Posted by Rojas @ 12:27 am on February 4th 2010

The Republican Health Care proposal

It’s Paul Ryan’s, it’s before the House, and it doesn’t just bend the cost curve. According to the CBO, it eliminates the long term entitlement deficit entirely.

Haven’t plumbed the mechanics of it sufficiently to form a coherent opinion. But it’s damn sure worth a look.

9 Comments »

  1. He’s certainly the star of a party that has very few.

    Comment by Brad — 2/4/2010 @ 10:14 am

  2. Worth noting too that Ryan is writing the Republican counter-budget this year, and in some circles he’s being a touted as their Contract with America guy for the 2010/2012 cycle.

    As to plumbing the mechanics, the two big points are:

    1. Significantly reducing benefits to anybody under 55 at the time of passage, and then privatizing social security (more or less the Bush plan, if anything a bit more in the immediate-term).

    2. Phasing out Medicare. Replaced by a system of vouchers for buying private health insurance.

    But, it also shifts the tax credit from employers buying insurance to individuals, which for my money, if coupled with revoking the anti-trust exemption for health insurance companies (which is not in this plan), is a terrific base for a conservative way forward on health care. I said at the very beginning of the debate that I think I’d rather try a significant one-stop reform which would either be that on the right or single payer on the left, rather than continue to bog us down in the Frankenstein system we have now. If this were coupled with regulatory/deregulatory measures that cracks the monopolistic system and the captive audience nature of health care customers, it would look a lot like my ideal conception of a conservative health care counter-plan.

    According to Ryan, doing those things still only gets us to eliminating the entitlement deficit by 2083, which seems like a long time.

    Josh Marshall has an interesting take on how seriously this is being taken within the Republican caucus:

    Now, Minority Leader Boehner (R-OH) and Minority Whip Cantor (R-VA) have been sort of dancing around the Ryan draft. They’re both saying they’re putting forward a detailed budget plan and then simultaneously refusing to say Ryan’s plan is endorsed by the conference. But Ryan’s their budget writer. So this is a bit like Peter Orszag releasing a budget document and having Obama and Rahm saying he’s just speaking for himself.

    That seems understandable to me, as essentially eliminating Social Security and Medicare is, well, friggin’ huge. But this is a serious proposal, in response to a very serious promise, and that’s more than can be said for any others.

    Of course, it’s more an academic exercise rather than an actual proposal until such a point when a party decides to push it as their agenda, and it’s, less say, somewhat less than likely that that happens here.

    Comment by Brad — 2/4/2010 @ 11:02 am

  3. Am I reading this wrong, or does Ryan actually represent Russ Feingold’s old House district? If so, that’s one weird constituency–and actually, kind of an awesome one in their willingness to select thinking human beings as opposed to talking heads.

    Comment by Rojas — 2/4/2010 @ 11:47 am

  4. According to Ryan, doing those things still only gets us to eliminating the entitlement deficit by 2083, which seems like a long time.

    Setting aside the actual moment at which the debt becomes a surplus, the plan makes a substantial dent in the projected deficits immediately and throughout the next seventy years–check out the CBO chart on publicly held debt in particular.

    I gotta admit, I’m starting to get excited about this. The long term entitlement deficit is THE greatest crisis America faces, and this is the first serious plan I’ve seen that would actually and demonstrably solve it without very seriously undermining retirement security. The best that can be said of the Obama approach, under optimistic assumptions, is that it takes the edge off of the medical-costs aspect of the problem.

    And that is a problem, because the Ryan plan is quite clearly mutually exclusive with the Democrats. I’m a fan of incrementalism, but in this case Brad is right; the Ryan plan CANNOT be implemented piecemeal, because the absence of any one of its major provisions throws the whole thing out of whack. I suppose you could choose to implement Ryan’s plans with or without Brad’s proposed improvements and treat THAT as incrementalism of a sort.

    Also worth noting: the Ryan plan seems to eliminate any prospect of universal health insurance coverage. The vouchers are incompatible with a public mandate.

    I can understand how people might prefer the Dem plan to the patchwork status quo. But if the choice is between the cobbled together Dem approach on the one hand and an actual solution to the entitlement crisis on the other–well, that is a very different matter.

    Comment by Rojas — 2/4/2010 @ 12:04 pm

  5. Am I reading this wrong, or does Ryan actually represent Russ Feingold’s old House district? If so, that’s one weird constituency–and actually, kind of an awesome one in their willingness to select thinking human beings as opposed to talking heads.

    Feingold was never in the House, but he did represent the 27th district in the Wisconsin State Senate for 10 years. Ryan was never in the state legislature. Fiengold’s state legislative district doesn’t overlap with Ryan’s congressional district.

    Although, worth noting, that Ryan worked for the incumbent, Bob Kasten, who Feingold defeated in 1992 to claim his Senate seat.

    Also worth noting: Ryan went from that to become the legislative director for Sam Brownback from 95 to 97.

    Comment by Brad — 2/4/2010 @ 12:04 pm

  6. Wasn’t aware of that last bit. There’s some aspects of his approach which remind me of certain other highly intelligent Brownback staffers of Brad and my acquaintance. I’ll ask around about him.

    Comment by Rojas — 2/4/2010 @ 12:08 pm

  7. And that is a problem, because the Ryan plan is quite clearly mutually exclusive with the Democrats. I’m a fan of incrementalism, but in this case Brad is right; the Ryan plan CANNOT be implemented piecemeal, because the absence of any one of its major provisions throws the whole thing out of whack.

    The same can be said of the Dem plan, and indeed liberals have been trying to scream that from the rooftops from the moment the public option looked to be axed. And they’re more or less right, which is why I’ve been against incrementalism here for both thrusts. You can’t mandate insurance and strike the preexisting condition disqualifier but not regulate the insurance companies or provide a publicly-controlled option to compete, because insurance companies have to offer preexisting condition patients insurance, but will jack up the prices to the point where it makes more economic sense for people to opt out at which point the government will have to fine them (or the state governments). So you wind up keeping uninsured people but adding a layer of penalty, which has precisely the opposite effect of, well, not screwing people without health insurance. The same can be said for the cost control measures. It never made sense to me to go for a “bipartisan” buffet-style bill here. You had to go big or go home.

    I could get excited about the original Dem plan, which I thought was pretty good, far from ideal but better by a mile than the status quo. I could also get excited, moreso, about the Ryan plan, but I have my doubts if it will ever go anywhere beyond Paul Ryan’s office and as fodder for a “We have ideas (even if we have no plan to specifically run on them or seriously try to get them through)!” talking points. But either way, I really do think health insurance reform is one of those things where you have to go big or go home, because it’s not this or that little thing that’s wrong with the status quo, but it’s very foundation and conception (and, only in addition, about a million friggin’ this or that little things the individual addressing of each one would take about a million years but each of course would have further ramifications for other little things, etc.)

    Comment by Brad — 2/4/2010 @ 12:16 pm

  8. My bad on the House thing. I was attending Beloit College in Ryan’s current congressional district at the time Feingold was elected to the Senate; I remembered Feingold as having been from that area (specifically, Janesville, the same hometown as Ryan) but I somehow conflated the Congressional race with the Senate race in my memory.

    Still a fascinating pair of politicians to come out of the same constituency. I’m a bit suprised that Ryan is electable there, to be honest.

    Comment by Rojas — 2/4/2010 @ 12:17 pm

  9. He’s won all his races by 2 to 1 margins too. Although four of those six races were against the same guy, ironically an orthopedic surgeon who described his primary issues as “health care, health care, health care” and ran on a single payer platform (he died just a few months ago, incidentally).

    Wikipedia is awesome.

    Comment by Brad — 2/4/2010 @ 12:23 pm

RSS feed for comments on this post.

Leave a comment

You must be logged in to post a comment.