By now, it’s old news that Republican Congressman Paul Ryan has worked with Democratic Senator Ron Wyden to draft a bipartisan plan to “fix” the Medicare program. What is being proposed, essentially, is a system of “premium support”–the federal government would make fixed contributions to offset the costs of seniors purchasing insurance from an exchange of private plans, while the traditional Medicare fee-for-service program would remain an option for those who wanted to remain in it.
If this sounds a lot like the Affordable Care Act with a public option included, it’s because it is. If that didn’t fly before, why would it be seen as the ideal way forward for saving Medicare? It’s simple, the Democrats envisioned such a plan as a way of moving the health care system towards a system of managed competition or even single payer, while the GOP sees this as a way of moving Medicare away from single payer to a system of managed competition or even traditional private coverage. The problem is that, while it may mask some of the problem, it won’t solve it.
In Western medicine, there seems to be much more emphasis on treating symptoms rather than preventing or curing disease, and this, in my opinion, is the same approach taken by Ryan-Wyden. In theory, injecting competition into the Medicare market should treat the symptom of high health care costs. The problem, however, is that it won’t work. The symptom is a result of the underlying design of the health care system, by which I mean “fee-for-service reimbursement by third-party payers.” There is a mountain of evidence pointing to the fact that a single-payer system, in which the payer has no intention of generating a profit, is the least expensive option for the design of a health care system. Moreover, there is ample evidence that capitation or global budgeting is far less costly than fee-for-service. Those are the elements that need to be introduced into the health care system to start cutting health care costs. Moving Medicare from single-payer towards an exchange of private payers will make it more, not less, difficult to make those changes. Without addressing the underlying “disease,” we will have no choice but to seek out new compromises in an attempt to treat the “symptoms” or else be left to suffer with them.