How to make the Medicare problem worse

Perhaps the most frustrating aspect of the debate over Medicare is the disconnect between the problem and proposed “solution.” The standard Republican line is that Medicare faces a serious financial shortfall in the future, with escalating costs threatening its viability. To deal with the problem, Republicans are pushing a plan that doesn’t deal with escalating costs at all.

Indeed, what’s often overlooked is the fact that the GOP plan to “save” money through Medicare “reform” actually costs more.

By now, the basics are probably pretty familiar. The Republican plan, as crafted by Paul Ryan, is to scrap Medicare and replace it with a privatized voucher plan. The voucher decreases in value over time, which produces “savings” for the government, not by controlling costs or addressing care delivery systems, but by transferring costs to you. And if the voucher doesn’t cover what you need, well, good luck.

For the GOP, this ruthlessness is just a fiscal necessity. The nation can’t afford Medicare anymore, so these “reforms” are unavoidable. This is absurd on its face, since Republicans intend to spend the difference on tax cuts, not debt reduction, but putting that aside, there’s the small matter of the GOP making care more expensive, not less. Peter Orszag explained the other day:

While more consumer cost-sharing would help reduce unnecessary care, the plan would not live up to its billing in cutting health costs for America. According to the nonpartisan Congressional Budget Office, it would do the opposite. That’s right: The CBO found that the Ryan Medicare proposal would substantially increase total health-care spending. […]

On the critical metric of whether the Ryan plan would reduce total health-care costs, though, the CBO conclusion is shocking: The plan would not only fail to decrease health-care costs per beneficiary, it would increase them — by an astonishingly large amount that grows over time. By 2030, health spending on the typical beneficiary would be more than 40 percent higher under the Ryan plan than under existing Medicare, according to the CBO report.

Health-care costs would not be reduced on the backs of seniors; they would be raised on the backs of seniors.

I can appreciate why this sounds ridiculous. The Republican plan to reduce the debt doesn’t really reduce the debt? The Republican plan to reduce health care costs increases health care costs? The Republican plan to save Medicare actually eliminates Medicare?

Actually, yes. None of this criticism is in any way hyperbolic.

What should be the point of Medicare “reform” is making the system cost less. The plan pushed by the GOP in the House and Senate makes the system cost more, only in this scenario, it’s seniors on a fixed income who’ll bear the increased burden. This, they assure us, is an example of fiscal responsibility.

It’s as if the whole party is taking crazy pills.

Media professionals who genuinely believe the Paul Ryan agenda is courageous and sensible haven’t taken the time to do their homework. It’s snake oil in a medicinal bottle.

Postscript: Before my friends on the right ask, “Oh yeah, smart guy? Well, what’s your plan to reduce Medicare costs?” I should note that Democrats already have a credible approach to restraining the growth of Medicare spending. It’s called the Independent Payment Advisory Board, and it’s likely to be quite effective in curtailing spending on ineffective health care treatments.

Republicans, who claim to be obsessed with Medicare financing, are against it, and are eager to kill the idea. It’s been that kind of debate.