by Maggie Mahar and Naomi Freudlin
original posted at Healthbeat blog
“Humanity is a well with two buckets,” said Wylie, “one going down to be filled, the other coming up to be emptied.” Murphy Samuel Beckett
Maggie Mahar and Naomi Freudlin at Healthbeat Blog weigh in on Congressman Ryan’s proposal for Medicare, Medicaid, and the budget proposal.
In “Ryan’s Proposal for Medicare -- Shifting Risk to Seniors;” http://www.healthbeatblog.com/2011/04/ryans-proposal-for-medicare-shifting-risk-to-seniors-.html Maggie Mahar compares Ryan’s plan to a 401k and its difference with a pension or turning Medicare from a defined benefit plan into a defined contribution plan with the seniors bearing more of the risk and cost.
“Under Ryan’s proposal, however, the 50-year-old 401-k investor who took a beating in the stock market over the past four years now has something else to worry about. He would be expected to “manage” his health insurance, along with his savings. Just as the typical 70-year-old is not a professional money manager, he is not trained as a human resources expert. Yet it would be up to the retiree to choose an affordable plan that provides adequate coverage and access to a network of doctors and hospitals that offer high-quality care. Today, Medicare guarantees that it will cover an essential set of benefit.
if Ryan’s plan became law, it would be up to the individual to decide whether he wants to sign up for a plan with a lower premium and a fairly to high deductible, gambling that he will be able to afford the deductible when he needs care. (Much may depend on his 401-k is doing).”
Maggie again questions whether today’s healthcare business can change much under Ryan’s plan to keep costs under control when the indistry’s basis for profitability is the quantity of services, procedures, and pharma sold rather than the benefit received from them. Ryan’s plan brings little to the table in controlling this rising cost other than shift it to the elderly and disabled who have little ability to control the passed on healthcare expenses from insurance companies other than not get treatment.
Naomi Freundlich also at Healthbeat Blog discusses how Ryan’s plan for Medicaid would impact the poor; “Medicaid Savings in Ryan’s Plan Would Come At the Expense of the Poor” http://www.healthbeatblog.com/2011/04/medicaid-savings-in-ryans-plan-would-come-at-the-expense-of-the-poor.html
“There is little in Ryan’s budget proposal to support just where these savings will come from, but it’s easy to imagine that state caps on Medicaid enrollment, cuts in covered benefits and lowered physician reimbursement, along with an increase in co-pays for beneficiaries will all play an essential role.
Under the Ryan budget proposal, the health reform law would be repealed—and with it would go the federal funding that would finance some 96% of the cost of this expansion. Block grants require that the federal government pay each state either a fixed dollar amount or cap payments at a specific level, with the state responsible for all Medicaid costs that exceed the cap. If Medicaid costs rise due to increases in enrollment, economic recessions, or even health epidemics like HIV/AIDS, the federal share would remain the same.”
Maggie Mahar comments on Paul Ryan’s claim of Alice Rivlin supporting his budget proposal and its imact on Medicare. “Alice Rivlin Does Not Support Ryan’s Plan to Bury Medicare” http://www.healthbeatblog.com/2011/04/alice-rivlin-does-not-support-ryans-plan-to-bury-medicare.html
“’on ‘CNBC’s Morning Joe,’ Paul Ryan claimed Alice Rivlin, Clinton’s OMB director, as an ally: ‘Alice Rivlin and I designed these Medicare and Medicaid reforms’ he announced. ‘Alice Rivlin is a proud Democrat at the Brookings institution. These entitlement reforms are based off of those models that she and I worked on together.’
POLITICO reported that ‘The other main difference is in the rate of growth in subsidies for beneficiaries entering the new exchange system: ‘In the Ryan version, he has lowered the rate of growth and I don’t think that’s defensible,’Rivlin declared.’It pushed too much of the cost onto the beneficiaries.’”
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