Wisconsin Representative Paul Ryan has come out with a detailed, real plan for healthcare reform, that (according to the CBO score) would actually drastically curtail healthcare cost growth (details here). The downside is that it looks like it would do so on the backs of some of America's most vulnerable - seniors and lower income folks.
The main part of the plan would essentially privatize Medicare and Medicaid by replacing guaranteed care with vouchers that could be used to purchase insurance. The value of the vouchers (initially set around $11,000/year) would be set to increase at a much slower rate than the projected cost of healthcare, so that a voucher that was good for a Medicare-level insurance plan in 2010 might pay for only a fraction of the cost of care in 2020.
Other parts of the plan involve a refundable tax credit of $5,700 for families to purchase care, the creation of state-based exchanges, tort reform, and number of other ideas.
I disagree with a lot of what's in it, but it's a positive sign that Ryan (ranking Republican on the budget committee) has crafted a serious, good-faith counter-proposal. Too often the GOP has resorted to merely shouting "no" at Democratic proposals, and you can't negotiate with "no." Ryan's plan shares some similarities (in spirit at least) to the Wyden-Bennet plan that came out last summer, which I really liked because it focused on putting consumers of healthcare in the drivers seat, and giving them information to choose from an array of policies. (the big difference is that Wyden-Bennet would have made sure that seniors and lower-income families had the resources, through government subsidies, to actually pay for the various choices).
The big deal here is that, when Congressional Republicans counter Dem plans with serious plans of their own, negotiations can be made and deals can be struck. Ezra Klein had an excellent interview this week with Ryan (available here) that had an interesting (and telling) exchange:
Klein: So there are a couple of folks out there who do this. You, Wyden, Pete Stark, who feel safe enough to propose big things. But how do you deal with the fact that nobody is wrong about the political benefits of this stance of full opposition? Republicans are doing well at it this year. Democrats did it nicely in 2006. No one is wrong about this. You and I agree that market incentives matter. And the market of elections pushes against cooperation.
Ryan: This is my 12th year. If I lose my job over this, then so be it. In that case, I can be doing more productive things. If you’re given the opportunity to serve, you better serve like it’s your last term every term. It’s just the way I look at it. I sleep well at night.
On healthcare reform, entitlements, the deficit and debt, we need people to propose big ideas, even if we disagree with them. Even though I would fight tooth and nail to keep Ryan's ideas on Medicare from ever becoming law, I welcome him to the debate.
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