ShareThisThe Republicans' point man on budget issues, Rep. Paul Ryan of Wisconsin, has presented his party's blueprint for saving the federal government about $6 trillion over the next 10 years, much of it by a massive overhaul of the two principal government health care plans, Medicare and Medicaid.
Ryan's plan is a serious one but the changes in health care raise serious questions about the program's scope and fairness.
The program would undoubtedly save the government money -- some reports suggest as much as $771 billion from cuts to Medicaid and $31 billion from cuts to Medicare over the decade -- largely by shifting the costs. The nonpartisan Congressional Budget Office says, "A typical beneficiary would spend more for health care under the proposal." The news services say "considerably more." It takes no great leap of the imagination to see this as akin to a middle-class tax increase.
The existing Medicare would be replaced by a voucher system. Vouchers, a long-sought GOP goal, have a negative connotation so Ryan is calling them a "premium treatment system." Seniors would receive government subsidies to buy private health insurance from a menu of government regulated plans.
Ryan says, "Putting patients in charge of how their health-care dollars are spent will force providers to compete against each other on price and quality."
As a practical matter, it could end up pitting the individual against giant insurance companies and, since the cost and scope of the plan would be government regulated, their lobbyists.
Americans now 55 or older would stay on Medicare. For everybody else, the age of eligibility for insurance vouchers would start at 65 and beginning in 2022 rise by two months a year until it reaches 67 in 2033. Depending on the private insurance market, this could leave seniors retiring at 65 risking two years without health insurance.
Ryan's plan would scrap the coverage of 30 million additional Americans under President Barack Obama's health-care plan. Instead, it would provide a refundable tax credit of $2,300 for individuals and $5,700 for families to buy insurance. If the tax credit must be spent on insurance, we have an individual mandate by another name.
Medicaid, medical coverage for the poor, would be replaced by lump sum grants to the states to design their own programs. The poor would no longer have a right to health care under federal law, meaning that people could be frozen out of state programs for budgetary reasons.
The Republican congressional leadership is braced for a storm of objections over Ryan's plan and concede it may come back to hurt them politically. But after a decade of complicity in spending the government deep into the red, the Republicans have an offer on the table. Now we'll see how serious they are about standing behind it.
(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
