Oregon progressives and the DPO should repudiate Wyden-Ryan Medicare sell-out
Chris Lowe
It's simple, really. Ron Wyden has allied with the author of the most reactionary budget proposal to come out of the House of Representatives in decades, to call for massive privatization of Medicare, ostensibly to control health care costs while preserving Medicare. This idea is wrong in principle, and should be rejected in principle.
We all as individuals should communicate our rejection to Senator Wyden, (202) 224-5244, and to the press. The county Democratic Party organizations and the DP of Oregon as well as other progressive parties and groups should formally repudiate it as well.
Senator Wyden insists that it is more complicated than that, and of course it can be made so. So in coming days I will post some more detailed considerations of aspects of the Wyden-Ryan white paper (downloads a pdf). Contrary to what the senator apparently is claiming about his many critics, I have read their proposal.
Senator Wyden, with his sidekick Paul Ryan The Boy Wonder, is proposing to add more loops, bells, whistles, ball bearings, bowling balls, hammers and see-saws to the Rube Goldberg Machine that passes for a health "system" in the United States. Using conceptual sleights of hand, the senator also is adding more Ptolemaic epicycles to the orrery of errors that falsely seeks to justify claims that insurance markets can control health care costs without harming individual and population health.
Among aspects to be considered in coming days:
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The failure in practice of efforts to use insurance markets to control costs, for reasons to do with the inherent nature of markets, and the inherent non-commodity nature of health care;
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The corrupt political power of private insurers, pharmaceutical companies, and corporate health care providers (particularly hospitals and for-profit specialty clinics and practices) in altering previous market-based efforts so as to reduce their already limited cost-controlling effectiveness, and the likelihood of Wyden-Ryan falling foul of the same forces;
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The conceptual sleight of hand lying (in both senses) between Wyden-Ryan's claim in the "Executive Summary" that "Any private plan that wishes to participate in this new program must provide at least as comprehensive a benefit as traditional fee-for-service Medicare," (p. 3) which sounds like a defined benefit approach, and the statement in the plan's main body that "Private health plans would be required to cover at least the actuarial equivalent of the benefit package provided by fee-for-service Medicare," (p. 8) which makes clear that the basis of comparison is cost of benefits, not benefits themselves.
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Uncertainties about the relationship between the proposal and the 2010 Patient Protection and Affordable Care Act, including peculiar provisions of the proposal having nothing to do with Medicare, that raise serious questions about political motives related to Ryan's well-know hostility to "Obamacare" and Wyden's willingness to acquiesce to collaborate in supporting Republican partisan motives for his own reasons.
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Why the only real way of controlling health care cost inflation while maintaining high-quality, effective, equitable care and make it truly universal (short of direct government provision of care as found the the V.A. system) is universal, publicly funded national health coverage, "Improved and Expanded Medicare for All" that deals with the Baby-Boomer problem by including seniors in a universal risk pool, cuts out private insurance related bureaucratic waste, and uses system leverage to create transparency about actual costs while changing perverse provider incentives to multiply services and buy excess high-cost technology.
For anyone champing at the bit to get down into the weeds, here is analysis from the Center for Budget and Policy Priorities "Ryan-Wyden Premium Support Proposal Not What It May Seem. Likely Would Shift Substantial Costs to Beneficiaries, Threaten Traditional Medicare, and Produce Few Savings". They too have read the whole proposal.
For an interesting political analysis from Physicians for a National Health Program's Don McCanne that is probably a little off most BlueOregon readers' web habittrails, here is "Why is Wyden supporting Ryan's Medicare voucher proposal?", which actually is a two-fer, beginning with an op-ed piece that Sen. Wyden and Rep. Ryan published in the Wall Street Journal, followed by McCanne's response.
And just for fun, for those ready to think about building a movement to overcome the supposed lack of political realism in full, publicly funded, universal and equitable health care reform, in the face of the manifest absence of economic and health realism of current private insurance based approaches, here is link to an event Saturday afternoon December 17 from 1-4 p.m., at the Portland Community College: A presentation and discussion led by organizers from the Vermont Workers Center, "How Vermont Won Health Care For All", sponsored by Portland Jobs with Justice and co-sponsored by the Center for Intercultural Organizing, KBOO Community Radio, and Asian Pacific American Network of Oregon. As a JwJ press release puts it: "The lessons learned from Vermont can inspire Oregon citizens to build from the ground up support [for] the Affordable Healthcare for All Oregon Act. sponsored [in the last legislative session] by State Rep. Michael Dembrow and State Sen. Chip Shields. It would provide comprehensive, affordable health benefits for every Oregon resident.
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8:47 p.m.
Dec 16, '11
Absolutely.. for policy reasons, for humanitarian reasons, and for political reasons, Wyden and this destructive ploy he has pulled need to be utterly repudiated and discredited.
10:16 p.m.
Dec 16, '11
While Senator Wyden's apparent error has drawn attention, long term Wyden watchers have pointed out his opposition to single payer and his affection for insurance companies.
Tonight, it would appear that President Obama will sell out again as it pertains to the Keystone XL pipeline; a fix in language has allowed wiggle room and perhaps by the end of February there will be a big distraction.
Key Obama advisors have been drooling for an attack on Iran. A key Clinton advisor (Hillary's) and others feel the only way for a second term is to have a war. Sort of like the rest of the GW Bush agenda is it not. Then, presumably the media will convince everyone that the filthy mess from Canada is needed. What with the closing of oil lanes and all. And a FICA cut will give folks more in their pocket to buy the five or six dollar gas. Sounds like Win, Win Win. M. Bachman will be so proud.
People expecting their Social Security payments? Not so much. Remember, Ann Coulter figures we could fight 37 Iraq wars if we didn't feed those useless bread gobblers.
1:08 p.m.
Dec 17, '11
Cram your Obama "sell out" on Keystone you are ignorantly attacking the wrong end of Penn. Ave.
But it seems some never miss the chance to fabricate soemthing to claim Obama "sold them out" on.
Pathetic.
1:21 p.m.
Dec 17, '11
You say it's "pathetic" to declare that Obama sold us out. In the past few days we've seen the president signal his intention to sign a bill that allows for the indefinite detention of American citizens without trial, a bill that he promised he would veto.
He seems to be acquiescing to, if not cheering for, the 'destroy-the-internet-forever bill.
He's backed off on a significant part of his own "pathetic" health care reform bill.
How would you characterize all this?
3:57 p.m.
Dec 17, '11
Cram? Seriously, Michell. One does not need to fabricate something; one does need to cling to a failed ideolgy wherein reality is just too painful to accept. Thus, the personal attack. Please go look up the nine poison pills in the proposal inserted by the GOP. Then, ask yourself why not let the FICA cuts expire? President Obama has given away the store. Oh yes from the beginning of this year Debbie Wasserman Schultz embraced the fallacy that by putting FICA cuts on the line the Dems would embarass the Norquist pledgers.
If one's inability to see that supply side is the source of weakened purchasing power and that Obama has embraced it by using FICA reductions to stimulate consumer purchaing power then one simply does not recognize reality.
Thus, by giving in to the GOP on a surcharge to millionaires and billionaires income to pay for the FICA extension Obama has signaled he has no cards. Better to have simply let the deductions lapse.
Now, this ghastly pipeline will be built, Social Security will be compromised and Obama may be given a second term by Republicans because he has given them everything they want. And that, my grummpy grinch, is selling out.
9:21 p.m.
Dec 18, '11
Hey folks, let's stay on topic. This is a post about health care, not about the oil pipeline, Iran, or military detentions.
7:34 a.m.
Dec 19, '11
As it would appear that one can not separate funds available for health care from the priorities set in the budget process I would respectively submit that my comment is pertinent. Being too narrow is not one of my faults; having blind faith was given up long ago. The album was good though.
11:16 p.m.
Dec 16, '11
As a long time Wyden fan, I'm really having trouble with this. I keep hoping there's more to learn, 'cuz I sure don't know much about it yet. In some ways, it doesn't sound much different than medicare advantage, and as I understand it preserves traditional medicare if it is less costly than private plans (and of course it will be.) So I'm in wait and see mode. I do have my team Wyden basketball out, ready to stick a fork in it, if I have to.
1:17 p.m.
Dec 17, '11
Between his support for elimination of the estate tax, his wanting to further reduce/eliminate capital gains, his opposition to single payer, and now this... I thought we got rid of Gordon Smith.
4:35 p.m.
Dec 17, '11
You are misrepresenting his position on taxes. You ought to do a better job of keeping up.
9:23 p.m.
Dec 18, '11
FYI, readers: Wayne Kinney is a field staffer for Senator Wyden in Central and Eastern Oregon. (Among many other important roles he plays in our state.)
(Wayne, don't forget to disclose when commenting about your employer.)
2:30 p.m.
Dec 17, '11
This thread shows why bi-partisan solutions are so rarely seen in Congress anymore.
If a possible solution has Ryan's name attached then you demonize it and Wyden for daring to fraternize with the enemy.
It is clear that BO liberatti have no interest in saving Medicare; it is much more useful to keep Medicare as a sword to wield against those "Wascally Wepublicans". Who cares about the future of this country or the debt to future generations when there are political points to be scored RIGHT NOW???!!!
I realize this is a board for the masses to continually gnaw their red meat, not a forum for intellectual discourse. However, I know I have seen quite a few posts over the years decrying the lack of bi-partisanship from Republicans.
I usually find y'alls hypocracy amusing, right now I find it sad.
4:05 p.m.
Dec 17, '11
Nothing says long term thinking like causing a debt default.
9:11 p.m.
Dec 17, '11
@Ken Ray: the Wyden-Ryan plan would eventually kill Medicare. The idea behind this plan is to get as many people as possible to opt out of Medicare Part A, thereby gradually drying up the funding for it.
There is no other wealthy country on Earth which relies on for-profit insurance for primary care. Which is why the US averages twice as much in expenditure per capita as all other wealthy countries. So, if you want to get out of debt, go universal single-payer (which is more free-market than the UK system, for example).
6:40 p.m.
Dec 18, '11
I don't oppose it because it's bipartisan. I oppose it cause it's a crappy idea.
7:10 p.m.
Dec 17, '11
This plan from Wyden-Ryan is so heartbreakingly awful and a slap in the faces of the working people and dwindling middle class that I do not see how I can ever vote for Ron Wyden again. Talk about moving in the total wrong direction when we most need principled representation, time to scrutinize his many corporate donors and then find someone to primary him--if not ask for his resignation NOW. I have been so pleasantly surprised by how even more progressive Jeff Merkley has proven to be after I supported him that the contrast is unexcusable. I want another senator like Merkley not a Gordon Smith-like tool of the insurance/pharmaceutical/hospital corporations.
9:02 p.m.
Dec 17, '11
I was at a progressive picnic in a park in NE PDX almost 20 years ago. I had a chance to speak with Wyden and I asked him why we can't have universal single-payer? His exact words: "I think we need the competition provided by the insurance companies". And I phoned his PDX office last week and the staffer said Wyden had told her to say that we need competition amongst private insurers in keep prices down. Of course, health insurance enjoys an anti-trust exemption, so collusion in the industry as regards pricing will not be prosecuted.
Ron Wyden (R-NY, Likud-Israel).
9:04 p.m.
Dec 17, '11
sorry for typo- should say "in order to keep prices down"
10:52 a.m.
Dec 18, '11
Senator Wyden has been very consistent throughout the national healthcare insurance debate that consumers should have choices. It does not surprise me that he would continue to look for new ways to offer choice. And, being anti-choice doesn’t seem like the answer.
Medicare is an insurance program and discussing the underlying cost of medical services is a red herring. As insurance, Medicare is broken. You only have to ask people who have recently made the transition from employer-based insurance to Medicare to hear the anecdotal evidence of problems.
Insurance companies offer two important services. One, they establish the customary and reasonable cost of medical services. Second, they evaluate and establish the likelihood of needing a medical service. While neither service is difficult, they have to be done each year without political influence. With these two number sets, you can determine a fair premium for insurance.
Medicare uses neither of these number sets. Instead, the premium and the payout are set by political processes. Judging from detailed medical bills, I guess that Medicare pays about 1/3 of the amount doctors want and about ½ of what they should be paid. Based only on my personal experience, premiums seem to be very low compared to employer-based insurance.
Today there are lots of choices in Medicare supplemental insurance and these offer an envelope of customer service. And, medical facilities are offering pre-paid subscription services in addition Medicare insurance. Both of these are reasonable ideas that enhance Medicare and are examples of choices.
Medicare is burdened with excessive end-of-life care where expenses can be extraordinary. The solution to this excessive risk is a larger pool of insured with younger and healthier people. A Medicare-for-all would be another way to increase the pool of insured. This is very attractive to me but only if the premiums and payouts are based on the actuarial tables.
Medicare does have a means test for premiums and this feature has to be maintained, even if the pool is expanded. All this means that if you are healthy, wealthy, and wise, you would have higher premiums than you might in a different pool of insured people. Over an entire life, a means test for premiums seems fair to me, and I believe this will be possible only in a public option.
I appreciate Senator Wyden for pushing change that seems to me to be destined to a public option with a variety of choices.
10:54 p.m.
Dec 18, '11
If the underlying cost is a red herring, it is Senator Wyden and Rep Ryan who have set it loose. Go read his white paper -- the first half of it is about justifying the proposal in terms of underlying costs to the federal budget.
What doctors "should" and need to be paid is substantially determined by overhead costs imposed on them by horrific inefficient private insurance related bureaucracy -- 20%-30% according to Dr. Berwick who was recently blocked by the Rs from full appointment as head of Medicare and Medicaid services.
Wyden-Ryan says it will offer seniors choice of insurance coverage -- but if you read it closely it is pretty clear that they are expecting less expensive plans to work by restricting choice of physicians. Choice is very much a shell game in market-oriented reform discourse.
9:21 p.m.
Dec 19, '11
Insurance companies are ill equipped to deal with the cost of medical procedures. They can either cut payout or deny coverage and these are ineffective and coarse tools. Medicare uses the former and the Oregon Health Plan the latter. Neither works.
With a public option, one can eliminate the profits of insurance companies and reduce the overhead to something similar to Medicare. One cannot eliminate the overhead entirely as collecting premiums and making payouts does cost something. You may be right that we can cut 20% of the cost of premiums, but such cuts are not sufficient.
Control of medical costs will take some very innovative and creative thinking. Basically, people will have to accept cheaper services. We have to pay doctors less, use much cheaper facilities, and forego lots of expensive procedures. The question then will be who decides.
I think the answer will be neighborhood clinics, nurse practitioners, and early intervention but I’m not really sure. I do know that we need some sort of metrics to measure our progress. I’d like to see our program measured on infant mortality, longevity, and disease rates just to name a few.
9:20 p.m.
Dec 18, '11
Why does Wyden take stupid policy positions like this one and not listen to his constituents?
He gets campaign money for it from the corporate insurance companies and health service providers. They buy influence from him (totals of individual and Pac contributions from 2007-2012):
Hospitals/NursingHomes-$311,900 Insurance Companies-$228,099
Health Services/HMOs-$144,800
http://www.opensecrets.org/politicians/industries.php?type=C&cid=N00007724&newMem=N&cycle=2012
Now, do we all understand why he is willing to turn Medicare over to the corporate insurance and medical service providers, and not put the citizens of Oregon first? Remember "corporations are persons and money is speech" according to our corporate owned Supreme Court. And Ron Wyden is a big part of that problem.
9:37 p.m.
Dec 18, '11
Monday morning 12/19 Ron Wyden is appearing on the OPB talk show, Think Out Loud, at 9AM. Call in and confront Ron Wyden on this betrayal.
10:45 p.m.
Dec 18, '11
Wyden was on TOL on Friday. Monday's topics are "Is a blogger a journalist?", the Trailblazers, and 2011 top environmental stories.
7:07 a.m.
Dec 19, '11
Sorry for the misinformation. I misread a notice.
9:41 a.m.
Dec 19, '11
Krugman on Wyden deal
Ron Wyden, Useful Idiot
I was too busy and too overstretched to weigh in on this earlier, but Sen. Ron Wyden did indeed do a bad, bad thing in his joint proposal with Paul Ryan. Ezra Klein explains why; and the devil isn’t in the details.
What Wyden did was to give cover to the fundamental fallacy of right-wing attempts to dismantle Medicare: the claim that market competition is the key to reducing health care costs. We have overwhelming evidence on this — and it just isn’t true. Looking both within the United States and across countries, if you ask which systems are best at cost control, the ranking looks like this:
Government provision as well as financing (socialized medicine) > single payer > market competition
Why doesn’t the market work here? Ken Arrow explained it all half a century ago. Patients by and large don’t have the information to evaluate medical treatments; in any case, they mainly buy insurance rather than medical care directly; and insurers profit not by providing the most cost-effective care, but by trying to insure people who won’t need care.
And it’s not as if market competition hasn’t been given a try; in this country it has been tried over and over, by politicians who won’t take no for an answer.
Oh, and if someone starts talking about how the Affordable Care Act relies on private insurers, give me a break; the reason the ACA works the way it does is the raw power of the insurance industry, which forced advocates of universal coverage to settle for an inferior system. I still think that deal was worth doing, but there’s no reason to take Medicare, which does it right — or at least closer to right — and degrade it into a worse system.
So why would anyone who isn’t a right-wing ideologue propose that kind of degradation? Inquiring minds want to know.
11:21 a.m.
Dec 19, '11
Lenny Dee speaks truth, Tonto. Return with us now to the thrilling moments in M. Moore's film where Nixon claims to have a solution to the "health care issue" and Haldeman informs his boss that the beauty of HMO (Hand the Money Over) is that the companies get rich by denying benefits.
Hoping to not get too far off topic lets try to remember other films where this is the plot. And then of course there is Social Security Disability where it is sop to deny every claim and the poor citizen must hire a lawyer and hope to have something left, and be alive, after the claim is resolved and the lawyer paid.
Adam Smith is spinning so fast in his grave that it is having an effect on gravity.
10:47 a.m.
Dec 23, '11
Marvin, thanks for the reminder that even though SS needs to be defended, it has serious problems.
My mother is a retired pscyhologist who used to work at a children's hospital in Boston. In that capacity she often worked with families of kids to help them navigate sources of support. When conservative Democrat Ed King was governor around 1980, he cut one or more social service budgets by the simple expedient of tossing off eligible people and forcing them to re-apply. Mostly they did and got re-instated, but it would take a couple of months, "saving" the state 1/6 of the annual cost -- while imposing incredible hardships and stress on people.
Of course Mass. at that time had pretty strong rules, possibly backed by state constitutional law, that eligible meant you got it (they had a super strong law on education for special needs kids that substantially predated ADA).
Here & now in Oregon we do it by denying new enrollments. Another reason we need a publicly funded universal health insurance system with a dedicated revenue stream insulated from the general fund.