Yes on health care
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The Path to Prosperity (Episode 2): Saving Medicare, Visualized
youtube.com
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- Part A and Part B trust funds are combined to create one unified trust fund. The new Medicare Program and the existing program continue to be financed by trust fund revenues, Medicare payroll taxes, and general revenue contributions as done now.
- By January 2021, insurance companies must establish competing healthcare coverage plans with specified benefits and limitations. Some would provide only high-deductible catastrophic coverage. Others could provide more liberalized coverage. Medicare would establish categories of generalized coverage. All plans which met specified requirements would become "Medicare certified" and eligible for premium payment cost sharing.
- Each patient would select from the approved list a plan best matching his or her expected healthcare needs for the coming year. Medicare would reimburse the health plan a fixed amount of money for each enrollee for premium payment support. If the Medicare-provided assistance exceeded the premium required for the selected plan, that excess would be credited to a "Medical Savings Account" (MSA) for the beneficiary's future use.
- Ryan currently estimates the reimbursement amount at an average $11,000 -- with further adjustment determined by income level. Higher-income patients would receive less premium assistance. Beneficiaries with annual incomes below $80,000 ($160,000 for couples) would receive full standard payment amounts; beneficiaries with annual incomes between $80,000 and $200,000 ($160,000 to $400,000 for couples) would receive 50 percent of the standard; and beneficiaries with incomes above $200,000 ($400,000 for couples) would receive 30 percent.
- After enrollment in a plan, all beneficiaries could, at their option, undergo an annual health "risk adjustment" examination. Results of this exam would be submitted to Medicare and become eligible for a higher risk-adjusted premium payment.
- To further assist those individuals with incomes near or below the poverty level, Ryan proposes additional payments above just premium support. While any enrollee, regardless of income level, would be able to set up a tax-free MSA if desired, the new Medicare Program would specifically establish and fund an MSA for low-income beneficiaries to help them with deductible payments required for care procedures. The amount paid to those below the government-established poverty level would be equal to the deductible for the average Medicare high-deductible health plan. Those with incomes at or 50 percent above the poverty level would receive 75 percent of the full deposit.
- Recognizing that Americans are becoming healthier than ever before and living much longer, Ryan further proposes that a phase-in of the start of the new Medicare program would, after 2021, be raised in a slow incremental fashion from the current age 65 to 69 years 6 months.
americanthinker.com
Also see becker-posner-blog.com
Then the plan was scaled back a bit, and focused slightly less on the private sector to try to get broader support
- Provides a refundable tax credit – $2,300 for individuals and $5,700 for families – to purchase coverage in any State, and keep it with them if they move or change jobs.
- Provides transparency in health care price and quality data, making this critical information readily available before someone needs health services.
- Creates state-based health care exchanges, so individuals and families have a one-stop marketplace to purchase affordable health insurance without being discriminated against based on pre-existing conditions.
- Equips states with tools like auto-enrollment programs and high-risk pools, so affordable health coverage can be accessed by all.
- Addresses health care’s growing strain on small businesses, by allowing them to pool together nationally to offer coverage to their employees.
- Encourages the adoption of health information technology and assists states in establishing solutions to medical malpractice litigation.
roadmap.republicans.budget.house.gov
But when Democrats did try to work with Ryan they where harshly attacked.
The War on Wyden
For daring to work on Medicare reform with Republican Paul Ryan, the Democratic senator from Oregon is lambasted by keepers of the liberal flame.
Mitt Romney has had a tough week, Newt Gingrich a tough month, Barack Obama a tough three years. But hey, they could be Ron Wyden.
Ticked off by Washington's failure to tackle big problems? Spare a moment for Oregon's senior senator. Mr. Wyden is the Democrat who in December had the audacity to team up with House Republican Paul Ryan on a proposal to reform and strengthen Medicare—the entitlement that is pushing the country, and seniors, off a cliff. As bipartisan exercises go, this was big, thoughtful, promising.
It was also a complete anathema to a Democratic establishment that is ideologically opposed to change, and cynically intent on using Mediscare to beat Republicans in 2012. Mr. Wyden, as a result, is taking a beating from his own.
"Ron Wyden, Useful Idiot," railed New York Times columnist Paul Krugman. "Is Ron Wyden trying to get Mitt Romney elected?" fumed the Nation magazine. Ron Zerban, a Democrat running for Mr. Ryan's seat, accused Mr. Wyden of giving the GOP cover and proclaimed him no longer a "Democrat."
The White House went defcon, insisting that the plan would cause Medicare to "wither on the vine." House Democrats hissed the plan would end "Medicare as we know it." Most informative was the gripe of a former Senate staffer: Mr. Wyden was taking away "a key argument for Democrats that are trying to retake the House." The nerve!
Ugly, yes, though it washes over Mr. Wyden, who by Washington standards is one odd duck. On his voting record alone, he ranks with the best of progressives. Yet he's spent most of his 16 Senate years working from the backbench, with Republicans, on big problems—with some 150 bipartisan bills to date.
Neither a headline-seeker nor a party rebel, he's best described as a wonk, a workhorse, a doer. That's kept him popular in his home state where—by contrast to the Beltway storm—the editorial boards praised his outreach to Mr. Ryan, and where seniors in recent town halls have been equally receptive.
As for this town, "you can't have been in Washington for more than 15 minutes and not have known what was coming," says a cheery Mr. Wyden, who agreed to an interview (and true to poindexter form, spent it talking policy). The big issues require bipartisan buy-in, he says, "and you are never going to get good policy if you don't try." He rejects Democratic complaints that he should have waited until after the election. "There is never really a good time to take on big, tough issues," he says. Elections are in fact the opportunity to highlight them.
And Lord knows he's trying. Mr. Wyden has been stressing to colleagues that this joint proposal is different from Mr. Ryan's initial reform—which Democrats attacked—and offers plenty to reassure his party. It preserves the option for seniors to stay in government-run Medicare, makes Mr. Ryan's "premium support" plan more generous, even adds a catastrophic benefit. Mr. Wyden notes there'd have been no plan had not Mr. Ryan agreed to "traditional Medicare remaining a permanent part of the program," a fact, he says, that rebuts any notion of it "withering on the vine."
The real problem, he acknowledges, is ideological opposition to any private-sector involvement—a position that frustrates the senator, since it is already reality. More than 40% of Oregon seniors already use private coverage, through Medicare Advantage or Medigap.
"This is a disconnected conversation," he pronounces. The Wyden-Ryan bill is simply acknowledgment that any serious entitlement reform must encompass choice and markets.
That's been clear since the 1990s, when Democrats like John Breaux and Bob Kerrey came out for premium support. Then, as now, there followed not just the attacks, but the inevitable silence—from the media and those who otherwise make a career out of noisily deploring the deficit. With entitlements the crisis they say they are, you'd have thought at least the Erskine Bowles and the Alan Simpsons would be defending Mr. Wyden for acting.
They haven't so far, which leads to one Senate Democratic staffer's lament: "Republicans are better at using Paul Ryan than Democrats are at using Ron Wyden. They both are nerdy policy guys who work on ideas. Republicans embrace Ryan, they get behind him. Democrats look at Ron as an outlier who makes their lives more difficult."
The Republican challenge is not to add to the difficulty. The GOP may be tempted to take the lazy route, to use Mr. Wyden as cover—which will only feed the liberal complaints. They'd be better off doing the hard work of explaining and promoting reform itself, positioning themselves, and Mr. Wyden, as the adults in the room.
That's been Mr. Wyden's focus, leading by example. Asked about the White House's comments on Wyden-Ryan, he notes only that there is great opportunity to address "big issues" with a "presidential bully pulpit." He hopes to help. "The first folks who reach out get the most flak," but hopefully make it "easier for others." It's a big hope and, at least right now in liberal-land, a lonely one.
online.wsj.com
Message 27960129
If your interested in the subject of health care, or health insurance, or government "reform" efforts in that area, there is a lot here
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