I understand a lot of the fixations of the far Right (although I disagree with virtually all of them). But I’m at a loss to understand their vendetta against Medicare, or their belief that access to healthcare should be considered a privilege, not a right.
If we take Paul Ryan and his ilk at their word, they evidently believe that market competition will bring healthcare costs down, and that guaranteeing access to healthcare promotes overuse (i.e. you’ll go to the doctor more frequently than you really need to). They believe these things–if they really do– despite overwhelming evidence to the contrary.
The great virtue of markets is that they enable voluntary exchanges; they provide an incentive to provide goods at a price buyers are willing to pay. The classic description of a market is “an exchange between a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.”
That is not a description of the “buyer” having a heart attack. Even in the absence of insurance requiring the use of specific providers, people do not–cannot–“shop” for medical care. We are generally not “willing” buyers, and as non-experts, we certainly do not have sufficient “information relevant to the transaction.”
You think it’s hard getting good insurance when you’re 30 or 50? Try getting good private insurance when you’re 70 or 80.
Providing health insurance coverage to seniors will unquestionably cost more if run through private insurance. No one who has looked at the comparative data on the cost efficiency of Medicare and private carriers can question this. There’s no money savings. Quite the opposite. The only difference is that seniors will pay vastly more out of pocket because the vouchers won’t come close to the costs of a policy. The upshot of the Ryan plan is significantly increasing the cost of what society pays for the medical care of seniors and then making seniors pay dramatically more out of pocket. All with none of the bedrock gaurantees Medicare provides.
There’s a reason administrative costs of Medicare–which doesn’t need to advertise, show a profit or cover outsized salaries to upper management– are dramatically lower than those of private insurance companies. As Marshall points out, the irony is that at the same time they are attacking Obamacare, Ryan and his cronies are proposing to replace Medicare with something that looks very much like Obamacare.
But building an exchange and subsidy adjunct for non-seniors onto an existing and fairly robust private health insurance system is one thing. Creating one from scratch for people who are all pretty much by definition bad risks is close to laughable. Laughable if you’re not bankrupted or dying because you couldn’t get care.
Remember the other things Medicare significantly guards against. If parents have insupportable medical bills or have no way to pay for care, they go to children. In the absence of any other options, that’s how it should be. But that money comes out of other things: buying homes, putting kids through college. The social insurance model of Medicare has positive effects well beyond direct beneficiaries.
Recent polls suggest that significant majorities of Americans don’t want to get rid of Obamacare, let alone Medicare. I still remember that senior at a Town Hall meeting carrying a sign that said “Keep Government’s Hands Off My Medicare.” He may not have recognized that Medicare is a government program, but he’ll certainly identify the perpetrators of attacks on it.
Fortunately, even in the Time of Trump, efforts to deprive millions of Americans of access to basic healthcare will not be a slam-dunk. As Marshall has also reported,
Many Republicans can see the political danger of touching Medicare. No one campaigned on this in 2016. Support for phasing out Medicare and replacing it with private insurance and vouchers is minimal outside libertarians and conservative ideologues. That’s why word play about ‘reform’ and averting ‘bankruptcy’ and ‘saving Medicare’ are the catch phrases. If anyone said, ‘We have an idea to have seniors get private insurance instead of Medicare and a check from the government to pay part of the cost’ they’d be laughed out of whatever room they were in. What’s most salient is that it is toxic within the coalition around which Donald Trump has at least temporarily remade the GOP.
In the real world, nothing about this Ryan/Trump effort makes sense. Practically, fiscally and politically, it would be a disaster. Given the characteristics of those who would be in need of coverage, it wouldn’t even benefit insurance companies or Big Pharma.
This is ideology-cum-religious fundamentalism: don’t confuse me with the facts.