Understanding Paul Ryan's Budget Plan
http://thedianerehmshow.org/shows/2012-08-15/understanding-paul-ryans-budget-plan
Republican presidential candidate Mitt Romney’s selection of Paul Ryan as his running mate has led to new interest in the Wisconsin congressman’s budget. In its latest form, the Ryan plan changes Medicare from a system of guaranteed payments for seniors to one that uses “premium support” credits. These vouchers may be used to purchase private insurance or to join traditional Medicare. The Ryan budget also cuts Medicaid, keeps the Bush tax cuts and streamlines the federal tax code. Critics say it will end Medicare as we know it. Supporters say reform is necessary to save the program from bankruptcy. Diane and guests discuss the Paul Ryan budget plan and what it means for the future of federal entitlement programs.
Guests
Jared Bernstein
senior fellow at the Center on Budget and Policy Priorities, and former chief economist and economic policy adviser for Vice President Joe Biden.
Mary Agnes Carey
senior correspondent for Kaiser Health News.
Grace-Marie Turner
president of the Galen Institute, a research group focusing on free-market health care reform and tax policy.
Damian Paletta
reporter for The Wall Street Journal.
Comments
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Ryan recieved his college education from Social Security - now he wants to reduce that program for others.
Ryan has become a multi-millionaire during his tenure in congress - the only real job he's ever had. How exactly does that happen?
The man is a profiteer on public service - he is a facilitator of the looting of our national wealth by those with all ofthe advantages.
The sound bite of Romney talking about people not asking for health benefits until they have a medical need distorts what he actually said. He was making the point that people who can afford to pay for health insurance, healthy or not, should do exactly that and, to that end, people who do not pay for health insurance but could afford to do so while they are healthy to simply pocket what the rest of us who do pay for it and that is not fair. In Massachusetts, Romney's mandatory health insurance plan - and here is where it differs signicantly from the Affordable Health Care Act - required people WHO COULD AFFORD TO PAY TO DO EXACTLY THAT and to allow them to escape the cost of insurance the rest of us have paid and, to that end, addressed the question of the public paying for health care for people who defered obtaining insurance when they could have and should have gotten it on their own.
So let's get this straight. Under Paul Ryan's vision of Medicare, where my folks and those close to needing it can still just go to a doctor and get seen, I will get a voucher for,let's say, $6000 and with that voucher I will have to go out and find a health insurance policy. Of course Ryan wants to repeal the Affordable Care Act so if, for example, I had a diagnosis of heart disease or some other condition I couldn't find insurance for $6000. Or if I could, it might carry a $5000 deductible or only let me see a doctor the third Friday of every month or some nonsense. And if that doesn't work for me, well guess I should have been richer....and this is supposed to be a better America?
I agree that the program needs fixing, I am not at all confident that Ryan's ideas are the best way to do that.
I am thinking that Ryan would be less dangerous and less powerful as VP than he is in the congress. VPs generally do not have their own agendas pushed forward, (with the exception of VP Cheney). I wonder what your panel would think. Thank you.
Jim Gamble wrote:
"That's enough to buy a new Cadillac."
Why should we buy anyone a new Cadillac?
There is one immutable fact about the current system: Medicare recipients don't care how much healthcare costs because Government pays.
Since the inception of Medicare, healthcare costs have never been market based. That is the only way to bring down costs and improve outcomes unless you are happy with rationing which is what comes next.
On Medicare costs, the Republicans have blocked one of the easiest ways to significantly reduce Medicare costs and human suffering. Studies have shown that counseling terminally ill patients about their end-of-life choices reduces their suffering, results in their end-of-life being more the way they want, reduces the family-members' suffering, and improves the family-members' recovery from grief. It also reduces the costs to Medicare (see note below*). But the Republicans' knee-jerk reaction to end-of-life counseling have made this subject impossible to talk about due to their cynical labeling of these discussions between patient and doctor as "death panels."
* 6% of Medicare recipients 65 yr of age and older who died in 1978 and 1988 accounted for 28% of all costs of the Medicare program. In the same two years, 77% of the Medicare decedents' expenditures occurred in the last year of life, 52% of them in the last 2 mo, and 40% in the last month. Inpatient expenses accounted for over 70% of the decedents' total costs.
Partisan Politics:
And you think seniors are going to vote for that- WHY?
Are you lost in a fantasy?
Ask the guest that is so enamored with the present medicare HMO plans. My wife has worked in medicine for 30 years and I am a teacher of nurses. She constantly encounters patients that need extra care i.e physical therapy, temporary nursing home care, extra procedures, all covered by the typical supplementary insurance but not covered by any medicare advantage program. My students that work in utilization review in the hospitals all say the same thing---DO NOT SIGN UP FOR MEDICARE ADVANTAGE PROGRAMS.They give cheaper rates up front and take away necessary services. So Obama took money away from insurance companies who do not provide good coverage to fund Obama care---GREAT!!
You know, I have an immense feeling of relief concerning the political discussion prior to the last election and here's why: after the Supreme Court stepped in during the 02 election and Scalia and Co. awarded Bush the presidency and then Bush gave us two unfunded wars, tax cuts for the wealthy, told us all to go shopping to prop up the economy, then pulled the flush lever on the way out the door, I vowed to never, under any circumstances, again vote for a Repuglican as long as I live. I don't care who or what is running on the democratic side, no votes for repuglicans. I know I'm not the only one who feels this way, and it's because of the GOP's constant march to the right. Their revered Ronnie Raygun would not even qualify as a Repuglican by today's standards. So any argument about Medicare, Medicaid, budget cuts, whatever. It no longer matters! And I've voted in every election since 1972.
Partisan Politics wrote,
"One major point of the Ryan plan is to create a sense of personal responsibility....How many times have you heard people say it's paid for by insurance to indicate their lack of concern for the cost?"
How's this "personal responsibility" supposed to work when you are taken into an ER semi-comatose and in urgent need of care, or you are in your 80s or 90s, feeble, and have dementia which will keep you from exercising your "personal responsibility"? Are you going to try to negotiate for prices in a condition like this? People like PP talk as if obtaining medical care is like buying anything in a store. It doesn't work like that. Medical care is not a "market good". You really have very, very little control over the cost of your care.
Jim Gamble wrote: "And you think seniors are going to vote for that- WHY?
Are you lost in a fantasy?"
One might hope to expect that most seniors do not want to leave behind a country in financial ruins.
Condescending comment from Catholic small businessman who used the term "gal" and talked about "bullying" from someone who's arguments out did the Ryan budget supporter. Strikes me she can hold her own in terms of the facts or not.
Why do Republicans including R&R whine about being attacked? They've had no problems standing idly by while the birthers went on and on ad nauseum!
MAN-UP GOP! if you can't take the heat. Get out of the kitchen!
This show is getting out of control. I am having a hard time listening to it, it's beginning to sound like an episode of "Hardball".
Everybody slow down and take your turn and explain your views in a calm manner and then wait for the response and let them finish please
I'm 67 and have hypertension. I can't afford Medicare Advantage - the rates are too high!
Going to a Medicare voucher system is privatizing medicare, which means putting it in the hands of health insurance companies who will scrape off money to pay multi-million dollar executive salaries, marketing, administration, and profits.
The health insurance industry is on a campaign to insure the healthiest people - read "cheap to cover" - while off-loading the less healthy people onto taxpayers.
The U. S. ranks 37th in health care quality. The 36 countries ahead of us get better results and spend less.
The Israeli health care system, which Mitt Romney applauded in his recent trip, is a universal, taxpayer-funded system, which covers everyone for half of the per capita cost.
The only way out of this is a universal system which covers everyone. Medicare for all is an example. When we are young and healthy, we subsidize health care for those who are older and less healthy. When we become older and less healthy, we are subsidized by those who are younger and healthier.
France - which is ranked 1 or 2 in the world - has a universal system operated by private health insurance companies and which costs 60% per capita of the U. S. cost. The difference is that in France, they must spend 96% of the premium on direct patient health care. In the U. S. the Affordable Care Act will INCREASE the percentage health insurers must spend on direct patient health care is 80%. The difference is inefficient administration, salaries, and profits for the insurance companies.
The most interesting thing is this: In the U. S., health insurance companies make approximately 1.5% in profits. In France, health insurance companies make approximately 1.5% in profits.
The Ryan plan will do nothing about the real problem, which is the cost of health care, not the cost of health insurance. When the US consumer is paying the entire bill for research and development of new products, and paying to subsidize medications to below cost levels in third world countries, it's impossible to control health insurance costs.
tax code change to support corporate profits seems to be not necessary. Stock market is up, corporate profits are up. I expect CEOs and others are making tremendous bonuses. Look at financial businesses and oil companies. Why does Ryan not care about the middle class??
Charles C
SteMar wrote:
"You know, I have an immense feeling of relief concerning the political discussion prior to the last election and here's why: after the Supreme Court stepped in during the 02 election...."
Earth to SteMar, Bush was elected in 2000, not 2002. If you voted in a Presidential election in 2002, you were either two years too late or two years too early.
Are you the same one who railed about the "Coke" Brothers, the other day?
Your talking-point blather means nothing here. Your decision to "never vote for a 'Repuglican' as long as you live" tells me you are a low-level thinking partisan hack who would never have voted for a Republican anyway. So who cares what you think? Sheeple like you should just watch your soap operas and stay home on election day.
Raising the Medicare age to 67 would be very bad. People say do it because we live longer.
However, it is a known fact that life expectancy in the US is several years LESS than all other developed countries (because they all provide health care to all their citizens as a right), as Physicians for a National Health Program (PNHP) has documented.
So it is evident that we are actually SAVING money by having our citizens die off a few years earlier than those in other countries. What’s not to like? Sort of takes away the argument that the eligibility age should be raised, doesn’t it.
On the other hand, we could just take away the eligibility age altogether and let everyone have Medicare. Oh wait, just think what that would do to our life expectancy. We wouldn’t have all these pesky seniors conveniently dying at a younger age.
Unless we get to a more competitive insurance policy, allowing 'cross' states insurance, you can forget any of these new ideas. Insurance companies will still have too much control.
So the GOP is hoping that government health care vouchers in a competitive insurance provider environment will result in a system that keeps medical costs from the continual escalation we are now seeing???
Does ANYONE see a similarity here with what is happening with the burgeoning student loan bubble? Government health care vouchers will just feed cash into the private system, and providers - insurance and hospital - will gobble it up, and things will escalate until we have another bust and another government bail-out of the health care system.
While I know that the Medicare and Medicaid programs need to be changed but what Ryan wants to do scares me to death. I see all these people who are for it seem to already have health insurance. Try being a 48 yr old female , who was a wife and mother her entire life, so only worked retail. I could have gotten insurance BUT it would have cost me $200.00 + per month and at $200.00 per week it just wasn't feasible. I was healthy until they found an aortic anyersum that needed surgery. Just try to find someone to do a surgery like that with NO insurance. After 4 months of living in fear I did but I had to sign away all my rights and have someone do it that had never done it before. The results were , I am still alive but had to fight for 6 yrs to get disability since I was unable to work after that. I now have Medicare and needed a second surgery this time by a respected vascular surgeon in a well known hospital and my care was 10 times better. I wish I could say I was able to reenter the work force but the first one messed me up so bad I couldn't ... I am now 60 and hoping there will still be Medicare and SS for me to collect . I have a feeling that if Ryan gets in there won't be. From what I have seen he and others of his ilk could not care less about people like me.
Idealogically this healthcare debate could go on for ever. The fact is that costs are too high. Doctors, hospitals, insurance companies, drug manufacturers are too expensive.
My personal opinion is that the looming growth in unemployment due to global competition and increased automation through technological breakthroughs will force the overall spending/income issue to self correct in the not too distant future.
"You really have very, very little control over the cost of your care."
Thats because healthcare IS a market good, just like any other good (contrary to your statement), but it has NEVER BEEN market based.
Economics 101 (and human history) dictates that free markets lower costs and improve quality (in this case outcomes).
foxy wrote: "How's this "personal responsibility" supposed to work when you are taken into an ER semi-comatose and in urgent need of care, or you are in your 80s or 90s, feeble, and have dementia which will keep you from exercising your "personal responsibility"?"
These are not your typical medicare recipients. Considering medicare is fouled with an estimate 25% of waste fraud and abuse as exposed by Obamas's own medicare appointee coupled to fact that there is little financial motivation to remain fit and at a proper weight, yeah I see many ways for the costs to be reduced significantly with more "required" personal responsibility.
ecgberth's comment about the possibility of "rationing" insurance falls into one of the clever linguistic traps the Republicans have set. Both Medicare and private insurance coverage has always been rationed, i.e., there are things that these insurance plans pay for and things that they do not pay for. There always has been and always will be a way toreduce the effects of this rationing which is to buy supplemental insurance (or more expensive insurance) that covers more conditions and more of the costs. For some reason beyond my understanding, many people assume that an insurance provider that makes more money by denying coverage ,i.e., a private insurer, is going to be more generous than a government provider whose costs are significantly lower than the private provider.
The problem with Ryan's plan - and also the problem with the Affordable Care Act is that they both keep the root cause of the health care crisis in their plans: The root cause to out of control health care costs is that we let the for-profit health insurance companies play a dominant rolgooe in our health care system. You cannot control costs as long as for-profit health insurers remain central players. We can only control costs and save quality by adopting a national health insurance program. Germany reported a surplus of 5.28 billion dollars last year with their national health program. Their medical outcomes are as good as ours but all are covered and they spend half as much.
If the Affordable Health Care Act is repealed and Ryan's plan is rolled in, what happens to pre-existing conditions?
Simple answer but no one is taking about it.... National Health Care.
1.5% of what? The private health insurance industry pulls a clever trick. They use a percentage of the TOTAL costs of medical care. That is completely false. If an automobile company claims they earn a certain percentage profit, it is based on actual products rolling off the assembly line. This is not true of private health insurance companies. They did NOTHING to provide that care. They provide NO product or service of value. See www.healthcare-now.org/divestment.