Health care policy and health care reform are back in the news in a big way. The Supreme Court is poised to hear oral arguments on the constitutionality of the 2010 health care overhaul. The Obama administration has just released guidelines for the operation of the state-based insurance exchanges that are the backbone of the law.
Gas prices have supplanted unemployment as the major attack line against President Barack Obama from Republican presidential candidates and party spokesmen and their media allies. But there is an increasingly vigorous effort to make “Obamacare” and the cuts to Medicare providers that help to finance the law central issues in the campaign and in the debate over budgets and spending bills that lay ahead in Congress.
Also on the target list is the Independent Payment Advisory Board, designed to have an independent group of health care experts set guidelines for Medicare payments, something now done poorly by Congress, with the proviso that it cannot recommend cutting benefits or increasing Medicare recipients’ out-of-pocket expenses. The House will soon vote to ax the IPAB, and attacks against it as a rationing vehicle, while patently false (unless you believe that any cut in the rate of growth of health care expenditures is rationing), are increasingly strident.
Prominent GOP lawmakers refer to the health care reform law as “a government takeover of 17 percent of the economy.” They, GOP presidential candidate Mitt Romney and their allies such as the lobby group 60 Plus Association hit the Medicare changes in the law as devastating for seniors. (Of course, Romney and the others fail to mention that the 10-year House budget crafted by Rep. Paul Ryan (R-Wis.) includes the same Medicare cutbacks to bring the budget in line while waiting for Ryan’s deferred blockbuster Medicare reform.) Tough rhetoric is tempting, to rally one’s supporters and to inflame the public, but these charges are laughable.
Start with the idea that the 2010 law is a government takeover of health care — a giant step to socialism. First a reminder: The health care reform bill is essentially the 1993 Republican alternative to the President Bill Clinton’s health care plan, crafted by the late Sen. John Chafee (R.I.), former Sen. Dave Durenberger (Minn.) and current Members such as Sens. Chuck Grassley (Iowa) and Orrin Hatch (Utah.) — not exactly a group of raving socialists. Add in the other elements of the bill, which are taken directly from the Romney plan in Massachusetts, and the fact that the law, to the dismay of liberals, did not include a public option, and the charge of government takeover rings very hollow.
Next, take a look at the Medicare plan of Ryan and Sen. Ron Wyden (D-Ore.), touted by Romney and other candidates as the free-market alternative to Obamacare.
It essentially uses regulated insurance exchanges to enable seniors to purchase health insurance, with Medicare as one option along with the private plans and with premium support for seniors. The exchanges are indistinguishable from those in the health care law, and the structure of the Ryan-Wyden plan is, as one conservative health care policy analyst told me, “Obamacare for seniors.”
That might be inaccurate in two ways. The premium support for seniors in the Ryan-Wyden plan is less generous than the premium support in the 2010 law, meaning seniors will pay considerably more out of pocket over time. Second, the Ryan-Wyden plan, unlike the overhaul, has a public option!
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