Medicare Vouchers

Billy Bob asked what I thought about Medicare vouchers.  I like the concept.  I like anything that gives consumers more control and/or more incentive to shop.  But I'm not sure the idea is really practical.  Unless your real goal is to get rid of government participation in the provision of health care.

The problems I see:

1. Too easy to cut - the utility of vouchers depends on the worth of the voucher.  A voucher for $100 is of limited utility if what you want/ need costs $1000.  Or $10,000.  This problem is compounded by the fact that vouchers will be easy to make ever more useless:  with medical costs rising at 12% per year, all you have to do to make them nearly useless is to wait.   The value of vouchers is almost completely dependent on the willingness/ability of Congress to approve increases in their value at a rate that equals the rate of inflation in medical costs.  
2. Too complicated - the people this would affect are all over 65.  Shopping for a good deal in the insurance exchanges will be well beyond the competencies of many (maybe most) of the people who will be using the vouchers.  Witness the mess in the prescription drug benefit arena.
3. Too susceptible to graft - I admit it ; this point is paternalistic.  But the enormous complexity of the choices that will face seniors in trying to decide how to use their vouchers will create openings for the scam artists.  The problem with Paul Ryan is that he believes everyone is (or should be) just like him in terms of their abilities to weigh options and analyze cost/benefit ratios.  Also he believes everyone should by themselves be able to duplicate the analyses he gets from the staff of a US congressman.

I think this is the essential flaw in the current Republican hubris:  they actually believe that everyone is (or if they had any gumption and initiative would be) JUST LIKE ME!!!

Romney and Ryan

There's been a lot written about Romney's selection of Paul Ryan as his VP candidate and what the choice says about Romney himself.  On both sides, pundits and editorial writers seem to assume that the selection of Ryan tells us something significant about what Romey's positions will be if elected.  I think that's wrong. 

The only thing consistent about Romney is his inconsistency, and I think the only calculation he made in selecting Ryan was the same one Kennedy made in selecting Johnson:  it'll help me get elected.  He may actually be wrong on that, of course.  It's possible, I suppose, that Ryan's positions could end up alienating more independents than it wins in Tea Party-ers.  But I don't have much of a doubt that the election was all Romney was thinking about.  After all, he's nominating Ryan for an office famously characterized (apparently by John Nance Garner) as "not worth a bucket of warm spit." 

As the Economist recounts:: 

WHEN Mitt Romney was governor of liberal Massachusetts, he supported abortion, gun control, tackling climate change and a requirement that everyone should buy health insurance, backed up with generous subsidies for those who could not afford it. Now, as he prepares to fly to Tampa to accept the Republican Party’s nomination for president on August 30th, he opposes all those things. A year ago he favoured keeping income taxes at their current levels; now he wants to slash them for everybody, with the rate falling from 35% to 28% for the richest Americans.

Given this history, does anyone doubt that Romney is fully capable of putting Ryan in a closet and leaving him there for four years?

Nothing Romney says or does before the election provides a basis for any inference about what he will do or say afterwards.  Given what he has said, though, perhaps that is a source of some comfort.

A Battle of ideas

This is what I hope this election becomes.  It will not do so explicitly, of course, but if people come to realize that this is what it is ACTUALLY about, I think it may be worth it.

Ending Medicare As We Know It

I’m probably going to vote for Obama this year. It’s mostly, I confess, a vote against Republicanism: that shameless (and to me loathsome) brand of politics that ignores the fact that Republicans created the mess they now pretend to despise, that they spent three years preventing Democrats from doing anything about it, and now campaign as if they are the ones who will “Save America.” It is so staggeringly hypocritical that it would be laughable if it didn’t look like they might get away with it..

But I can’t say I am any longer much of a fan of Barak Obama. He has been a disappointment. I credit him with taking a first stab at dealing with the health care mess, but even there the focus was mostly on coverage rather than costs, which I believe to be the cause of the coverage problem. But still, he got us a bit closer, I think, to a solution.

Beyond that, it’s hard to see what he did with all the advantages he had – and to an extent still has. His lack of success is not all his fault, of course., but in the end the buck stops there: he had the chance, he had the power and momentum, and yet could do little with it. The result is that he is now running a truly awful campaign, a campaign in which we are told over and over (for example) that Ryan budget plan would “end Medicare as we know it.” Is that supposed to be a bad thing? Medicare “as we know it” MUST end. It is bankrupting America. We have got to find a way make Medicare and Medicaid and medical costs generally, manageable. Obama, of all people knows that. But he has chosen, for political ends, to hammer away at a slogan that has no purpose other than to scare people and that will only make coming up with a solution even more difficult. Alas, the politics of hope.