Will One Election Decide The Fate Of The Ryan Plan?

Voters in New York State may help move the budget debate on Capitol Hill.

Voters in Western New York are headed to the polls today in an election that, whether it should or not, is being viewed by many as a referendum on the Ryan Plan:

It’s election day in a once little-talked-about contest to fill a vacant congressional seat in upstate New York, that is now firmly in the national political spotlight.

And over the past month, the race in New York’s 26th congressional district between Republican state Assemblywoman Jane Corwin, Democrat Kathleen Hochul, the Erie County clerk, and Jack Davis, a once-conservative Democrat who is running as a so-called tea party candidate, has to a degree turned into a proxy battle on House Republican plans to alter Medicare.

When it comes to Medicare, some national Democrats see this contest as a testing ground for next year’s elections. But national Republicans disagree, saying the reason the contest between the Democratic and Republican candidates is close is because of the inclusion of the third party candidate.

The Democratic and Republican candidates have been using the issue to attack each other, and both campaigns, party committees, and outside groups have flooded the airwaves with television commercials, with many of the ads spotlighting the political battle over House Budget Chairman Paul Ryan’s plan to dramatically cut federal spending by reforming Medicare.

“Jane Corwin has 100 percent embraced the Paul Ryan budget. Even when Republicans in Washington walk away from it, she’s been asked again and again and she continues to support it,” Hochul told CNN.

“I think it boils down to score tactics used on my opponent’s part. She’s trying to put out the idea that I’m trying to end Medicare. There’s nothing further from the truth, I’m working to protect Medicare,” responded Corwin.

The winner of the May 24 special election will fill the seat of Republican Rep. Chris Lee, who quickly resigned in February hours after the gossip website Gawker posted a shirtless photo and e-mails from the married congressman soliciting a date with a woman through the website Craigslist.

A loss by the GOP candidate here would be something of a surprise given that the 26th District has been in Republican hands for sometime, and went for John McCain by six points in 2008. However, as Nate Silver points out drawing national implications from a special election in one House District isn’t always a good idea:

As to the interpretation of the results, one thing I’d remind the readers of is that the margins matter as much as the victor: if Ms. Hochul wins by a single vote, that tells us almost exactly the same thing as if she loses by a single vote. Also, Ms. Hochul’s share of the vote matters: the lower Mr. Davis’s vote goes, the more we can read into the results. As I noted two weeks ago, if Ms. Hochul finishes with a vote share in the mid-to-high 40s, that would be consistent with how Democrats performed in the district in the strong Democratic years of 2006 and 2008 and is a result that Democrats could be pleased with.

There is also some evidence that Republican plans to significantly alter Medicare, which has been the focal point of Ms. Hochul’s campaign, may indeed have made some difference in the race. In the Siena poll, voters were asked to identify their most important issue. Of the 21 percent who picked Medicare, some 80 percent said they planned to vote for Ms. Hochul

(…)

If the results end up something like Ms. Hochul 46 percent, Ms. Corwin 44 percent and Mr. Davis 9 percent, that will reflect a fairly big departure from typical outcomes in the district. What will be more difficult to determine is whether they represent any sort of leading indicator. Medicare is likely to be more important in this district than in most others because of its preponderance of older voters, and Ms. Corwin has committed at least one major gaffe in the race unrelated to the issues themselves. At the same time, it would be naive to suggest that the Medicare issue has had no impact at all.

Once there have been several special elections, they may begin to have some predictive power — but reading too much into the results of any one of them is dangerous. Nevertheless — since Democrats are going to hammer away at the Medicare issue almost no matter what — the burden of interpretation will be with Republicans if they have a disappointing evening. They’ll face a choice between toeing the party line on the issue of entitlements and allowing their candidates more wiggle room. Because of the issue’s salience in the presidential primaries, it’s a choice that they’ll have to make on an accelerated timetable without the luxury of waiting for more data to come in.

For better or worse, and no matter how accurate it actually is, a Republican loss in this one Congressional District in New York, which may not even exist after New York finished redistricting, will be interpreted as a rebuke of the Ryan Plan. It will likely lead to more GOPers throwing the plan under the bus in the manner Scott Brown did yesterday, and it will hand Democrats a temporary, but perhaps important, victory in the ongoing budget debate. All of which just makes this story from yesterday’s Politico all the more mind-boggling:

It might be a political time bomb — that’s what GOP pollsters warned as House Republicans prepared for the April 15 vote on Rep. Paul Ryan’s proposed budget, with its plan to dramatically remake Medicare.

No matter how favorably pollsters with the Tarrance Group or other firms spun the bill in their pitch — casting it as the only path to saving the beloved health entitlement for seniors — the Ryan budget’s approval rating barely budged above the high 30s or its disapproval below 50 percent, according to a Republican operative familiar with the presentation.

The poll numbers on the plan were so toxic — nearly as bad as those of President Barack Obama’s health reform bill at the nadir of its unpopularity — that staffers with the National Republican Congressional Committee warned leadership, “You might not want to go there” in a series of tense pre-vote meetings.

But go there Republicans did, en masse and with rhetorical gusto — transforming the political landscape for 2012, giving Democrats a new shot at life and forcing the GOP to suddenly shift from offense to defense.

Now there’s nothing wrong with the GOP taking a position that is political unpopular, but to do so without any clear plan about how you’re going to explain that plan to the public with the hope that you’d educate them about why your ideas are better is just plain dumb. Also dumb is letting your political opponents define the debate, which the GOP did almost from the moment the Ryan Plan was introduced. There’s nothing wrong with being bold, but being bold and stupid is a fatal combination.

FILED UNDER: Congress, Deficit and Debt, Health Care, US Politics,
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010 and contributed a staggering 16,483 posts before his retirement in January 2020.

Comments

  1. legion says:

    You know, I’d like to think that the Ryan Plan’s ineffectiveness, deliberate raping of the middle & lower classes, and basic mean-spirited nature would decide its fate. But I suppose I’m just a dreamer.

  2. I guess I’m a dreamer too because I’d like to think that people would wake up and stop thinking they have a right to live off the taxpayer dollars of the next generation.

  3. reid says:

    legion: No no, they just need to work on their messaging.

  4. hey norm says:

    Ryan’s plan was doomed from the start – not because the left defined the dabate – but because it is bad policy – abolishing medicare to pay for additional tax cuts for the rich.
    I also think the whole living off the next generation of taxpayers meme is tired. we are trashing the resources and the environment of the next generation yet where is the concern? drill baby, drill. cut taxes baby, cut taxes.

  5. ponce says:

    I guess I’m a dreamer too because I’d like to think that people would wake up and stop thinking they have a right to live off the taxpayer dollars of the next generation.

    I always laugh when I see a libertarian make nonsensical statements like that on the government funded, government developed internet.

    The Democrats have been leading in most generic Congressional polls for about a month now.

    It wouldn’t be surprising to see them pick up some “Republican” seats heading into the 2012 elections.

  6. EddieinCA says:

    I’m a dreamer too because I want the crooks on Wall Street who created the economic mess sent to prison, and have their ill-gotten gains confiscated.

    It’s capitalism when they’re making money (they get to keep the profits).

    But…

    It’s Socialism when they’ve lost it all (the government, i.e. taxpayers) bail them out.

    But, still Democrats are worse because Obama is a foreign born, sekret, mooslem, anti-murkin, communist who has Bill Ayers and Rev. Wright as friends, and teamed with Acorn to steal the election.

  7. To answer the headline question: no, because it was already dead and really was DOA from the start.

  8. Brook says:

    The very fact that people are using the phrase “abolish Medicare” is debate definition. Ryan’s plan does not abolish Medicare at all, in fact it expands choices beyond the single premium option seniors now have, but he did completely screw up by trotting it out to the public in this manner.

    First, you have to define the problem. Many Americans remain blissfully unaware that the Medicare surplus will be gone in 10 or so years. Young Americans are going to be forced to pay FICA taxes into a plan that has no realistic future of surviving the Boomer retirement wave. It’s interesting how the GOP was the party of No just a year ago. Democrats forget Obama’s commission came out with some pretty drastic recommendations, and of course liberals howled, calling it the Catfood commission. Obama retreated from the recommendations of his own bi-partisan panel. There will be no leadership from the WH on Medicare, and we cannot afford to wait another 6 years. That is the message that has to get out.

  9. legion says:

    Doug,
    It’s not that people have a “right” to, it’s about the purpose of the program in the first place. It seems to me that either:
    – It’s basically an enforced savings program, putting away money to provide aid for people when they’re no longer able to work – this is such a long timeframe that it pretty much _has_ to be cross-generational in format, in which case we should fix it & leave it alone, or
    – The Boomer generation set up an unsustainable Ponzi scheme that could make their own golden years comfy at the expense of their children’s & grandchildren’s futures, in which case we should hunt them down in the streets and live off their carcasses.

  10. Scott F. says:

    Now there’s nothing wrong with the GOP taking a position that is political unpopular, but to do so without any clear plan about how you’re going to explain that plan to the public with the hope that you’d educate them about why your ideas are better is just plain dumb.

    Doug, I’m curious about how you would have explained that the Ryan plan was a good idea to the public. How would you sell changing Medicare into a voucher, which would be used to purchase private health insurance? Do you have something better than “Our plan is to give seniors the power to deny business to inefficient providers”?

  11. Herb says:

    Yeah, no wonder the Ryan Plan’s marketing has been bungled. It’s entitlement reform dressed up in a budget plan costume. You need marketing and a certain amount of gullibility to make that fly.

    And as Dr. Taylor already pointed out, the fate of the Ryan plan has already been decided. It won’t pass the Senate and the president wont sign it.

    You know what could conceivably pass the Senate and could conceivably get a presidential signature? Actual entitlement reform….

  12. ej says:

    The Boomer generation set up an unsustainable Ponzi scheme that could make their own golden years comfy at the expense of their children’s & grandchildren’s futures…

    That’s pretty much what it is.

  13. ej says:

    “You know what could conceivably pass the Senate and could conceivably get a presidential signature? Actual entitlement reform….”

    What exactly is that “actual entitlment reform?” Everyone three both the bipartisan comission reports in the trash also. Right now the electorate is acting like a child – they want eveything to fix itself without having to pay for it in any way. And the parties are happy with attacking each other for short term political gain while Rome continues to burn.

  14. … deliberate raping of the middle & lower classes…

    Yes, of course. But it’s not rape-rape like this. Or perhaps that’s just a messaging problem as well.

    Brook, there is no Medicare surplus or Social Security lock box. All that exists are IOUs that will either come from general funds or the benefits will be taken away. And the really nasty part is that any plan to use inflation to wipe away the debt only makes these particular government solutions even worse for those they pretend to serve.

    We are doomed.

  15. hey norm says:

    brook…
    no, a thousand times no – by definition Ryan’s plan abolishes medicare. the two plans are apples and oranges. one is a federal insurance. one is private insurance. one has guaranteed benefits. one has benefits specifically designed to not keep pace with cost increases. he may call his new program medicare – but if anything that is an attempt at debate definition. for the life of me i cannot see how anyone can be hood-winked by this, but there you go.

  16. sam says:

    You’re always doomed, Charles. It’s the way you gets around.

  17. hey norm says:

    ej,
    no – the electorate wants a rational mix of spending cuts and revenue increases. poll after poll shows this. what they do not want is what ryan has proposed – additional tax cuts for the rich payed for on the backs of seniors and the sick and the poor.
    this is not hard to understand folks.

  18. hey norm says:

    i want to see some of our seniors, with reduced resources and failing faculties, having to deal with private insurance companies. what a genius idea. what could go wrong? i wonder if ryan even discussed this with insurance industry – what companies want any part of insuring the elderly? name them.
    but it’s about messaging. right.

  19. mantis says:

    I guess I’m a dreamer too because I’d like to think that people would wake up and stop thinking they have a right to live off the taxpayer dollars of the next generation.

    Yeah, what are those freeloading looters thinking! Oh wait, they paid into these evil soshulist schemes themselves? Whatever, screw em! The free market will clean your corpse off the sidewalk, gramps.

  20. Herb says:

    What exactly is that “actual entitlment reform?”

    I think there’s a genuine appetite for entitlement reform on both political aisles. If you ask most lefties, they’ll tell you they want to reform SS and Medicare to make it more stable, sustainable, and effective. The right wants to reform it by lowering the number of entitlements and increasing the standards for getting them. There’s room for compromise in both camps.

    “Actual entitlement reform” will be that compromise.

    Trying to sneak the right’s wet dream version of “entitlement reform” through the budget process, though….well, that just ain’t gonna fly.

  21. hey norm says:

    herb,
    actually the “lefties” passed the ACA which makes Medicare more sustainable, stable, and effective. more needs to be done, certainly. but to portray this – which you didn’t do but many have – as only the right putting out a proposal is total bunk.

  22. Stan says:

    “I guess I’m a dreamer too because I’d like to think that people would wake up and stop thinking they have a right to live off the taxpayer dollars of the next generation.”

    I wish people who write sentences like this would learn something about policy if they intend commenting about it. The organizations that pay for health care in the rest of the developed world have the same kind of clout when it comes to negotiating medical prices that Walmart has when it buys canned orange juice from its suppliers. As a result of tough bargaining by these organizations, per capita medical costs in the other OECD countries are much lower than ours, and their rate of medical inflation is lower. This is discussed in articles by Uwe Reinhardt and others in Health Affairs (22, No. 3 (2003)) and elsewhere.

    Suppose instead that we go over to Ryan’s plan. Does anyone really think this would cut medical costs in the US? Yes, it would save money for the government, but only at the cost of forcing seniors to pay much more money out of pocket. And every dollar spent on medical care is a dollar not spent on something else.

  23. legion says:

    Norm,
    I’d also love to see how the GOP can guarantee seniors that they’ll even be able to find a private insurance plan that will accept them. Unless, of course, they plan to pass laws forcing such acceptance, which kinda flies in the face of their “free market uber alles” philosophy and attempts to repeal the preexisting conditions protection in the current HCR plan.

  24. john personna says:

    Re “end of medicare.”

    If I were GM, and decided to give you a 3-cylinder hybrid electric, and call it a Corvette … would you agree? Would you actually say “it is not the end of the Corvette! it still says that name right on the frail little electric bumper.”

  25. ej says:

    Herb, Norm,

    I want to hear specifics. What “actual reforms” are out there that the public and the poltical parties actually want. Saying “make sustainable” doesn’t mean crap.

    Right now poll after poll does not support any of the entitlment cut backs such as raising retirment age, means testing, increasing co-payments, indexing increases differently, or on the tax side of raising peoples taxes. The only thing popular righ now is cutting foreign aid raising someone elses taxes. So like i said, the electorate is full of children right now.

    So again I ask, give me some specifis that are “actual reforms” that would be popular.

  26. legion says:

    The right wants to reform it by lowering the number of entitlements and increasing the standards for getting them.

    No. The right wants to “reform” entitlements by eliminating them, and then taking the taxpayer contributions & handing them directly to themselves and their friends.

    There can be no compromise because there is no honest counter-proposal from the other side. None.

  27. ej says:

    and im still waiting for the democrat’s offical plan… because Obama threw his own commission’s report in the trash.

  28. ej says:

    legion – you are an example of why no fix is going to occur in time. Medicare needs to be changed somehow. It doesnt have to be Ryan’s plan. But I’m waiting to hear alternatives – and all i’m hearing are crickets right now.

  29. john personna says:

    @ej,

    and im still waiting for the democrat’s offical plan… because Obama threw his own commission’s report in the trash.

    The problem is that everybody shirked that report. I mean, I signed on here, but just about everyone here or in Washington had one reason or another to hate it. Republicans hated the tax increases more, but I don’t think you can really say that Democrats that were the only ones who hated the spending cuts. Military cuts, farm subsidies, energy subsidies … pols on all sides can’t quit them.

    So no, “Obama” didn’t “throw out” the report. He let it be a flag run up the pole maybe, and when no one saluted …

  30. ej says:

    John,

    I know everyone did – my comment was not the democrats where the only ones that disliked it. What I’m saying is, yes people don’t like the Ryan plan, but people dont liek any mathematically vaible plan – because its going to mean either much higher taxes or some kinds of reductions to future entitlment spending.

    This is my point of the electorate acting like babies right now. They want everything for free and someone else take care of it. And the political parties are playing into this.

    My only point with the democrats right now – is that they havent put up any plan themselves. If they don’t like the Ryan plan, they should put out their own unpopular version. I’m wainting for some specific alternatives.

  31. ej says:

    and Obama and his party are far more happy at the moment to just scare the shit out of old people that the republicans want to kick granny onto the street rather than proposing thier own plan.

    If our political class where made up of adults right now, everyone would be saying changes need to be made – the status quo is not an option.

  32. Herb says:

    I want to hear specifics.

    How about we talk about that when “entitlement reform” actually becomes the issue?

    So like i said, the electorate is full of children right now.

    Agreed, and many of them think that the budget process is the appropriate venue to broach the entitlement reform issue. It’s not.

  33. ej says:

    “How about we talk about that when “entitlement reform” actually becomes the issue?”

    Exactly herb – you have nothing – so your claims about “actual reforms” meant nothing.

    I want to hear what your alternative is – because if you don’t have anything, attacking Ryan’s plan does nothing.

  34. Pug says:

    Young Americans are going to be forced to pay FICA taxes into a plan that has no realistic future of surviving the Boomer retirement wave.
    .
    So, of course, the solution contained in Paul Ryan’s brilliant plan is to exempt the Baby Boomers from the changes in Medicare. The first thing out of the mouth of any advocate of the Ryan plan is, “…if you are over 55, this plan doesn’t have any effect on you.” Got that, Baby Boomer?

    and Obama and his party are far more happy at the moment to just scare the shit out of old people

    I guess you weren’t alive in November 2010 when the Republicans were talking about death panels, $500 billion cuts in Medicare and that Obama wants to “kill Granny”. Worked like a dream for them, too.

    It’s not Obama’s fault they are stupid enough to come forward with Ryan’s plan immediately after they get elected.

  35. ej says:

    “I guess you weren’t alive in November 2010 when the Republicans were talking about death panels, $500 billion cuts in Medicare and that Obama wants to “kill Granny”. Worked like a dream for them, too.”

    Is the fact that Obama and gand are tryign to scare the shit out of old people in conflict with the fact that republicans did so as well?

    When your only reponse to this is “na na na na nah – but they did it too!” then you have nothing constructive to add to this. And you have added to my point this whole chain that the electorate are a bunch of babies and the politicians are more than willing to play into it.

    With every passing year that nothing is done, the fix becomes more painful. Apparently everyone is going to sit by while the country burns.

  36. Pug says:

    If our political class where made up of adults right now, everyone would be saying changes need to be made – the status quo is not an option.

    That is what the adults are saying. The childish Libertarians, like Paul Ryan, are the ones saying we should reduce top tax rates and corporate tax rates and give Granny a few thousand and send her off to talk to United Healthcare or Cigna with her little voucher in hand.

  37. ej says:

    does anyone on this chain want to personally offer up an alternative? Could we maybe talk about that?

  38. Kill puppies. You forgot to also state that the Right wants to kill puppies. Or is that Republicans?

    The complaints about eating the seed corn are mistaken. It has already been eaten. The argument now is about who is going to have to starve as the harvests fail. The poor? The sick? The infirm? The undocumented? The rich bastards (note that rich keeps getting redefined downward as it necessarily must to allow the supply of rich bastards to stay apace of demand, it goes without needing further justification that they are bastards)? The Blue Staters? The Red Staters? Men? Women? Children? Unions? Wal-mart shoppers? College students? The military? The debtors? The creditors?

    I take no pleasure in noting we are doomed. The problems have become so ingrained and systemic that I worry about the system’s ability to correct itself from the inside. As another wise man once said, things that can’t go on won’t.

  39. ej says:

    So Pug, first off you are mising the whole concept of cutting rates but broading the base by reducing creditis and deductions – that’s not a tax cut . But this gets off track.

    I’m assuming that you consider yourself an adult. So what “adult” plan do you propose? Will you sign onto the deficit commission report? The same one that the “adults” in the WH and democratic caucus rejected along with the republicans?

  40. ej says:

    Charles,

    I worry about that myself. I’m increasingly thinking it possible that this coule be the beginning of the end. If we enter a bond crisis, there will be no IMF or EU to bail us out.

  41. mantis says:

    Is the fact that Obama and gand are tryign to scare the shit out of old people in conflict with the fact that republicans did so as well?

    Yes, because the Republicans have to make shit up like “death panels” for their scare tactics. All Democrats have to do is tell people what the Ryan plan, which almost the entire House GOP voted for, would do to Medicare. One scare tactic is bullshit, while the other is fact. There’s your conflict.

    Also, if you want plan specifics, please do us all a favor and read the PPACA. It does a lot to help insure the stability of Medicare. Got a problem with those specifics? Explain your problem.

  42. mantis says:

    Will you sign onto the deficit commission report?

    The commission didn’t even sign on to the report. It failed to secure the required number of commission votes. Why are you so hung up on a report even its authors couldn’t agree on?

  43. sam says:

    @ej

    “yes people don’t like the Ryan plan, but people dont liek any mathematically vaible plan”

    The Ryan Mathematical Formula for Solving Medicare Costs Problem:

    Seniors + Vouchers (rate of increase Costs to Government Decrease as Seniors Decrease).

    Jesus! It works!!.

  44. ej says:

    Why are you so hung up on a report even its authors couldn’t agree on?

    Because people like you are whining and complaining that you don’t like Ryan’s plan but then you offer nothing else as an alternative. The commission report is the only other plan out there right now that adds up.

    So if you don’t like Ryan’s then there are two options. You back the commission report, or you come up with something else.

    And even if you take the PPAC as something that reduces the deficit (only true if you ignore the long term care entitelment ponzi scheme built into it and the doc reimbursment cuts that will never happen), the bill still doesn’t do anythign close to enough to slow the deficit down enough. Much more action would be needed.

    This is my point – everyone on this board is complaining about the Ryan plan, and yet they are unwilling to offer any alternative. Just as the elctorate as a whole, no one wants to hear that some kind of pain has to happen and most politicians are more than willing to play off of that sentiment. The problem is not going to just go away. The status quo IS throwing granny into the street because in a bond crisis, medicare doesnt exist.

    So I’ll try with you Mantis, roughly speaking, what is your ideal solution to the debt problem?

  45. ej says:

    i would add that the PPAC only “strengthens medicare if it creates a major deficit increase to the general fund. You can’t double count medicare savings as such AND use them to fincnace the new entitlments. The medicare actuary and trustees report both said this.

  46. mantis says:

    So I’ll try with you Mantis, roughly speaking, what is your ideal solution to the debt problem?

    Clarify. Are we talking about Medicare, national debt, or the budget deficit?

  47. David M says:

    The democratic plan is the PPACA, which does much more to control costs and fix the deficit than the Ryan plan. The Ryan plan looks at the projected increases in medical costs, shrugs it’s shoulders and says good luck seniors. There is no problem with Medicare/Medicaid, there is a problem with increased medical costs in general. Removing Medicare/Medicaid from the mix and moving to private insurance with it’s increased costs is probably the worst possible plan of action.

  48. sam says:

    Damn, let me try that again (doesn’t like less than, greater than signs, etc.)

    The Ryan Mathematical Formula for Solving Medicare Costs Problem:

    Seniors + Vouchers (Value Always < Rate of Increase of Medical Costs ( = Value Always < Rate of Increase Cost of Insurance) = Decreasing Number of Live Seniors ( = Decreasing Costs to Government as Cohort of Seniors Decreases Eligible (= Living) to Receive the Decreasing-in-Value Voucher)

    See, I told you it worked.

  49. sam says:

    “This is my point – everyone on this board is complaining about the Ryan plan, and yet they are unwilling to offer any alternative. ”

    I suggested we move away from the fee-for-service model, which is the driver of costs, to perhaps something like the Accountable Care Organizations that would get paid a fixed amount each year for a patient’s care that Massachusetts is considering.

  50. ej says:

    sam,

    one of the things any change needs to accomplish is actually slow down the rate of healthcare cost growth. If that could happen, then creating a voucher wouldnt be bad. The problem is I don’t think ryan’s voucher plan will actually clow down costs.

    What needs to happen is to create a compeditive market in the delivery of healthCARE, as opposed to just health INSURANCE, which requires that patients actually care abou where they get care via shopping around. And just giving you a voucher for a private comprehensive plan doesnt do that. If i had it my way any change would include some type of means tested icnrease in co-insurance, deductables, and copayments so that patients start caring about how much they spend – they need to have skin in the game. This in turn will make providers care about innovating in ways that reduce costs, because now they must compete for cutomers. As long as a hospitals knows that the patient will purchase their care regardless of what the price is, healthcare costs will continue to grow.

    The healthcare systems in the world that work relatively well like Switzerland and Singapore are based around patients paying for much more of their care out of personal savings coupled with the government backing up catostrophic expenses. This is what needs to happen here.

  51. ej says:

    “I suggested we move away from the fee-for-service model, which is the driver of costs, to perhaps something like the Accountable Care Organizations ”

    There may be something to this, but this isnt a sure bet – it has its own set of problems. Private insurance has been playing around with this for a number of years now and it hasnt stuck. It creates all kinds of new bureuacratic messes because how does one define the actual ailment in isolation? And because of this problem, you create a perverse incentive for the doctor do do the bare minimum to treat the specified ailment even if this makes another one worse. And from the doctor’s point of view, you can’t plan out your revenue and costs very well, making administration very difficult. And this still doesnt do much to align patient behavior.

    But lets assume this does make some imporvment, how much money roughly is that actually expected to save? No one really knows, and we dont have many more years before a crisis hits to find out.

  52. john personna says:

    It is a tragedy of political reality that the Democrats have no crude, short-term, self-interest in putting up a plan. It would essentially be falling on their electoral sword for 2012.

    That, for the reasons you describe (” people dont liek any mathematically vaible plan”)/

    Some people demand Obama “lead” when what they really want is for him to fall on that sword.

  53. sam says:

    Are we talking about medical care for seniors or medical care simpliciter ? Because, and I can tell you from experience, being aged is a pre-existing condition (the pre-existing condition). I find impossible to believe insurance companies would offer seniors policies both affordable and adequate. In any event, your solution assumes the fee-for-service model — a model whose abandonment in the case of Medicare might just solve the cost problem.

  54. sam says:

    “There may be something to this [Accountable Care Organization scheme], but this isnt a sure bet – it has its own set of problems.”

    I’ll tell what is a sure bet: The current system is bankrupting us.

    And, I would point out, all this

    It creates all kinds of new bureuacratic messes because how does one define the actual ailment in isolation? And because of this problem, you create a perverse incentive for the doctor do do the bare minimum to treat the specified ailment even if this makes another one worse. And from the doctor’s point of view, you can’t plan out your revenue and costs very well, making administration very difficult. And this still doesnt do much to align patient behavior.

    is speculation absent any test of the scheme.

  55. hey norm says:

    ej…
    this double counting thing is another of the great republican myths – like tax cuts pay for themselves, and al gore said he invented the internet. please – if you read it on hotair.com you should automaically discount it.

  56. Scott F. says:

    which requires that patients actually care about where they get care via shopping around

    ej –

    This assumes that healthcare works like other markets and I’ve seen no evidence this is the case. Who is going to shop around for a good deal on a kidney replacement?

  57. This assumes that healthcare works like other markets and I’ve seen no evidence this is the case. Who is going to shop around for a good deal on a kidney replacement?

    I think you mean shop for a better deal. I’m not familiar with anyone who turned down a kidney replacement because they thought they might be a better deal across town. Do you think that people won’t shop for better prices on less extreme examples like Pprescriptions, flu shots, etc?

  58. john personna says:

    charles, people do shop now, it’s called “medical tourism.”

    If we go down this route, that’s where we’ll all end up, flying to India where the hospitals, doctors, nurses, and staff, are willing to accept far, far, lower wages.

    It’s a winger radio fantasy that we’ll get lower prices here, without an entire industry lowering themselves to Indian pay.

  59. André Kenji says:

    You can have something similar to a free market, provided that you have tough regulation. On federal level. That´s seems to work here in Brazil.

  60. Herb says:

    I want to hear what your alternative is – because if you don’t have anything, attacking Ryan’s plan does nothing.

    Here’s my alternative: The Republicans go back to the drawing board and come up with something that has a snowball’s chance in hell of becoming a law.

  61. Stan says:

    As usual the experience of Great Britain, France, Canada, Germany, Switzerland, the Netherlands, Japan, Israel, etc. counts for nothing in the eyes of the conservative faithful. These countries and lots of others have better health statistics than ours, get more medical care than we do, provide universal health insurance, and pay from 40% to 60% of our costs on a per capita basis. The reason, explained by Professors Hsaio of Harvard (http://tinyurl.com/3e7lz5z), Reinhardt of Princeton (http://tinyurl.com/3sdt75y) and the Congressional Budget Office is that the organizations paying for health care in these countries are fewer in number and more powerful than in the US, and work hard at negotiating lower prices. Doctors and hospitals have to go along with the negotiated prices because they have no alternative. To get medical costs under control, we don’t have to decrease present compensation for doctors and hospital administrators, we just have to keep it from rising markedly faster than inflation.

    There is nothing pie in the sky about what I’m proposing. It’s verified empirically. Yet somehow our nation’s conservatives, including the people posting in this site, refuse to understand it. And neither do many liberals. In the words of the bard, “I have met the enemy and he is us.”

  62. Eric Florack says:

    It is a tragedy of political reality that the Democrats have no crude, short-term, self-interest in putting up a plan.

    Yes, after all, we’ve seen there carefully made long term plans, and their results.