Paul Ryan is desperately trying to resuscitate his failed plan to end Medicare by offering it as the replacement element in the long-sought “repeal and replace” strategy for the Affordable Care Act. [The one the GOP calls Obamacare - Xoff.]
So if you liked getting a coupon instead of your Medicare and being pushed out on your own onto the individual marketplace, you’ll love getting the same coupon for Medicaid and for any coverage you get from an employer. It would basically spell the end of risk pooling, the end of collective bargaining for lower costs in health care. The costs would get shifted from government to the individual, and overall health costs would rise, as the insurance industry would be unburdened by the need to negotiate down prices with powerful coalitions of potential customers. This just replaces public debt with private debt, and grows that private debt larger.“Giving patients and consumers control over healthcare resources would make all Americans less dependent on big business and big government for our health security; give us more control over the care we get; and force health care providers to compete for our business,” Ryan said.
Ryan argued that a tax credit in lieu of Medicare, Medicaid and government-credited employer-sponsored healthcare would commoditize healthcare costs, enabling individuals to choose their coverage and allowing the free market to drive down prices and make care more affordable — and generous — for all.
This is the fundamental difference between liberals and conservatives on health care: the argument of rugged individualism versus the argument of collective responsibility and the power of bargaining. It’s pretty clear from the available evidence that putting more “skin in the game,” the linchpin of Ryan’s strategy, ends up raising health costs. The health care marketplace simply does not act like a real marketplace.
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