Paul Ryan has repeatedly criticized Obamacare because it has “an architecture, a foundation, that's just not workable” and that “it’s borne on such a fundamentally flawed premise.” Ryan has repeated these claims over and over.
Ryan has provided some insight into what he views as the fundamental flaw: “The law takes power away from patients and hands it to bureaucrats.” Under Obamacare, bureaucrats have a few powers.
First, they have the power, through a commission, to regulate the marketplace of health plans. Under Obamacare, individuals choose which plans to purchase from private insurance companies, but those plans have to meet minimum criteria of coverage.
Second, bureaucrats will have the ability to adjust and increase or decrease the premium support they provide for individuals who buy plans in the marketplace. The premium support was set when the law was first passed, but it can and will be adjusted in future years in light of the changing landscape of medicine.
When Ryan condemns the role of bureaucrats in the functioning of Obamacare, he condemns a regulated market of plans with premium supports. He must view these aspects of Obamacare as “fundamentally flawed.”
But Ryan’s concerns about health care are not limited to Obamacare. He also thinks that there are serious problems with Medicare. His desire to change Medicare has led him to make claims that are patently false, but that doesn’t mean that Medicare can’t be improved. What’s interesting is if we look closely at how Paul Ryan wants to change Medicare.
Specifically, he suggests fundamental changes to the way Medicare operates, and in light of his criticisms of Obamacare, these suggestions are surprising. Two aspects of his suggestions:
“For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.
“Premium support, competitive bidding, and more assistance for those with lower incomes or greater health care needs will ensure guaranteed affordability for all seniors.”
These two aspects of Medicare reform may look familiar because they are precisely those same aspects of Obamacare that make it “fundamentally flawed.” The only way to provide “a list of guaranteed coverage options” is through a bureaucratic regulation of the market, and the only way to provide premium support will be through bureaucratic determination of appropriate levels of support.
How should we interpret this blatant inconsistency? It’s possible that Ryan is unaware that his positions on Obamacare and Medicare don’t make sense when lined up against one another. It’s more likely, however, that he does believe premium support for a regulated market of health insurance plans is fundamentally flawed. In which case, we should understand the suggestion to “reform” Medicare as the first step in a process to eliminate it.
Looking at his positions altogether, Ryan wants to turn Medicare into Obamacare and wants to eliminate Obamacare altogether. Which means he would probably eliminate Medicare, too. But given that patients (who Ryan says he wants to help) are generally satisfied with Medicare, Ryan seems to have it backwards. Rather than turn Medicare into Obamacare, we should be turning Obamacare into Medicare. Telling us that he’s looking out for us as he does otherwise is playing us for suckers.
Abraham Schwab is a Fort Wayne associate professor of philosophy and medical ethicist.
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