AND THE RYAN BUDGET
Health care is on the mind of many Americans. The Supreme Court is taking up
Obamacare. Costs are going up at an alarming pace. The access to quality medical care is
eroding. Hospitals are under pressure and closings are rising. Doctors brace for reduced
payments for services. No wonder any proposal for altering the trajectory of all these
trends gathers interest. Medicare is the gorilla in the federal budget china shop. This
primate is hungry for more takings. Survival of the fittest may well come down to the
realignment of the entire health care system. Just what can the public expect out of this
struggle for wellness?
Within this context, the Paul Ryan budget proposal bears
consideration. Forbes provides the analysis Paul
Ryan's New-and-Improved Plan for Medicare and Medicaid Reform.
"Ryans proposal for Medicaid reform involves "converting the federal
share of Medicaid spending into a block grant indexed for inflation and population
Another key detail: Ryans plausible assumption is that competitive bidding could
drive Medicare spending down without hard spending caps. However, as a backstop, the
proposal caps the growth of Medicare spending at GDP plus 0.5 percent, whichnot
coincidentallymatches the targeted Medicare growth rate in President Obamas
The PTP 2 growth rate cap of GDP + 0.5% is meaningfully higher than that of PTP 1,
which grew Medicare at the rate of inflation, something that was a principal source of
criticism from the left (Alice Rivlin called it "much, much too low" ).
A key question is: what will the CBO do? Will the CBO score this new plan with the GDP
plus 0.5 percent Medicare growth cap? Or will CBO give Ryan any credit for the benefits of
Congressman Ryan argues his case in the You Tube, The Path to
Frightening prospects and dire results are unavoidable. All should acknowledge the
danger, but the denial blame game seems to be the only factor that spikes higher than the
The National Review warns in Ryan
and the Middle Class.
"Ryans Medicare and Medicaid reforms are both slow, workable, conservative
solutions to the fiscal imbalances of those programs. The American middle class may not
accept Medicare reform willingly, but it is something close to a mathematical certainty
that it ultimately will accept it in some form. One possible form is that the checks stop
coming as the nation becomes insolvent, another is that the government pays benefits
nominally to the penny but radically devalues the dollar to do so. I suspect that the Ryan
plan, or something like it, will be enacted long before that happens. Were stupid,
but were not that stupid."
The underlying assumption that Medicare and Medicaid are intrinsic entitlements and an
inherent right is an assumption that is seldom challenged. The stupidity is not in the
creative social engineering of payment alternatives, but in the very concept that personal
liberty and corresponding responsibility is a chronic disease. Few distortions in the
nature of a free people are more confused than the mental disorder that demands government
mandated health care.
It is because of this sharp departure from sanity that the nanny state demands
compliance. The pharmacology complex, which is the driving force that underpins hospital
therapy and officially sanctioned medicine, is managed treatment. The managed aspect,
frequently based upon the funds available for further coverage, is cold-blooded. Medicine
has evolved into a monitory arbitrage function for HMO to hedge their returns.