Congressman Paul Ryan and Senator Ron Wyden have a new plan to reform Medicare. Joe Klein claps:
It doesn’t fully address the cost containment issue at the heart of Medicare. It doesn’t fully address the excesses of fee-for-service medicine. But it does recognize that you can’t simply repeal ObamaCare–that the health care system has to be reformed if we’re going to get a deficit problems under control. It also is clear evidence that there are compromises to be had, if politicians eschew cheap politics and begin thinking about the greater good.
Josh Barro's main criticism:
I like this proposal structurally. What I don’t like about it is another feature it keeps from Ryan’s original plan–it wouldn’t be effective until 2022, and then only for new retirees. That means, like Ryan’s proposal before it, it saves no money this decade and almost no money in the next decade. I understand the political impulse–it avoids impacting anybody now, so maybe Ryan and Wyden won’t get beaten up for taking away Granny’s benefits. But this delay is still a serious mistake–reforms should be effective immediately, and for current participants as well as new ones.
Noah Millman thinks the plan would cement Obamacare into law:
[F]rom the right the big win here is that the door is open to “privatizing” Medicare. There’s likely some benefit to innovation from such a move; I also think it’s a small way to hedge possible bureaucratic missteps by the Medicare bureaucracy, since private health insurance bureaucracies might not make identical errors (though, in practice, there’s a huge amount of convergence here). From the left, the wins are that this reform basically can’t work without the ACA, and, moreover, post-reform it’s much easier to argue for expanding the Medicare public option to include people besides the elderly. But the real question, in my mind, is: are these wins big enough to induce left and right to agree on a serious cap in health-care costs? Because that’s the big win for the country.
Kevin Drum makes related points:
[T]he entire Wyden-Ryan plan goes a long way toward making Medicare similar to Obamacare. Basically, Obamacare moves our current private insurance system in the direction of government support with competitive bidding, while Wyden-Ryan moves our current federal Medicare system in the direction of private support with competitive bidding. Somewhere in the middle they meet, and our entire healthcare system becomes a fairly homogeneous blend of public and private, similar in some ways to the systems in Switzerland or the Netherlands. Yuval Levin makes this point explicitly here, and as a conservative he's not especially happy that this is where we could end up. But done right, it wouldn't necessarily be a bad place to be.
Jonathan Cohn disagrees:
Wyden is embracing premium support and, in the process, lending respectability to Ryan and the House Republicans. Ryan although distancing himself from his former proposal, still isn’t coming to terms with the Affordable Care Act. That’s been the story for a while now: Democrats are more willing to compromise than Republicans. Until that changes, Democrats make concessions at their own peril and with great risk for their constituents.
Ezra Klein is skeptical of the plan as a whole:
[W]e have tried competition-based structures before — the Federal Employee Health Benefits Program, Medicare Advantage, Massachusetts, etc — and they’ve never lived up to the high hopes of advocates. I hope that we just haven’t cracked the code yet, as I think there are important reasons to prefer a competition-based system to one in which the government simply sets prices. But I’m not optimistic.
Neither is Peter Suderman:
[T]he Ryan-Wyden compromise seems like an effort to work around the major difficulty rather than solve it: If federally run “traditional” Medicare is the problem—and it is—then why propose an overhaul that promises to keep it in place? That already tough fight may have just become more difficult thanks to this compromise.
Is this a step toward a better Medicare system than the one we currently have? Perhaps. But it may also be a step—or two—toward a too-easy, politically driven compromise that fails to fix the real problem.
Chart above from the Ryan-Wyden plan, which Weigel posted as a Scribd document.