Ryan proposes that each state develop an insurance exchange to organize the private market, but he would mandate that they offer the basic benefit now available to federal employees and Members of Congress.
Policies sold on state exchanges couldnt discriminate on the basis of pre-existing conditions, and states would prevent cherry-picking of healthy patients by having insurance companies risk-adjust share the risk for covering sicker patients.
Unlike most Republicans, Ryan shares Obamas view that the health care system in America is broken with costs rising at an unacceptable rate, both doctors and patients trapped by current insurance practices and 47 million people uninsured.
However, hes dead against the Democrats public option proposal. The federal government would run a health care system ... with the compassion of the IRS, the efficiency of the post office and the competence of Katrina, he says.
Ryan thinks that, even without an individual mandate, nearly everyone would sign up for some insurance plan possibly a high-deductible plan because states would make it convenient and cheap to do so.
House and Senate Republicans are offering some useful ideas. In the Senate, they will propose giving the uninsured and self-employed the same tax break that employer-insured workers get. House leaders think thats too expensive.
In both chambers, theyd reform Medicaid, crack down on Medicare fraud, cap malpractice awards, allow small businesses to form insurance pools and permit interstate purchase of insurance.
Democratic majorities will vote it all down, of course. And maybe Republicans can use public doubts to kill Obamacare. But then, as Ryan says, the U.S. health care system will continue to be broken.