A reader writes:
Andrew, you are too quick to call for a pox on both their houses regarding Medicare reform. Yes, the Ryan Plan is risible nonsense. However – the Democrats have not only "proposed a serious alternative" – they've already put one into law. It is called the Affordable Care Act – perhaps you've heard of it? The pay-for-performance portions kick in in October. Real reform, happening now, and without putting granny adrift on an ice floe so the Koch brothers can have another tax cut.
I refer to my post earlier today. Another points to an analysis from CAP "that projects the % of GDP assumed by total Medicare spending to be considerably lower thanks to the ACA's provisions." Another elaborates:
Obamacare includes provisions immediately saving hundreds of billions in projected Medicare spending and implements the IPAB to limit Medicare cost growth, which can only be overruled by a Congressional supermajority or a Congressional proposal limiting growth to a similar extend. Opponents have said this doesn't count because future Congresses will overrule the panel's recommendations – so what? This is true of any law, including Ryan's proposals. In fact, he's not even proposing a supermajority requirement to protect his plan.
The fact is that Obama has proposed and pushed through a law that saves trillions over the coming decades relative to Medicare as it stood when he entered office. If Congress doesn't get in the way and some modest cost control measures are added, this is sufficient to deal with the fiscal dilemma posed by Medicare. Combine this with axing the Bush tax cuts, eliminating the payroll tax exemption, and removing some counterproductive tax subsidies and you've got a sustainable budget for many decades. This is the Democrats' plan and for the most part it's already law.
Now, I'd prefer we adopt one of several health systems proven to provide better care at half the cost in other countries. National healthcare would eliminate a large majority of the debt problem as well as addressing the increasing number of companies and state governments unable to meet their pension obligations because of unforeseen healthcare cost inflation. It wouldn't be fair to a lot of people – companies that can't support their retirees would be bailed out, hospitals would be nationalized, health insurers would become much smaller, drug companies would no longer survive on America's insistence on paying more than anyone else, no more subsidized scooter commercials, and health workers would be paid less. If the debt is really as severe a problem as you think it is, though, are these consequences really so severe?
The Dish 