey Panthers oppose Ryan-Wyden.

I’m listening, on a few conditions:

  1. Most importantly, it’s not just for seniors. Add a Medicare option to the exchanges and watch insurance rates drop. There’s a reason the insurers killed the public option.

  2. Guaranteed issue and community rating for any plans in the “Medicare exchange” - should be obvious, but I’d want to be very clear that companies can’t undercut Medicare to beef up the rolls and then drop people when they get too costly. Or grab all the healthier elderly by denying coverage to the most sick - remember that even amongst the elderly the costs are heavily concentrated in a relatively small slice of the population each year.

  3. Some method for ensuring that old folks don’t get screwed by not switching every year. I’m imagining these bids coming in all over the place and folks in nursing homes having to switch plans annually to avoid big principal payments. On that front I think it might be better if the bidding process was a multi-year thing (perhaps including a year-by-year principal increase rate).

  4. I’d probably want to leverage the existing billing/payment infrastructure. One of the unsung benefits of Medicare is that it’s (comparatively) simple for billing and payment, at least from what I’ve heard from providers. I’d hate to thrust seniors into the system the rest of us have to deal with for claims processing and billing.