Vouchercare Is Not Medicare
By PAUL KRUGMAN
June 5, 2011
Republicans are seeking to dismantle Medicare as we know it, replacing it with a much worse program. For some reason, many commentators seem to believe that accurately describing what the G.O.P. is actually proposing amounts to demagoguery.
There’s nothing demagogic about telling the truth.
Start with the claim that the G.O.P. plan simply reforms Medicare rather than ending it. You can name the new program Medicare, but it’s an entirely different program — call it Vouchercare — that would offer nothing like the coverage that the elderly now receive. (Republicans get huffy when you call their plan a voucher scheme, but that’s exactly what it is.)
Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead. Specifically, the program would pay a fixed amount toward private health insurance — higher for the poor, lower for the rich, but not varying at all with the actual level of premiums.
If you couldn’t afford a policy adequate for your needs, even with the voucher, that would be your problem.
And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.
Most of the health reformers I know would have greatly preferred simply expanding Medicare to cover all Americans. Vouchercare would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.
But what about the claim that Medicare as we know it is unsustainable?
Nonsense.
Yes, Medicare has to get serious about cost control; it has to start saying no to expensive procedures with little or no medical benefits, it has to change the way it pays doctors and hospitals, and so on. And a number of reforms of that kind are, in fact, included in the Affordable Care Act. But with these changes it should be entirely possible to maintain a system that provides all older Americans with guaranteed essential health care.
Republicans don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it. So in voting for the House budget plan, Republicans voted to end Medicare.
Saying that isn’t demagoguery, it’s just pointing out the truth.
