All about ideas…

RyanCare Hits Today’s Seniors Too

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Much like Geo. Bush’s failed Social Security plan, today seniors inevitably will be pinched by the results of WI Rep. Paul Ryan’s Medicare drastic changes.

Here’s how Matt Yglesias puts it:

My colleague Igor Volsky adds the observation that even if this problem is avoided, Medicare will be actuarially destabilized anyway:Representative Paul Ryan (R - WI)

In 2022, newly-eligible beneficiries would have to enroll in a private plan, but existing beneficiaries (those who are over 55 today) would also have the option of leaving traditional Medicare. As Ryan’s budget put it, “While there would be no disruptions in the current Medicare fee-for-service program for those currently enrolled or becoming eligible in the next ten years, all seniors would have the choice to opt into the new Medicare program once it begins in 2022. No senior would be forced to stay in the old program.”

That opens up the possibilities of private plans trying to lure away the healthiest beneficiaries (as is currently the case in Medicare Advantage) and of health care providers abandoning traditional Medicare patients for the higher reimbursement rates of private insurers. For chronically ill seniors who are more likely to remain in fee-for-service Medicare this means two things: higher costs (as the healthier beneficiaries exit the risk pool) and fewer doctors.

You could conceivably deal with the adverse selection issue, but the provider abandonment problem is completely unsolvable. Right now most health care providers accept Medicare even though its payment rates are stingy because the customer base is so large. Under Ryancare, starting in eleven years the size of the Medicare customer base will start to erode. That means each and every year more providers will find it’s in their interests to abandon Medicare patients. Imagine the sorry fate of the Last Medicare Patient In America, alone and adrift in a world of privatization. Who’s going to take his insurance? Nobody. But of course there won’t be any such Last Medicare Patient because the combination of actuarial and political instability ensures that sometime in the late 2020s or early 2030s, the remaining stock of Medicare beneficiaries will be tossed into the higher-cost voucher pool.

As someone who bought goods and services and managed multi-million dollar budgets for a career, I’m all for saving money and being fiscally responsible. But one thing I learned was too look for unintended consequences. RyanCare, besides shifting the cost of health care from an efficient, low cost government program* onto seniors while doing nothing to reduce delivery system costs (bend the cost curve), offers worse consequences than any of us imagined. If you or your parents have a chronic or critical disease, they can expect their insurance costs to skyrocket to potentially $20,000 to $30,000 or more per year under RyanCare.

Are you ready to mortgage your house – or sell it – to take care of your parents’ health care bills?

* In comparison to Medicare, Advantage Plus, the private insurance for seniors, costs the government 14% more.


Written by Valerie Curl

April 15, 2011 at 3:20 PM

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