Posted 4/06/12 on Managed Care Matters
Rep. Paul Ryan (R WI) and the House Republicans are touting their budget as fiscally responsible and prudent. What Mr Ryan conveniently forgets, or more likely avoids, is this:
Eight short years ago he – and his GOP buddies – passed the single largest entitlement program since Medicare – the Medicare Part D drug benefit – with no dedicated financing, no offsets and no revenue-generators – the entire future cost –which is now around sixteen trillion dollars [see page 148] – simply added to the federal budget deficit.
According to Bruce Bartlett writing in the Fiscal Times, “By 2030, Part D alone will cost taxpayers 1 percent of GDP.”
Continue reading “The GOP Budget, Fiscal Responsibility and Part D” →
Posted 4/5/12 on the Altarum Institute’s Health Policy Forum
If you have followed Parts I and II of this series, you will be aware of the key role played by federal non-health spending in my calculation of the sustainable growth rate in national health expenditures. Given the expanded coverage provisions of the Affordable Care Act, I argued that the sustainable rate of growth in health spending is largely determined by what the nation chooses to allocate to federal health spending in future years. And this allocation is simply the difference between what the nation is willing to provide in total tax revenues and the amount of those revenues being set aside for non-health federal spending.
For example, suppose the nation wishes to keep tax revenues at 18 percent of GDP and set aside 13.5 percent of GDP for non-health spending (under a balanced primary budget). (1) Then the amount available for federal health spending would be 4.5 percent of GDP. Using 2035 as the target year for bringing federal health spending in line with this target, I calculated that the corresponding growth rate in national health expenditures would be 2.6 percent annually, starting in 2012. This is 2.2 percent below the expected GDP growth rate over this period, and lowers the health spending share of GDP to 10.8 percent by 2035—a stark contrast to the 2011 health spending growth rate (4.5 percent) and share of GDP (18.1 percent).
Continue reading “Sustainable Health Spending Under the Ryan Path for Federal Non-Health Spending” →
Posted 2/1/12 on Health Policy and Marketplace Review
In two companion articles in January’s New England Journal of Medicine, Henry Aaron with Austin Frakt, and Joe Antos critique the Wyden-Ryan Medicare reform proposal.
Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) are proposing a hybrid Medicare reform proposal combing both Republican defined contribution free market principles—a premium support scheme—with Democratic defined benefit principles—a baseline guaranteed plan and premium support.
Continue reading “The Wyden-Ryan Plan Will Be the Foundation for Serious Medicare Reform—and Maybe More” →
Published 12/16/11 in the Fiscal Times
Last spring, the House passed on a straight party-line vote Rep. Paul Ryan’s mandatory Medicare privatization plan, which the Congressional Budget Office said would force future seniors to pick up two-thirds of their health care costs with no guarantee that those costs would come down.
On Thursday, Ryan, R-Wis., with a bipartisan boost from Sen. Ron Wyden, D-Ore., offered a revamped version of his plan, dubbed premium support because the government gives beneficiaries cash or a voucher to help them pay for plans sold by private insurance companies. The changes from his earlier plan were stark.
Continue reading “Wyden Covers Ryan’s Retreat on Medicare Vouchers” →
Posted 12/15/11 on Health Policy and Marketplace Review
House Budget Chair Paul Ryan (R-WI) and Senator Ron Wyden (D-OR) have embraced a Medicare reform plan that in concept borrows heavily from one championed by former New Mexico Senator Pete Domenici and former Clinton budget chief Alice Rivlin.
Specifically, Wyden and Ryan are proposing to alter the earlier Ryan Medicare plan by:
1. Continuing to offer the traditional Medicare plan—Ryan would have eliminated it—in addition to a range of private Medicare plans offered by health insurers.
2. Tying federal Medicare premium support to an amount equal to the second lowest cost Medicare plan—public or private—available to seniors in each market. Ryan would have set a flat premium support amount in year-one and increased that only at the rate of inflation.
3. Instituting a series of consumer protections and medical underwriting rules designed to protect seniors.
4. Instituting an annual cap on what the federal government could pay for Medicare at an amount equal to the increase in the nation’s GDP + 1%—Ryan would have capped annual increases in the federal premium support amount at the increase in the consumer price index.
The Wyden-Ryan would begin in 2022.
Continue reading “Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open!” →
Posted 10/11/11 on Health Care Reform Update
Having cost the Republican Party a Congressional seat earlier this year with his plan to turn Medicare into a voucher program, House Budget Committee Chair Paul Ryan is back with an even more sweeping health care proposal.
Ryan’s latest offering, unveiled in a speech a week ago at Stanford University’s conservative Hoover Institution, is nothing less than a blueprint for replacing the Affordable Care Act with a consumer-driven model that would eliminate the current tax-exempt treatment of employer-paid health insurance. Is Ryan right? Or wrong?
Continue reading “Paul Ryan is Right! (Even Though He’s Wrong!)” →
First posted 9/28/11 on Health Policy and Marketplace Review
In a speech at the Hoover Institution today, Representative Paul Ryan (R-WI) argued again that his proposal to reform Medicare, and now his tax credit proposal for replacing the Democratic health care law for those under-age 65, would guarantee to citizens “options like the ones members of Congress enjoy.”
His proposals would not give people the guarantees members of Congress, and all other federal employees for that matter, now enjoy.
This is not a small point.
Previously on this blog, I have argued that many of the defined contribution reform proposals, Ryan’s included, should be faulted for putting all of the future risk of health care costs on beneficiaries.
Continue reading “The Ryan Health Care Proposals—Not Your Congressman’s Health Plan” →
First published 6/6/11 on Gooz News
The health care cost debate takes place on two stages using two languages, one scientific, the other economic. The net result is a failure to communicate.
The scientific texts emanated over the weekend from the American Society of Clinical Oncology meeting in Chicago. Ongoing clinical trials showed that science has come up with new drugs that can reduce the incidence of breast cancer and prolong life for people with skin cancer. The former is an estrogen inhibitor that would have to be taken by tens of millions of older women to have a major impact on reducing the rate of breast cancer. The latter would only be given to a subset of the 68,000 new cases of melanoma each year, and would extend life from a few months to a few years for some of the 7,700 who die from the disease each year. Again, most of those people are older, although there are a number of younger people, especially young women, who disproportionately get advanced skin cancer.
Continue reading “VoucherCare for Cancer” →
First published 5/22/11 on American Health Scare
It’s been interesting watching the political maneuvering since Newt Gingrich criticized the plan to reduce the federal budget deficit proposed by the House Budget Committee Chair Paul Ryan of Wisconsin. After receiving push back from fellow Republicans, Gingrich spent the week backpedaling from his earlier remarks.
Many pundits have recognized Ryan for his courage to present his ideas in the first place. I also applaud the fact that he was willing to put the issue of fiscal sanity on the radar screen in a concrete way few other politicians have been willing to. This comes against the backdrop of recent estimates that a 56-year old couple will pay $140,000 in Medicare taxes per person over their work lives, but will receive $430,000 of benefits. This is unsustainable welfare.
Continue reading “The Ryan Plan” →
First published 5/25/11 on Health Policy and Marketplace Review
It should now be clear to Republicans they are in trouble over the Ryan Medicare plan.
Yesterday, they lost a seat in a solid Republican New York House district. Their candidate had benefited from lots of money and House leadership attention. The big issue was the Ryan Medicare plan.
All month, Republican Presidential candidates have been walking a tightrope over the Ryan plan–don’t embrace it but don’t criticize it either for fear of offending the base who will drive the primary outcomes next year. You only had to watch the Gingrich implosion to see what happens if you fall off that tightrope.
Continue reading “Earth to Republicans: You Are In Big Trouble Over The Ryan Medicare Plan” →
How does a Medicaid block grant proposal like that of Congressman Paul Ryan relate to (1) poor treatment of cancer pain, (2) the epidemic of overdose deaths from prescription opioids, (3) the neglect of preventive medicine in the U.S., (4) unnecessary anticoagulant drug related bleeding deaths, (5) FDA drug regulator unresponsiveness to drug safety concerns, and (6) our broken medical malpractice system? My saga at the Los Angeles County + USC Medical Center (LAC-USC) ties these components of our health care system in crisis together.
Continue reading “Whistleblower Doctor Advocates Medicaid Block Grants” →
First published 5/9/11 on Health Policy and Marketplace Review
A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction–it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.
What lies at the heart of Ryan’s Medicare difficulties is that he would all but abandon future seniors (those now under age-55) to a health care system whose age-adjusted premium support would increase each year only at a rate equal to the increase in the consumer price index while their health care costs would likely continue to increase far faster.
Continue reading “Both Democrats and Republicans Would Dump Cost on Consumers Rather Than Face Providers” →
C. Eugene Steuerle
First published 4/21/11 on The American Square
President Barack Obama and House Budget Committee Chairman Paul Ryan (R) have laid out different approaches for curbing growth in health care costs. One would empower government-appointed officials to constrain health prices and services by, for instance, strengthening the power of the Independent Payment Advisory Board (IPAB) created in 2010’s health-reform legislation. The other would provide Americans with premium support up to some dollar limit to cover their health insurance purchases. Both count on efficiency improvements as well. The political debates have quickly centered over whether Obama is heading toward ever-more cumbersome government regulation and price-setting and whether Ryan is opening up unregulated markets that would deprive many of needed health care.
It’s not that simple, though. Three questions are actually at issue:
(1) How should budget constraints be applied?
(2) Should automatic budget growth for health care programs (particularly, Medicare) finally be reined in?
(3) Should government health program budgets be limited even if neither side gets its way?
Continue reading “Does Constraining Health Cost Growth Require Choosing between Obama and Ryan?” →