Representative Ryan’s Plan for Medicare–Explicit Economic Rationing of Care

In and op-ed Representative Ryan of Wisconsin outlines his play for taking Medicare apart.

Given that we spend one and a half to two times as much on health care than other industrialized nations it’s clear we have to change. Indeed as Ryan notes there is predicted “38 trillion shortfall” over the next 75 years.

So there is a problem and Ryan seems to object to the savings outlined in the recent health care reform bill even if it’s savings attained through smarter spending and choosing the best most efficient treatments.

Instead his radical solution is to gut Medicare and replace it with “vouchers” to be used to “apply” to a list of medicare certified coverage options. No discussion of the amount of money the voucher will provide; the coverage it will buy; whether it will cover the premium; whether it will suffice if the premium is raised because of illness; whether the “certified coverage option” can turn the beneficiary down for coverage; and so on.

There is no discussion of what he means by “additional support” for those who have low incomes and higher health costs, and what he means by high-income beneficiaries–what is high income in the context of retirement? He is therefore proposing a replacing a simple system of insurance which has very low administrative costs with one that will have to evaluate and adjudicate the level of government support for, I would predict, the great majority of beneficiaries.

Left unclear is how this will cut costs in our very inefficient health care system other than create a system where economic rationing of care is the rule.

Medicynical note: There must be a better way. This may be a way to start a discussion but is a totally inadequate solution to the problem. The U.S. is the only country in the world without a national health care system. Ryan’s solution won’t change that.


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