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Paul Ryan's plan would end Medicare as we know it

PH2010080103527.jpg"The Democrats' political machine has attacked my contribution to this debate," wrote Paul Ryan, "making the false claim that the only solution put forward to save Medicare would 'end Medicare as we know it.'"

This is a baffling line of argument. There's nothing false about the claim that Ryan's plan would end Medicare as we know it. In fact, it's unambiguously true. Currently, Medicare is a government-run insurer that pays the health-care costs of all senior citizens. Under Ryan's plan, senior citizens would be given vouchers that they could use toward private insurance. Poor seniors would get more-generous vouchers, and rich seniors would get less-generous vouchers. The way Ryan saves money is by holding the growth of the vouchers beneath the growth of health-care costs, so as care costs more and more, the vouchers cover less and less.

This might be a good reform or it might be a bad reform, but it's undoubtedly a wholesale transformation of Medicare. Ryan should argue that this is a good thing, rather than try to obscure what he's attempting to do.

Photo credit: Melina Mara/the Washington Post Photo.

By Ezra Klein  |  August 16, 2010; 12:00 PM ET
 
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Comments

You should be fined for not having insurance because if you have an emergency and go to the emergency room, then you do not have the money for the bill, it gets charged to everyone else. Get medical insurance for your entire family at the best price from http://bit.ly/9fDY7U By contributing to the pool and doing your part, overall costs come down. Its like stores that have to charge more because of all the theft. People go to the hospital and then not pay, it gets charged to everyone else.

Posted by: caryblair | August 16, 2010 12:08 PM | Report abuse

Sometimes I think that many members of Congress don't really understand how our health care programs really work--in fact sometimes I think they don't really understand how government actually works.

But Ryan was supposed to be one of their thinkers, one of their smart guys. Mike Pence is a dunce, but I thought Ryan at least had some intelligence. Is he being dishonest or truly confused about Medicare or about his own proposals?

Posted by: Mimikatz | August 16, 2010 12:21 PM | Report abuse

it's a sign of how far our press standards have fallen when Ryan complains that they are smearing him by accurately describing his proposal.

Posted by: Quant | August 16, 2010 12:24 PM | Report abuse

A person could almost imagine that Ryan is engaging in "flim-flam."

(Though I agree that Krugman and others should be careful about assertions of motive.)

Posted by: bobsomerby | August 16, 2010 12:34 PM | Report abuse

The corollary is that the critics should be making the argument that his reform would be a bad thing.

"End medicare as we know it" is a dishonest approach to the debate, whether technically accurate or not, because the goal of the argument is to make people believe things that aren't true. The implication is he will end medicare. The reality is that we have the government sending out checks to pay for medical care for seniors now, and we'd have the government sending out checks to help pay for medical care for seniors under his plan.

Posted by: eggnogfool | August 16, 2010 12:36 PM | Report abuse

This is good one Ezra - plain, simple, easy to understand and factual. Keeping holding Ryan accountable.

Posted by: umesh409 | August 16, 2010 12:37 PM | Report abuse

Nice misnomer. You could have said he wants to reform social security... instead you say it wants to destroy social security*!

*(as we know it)

How long did you and your Journolist friends spend working on that misnomer? Your editors should be fired for allowing you to purpose misrepresent his position using a blatant misnomer.

Posted by: nptalcott | August 16, 2010 12:38 PM | Report abuse

Yes, Paul Ryan should come right out and say "This would end Medicare as we know it, and here is why that is a good thing." He'd get killed for it of course, and his party would look like idiots for demonizing any Medicare cuts for the last few years. His position is just typical dishonest politics.

I just wish Ezra et al would hold the politicians from their own side to the same standard. So when Obama says "if you like your plan you can keep it" Ezra would say this was dishonest and say that Obama should say PPACA is going to make you change your plan and defend why it is a good idea. And when Obama says they are not going to reduce the benefits people receive through Medicare, Ezra would say that was a lie and say that Obama should defend the idea of reducing some Medicare benefits. I could list probably half a dozen more examples exactly like that.

There is nothing new or shocking here, it is just politicians playing politics. If only our pundits would hold both sides to the same standards.

Posted by: ab_13 | August 16, 2010 12:39 PM | Report abuse

Just because something is 'true' does not mean it is unambiguously true. In this case you have used an ambiguous misnomer: "Ryan Paul wants to end Social Security as we know it". This could mean he wants to reform social security... or it could mean he wants to eliminate social security. It is CLEARLY AMBIGUOUS. It is also a misnomer intentionally used to mischaracterize his position.

Posted by: nptalcott | August 16, 2010 12:41 PM | Report abuse

If the growth of healthcare costs is greater than the growth of voucher costs, then obviously the 'cost controls' enacted by the government aren't functioning as well as they need to be.

Posted by: krazen1211 | August 16, 2010 12:49 PM | Report abuse

Cong. Ryan's program would clearly end "medicare as we know it" and, in fact, it would be accurate to say that it would end medicare, because medicare is a government program whereby the government is the insurer and pays your medical bills for you out of taxes and premiums paid into medicare, while Cong. Ryan's proposal would end that and replace it with a new program of vouchers to purchase private insurance, with the vouchers being intentionally inadequate to cover the cost of the private insurance.

Posted by: gregspolitics | August 16, 2010 12:51 PM | Report abuse

Would end medicare in the sense that Obama ended America,

and will try to end America (with or without "as we know it") again.

America has an evolving government,

and Medicare has been an evolving program. Under Ryan, it would have the same funding source and provide the same types of services to the same group of people. In fact, Medicare has been paying private insurers to provide benefits for more than a decade now. So apparently, Ryan "ended Medicare as we know it" in 1997.

Posted by: eggnogfool | August 16, 2010 1:25 PM | Report abuse

umesh409 wrote:
This is [a] good one Ezra - plain, simple, easy to understand and factual. Keep[ing] holding Ryan accountable.
================================
Couldn't agree more. Now, how about you and your brethren cover everything Republicans and Democrats try to speak-spin by the public -- THAT would be real NEWS.
Keep up the good work -- everybody's hungry for more.

Posted by: bgreen2224 | August 16, 2010 1:37 PM | Report abuse

"This might be a good reform or it might be a bad reform, but it's undoubtedly a wholesale transformation of Medicare. Ryan should argue that this is a good thing, rather than try to obscure what he's attempting to do."

Completely agree Ezra. Ryan's op-ed doesn't help his position. His original interview with you was a much better argument for his plan.

Posted by: jnc4p | August 16, 2010 1:44 PM | Report abuse

Trademark Klein dishonesty. Pelosi implied that Ryan wants to "end Medicare", but Klein focuses on the "as we know it" to dishonestly twist the implication.

You can't have it both ways, propagandist.

Posted by: msoja | August 16, 2010 1:46 PM | Report abuse

Trademark Klein dishonesty. Pelosi implied that Ryan wants to "end Medicare", but Klein focuses on the "as we know it" to dishonestly twist the implication.

Further, Klein picked his dishonest quibble out of the squads of other points that Ryan made, which points up other sides of the boy's dishonesty.

Posted by: msoja | August 16, 2010 1:50 PM | Report abuse

One final point:

"The way Ryan saves money is by holding the growth of the vouchers beneath the growth of health-care costs, so as care costs more and more, the vouchers cover less and less."

Central to Ryan's premise is that by forcing people to comparison shop rather than just have Medicare/insurance pay for everything, there will be market forces brought into play to actually reduce the growth of health-care costs.

It's not just about saving the government money by capping the amount that government contributes, but also reducing the growth of heath care costs. You may not believe this will actually work, but his plan is about more than just saving the government money by shafting seniors.

The single best one line description of his plan is from your original interview:

"Rationing happens today! The question is who will do it?"

That should have been the title of his op-ed.

Posted by: jnc4p | August 16, 2010 1:51 PM | Report abuse

What I don't get is how he can claim that "Future seniors would have access to the same coverage I enjoy as a congressman. " Is there are plank in his plan that guarantees buy in to the Congressional plan for the value of the voucher? I don't see it.

I see his plan setting up an exchange, and penalizing providers that adversely select their customers, But not if they're charging the cost of care. And that cost might be higher than the value of the voucher.

It actually looks a lot like Obama/Romney Care, except in Ryan's plan all people currently on Medicare are put into the exchange with a voucher.

Posted by: zosima | August 16, 2010 1:56 PM | Report abuse

Moving away from the whole "trying to mislead people is fine as long as long as there exists a perspective from which your claims are technically accurate",

How exactly is the Ryan plan going to work?

From a cost control perspective fine, but from services:

Will the private insurance companies be required to take all comers at the same price? If not, won't they just reject unhealthy seniors and take voucher money from the relatively healthy?

If they are required to take all comers at the same price, won't they have an incentive to treat unhealthy customers as poorly as possible, in the hopes they go elsewhere?

Posted by: eggnogfool | August 16, 2010 2:07 PM | Report abuse

"The way Ryan saves money is by holding the growth of the vouchers beneath the growth of health-care costs, so as care costs more and more, the vouchers cover less and less."

We should be clear that it is generally not the cost of the *same* health care that is rising. The cost of an MRI machine or a Prozac or an aspirin is not rising that fast. The cost of an hour of doctor time is rising only slightly faster than inflation. It is the increased use of these services, where people get an MRI when they would have gotten an x-ray or nothing at all, where they get a Prozac when they just would have been moody, or go to the doctor demanding Tamiflu when they would have just waited out a flu with Tylenol a few years ago.

The real winning idea is that consumer power can lower cost of care, not just cost of insurance, just as it does in most open markets. When I get to shop around for health care, with price as one of the determiners of value (just as one would for LASIK or cosmetic surgery), I will know that we have a chance of getting a fair deal.

Posted by: staticvars | August 16, 2010 2:16 PM | Report abuse

Ryan is a dishonest sack of garbage who writes up legislation that accomplishes something he wants [destroy Medicare, lower taxes on the wealthy at the expense of everyone else] and then tries to sell it as something it's not.

He's pulling a George Bush manoeuver, marketing likely unpopular legislation with obfuscation and tall tales.

Hey, Ezra! What do you think of his claim that the Affordable Healthcare Act "raids" Medicare?

Posted by: bcbulger | August 16, 2010 2:21 PM | Report abuse

One thing Ryan fails to explain is, since the Medicare system pays all itys employees on Government scale and private insurance pays its executives on Insurance executive (read excessive and more than excessive) how senoirs will get as much insurance with their vouchers as they would get from the government.

Now if the Government could buy medical on the market using ITS economy of scale, as in just hiring its doctors ala some healthcare plans, and buying its own hospitals, and setting up its public health care clinics...

OOPS, that would be single payer socialized medicine, and therefor unacceptable no matter HOW well it covered its users.

The least expensive, highest quality medical that we could bet would actually be a totally Government run system.

But guess the likelihood of that happening.

Posted by: ceflynline | August 16, 2010 10:09 PM | Report abuse

Hey EK, have you looked at an actuarial table for Medicare lately? Medicare, as currently structured, will end Medicare as we know it, but not in a very pleasant way. Maybe the Ryan plan is not the best or final word but at least it is a viable plan and a great starting point for honest people to try to pull our collective chestnuts out of the fire!
You sniping from the cheap seats is, um, not helpful.

Posted by: JustaFarmer | August 16, 2010 10:29 PM | Report abuse

Let's see a kid (26 years old) try's to give the Democratic Elite a seminal work on Medicare! LOL! Your last sentence "rather than try to obscure what he's attempting to do" so adequately describes what you are trying to do. Try bringing a little more balance to your future points (not likely for a Democratic Hack).

Posted by: hstad | August 17, 2010 11:53 AM | Report abuse

And this is coming from the man you hold in such igh regard? That's the stuff that we should take for serious, as you said? Really?

Come on Ezra, what's the matter with you recently? That's crap! And Ryan is nuts. There can't be any real discussion about this.

Posted by: Gray62 | August 17, 2010 5:49 PM | Report abuse

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