That’s not cost control. That’s cost-shifting. And even assuming Congress would turn a deaf ear to the cries of seniors, it wouldn’t solve our nation’s fiscal problems. It would just shunt them off the federal budget and onto family budgets, and make them worse.
It’s been fashionable for commentators to admit to Ryan’s failings and wonder why Democrats haven’t proposed anything of their own. The chorus has grown loud enough that Obama is scheduled to give a speech Wednesday outlining his alternative. But unlike Ryan, Democrats not only have a plausible proposal for controlling health-care costs, they have a law.
Ezra Klein is the editor of Wonkblog and a columnist at the Washington Post, as well as a contributor to MSNBC and Bloomberg. His work focuses on domestic and economic policymaking, as well as the political system that’s constantly screwing it up. He really likes graphs, and is on Twitter, Google+ and Facebook. E-mail him here.
The Affordable Care Act, as Reischauer says, isn’t perfect. You can argue whether its cost controls are a five or a six, but not that they’re a 10. Nevertheless, it’s built atop a theory that actually makes sense, because it focuses on making medical care cheaper rather than changing who pays for insurance.
The law has three big ideas for controlling costs: First, pay doctors for quality rather than volume; second, vastly increase the amount of information available about which treatments work best and when; and third, pay providers more to keep people out of the hospital than to treat them once they get in it. If any or all of these strategies work, costs will go down, but not because the premiums seniors pay have gone up.
And the law takes the next step by including some big ideas for how to spread cost controls through the health system: a board of experts empowered to reform Medicare even when Congress is paralyzed or worrying about other things; exchanges where people can easily compare insurers based on cost and quality (the same model Ryan uses in Medicare, incidentally); electronic medical records that give doctors easy access to the latest information about drugs and treatments.
One refrain we’ve heard about Ryan’s budget is that it may be flawed, but at least it’s a starting point. Maybe so, but it’s the wrong one. Taking Ryan’s zero and making it into a five would be a lot harder than taking the Affordable Care Act’s five and making it into a seven — and the Affordable Care Act has the advantage of already being law, not just a glimmer in a congressman’s eye.