Premium Support for dummies
by digby
Scott Lemieux links to this panicked warning from William Galston who says that an argument about Medicare could wind up taking “premium support” off the table, which Galston thinks is a bad idea and leaves us with no solutions for the rise in health care costs. This is not true, of course, but it’s an article faith among conservatives and centrists alike that there is no way to reduce costs without “competition,” (which speaks to a deeper set of delusions than health care policy.)
As Lemieux points out:
So it would stop us from replacing Medicare with “premium supports.” Uh, good? Here’s the thing — Ron Wyden foolishly agreeing to give Paul Ryan cover doesn’t make his proposal a “Democratic” proposal in any meaningful sense; it proves that it’s long past time for Wyden to retire. As Galston implicitly concedes, most Democrats reject Wyden’s kinder, gentler end to Medicare for the obvious reason that it’s a horrible idea. As Medicare Advantage conclusively demonstrates, replacing Medicare with “premium support” (even in the somewhat more generous Wyden version) would result in greater inefficiency, with less money going to the provision of health care and more money going to rentiers. It can “stabilize” Medicare only by denying people medical care and/or greatly increasing costs to individuals. It is the unappealing option.
(I’ll also refer you once again to this piece from one of the people who originally conceived the idea of premium support for the reasons why he changed his mind.)
There are Democrats who like this idea. Some health care wonks dream of the day when Obamacare is universal, even for the elderly, with some sort of Medicare/public option as part of the mix. But even they know that Obamacare needs to be fully implemented and analyzed before you can put this very sick population into the mix. Right now, the ACA is theoretical and it’s important to have some real world experience, both with the system itself and the politics around it.
And this is because unlike other western nations that have various forms of universal health care, the (powerful) American right is rigidly hostile to any form of government guaranteed social insurance or regulatory scheme. This makes it a unique challenge, one which requires the defenders to create programs that not only work but that have mechanisms which will make it very difficult to dismantle once they are in place. If it’s very complicated, all the Republicans have to do is start pulling out small pieces or targeting the poor to make the whole thing fail. (This is why I was so nervous about the ACA in the first place, particularly the Medicaid portion, which was always the most vulnerable component. If you look at Ryan’s Dystopian Hellscape plans, it’s obvious that this will be their first hunting ground.)
And needless to say, the problem isn’t just the Republican Party. As Lemieux says:
Alas, I don’t think Galston is right that attacking Ryan ferociously would permanently kill premium support, but I certainly wish he was right.
And that’s because there are far too many Democrats willing to jump on this sort of “compromise,” some of whom are sincere people who see this as a positive but fail to fully grasp how it undermines the entire system once the eternally hostile GOP gets in power. The politics are just as important as the policy.
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