Brian Beutler of Talking Points Memo got Sen. John Cornyn to admit that what Rep. Paul Ryan is proposing in his Medicare privatization scheme "is exactly like Obamacare." Say again, Senator? "It is. It's exactly like it. Which strikes me as bizarre that you're seeing so much pushback [from Democrats]."
Well, not exactly. Ryan's plan ends Medicare's guaranteed coverage and replaces it with vouchers seniors could use to get private insurance, then shifts the burden of costs more and more onto seniors themselves over time. It's only "exactly like Obamacare" in that under the Affordable Care Act, people who are not seniors or on Medicaid will continue to get coverage from private insurers, and some will get subsidies to cover part of the cost, just as seniors under Ryan's plan would get vouchers that cover part of the cost of their care. But that's really where the limited similarity ends, because the core of the ACA -- the regulations that mandate that insurance companies cover everyone without respect to pre-existing conditions, and also mandate that everyone get insurance -- is exactly what Ryan and other Republicans want to repeal. Beutler argues that there's an irony afoot:
If you think of the health care system as a highway with unbridled free market private insurance on one end and universal single payer on the other end, then two parties are now approaching each other from opposite directions. Democrats pushed ObamaCare for working-aged people as a move away from unrestrained private insurance, toward a universal program. In trying to dismantle Medicare, Republicans are seeking to rollback a successful example of single payer toward freer market.They've now awkwardly encountered each other in the middle. The similarities between the two policies creates a dilemma for Republicans who have smeared the health care law as an existential threat to the United States and for Democrats who've attacked the GOP plan as a corporate giveaway and dangerous for seniors.
I don't really see this as awkward at all for Democrats. The pre-ACA status quo was that, from the Democratic perspective, seniors existed in the best insurance system (single-payer), and people who don't get coverage through their employer existed in the worst (at the mercy of cruel and capricious insurance companies). The Affordable Care Act gives the second group the protections of new regulations on insurance companies (e.g. no pre-existing condition exclusions) enabled by the near-universal coverage created by the individual mandate. Most progressives think it would have been better if this group too could be within a single-payer program, but if the private insurance companies are still going to be providing them coverage, at least they'll be better off than they are now. It's a movement in the right direction, but nobody said this middle position produced some kind of paradise. Republicans, on the other hand, have in fact characterized this middle position as a horrific nightmare of statist oppression.
The other important point is that as awful as Ryan's plan is, it is only even remotely possible within the context created by the ACA. Seniors are a distinct population, in that they have much greater health-care needs than the rest of us. Right now, if you're 75 and you tried to get an insurance policy from a private carrier, they'd either say no, or charge you premiums that are so outrageous that almost no one could afford them. But once the ACA is in place, insurance companies will have to offer policies to anyone who wants them, and while they'll be able to charge somewhat more to people based on their age, those higher rates are limited by the law.
To repeat, Ryan's plan is terrible because it ends Medicare's guarantee and shifts costs onto seniors. But if Republicans were successful in repealing the ACA and its regulations, then instituted Ryan's plan, the entire elderly population would essentially be left with no coverage at all, because insurance companies would never cover them unless they paid astronomical premiums. That 75-year-old would go to an insurance company with his $15,000-per-year voucher, and the insurance company would say, "No, we're not going to cover you. Unless you want to pay a premium of $15,000 a month, then we'll consider it. But probably not even then."
The ACA certainly represented a compromise for Democrats. But it's hard to see where the Ryan plan, which privatizes Medicare, effectively ending one of the most successful social policies of the last century and throwing seniors on the mercy of the insurance companies, represents anything like a compromise for Republicans.
