On Tuesday, House Budget Committee Chairman Paul Ryan (R-WI) will introduce a 10-year budget proposal that would over time eliminate Medicare and Medicaid and replace them with less generous health care plans for the elderly, poor, and disabled. The reviews are in, from experts and advocates, and it looks like there's gonna be a fight.
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Phasing Out Medicare
Starting with Medicare, Ryan's critics attack his plan as a step back from the single-payer system that, despite looming financing problems, serves the elderly very well.
"There ought to be a TV show called 'That 90s Show,'" said David Cutler, a Harvard economics professor and one-time adviser to President Obama. "What Paul Ryan has in mind is to recreate the managed care era, do for the elderly what we rejected for ourselves."
Republicans will be loath to admit this, but the system Ryan has in mind for Medicare works a lot like dread 'ObamaCare,' too. He developed it in concert with Alice Rivlin, who used to run the Office of Management and Budget for President Clinton. They propose giving the elderly a menu of private insurance options (think the health care exchange) and then subsidizing those plans based on need (think insurance credits). Thus, in addition to all the questions Republicans will have to answer about the plan from experts and stakeholders, they'll have to explain why the health care law is terrible for working adults, but a great idea for retirees.
"I keep talking to Paul and trying to convince him of that," Rivlin told Ezra Klein recently. "But even if he agreed with me, he couldn't say so."