The Republican Case for Medicare Vouchers

Welcome to Politics Bites, where every afternoon at It's A Free Country, we bring you the unmissable quotes from the morning's political conversations on WNYC. Today on the Brian Lehrer Show, Congresswoman Nan Hayworth (R-NY 19) discussed the battle in Congress over what to do with Medicare.

Trickle-down responsibility

Democrats have attacked House Republican Paul Ryan's proposal to transform Medicare into a private insurance voucher fund, saying it will shift the country's debt burden on to senior citizens without improving health care or controlling costs.

But Representative Nan Hayworth wouldn't characterize it that way. She says the current system sweeps the cost of medical treatment under the rug: the elderly can expect the government to foot almost any bill, leading to a sort of "why not?" attitude toward accepting care. Hayworth said we need individuals and doctors to pay greater attention to what's really necessary, and how much it really costs, rather than mandating it from Washington.

It has been shown in areas of the country that have programs...with health savings accounts for state employees and Medicaid recipients: when people are aware of what it costs to do certain things, they will make sensible choices. Right now we don't have an incentive that is based appropriately in the consumer world. There are no incentives to bring those costs under control, and yet we are faced with a situation in which those restraints will be forced upon the public through mechanisms like [the Affordable Care Act].

Incentives and efficiencies

The Republican approach is about letting health care decisions fall to states, consumers and providers, and forcing action at the bottom of the policy ladder, rather than from the top. Revamping Medicare and Medicaid is "a broad stroke approach, it's true," said Hayworth, "but smaller strokes really do have to exist within our states and communities."

However, people receiving excessive care aren't the only cause for rising costs, Hayworth said. Federal oversight (and overreach, depending on who you ask) runs counter to private sector mechanisms that would deliver a better product. Getting government out of the way, as the Ryan plan suggests and Hayworth supports, would improve the heath care market.

The universe of choices been limited. One example is that we have a limited selection of insurance options in a state like New York. Insurers have to honor menu of more than 50 mandates and that makes the cost of insurance in New York for those of us not in large purchasing groups nearly prohibitive. It's an expensive proposition and the number of insurers entering that marketplace becomes limited.