TPM's Lauren Fox caught up with Dent yesterday on Capitol Hill and asked him whether he supported Ryan's plan, which generally goes under the name "premium support" - i.e., moving seniors into private insurance and giving them vouchers as "premium support", i.e., money toward paying their premiums.
Dent: "Premium support is not a new concept. That is something that is very similar to Medicare Part D and something that Alice Rivlin had thoughtfully presented years ago and I think Premium Support is going to be on the table for discussion in terms of Medicare reform at some point not for current beneficiaries."
TPM: "Is that something you support?"
Dent: "Depends what it looks like. I got to see the proposal first, but I'm OK with the concept."
At this point a Dent aide piped in and said "Ryan's plan maintained traditional fee for service." Fox corrected him, noting that while the latest version did, it did not in earlier versions, including the one Ryan developed with Rivlin.
Dent: "I believe it is going to be part of the mix and I can certainly be supportive, but that support is contingent upon which plan is going to be presented."
In other words, he wants to see the details but in general he's in support.
I will address in a subsequent post why the idea of continuing 'traditional fee for service' Medicare for those who want it is really a dodge. Ryan has never been clear on just how he can do this or whether he's even in favor of it. But the reality is that if you did phaseout and also keep 'traditional' Medicare available for those who want it, the people who stay in would overwhelmingly be the sickest seniors. We already see this pattern in the much more limited system of Medicare Advantage.
This is what health care economists call 'creaming', picking up the healthiest, best risks from the pool and leaving the sickest in the direct government run program. That would lead to the same kind of classic risk-pool death spiral where the government would lose the ability to spread risk over the whole senior population. 'Traditional' Medicare would collapse and phaseout would be complete for everyone.
As I said, we'll get to that issue in future posts. Bottom line: Rep. Charlie Dent (R-PA), often seen as a moderate, is going to be a yes vote for the Trump/Ryan phaseout plan.