Wednesday, June 15, 2011

Double down on Pawlenty's Medicare Option proposal

Tim Pawlenty has proposed, vaguely, to modify Paul Ryan's scrapping/replacement of Medicare by saying he'd keep Medicare as an option people could choose in competition with privatized alternatives:

"I'm going to have my own plan, John, that will feature some differences from Congressman Ryan's plan. It will feature performance pay rather than just volume pay ... it will allow Medicare to continue as an option, but it will be priced against various options," Pawlenty said.

Recall that Ryan's plan for Medicare for future seniors is to replace it with something very similar to what Obamneycare provides to non-seniors. That makes Pawlenty's proposal, if (Big If) applied fairly, Obamneycare plus a vigorous, already-dominant public option.

Democrats should offer a deal. They should say that they don't think privatizing Medicare is a good idea, but Pawlenty's proposal has some safeguards, so they'll agree to it as long as the Republicans agree to let non-seniors also be eligible (or eligible for a stand-alone public equivalent of the Medicare option in case seniors don't want to share Medicare). If the Republicans are confident that private alternatives can outcompete Medicare among seniors, they shouldn't have any worries about making making the options available to nonseniors. Democrats should have the converse perspective, and then we'll see who's right.

Maybe this offer would do no more than expose the Republican lack of confidence in their proposal. OTOH, if they drink their own Kool Aid, it could get interesting.


Anonymous said...

Dr. Jay Cadbury, phd.


My understanding of the health care problem is that everyone is complaining about people showing up at the emergency room which causes insured people to absorb the costs. So what? This already happens. If you or I were diagnosed with cancer, the money we've paid into our plans wouldn't be near enough to cover the treatment. So I think it is a useless point to make. Also Eli, how is Obamacare going to insure people who are paid under the table, like bartenders or people who cut grass? Most of which, I note, are young people, teens to twenties. If they make those employers insure their workers, watch the wages slash and burn.

On a side note, our companys insurance rep told us a few months ago that most insurance companies cover pre-existing conditions. Plus, some people like myself do not need a plan that covers pre existing conditions, so why would I want to pay extra for something I have no use for? It is horribly inefficient for the government to dictate plans when everybody needs a different plan.

Brian said...

Jay - on pre-existing conditions, you're missing the point about risk pooling.

On your other points, you miss the fact that Obamneycare already exists in Massachusetts. It's extended coverage to near universal levels. It hasn't done much to solve cost problems there, but they're the same cost problems as elsewhere, and federal Obamneycare does have some other cost controls that the Republicans are trying to sabotage as we speak.

Anonymous said...

Dr. Jay Cadbury, phd.


Well what happened with people getting paid under the table? Are their employers now covering them? Do these workers now have to pay taxes? Were wages cut?

Anonymous said...

Dr. Jay Cadbury, phd.

Also I'm very happy I can comment here, I accidentally took some cheap shots at the bunny and for that I apologize. However, there are some people who play cheap and deserve cheap shots. I've recently been banned from skepticalscience and my suspicions tell me its all because of Albatross complaining. Albatross checks out the posts daily, and if there is anything he disagrees with, he throws a fit.

cce said...

Yes, moving Medicare into the new insurance exchanges and letting anyone, seniors and nonseniors, pick between it (the public option) or private insurance is an ideal compromise. It also avoids the question of the constitutionality of the individual mandate, since anyone who doesn't buy insurance would automatically be enrolled into Medicare and taxed accordingly. Of course, it would never go anywhere because it involves compromise with Democrats.


Your premiums don't go into an account for the purpose of paying only your healthcare. Everyone in the plan pays into a pool. So if you get cancer, it's the healthy people who will pay for your treatment.

The insurance plans that cover pre-existing conditions are provided by large companies with large risk pools. If you are buying insurance on the individual market and you have a pre-existing condition, good luck.

Obamacare contains subsidies for businesses and individuals which will alleviate the extra burden in many cases. I don't know how this will interact with tax cheats. Although I'd guess that Hospitals will become more agressive in collecting from deadbeats because there will be fewer of them. That will put pressure on businesses and individuals to play by the rules, because there will be little excuse to not have insurance.

You can play around with this calculator to get an idea of the size of subsidies for individuals:

Brian Schmidt said...

Eli's a pretty forgiving bunny. Comment editing is pretty light around here. I haven't quite figured out my policy here and hopefully won't need to, but will model it after Eli's mostly light editing.

Richard Mercer said...

One problem with our health care system is a lack of primary care physicians. Over specialization you might say.

Regarding over use of emergency rooms, I think there should be far more outpatient first aid facilities that handle everyday medical issues like minor injuries etc, but are not a hospital.
Somewhere where you can go get a few stiches and some antibiotics, and not get a $1,000 bill for it.

I was accidently shot in the hand with a BB gun. (Dont ask) I had no insurance and went to the emergency room at the local hospital. They x-rayed my hand to find the BB, washed the wound and bandaged it, along with one of those ready made casts. They made an appointment for me to go to a private hand doctor to remove it. The bill from the hospital was over $2,000. The hand doctor, Dr. Hand (true story), only charged about $150.
He thinks we should have universal healthcare.

Another problem with our healthcare system is overpaid executives at insurance companies. The CEO of United Healthcare made $83 million last year and $760 million in ten years.
That's just one executive.

All during the Obamacare debate in congress, Republican congressmen were quoting United for Health, as if it were an independent think tank. It is United Healthcare Inc. Rachel Maddow showed about 15 or more of them quoting this outfit in congress.

When you think about it, the CEOs job is to not provide healthcare. They are an insurance company beholden to shareholders to profit by providing the least healthcare they can. And this guy is getting filthy rich for that service.

American corporate CEOs that used to make 25-40 times what workers made back in the 1970s, now make 250-400 times as much. The CEO above, made 1,660 times as much as a $50,000/year worker makes.

Anonymous said...

The biggest problem with RyanCare is that it holds the growth rate of vouchers to price inflation, well below the actual rate of health care cost inflation. By the time I retire I'd have to spend all my social security in addition to the voucher and some of my 401k to get something resembling Medicare. Not sure if Pawlenty's plan would charge for Medicare, but if not I really like your compromise.

- Eric L

Anonymous said...

Dr. Jay Cadbury, phd.

"Your premiums don't go into an account for the purpose of paying only your healthcare. Everyone in the plan pays into a pool. So if you get cancer, it's the healthy people who will pay for your treatment."

Well that's exactly my point. That is the same thing that happens if someone with no insurance shows up at the emergency room.

I don't know what to think but I am worried about the waivers being granted for the new health plan. I would think even people who support the new plan must find these waivers troubling.

cce said...


People with insurance don't put off treatment until ordinary ailments become emergency room visits. Furthermore, people with insurance tend to pay for their emergency room visits.

Waivers last a year before they have to be renewed and won't be needed after 2014 when the exchanges (and all of the subsidies) are up and running.

EliRabett said...

It's Ryan Don't Care

And once again the Republicans get their way as the Obama administration ends the waiver program