on the gop’s new vision for medicare

To all those who have been regularly checking in over the past few weeks, I thank you for your continued interest and support.  Recent obligations in life have kept me from writing as often as I’d like, and my updates have lapsed as a result.  Much has happened on the national stage while I’ve been on hiatus, from early Republican primary debates to conflict over the upcoming debt ceiling vote.  One of the most hotly debated topics (and most relevant to the scope of this blog), however, is the proposed changes to Medicare laid down by Representative Paul Ryan (R-WI).  So without further ado, let’s get to it.


“Chairman Ryan and the members of the Budget Committee have done an excellent job putting together a budget worthy of the American people.  I hope every American concerned about our country’s future will take a look at it.”

-Speaker of the House John Boehner

Like it or not, the national deficit is the current subject of debate in Washington.  At the center of the dialogue is the budget recently proposed by Congressman Paul Ryan, a Republican from Wisconsin and Chairman of the House Budget Committee.  His framework would slash $6 trillion from the federal deficit over the next 10 years, and while the entire scope of the document is too large to discuss here, one area of reform has drawn particular controversy: Medicare.  In brief, the proposed plan would gradually transition Medicare away from the current system, in which health insurance is provided to everyone over the age of 65 directly by the government, to what many have described as a voucher program.  The government would provide eligible seniors with a fixed stipend which they could then use to purchase plans on the private insurance market.  While seemingly reasonable on the surface, as with any sweeping policy change, the devil is in the details.  The questions we must ask are twofold: first, how will this impact our budget and long term health care spending?  Second, and most importantly, what will these changes mean for the average people, the patients, who depend on the program?

When looking at the finances of this new Medicare, we have to examine the impact of two fundamental shifts which account for the decreased strain on the government’s balance sheet: from government financing to individual financing, and from government insurance to private sector insurance.  The first proposes a simple option for decreasing the red in the nation’s Medicare column: it simply has seniors pay more for their health care.  While the current system is relatively comprehensive, Ryan’s vouchers provide only a fixed amount ($8000 in 2022 dollars, adjusted for age) which is pegged to inflation, not actual health care costs [1].  Since health care is increasing exponentially faster than inflation, this means that over time, seniors will be responsible for more and more of their health costs.  For a 65 year old in 2022, this would mean an additional $4,380 per year; for an 85 year old in 2050, that number climbs to an extra $20,200 (numbers in 2011 dollars)[1].  While this represents a substantial shift in costs from one payer to another, does it actually save money overall?  The thing is, Medicare is actually very cost-effective; while its budget has been increasing dramatically year after year, health care costs in the private sector have grown even faster [2].  Politicians and pundits will debate the reasons without end (administrative costs, pool size, etc), but the data has shown that Medicare is consistently more efficient at delivering health care than are private insurers [2][3].  In fact, analysis of the CBO’s projections shows that national health care spending may increase by up to $30 trillion over the program’s 75-year planning period, simply from the decreased efficiency of relying on private insurers [3].

So with the financial considerations less than convincing, what does the plan mean for the people receiving care?  Well for starters, it means a whole lot less of them would be receiving it.  By 2050, the cost of a Medicare-comparable plan for a 65 year old would be 68% of the median income; for an 85 year old, that number shoots up to a whopping 200% [2].  An average person in their 30’s today would have to come up with an additional $400,000 to pay for health care in their retirement years [4].  Simply put, huge swaths of people would no longer be able to afford their health care [2].  Even those that could would see a decline in their health, as the proposed age of eligibility increases have been demonstrably linked to increased morbidity from conditions like heart disease, stroke, or diabetes [5].

With the implications for both national health care spending and the quality of health care available to patients, one must wonder why conservatives have chosen this as their rallying point.  The ostensible answer is to decrease the deficit, but if the end result is to substantially increase the nation’s total health care spending, you have to wonder whether the meager budgetary gains are worth it.  More importantly, though, is what this plan means for patients looking toward their retirement years.  Those unable to afford an additional half-million in medical expenses will find themselves increasingly shut out of our already exclusive health care system, searching in vain for some means of alleviating their illnesses and cancers.  When juxtaposed with the fact that the Ryan budget contains yet additional, massive tax cuts for the super-rich [6], these changes leave me in dismay as to why so many are eager to shift our hardships to those least able to bear them.  I pray fervently that we reconsider.

One Response to “on the gop’s new vision for medicare”
  1. N. Asher says:

    Curious how your Congressman voted on this measure? Voting tallies available here:

    House: http://politics.nytimes.com/congress/votes/112/house/1/277
    Senate: http://politics.nytimes.com/congress/votes/112/senate/1/77

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