Maggie's Farm

There is no perfect solution to what varying interest groups or segments of public opinion desire as reforms to US healthcare. Now that we’ve gone down the path of ObamaCare and RomneyCare, that is more evident. The question, then, is what course is more promising? The answer is less government intervention in healthcare than preceded ObamaCare or RomneyCare.

There are three core problems with either ObamaCare or RomneyCare. Each by itself raise conflicts with facts, law, and public desires. Together, they are a witches brew. Both ObamaCare and RomneyCare are based on wrong premises of government intervention and result in worsening the future of healthcare in the US.

ObamaCare and RomneyCare are premised on extending more medical care to the uninsured even beyond need or personal responsibility or affordability. They are premised on reducing or moderating our national costs of healthcare even though they fail to do so and in many ways increase costs. They are premised on the imposition of added government regulation and intervention into individual choice and circumstances even though neither science, management, competence, politics nor majority public support is up to the task nor expected to be.

But one has to go deeper than that to find the roots of the false premises of ObamaCare and RomneyCare. The roots are in government healthcare programs themselves like Medicare and Medicaid. Regardless of any good intentions or needs, they set the course of government being the solution.

Regardless of promises or embedment they have expanded beyond initial promises or need. Regardless of the good they do they have done more harm to healthcare by distorting its economics and its public perception. Regardless of cost they have increased costs to those outside these programs. Regardless of their public acceptance they have become unaffordable.

It is painful to abandon ObamaCare or RomneyCare. It is less painful to change course entirely.

From decades and certifications in health insurance I am highly critical of health insurers, and moreso as they have become more self-servingly enmeshed in government healthcare programs. That said, private insurers are more responsive to change, improvements, competition, and tailoring coverages to individual needs than any government program is capable. Further, individuals – including the poor or uneducated – are more able to discern their own needs than any government bureaucrat. Further, groups advocating types of health insurance coverage beyond the core would have to compete with more transparent facts and costs instead of canoodling with and paying off politicians.

Congressman Paul Ryan has proposed the reform of Medicare that would reverberate throughout US healthcare. It is estimated by the CBO to “totally reverse the course of recent fiscal history by lowering federal health care spending from 8% of GDP today to just 5% by 2050. If we remain on the current course, the spending would jump to 14% in that time frame.”

For a good summary, see here. As Fortune says,

In effect, Ryan is asking Americans to make a historic leap of faith…. Ryan's vision of bringing the market to Medicare is the best choice in a world of poor alternatives….

 

Americans will no longer get more than 70% of their Medicare costs paid by the government. [Instead there would be premium subsidies, declining with means, and co-pay subsidees for the poor. –ed.] Retirees are bound to pay a much bigger share of their own medical costs. More and more seniors will choose high deductible plans, and HMO or PPO-style programs that limit choices of doctors.

 

Still, the rise in costs for the elderly could prove far less than the giant annual increases we're experiencing today. We've simply never seen a competitive environment like the one in the Ryan blueprint. "The Obama plan is all about price controls," says Joseph Antos, an economist at the American Enterprise Institute. "Ryan's is all about unleashing the market."

 

The Ryan plan has another major strength: It will stop heaping a bigger and bigger Medicare burden onto younger taxpayers. Ryan is making a bold, wrenching choice that wins because it's less painful than all the others.

 

The Obama re-election administration has lambasted Ryan with Democrat MediScare (even though Ryan's program would reduce government subsidies for the wealthy!) Mitt Romney tries to explain that ObamaCare exceeds RomneyCare’s ailments instead of admitting original sin. The other major Republican candidates, in this as in other areas, have not put forth anything but slogans. Perhaps that’s about all we can expect from an election season.

To avoid facing the battle during the elections, I suppose that Ryan will not be the V-P nominee. (Even though "70% Favor Individual Choice Over Government Standards for Health Insurance," there doesn't appear sufficient courage or faith in the voters for leading candidates to take the risk.) However, after 2012, we must either turn to Paul Ryan or continue our present muddle that resolves little and increases faults. I don’t know whether Ryan would be most effective in Congressional leadership or as Secretary of Health and Human Services. Whichever will depend on the size of the Republican majority and the intelligence and guts of the next president and Congress.