Monday, August 20, 2018
Opinion

Paul Ryan's big plan: freedom from help

The Medicare "death panels" bogeyman is back, reintroduced by, of all people, Rep. Paul Ryan, the man who would transform the Medicare entitlement. What did Bill Clinton say about "brass"?

It was last month at the Republican Party's happy hunting grounds known as the Villages, a retirement community north of Orlando, that the vice presidential hopeful told the assembled that President Barack Obama "puts a board of 15 unelected, unaccountable bureaucrats in charge of Medicare who are required to cut Medicare in ways that will lead to denied care for current seniors."

Ryan is feeding seniors' fears over rationed government care but fails to fess up to all the rationing he has in store.

First let's sweep away misconceptions about the "Independent Payment Advisory Board," (note the word "advisory") to which Ryan is referring. This is a key Medicare cost-containment provision of the Affordable Care Act and a part of why the solvency of Medicare's primary trust fund is eight years longer under Obamacare than without it.

Here's how the board works: Fifteen experts in health care, including consumers and seniors — not government bureaucrats — appointed by the president but confirmed by the Senate, would be charged with finding efficiencies in Medicare's medical delivery and payment system. If increases in Medicare costs exceed a targeted amount —growth in the nominal GDP plus 1 percent after 2017 — the board must offer ways to rein those costs in. But the elected, accountable Congress has the last word. It can adopt the recommendations or reject them as long as it offers an alternative way to contain the rate of growth.

Contrary to Ryan's claims, the board cannot ration care, raise taxes or premiums, or restrict benefits to bend Medicare's cost curve.

This studied approach preserves Medicare's safety net features while forcing Congress to be fiscally responsible, similar to the commission that helps close redundant military bases. It should be applauded by Ryan, who claims to be a fiscal conservative.

Except no true fiscal conservative would vote to put two wars, tax cuts for the wealthy and the Medicare prescription drug benefit on America's credit card; or help scuttle the bipartisan $4 trillion deficit reduction deal from the Simpson-Bowles commission; or propose a fiscal plan that includes generous tax cuts to the rich and no balanced budget for at least another 28 years. All of which Ryan has done.

So, not a fiscal conservative, but he is opposed to government rationing care, right? Not really.

Ryan's budget blueprint, the one passed by the House in March, is a manifesto of government-rationed care, a modern-day Magna Carta Libertatum to Ryan's philosophy that freeing Americans from debilitating government aid is the only way their productive potential will be fully realized. Ryan introduced it by saying he doesn't want America's safety net programs to become "a hammock that lulls able-bodied people into lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives."

Ryan's freedom agenda includes vouchercare where Americans who become Medicare-eligible in 10 years would have the freedom to hunt for private health insurance with a rationed voucher that inevitably won't keep up with medical inflation.

For middle-class seniors needing a nursing home placement paid for by Medicaid, Ryan gives them the freedom to cover the average $80,000 annual price tag or find some other living arrangement, by transforming Medicaid's open-ended guarantees into a rationed block grant to the states and cutting funds 35 percent by 2022.

Poor families would have the freedom to either find decent paying jobs or go hungry since their access to food stamps would be rationed. Ryan would block grant that program too, and institute a time limit.

The man's taken as an injunction Janis Joplin's lyric that freedom's just another word for nothing left to lose. Where FDR would grant us freedom from want, Ryan gives us freedom from help. But at least there will be no "unaccountable bureaucrats" subverting Medicare. He already did that job for them.

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