What would make even more sense than that is to eventually link Medicare, Medicaid and the rest of the market in the same system. This is essentially what they do in the Netherlands and Switzerland (and what I recommended in this column), and it works pretty well. The obvious advantage here is that you can stay with the same insurer forever, which creates continuity for you and the right incentives for your insurer. That sort of seamlessness is much better suited to keeping an individual healthy over the course of a lifetime than our fractured, confusing system, where people are constantly shifting from one insurance arrangement to another, and sometimes go without insurance at all.
So I’d be a lot more sympathetic to what Paul Ryan is proposing if he wanted to build on the Affordable Care Act. But what he actually wants to do is repeal the Affordable Care Act, slash Medicaid and privatize Medicare. There’s no vision of a working health-care system in that proposal. It wouldn’t just leave more people uninsured than the Affordable Care Act does, but due to the Medicaid cutbacks, it’d probably leave more Americans uninsured than the status quo does, too. That’s not only morally unacceptable, but it’ll impede our efforts to bring down health-care costs systemwide. Remember that controlling health-care costs is, in the end, either about treating sick people or keeping people from getting sick. That’s why the Affordable Care Act focused so heavily on delivery-system reform. Ryan just yanks health-care insurance away from various groups of people, pockets the savings and calls it a day. That’s not good enough.