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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Could Ms. Rehm perhaps bring herself to ask how once again funneling money to for profit insurance with gargantuan CEO salaries and bonuses results in better care for people?
Ecgberht, here are three reasons why health care is NOT a market good:
#1 We do not choose the illnesses or injuries we suffer as we choose an item available on the open market, a "market good". They choose us.
#2 Medical costs can rapidly escalate to such high amounts that a person with an average income could not reasonably be expected to pay for them. Other kinds of insurance cover catastrophic costs most individuals could not cover on their own, sharing losses and preventing financial calamity. Private health insurance in the US does neither and should not be called insurance. It is very revealing that we call it "health" insurance; it is just for the healthy. In German it is called Krankenversicherung, sickness insurance. Insurance should be for the sick.
#3 You cannot realistically negotiate for health care costs the way you can with real market goods, even if you could get the information. And you need the care at the very time you are most vulnerable and least able to negotiate.
Yes, Ken, the question we need to ask is, why do people who think we should reduce government want to be a part of it?
ford712 wrote:
Simple answer but no one is taking about it.... National Health Care.
Right you are. See www.pnhp.org.
dr.ckadams@gmail.com wrote:"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"
Sure Doc?
How about the vastly increased treatments and medications that have come on line and continue to do so. How about the overall deterioration of the general health of the populous with obesity and other maladies caused by inactivity?.
ecgberht wrote:
"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."
Right back at you, except for the "Repuglican" comment.
mmb wrote:
Could Ms. Rehm perhaps bring herself to ask how once again funneling money to for profit insurance with gargantuan CEO salaries and bonuses results in better care for people?
You are right; that is the question all of us need to be asking, because most of the people on these panels who get to be on the air certainly aren't. It certainly results in better care for those CEOs.
majorml wrote:
"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."
Worse than a "clever linguistic trap", that is simply false.
If you buy a bare-bones plan, maybe, but most employer-provided HI which involves most people not on MC in this country covers just about everything. If I develop cancer or some dibilitating disease, they do not have the option to "not cover" me. Try reading your policy. It is very specific as to what is and is not covered.
"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."
They won't be "generous", but if I live in MT and can buy insurance from a provider in NC, insurance companies will have to compete for my business. Today, that does not, and cannot happen. That was one of the things Republicans wanted to put into PPACA. Democrats refused.
And again, the idea that insurance companies can suddenly deny you coverage on a whim is a scare tactic and false. Read and know your plan. That's part of the "personal responsibility part" of this discussion.
OldBrit,
Here finally is some useful information. Thanks.
Mike Sergeant wrote:
OldBrit,
"Here finally is some useful information. Thanks."
No not really, if your referring to examples of foreign "success" stories in countries that are going bankrupt or you don't investigate why costs "might" be under control which usually mean very high deductibles, the information is worthless.
"Ecgberht, here are three reasons why health care is NOT a market good"
Sorry, I jumped ahead a few steps in the discussion. You are conflating "healthcare" and "health insurance". As simply as I can put it:
Health insurers stand between healthcare providers and patients. Their interest is in keeping healthcare costs down, but currently have no incentive to keep insurance costs down. But patients have no say in the cost of either if they cannot force health insurers to compete for their business on a national basis. So you should not need to "negotiate for health care costs". Insurance companies will do it for you - but ONLY if all insurance providers are competing for the business of every person.
For job creation, give tax breaks to domestic companies (those that do most of their manufacturing an development within the US).
"Right back at you, except for the "Repuglican" comment."
Really? I have voted for Democrats, Mike. By the way, in one particular race, I will likely vote for one in November ... though it will not be Mr. Obama.
Diane
Todays show like most of the pundits addressing the healthcare programs . . . dwells on the money side iof the issue, while the care provided goes off to anouther world of hapstance.
Such subject changing among your guess is about as political as it can get. I would suggest you monitor these types of "for-profit" interviews & insist on being helpful to your listening audience.
You do wnat a rerliable following, as CNN has lost all theirs some years ago, when Ted Turner sold out! Think that makes the point!
ThankYou
Ed
foxy wrote:
"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."
If that was directed at my comment about France (ranked number 1 or 2 in health care) and the US (37th) insurance companies both netting 1.5% profit, you are correct. The French system is based on private health insurance companies, but it is highly regulated to eliminate the trickery to which you refer.
As I pointed out, in France the insurance companies are required to spend 96% on patient health care. In the U. S., that number has increased to 80% under ACA.
THE MEDICARE ADVANTAGE PLAN IS A TROJAN HORSE MEANT TO DESTROY MEDICARE (1/2)
Paul Ryan and Grace Marie-Turner may or may not mean well in their efforts to reform Medicare and in their compassion for the poor. Respectfully, with respect to the facts of healthcare delivery, costs, and compassion, their proposals do not favor positive healthcare reform, their proposals add insult to injury in terms of the future of Medicare, and they live in a pollyanna fantasy land, if they actually believe the words coming out of their own mouths.
In theory Medicare Advantage offers value added benefits at lower cost and via the Private Sector Health Insurance Industry under strict Government regulation.
The only truly significant value added benefit provided by these Plans is the Maximum Out of Pocket Protection (MOOP), which caps annual co-payment/co-insurance out -of-pocket costs of Medicare Beneficiaries. This is significant because it may greatly reduce the asset risk of Medicare Beneficiaries in the event of Financially Catastrophic Medical Event(s). As the greatest asset risk to the Medicare Beneficiary is house foreclosure (an existing national crisis), MOOP is a critical benefit that exists in Medicare Advantage and not in Traditional Medicare. And this is where the Trojan Horse enters into the Walls of the City -- or in this case, inside the proverbial white picket fence.
I am a biller for a psychologist and it is an administrative nightmare any time a client switches to a Medicare Advantage plan. I end up spending hours making calls and sending faxes trying to get reimbursed for clients who had previously been no problem under the traditional Medicare plans. When the private insurers administrate these Advantage plans their need to make profit off the clients makes it an absolute struggle to get reimbursed for our simple claims. My files swell from containing just a few pages to being inches thick (and I bill electronically). It is well documented that the Advantage plans are administratively inefficient, unlike traditional Medicare.
THE MEDICARE ADVANTAGE PLAN IS A TROJAN HORSE MEANT TO DESTROY MEDICARE (2/2)
Back in the 1970's, President Richard Nixon proposed that, due to the deductibles and lack of MOOP in Traditional Medicare, that Medi-Gap Premium Costs be Government subsidized for the Income-challenged American Citizen. Medi-Gap (formally known as a Medicare Supplement Plan) offered value added benefits including MOOP to those, who could afford the premium payments. Nixon was right to suggest his elegant solution to filling in the coverage gaps for those, who could not afford the premiums. Congress failed the Nation at that time.
Today Medi-Gap Plans are being scaled back in favor of shifting responsibility for payment of premiums and costs to the taxpayer. As Medicare Beneficiaries are encouraged into Medicare Advantage Plans, Traditional Medicare and Medi-Gap will become a relic of the past. Then, watch out for Premium Inflation to occur in the Medicare Advantage Plan!
Once the Traditional Medicare demand shrinks to a certain level, then the Traditional Medicare structure loses it's viability in terms of costs, personnel, and infrastructure and must then necessarily come to an end. With the end of Traditional Medicare, then there may be no leverage to counter-balance the demands of the Private Sector into whose mercies we all shall be plunged.
"No not really, if your referring to examples of foreign "success" stories in countries that are going bankrupt or you don't investigate why costs "might" be under control which usually mean very high deductibles, the information is worthless."
Earlier you referred to Sweden as a model of success, "it works beautifully" I believe you stated, yet they have the highest taxes in the world. OldBrit posted useful information and so did you. Thanks
"If you don't have health insurance or cash to pay for your treatment, you can sit on the sidewalk until you die."
Since, we will not refuse care to patients who show up in emergency rooms and taxpayers will continue to foot the bill, the only solution is a system which covers everyone and which uses the premiums or taxes paid by the healthy to subsidize the unhealthy instead of skimming off the profits from the healthy as profit and dumping the unhealthy onto the taxpayers.
Healthy people benefit everyone including taxpayers and businesses. Unhealthy people drain our resources. It is to everyone's benefit to keep all of us as healthy as possible.
Check out:
http://www.pnhp.org/
ecgberht wrote:
"Really? I have voted for Democrats, Mike. By the way, in one particular race, I will likely vote for one in November ... though it will not be Mr. Obama."
I have voted for many Republicans, and will again and I suppose that surprises you. By the way, I haven't decided who to vote for in the Presidential race. I am very disappointed with Obama's leadership style and Mitt is just like a mitt, will do/say anything the hand up his back tells him to do/say. I suppose that surprises you also.
In light of all the name-calling and kill-the-messenger stuff, maybe liberals should take another stance: reduce the nastiness. Maybe liberals should take a Jonathan Swift approach to the Ryan budget:
a. Old timers are very sociable. When cuts obviate rent, their pre-existing conditions block coverage, they become homeless - they can putter in parks and byways chatting - and oldsters do like getting out in the fresh air.
b. Sales of cat and dry dog food will skyrocket - that really helps the free market and an underutilized part of our economy. In fact strays will be reduced as they are picked up as pets or snacks. Steak/lobster will get cheaper from less demand; one-percenters will benefit.
c. Elimination of EPA, USDA, OSHA, Ed. Dept. etc. will make everyone compete for fresh air and water - always good for the economy. Workers will become more cautious, kids will work harder to learn and earn; states will compete for educated workers - those that can't keep up will be penalized; ones that excel will be rewarded.
d. ERs will expand - opening bigger markets for immediate care; new markets will boost competition and cut costs. Patients who fail to maintain health will cease to exist as part of the problem; others will, by default, be healthier, more cost conscious. Anyone injured/unable to bargain for treatment will rely more on doctors and attorneys to make decisions- increased demand for private end-of-life advisors - another new market.
e. The military will grow; homeless, unemployed, elderly will be able to enlist by greater numbers. Oldsters may be added to the ranks as cheap admin types. And wouldn't it be pleasanter with "greeters" added at the induction sites/gates of bases and forts? PLUS other nations will finally get the notion the US really top gun - to engender much greater respect among friends and foes alike.
Yup....... I'm sure Jonathan Swift could offer a much more incisive and erudite approach to these discussions.
Mike Sergeant wrote:
"Mitt is just like a mitt, will do/say anything the hand up his back tells him to do/say."
That is exactly the kind of "talking point" that I was objecting to earlier.
You should read some about his time as Governor of MA. He worked with a fully Democratic State House to get things done there. Mr. Obama seems completely unable to do that. This is not about "Republicans being obstructionists" which is another talking point, it's about a failure of Leadership. Reagan worked with a Democratic Congress. Clinton worked with a Republican Congress. Obama has refused to learn from his predecessors although the voters were screaming at him to do so in 2010.
Quick question:
IF Gov. Romney trusts the states to better manage Medicad ala block grants, why does he not trust those same states to administer the work requirements in welfare? (i.e. If states are the centers for greater efficiency in health care, why are they not also more efficient in moving folks from welfare to work? His recent comments say the Pres is removing work requirements from welfare by allowing states who request more flexibility.)
Q-1: ARE THE PER CAPITA MEDICARE FUNDS -- WHICH ARE PAID BY THE FEDERAL GOVERNMENT TO THE INSURANCE COMPANIES THAT PROVIDE MEDICARE ADVANTAGE COVERAGE -- INTERMINGLED BY THE INSURANCE COMPANIES WITH THEIR OTHER INSURANCE AND FINANCIAL INSTRUMENTS AND ACCOUNTS, SUCH THAT THEY AND THEIR ASSOCIATED FINANCIAL ENTITIES MAY (A) INTERMINGLE THOSE FUNDS, (B) "COOK" THEIR BOOKS, (C) "LAUNDER" FUNDS, AND (D) "SQUIRREL" FUNDS AWAY IN OFFSHORE AND SWISS BANK ACCOUNTS?
Q-2: WHAT ARE THE SPECIFIC FEDERAL AND STATE LAWS, STATUTES, AND REGULATIONS SETTING THE PARAMETERS BY WHICH THE FIDUCIARY RESPONSIBILITY OF MEDICARE ADVANTAGE CONTRACTED INSURANCE COMPANIES MAY (OR MAY NOT) BE HELD ACCOUNTABLE?
Q-3: WHAT ARE THE ENFORCEMENT BODIES AND MECHANISMS IN BOTH THE PUBLIC AND PRIVATE SECTORS, THAT MAY (OR MAY NOT) KEEP THE MEDICARE INSURANCE INDUSTRY HONEST AND SOLVENT? (AND ARE THOSE MECHANISMS PRO-ACTIVE AND WELL-FUNDED?)
Note: These are vital questions, not accusations. We ought not assume that proper protections exist. They may, and then again, they may not....
Honest?Abe wrote:
"Old timers are very sociable. When cuts obviate rent, their pre-existing conditions block coverage, they become homeless - they can putter in parks and byways chatting - and oldsters do like getting out in the fresh air."
At the risk of looking foolish by treating this nonsense with any seriousness, your points are based on the lie that "old timers" will be affected by the Ryan plan. If you are over 55, you will not be affected. If you think 55 is an "old timer", I think most baby-boomers would take exception.
Late getting in on this....
I am now a 62yo foody, started by my mom and Boy Scouts as a child, and 'refined' by Julia, beginning with her first show here in NY. I so loved this lady.
Henry Doll
Long Island
Henry, this is the board for the first hour discussion of the Ryan plan and Medicare.
If you want folks to see your post about Julia Child (whom I also loved watching), you should post on the other discussion board for the second hour.
As a neutral observer of the budget debate (I am a "legal" resident, not a citizen), I find it somewhat surprising that the discussions are mostly anchored on issues of medicare, medicaid, social security, and such issues. in a previous life, I made a living analyzing budgets for another (friendly) government. As such, I am forced to note that few base their analysis ( in either party) on a careful systematic deconstruction of the federal budget and meaningful dissection of the federal debt structure.
The Irak war represents a sizable part of the debt and an immediate burden on the budget. It is the reimbursement of that debt (via a temporary tax dedicated solely to that reimbursement, for instance) that would make the most significant and immediate positive impact on budget and debt.
The issue of medicare, social security, and the like can be handled later down the road with no immediate negative budgetary consequence...
I am a friendly neutral observer... Don't hit me over the head with a baseball bat. Thanks!
Ferdnam wrote:
"I am a friendly neutral observer... Don't hit me over the head with a baseball bat. Thanks!"
OK, we'll only use a "foam" bat!
Seriously, thanks for the thoughtful post. You make many good points and suggestions. The wars are not that large a portion of the debt, I certainly wouldn't call it a "sizable part" as you say, but certainly not insignificant either. Still, in many countries a "war tax" might make a lot of sense. There are some problems with the idea here though and most of them lie with Congress. The biggest is, historically "tax increases and spending cuts" combining to reduce deficits haven't worked because the tax increases go into effect, but the spending cuts never happen - for either paty. (That's why the Republicans got booted in 2006). So if a "war tax" were put in place, would it ever go away? Not bloody likely.
The second problem is the misappropriation of funds. SS is the classic example. Billions of SS withholding out of workers' paychecks have been replaced with debt instruments and the money has been spent. SS is about to turn upside down (you can look at the Trustees report on the "trust fund" to see it). When that happens, the FG must start redeeming those debt instruments into cash to make payments. So the question arises, would the "war tax" be spent on the wars? Based on history, probably not.