Paul Ryan's Medicare Proposal 2.0

Thursday, March 22, 2012

Republican Vice Presidential candidate Paul Ryan on the campaign trail. (Getty)

Nicole Gelinas, contributing editor of the Manhattan Institute's City Journal, analyzes the budget proposal announced by Representative Paul Ryan (R-WI) on Tuesday.

Comments [51]

Paul Ryan's budget follows the classic Republican philosophy of reversing Robin Hood: take from the poor and middle class and give to the wealthy.

Let's check this Republican myth against reality, folks: We tried that road for 10 years under Bush and it led to irresponsible risk taking on the part of Wall St. and a near financial collapse that ordinary people are paying for. It wasn't government overspending on wars alone that got where we are. Those 10 years also had a nearly flat employment growth. (So much for the rich as "job creators" myth.)

As for medical care, Ms. Galinas has such a short memory that she has forgotten that insurance companies routinely dropped coverage as soon as people got sick. She also has forgotten that fully 1/3 of family bankruptcies were caused by medical catastrophes that were not covered by insurance or were the consequence of being dropped. And she fails to note that the taxpayer already regularly has been paying for the medical care of those who are not covered by insurance. It is not the case that people are refused medical care when they show up at hospitals, and lack of on going healthcare means more hospitalizations, and those are much more expensive than insurance. So, on the basis of economics alone, right wing arguments about healthcare are counter factual. And we know that because we have experienced it!

Republican economic philosophy depends upon people doing for themselves, and to a great extent we all do depend upon that. But it is also true that few of us live in a cabin in the wilderness anymore. And most of us live enmeshed with thousands of others whose jobs we depend upon for safe water, for electricity, for roads, for schools, for garbage collection, for food getting to groceries, etc., etc. It behooves us to create a society where we can care for each other because we see all over the world the sad consequences in societies that care only for the wealthy elite. When a small percentage of the population buys political power with their economic power, the entire nation suffers, including ironically, the people with the most money.

Ryan's budget is bunk. Buying into the myths of the more righteous rich and the holier-than-thou church goer is as much an invitation to national decline as Russian socialism.

Mar. 22 2012 11:45 PM

Gelinas essentially said that the current health system forces people to take more medication than they need and prevents them from picking and choosing treatments. First of all, people already have the right to refuse treatment, they just don't have financial incentive to do so. Second, do we want to be providing financial incentives to refuse medications prescribed by doctor? (Perhaps they were prescribed for a reason?) Third, it is not a good idea for healthcare to be purely based on free market principles. Why? A free market is successful with an informed consumer. Can the typical person (or worse yet, the ailing older adult with cognitive problems)be expected to be as informed as medical doctors who spend many thousands of hours learning their trade? Probably not. Also, free markets encourage a wide range of income-appropriate quality (think shoes, cars, cell phones, etc.). Do we want to encourage a wide range of medical quality (on-sale non-elective surgery? half-off 'slightly irregular' pharmaceuticals. Bottom line is that adequate healthcare is not and should not become a market economy. With relatively standard quality control and prescription behavior, for-profit providers just inflate costs for their own gain.

Mar. 22 2012 10:34 PM
Brooks White from nyc

Ms. Galinas started to address the real solution, which is matching the principle Medicare cost-catastrophic/chronic care- with the greatest source of funds. Mr. Lehrer then moved the discussion to preventive care, which while true, is beside the point. Essentially, government income tax should cover all chronic/catastrophic care (a modified universal health system). Medicare could still cover seniors, but not chronic and cat coverage. Day to day expenses are not bankrupting medicare nor the health system in general. With chronic/cat coverage costs taken out of the private healthcare and Medicare system, premium should go down and be affordable to all but the most poor. In insurance you match premium with costs. Cats always distort premiums and it time the whole health system aligned with exposure, even if universal healthcare can't be provided in this country.

Mar. 22 2012 08:17 PM
Martin Chuzzlewit from Manhattan


LOL, you little fool.
George Miller (one of the few brigands even further to the left than his fellow Californian Pelosi) on the floor of the House is your evidence that Obambicare was allowed a full debate by Nancy??!!

Bwaaaa-haaa. Thanks for proving my point, Mr. Poirot.

Mar. 22 2012 07:26 PM

So, Martin, what were these guys discussing? Proceed from facts, please, not your faulty memory.

Or make it very clear that you are *trying* to make a funny...

Mar. 22 2012 05:17 PM
joe g from LI NY

let's face it the entire medical system is a mess !!!!!
millionaire doctors who make you sit 2 hrs after your appt time in their waiting room---
hospitals with $8 aspirins and unsolicited services and dr visits
that add up to thousands of unnecessary $$$$ per stay--
drugs co's who pay ceo's millions to maintain astronomical prices---



Mar. 22 2012 11:09 AM
Donna from Ridgewood, NJ

Hat's off to the caller from Staten Island! This is a philosophical issue. What kind of a society do we want? Who is going to have a say in it? This issue is so important to all of us but some of us are not engaged in the battle and may regret it in the end.

Mar. 22 2012 11:08 AM
Alexis from Bklyn

When asked if you would rather have a democracy decide or a corporation decide what medical treatments/device/medications are to be covered and what are not, Ms Gelinas evaded the question. While I am sure that I would not always agree with government choices, I am astounded that ANY THINKING PERSON would choose insurance companies. We have an abundance data suggesting that insurance companies will always put profit ahead of the individual and doctor. What is overwhelming indicated is the pressing need for government managed universal health care so that our nation can have a healthy and vibrant citizenry. Yes. I prefer my democracy rather than the death panels of the insurance companies.

Mar. 22 2012 11:07 AM
Sheldon from Brooklyn

Well Jawbone - I thought about that. If someone has cancer or some other catastrophic illness that cost 100's of k's they will get their treatment, obviously - they will not get any refund, as they will be beyond their "max"

Also, people will not get 100k or whatever it is, from the govt, they will get a line of funding.

Right now there is no incentive for any patient to pick and choose what they pay for "because the govt pays for it"

I bet you, if people knew that they would get 10-20% of any unused portion of their funding line back at the end of the year, they will be more economic with their health decisions.

Mar. 22 2012 11:07 AM
opal from NYC

There's one program that should be audited--Visiting Nurses Service. There's a congressional act through Medicare that allows VNS to estiamte how much time the patient will need and whether the patient receives the alloted time or not they are paid by Medicare for the estimated time. I am speaking from experience, my sister's and my own.

My sister had a few P.T. sessions and it wasn't working. VNS billed Medicare $1500. and Medicare paid VNS $5000.

My own experience was after hip replacement. VNS estimated that I would need 9 weeks. After 4 weeks the VNS therapist said he could no longer help me and suggested I use an outside therapist with more therapeutic equipment. I went to a recommended therapist for rehab. There was an overlap with 9 weeks estiamte and VNS was paid by Medicare for 2 weeks of therapy that I never got from them and I had to pay out-of-pocket for two weeks of therapy from the private rehab place because Medicare refused to pay it.

Except for the home health aide, who was very good and very underpaid, the nurse and therapist were only so-so.

There's something wrong with this system. I was in contact with Medicare and my congressman's office and was hoping at least to get VNS audited and nothing happened.

I notice that VNS now has TV ads and subway ads. I think VNS services and privileges need to be checked.

Mar. 22 2012 11:03 AM

Ms. Galines is completely out of touch with the reality of getting needed medical care.Cost issues are the smoke and mirrors that Republicans are using to push thier agenda of privatizing yet another area of our social network to enrich thier corporate friends.

"Free market" insurance plans will be free to cut out all kinds of coverage while citizens already overwhelmed with trying to keep thier families going and thier heads above water will have yet another complicated field to study and become expert in. As if one could chose how much and what kind of coverage they'll need without a crystal ball to let them know the health issues they will be facing.

Mar. 22 2012 11:01 AM
Amy from Manhattan

Interesting that you chose Cigna as your example, Brian. Part of what Cigna does is provide insurance to self-employed people through associations. But they decided to stop doing that in several states over the last 10 years, starting w/New York. As a private company, they were entitled to make that decision. I suppose they were also entitled not to call & notify the separate company contracted to administer their program until the day their own members received the notice in the mail, but that's what they did, so the administrators found out just in time to get the panicked &/or outraged phone calls & had no answers for what they could do to replace the insurance they were losing. At least we got...I think it was 3 months' notice, but it was still a scramble to find replacement coverage. (I was insurance liaison for 1 of the associations & had Cigna insurance myself.) If Medicare/Medicaid is changed so more of it goes through private insurance, I would want it regulated to keep companies from pulling this kind of crap.

Mar. 22 2012 10:59 AM
ellen Schecter from Manhattan

The government does NOT have the right to decide which drugs or what treatments are to be given for
an illness. The government is NOT a doctor. If my doctor had not fight my medical insurance company for fifteen years so that i could obtain the drugs I needed for a potentially fatal chronic disease --expensive drugs -- I would be dead by now. The drugs were IVIG, humira, enbrel, kineret, etc.

Furthermore: her grandmother is lucky; she is in relatively good health. And why didn't she JUST SAY NO to
medications and stockings she didn't think she needed?

But if Nicole or her grandmother would get sick she would suddenly understand why they need medicare or medicaid or a good insurance company which allows good care: a lethal disease, or even an expensive chronic disease, would quickly help/make her understand how incredibly expensive it can be to stay alive, find the best doctors and hospitals--and merely to continue living in the best possible way.

Even one month of serious illness can drain savings at an unbelievable rate. Nicole and Paul Rand would suddenly change their tune if they received bad diagnoses that required hospitalization and cutting edge expensive drugs.

Mar. 22 2012 10:52 AM

Sheldon -- A person gets $100K from the government? For how many years? Right now, maybe I could opt in to that, but one really serious ailment or accident would probably be well over $100K in costs. Not so sure I can afford that kind of gamble.

What LBJ tried to do was to make health care for the elderly less a roulette game of chance and more a secure means of maintaining health.

But, I guess some, such as the guest, really do want to get into depopulating the US. At least of the poor and sick.

Mar. 22 2012 10:50 AM
Peter from NYC

The guest, bringing the market issues into the cost analysis as the way to cut costs completely ignored the fact that private industry is designed to make a profit - whereas the government theoretically does not need to do so. That should be a simple, defining reason as why NOT to let the market decide health care issues. It seems more than obvious to me.

Mar. 22 2012 10:50 AM

People with higher incomes DO pay more for Medicare. Social Security gets prior year income tax information from IRS and then adjusts the required Medicare payments deducted from Social Security accordingly.

Mar. 22 2012 10:50 AM
John A.

Whoa, Whoa.
Buried in this interview -
'One price, the same price for cash or medicare.
Pricing exposed on a public website.'
Way important for either cost control purposes or fairness to the uninsured purposes. I estimate I've paid $10K in bold-faced overcharges (lies - fraud) in the last 15 years and I'm not even chronically ill. Strongly support this, it should be a human right.

Mar. 22 2012 10:48 AM

PLEASE REMEMBER THAT WE ALL PAID DEARLY FOR MEDICARE THROUGH DEDUCTIONS FROM OUR PAYCHECKS for as long as we were employed. This is NOT an issue of the "GOVERNMENT paying" for the healthcare we receive during our post-working years. Thanks for recognizing this.

Mar. 22 2012 10:48 AM
RBC from FiDi

"It is outrageous that this show has a speaker who is allowed to state categorically wrong information and not be corrected"

The Manhattan Institute always states categorically incorrect information.

Mar. 22 2012 10:47 AM
Jubbe from nyc

I had a broken leg one day, I do not have insurance.

An ambulance came to pick me up, I asked them how much they wanted to take me to the hospital, it was a lot. I said i want to shop around. That did not go well for me.

I asked which hospital they will take me too. I know the other one is cheaper for broken legs then the one they want to take me too.
Again it did not go well for me.

I agree everyone needs to bargain with their medical providers.

Mar. 22 2012 10:46 AM
barbara jacobs from CT

My elderly mother lives in an expensive assisted living facility. She was complaining of pain in one hip. They ordered x-rays of both legs. No surprise, they weren't broken. THE PAIN WAS IN HER HIP. Then they ordered xrays of both hips when pain was only in one hip. Then they noticed one leg was swollen so they ordered ultrasounds of BOTH legs. The report was a blod clot in one leg. She was sent to the hospital, and the hospital ultrasound found NO blood clot. Apparently the portable ultrasound machines are not very accurate.

All of this was money totally wsted and fully paid by medicare.

Mar. 22 2012 10:46 AM
Bob from Westchester

Your guest said that the Federal govt pays 100% of Medicaid, but in New York don't the state and localities pay a share? (used to be 50% Fed, 25% state, 25% county/municipal). Can you fact-check this with your guest, as NY localities are always screaming about these costs imposed by Feds and state. Thanks.

Mar. 22 2012 10:46 AM
Sara from Long Island

What this guest just said is crazy. She is saying that the providers/doctors are wastefully overusing benefits for rehab and I think I just heard her insinuate they are prescribing unnecessary medicines. First, there are usually too few days covered for admissions and services and costs are already too high for the vast majority of seniors. And patients shouldn't be deciding whether their medicines are necessary. That is why they go to a physician or the qualified expert to treat their medical conditions. Physicians don't generally prescribe medications they don't feel are necessary, particularly for struggling seniors. A lot of time and resources are spent trying to find ways to help seniors afford their needed medications for blood pressure, COPD and other chronic conditions so they don't have to choose between eating and medicine. I spent the last 2 years working for an insurance company trying to help struggling seniors with this very issue. She is full of it and I find it very disturbing.

Mar. 22 2012 10:46 AM

Wow -- this guest really is into the Hurry Up and Die thing.

Remember when the Republicans accused Obama of setting up Death Panels when he wanted to reimburse doctors for simply consulting with patients about their end of life wishes?

This woman wants de facto Death Panels, but the guidelines will simply be how much money an individual has. Too little and then the Death Panel automatically takes over.

Mar. 22 2012 10:46 AM
RBC from FiDi

Remember everyone, she's from the Manhattan Institute where the government and its citzens are ALWAYS wrong and corporations are NEVER at fault for anything.

Mar. 22 2012 10:45 AM
Unheard from NYC

Gelinas is simply wrong. While she has made valid points that need to be addressed Ryan's way is not the path.

Mar. 22 2012 10:45 AM
Barbara Pickell from Monmouth Beach

Nicole Gelinas has completely MISTATED how Medicaid is funded. The funding is SHARED between the Federal government and state governments. It was this way when I worked in NYS at the local Department of Social Services in the 1980's (then, 25% local, 25% state and 50% Federal) and I just checked some sources and states still DO pay a portion of the costs. The percentages of the share are based on a formula. It is outrageous that this show has a speaker who is allowed to state categorically wrong information and not be corrected. Check this website: ----- National Conf of State Legislatures: "States and the federal government share in the cost of Medicaid. The federal share of a state’s Medicaid expenditures is determined by a formula—called the Federal Medical Assistance Percentages (FMAP)—that is outlined in federal statute and that allocates funds to pay a share of the cost of services delivered through the program. States with per capita incomes below the national average receive higher matching percentages, and those with per capita incomes above the national average receive lower matching percentages. Every state receives at least a 50 percent match."

Mar. 22 2012 10:45 AM
Tim from Brooklyn

If I could pay what my insurance company pays, I could afford medical care. EG. My doctor charges $3000 for a procedure and the insurance company pays $300. If I was only charged $300 I could afford the care. I have a medical device that the company charges $300 per month for its use but the insurance company only pays $30

Mar. 22 2012 10:44 AM
Arlene from Brooklyn

Who said Medicare is free? My husband pays a premium for his Medicare insurance as well as a supplemental insurance policy to cover the 20% that Medicare does not cover. That puts him into the same category of payment that people in insurance groups (as in a workplace) pay. Of course, that is preferable to trying to pay for private insurance, which is extremely expensive, but it is still not free.

Mar. 22 2012 10:44 AM
Richard R. Binkele from Tarrytown, NY

The problem is the rising cost of medication! And since when is the patient the person knowledgeable enough to decide what and how much treatment is enough?

Mar. 22 2012 10:43 AM
Karen from NYC

Nicole is suggesting that middle-class Americans, including those not yet eligible for Medicare, pay their own health care costs. She insinuates that Americans are wasteful and irresponsible in choosing medications, tests and treatments.

My husband is under sixty-five, does not smoke or drink, exercises regularly, but has gastro-intestinal and blood pressure issues -- probably hereditary. His medication costs about $400 per month. Is Nicole suggesting that, rather than have insurers pay for such costs, middle-class families pay such costs out of their middle-class salary.

Mar. 22 2012 10:43 AM
Sheldon from Brooklyn

Why can't govt give individuals a line of health funding that they are in control of, for spending wherever they want 50, 80, 100k per year, then give 20-25% of any unused portion, back to the individual at the end of the year? People may have an incentive to spend less.

Mar. 22 2012 10:43 AM
Martin Chuzzlewit from Manhattan

No, Bonnie, these issues were NOT ARGUED when they "passed" this bill because the Dems allowed NO debate on this bill.

What planet were you on...or just lying??!!!

Mar. 22 2012 10:43 AM

Bonnie, caller at about 10:42AM -- WORD!

Mar. 22 2012 10:42 AM
June from Manhattan

Ms. Gelinas seems to think that the States get fully reimbursed for Medicaid from the Federal Government. It is silly to think that there is no incentive to hold down costs.

Mar. 22 2012 10:42 AM
Steve from Manhattan

Brian's comment a few minutes ago about the impact of a block state grant on corruption - implying that republican's are uniquely corrupt - is completely irresponsible and perpetuates partisan politics. Both parties are corrupt and the underlying point of the guest's comments are spot on the - the current system has perverse incentives - ie states spend more to get more federal funding. Look at the unintended consequences and costs, and stop blaming a particular party. Please show more balanced reporting.

Mar. 22 2012 10:42 AM
Listener from NYC

If I were to get laid off or go freelance, it would cost me $700 a month to keep my health insurance, which would be for my so-called "day-to-day" needs. How on earth would I afford that? Many Americans worse off than I face this very issue, which is why so many are uninsured. And let's not forget the benefits of preventative care, which is a day-to-day approach. I also work in an industry - media - which is more and more hiring freelancers so as to avoid having to pay the high cost of maintaining their employees. So I would not put my money on either private business or insurance companies to look after my health care needs.

Mar. 22 2012 10:42 AM
Charlotte Brooks from Bedminster, NJ

Is this woman nuts!? Our medical costs were $24,000 in
2011 & this was with Medicare and secondary insurance. This is 1/3 of our income. I cannot imagine what would happen if we had to pay for all of it. We might as well give up & die.

Mar. 22 2012 10:40 AM
Teal from Tarrytown

"If you want to take a cholesterol drug instead of a glass of wine, that is your choice and you should pay for it".. Clearly you don't have type IIA Hypolippoprotienima... choice.. cholesteral level at 550 and heart attack or out of pocket price at hundereds of dollars per month, for elederly on fixed incomes... oh I forgot they want to dump Social Security as well.

Mar. 22 2012 10:40 AM
Joshua Cohen from New York, NY

Regarding Ms. Gelinas's contention that the government should pay for catastrophic care and not regular, everyday care: Don't studies show that greater access to ongoing, regular care reduces reliance on, and expense from, catastrophic care? If the government is to be on the hook for the latter, doesn't it have a vested interest in providing the former?

Mar. 22 2012 10:39 AM

I think your guest is a fully committed promoter of the Hurry Up and Die philosophy.

Don't have the money for life saving medicine? Hurry Up and Die to the rescue!

And there won't be any ice floes handy when we seniors need them. How about Soylent Green getting set up to handle the soon to die from lack of health care?

(BTW, no good support stockings cost only $5. Really. I needed them and could not find anything in a store which matched the stockings prescribed. Nicole needs a reality intervention.)

Mar. 22 2012 10:38 AM
Joe Mirsky from Pompton Lakes NJ

We'll see how you feel when you get that disease.

Mar. 22 2012 10:38 AM
Jesse from New York


—Moron Guest

Mar. 22 2012 10:38 AM
Rick from Connecticut

The Ryan plan to end medical care for the elderly,(are seniors to flip burgers in the 80's?)would make the US the only advanced country in the world not to take care of their parents, it has zero chance of passage and will re-elect Obama by 10 points

Mar. 22 2012 10:38 AM
Martin Chuzzlewit from Manhattan

Why isn't this woman on this show more often?

Mar. 22 2012 10:37 AM
Sheldon from Brooklyn

In a Party devoid of having ANY ideas the last 30 years I give Mr Ryan some credit for have some but - didn't this guy vote for Medicare part D, a multi-trillion entitlement that was never paid for, plus the bailouts and Tarp.

Mar. 22 2012 10:31 AM
David from West Hempstead

If we can put ideology aside for a second: federally provided universal healthcare is demonstrably the cheapest way to get care for everyone (provided that is something we're interested in doing at all). Why don't we do it simply on those grounds.

Mar. 22 2012 10:31 AM
Jubbe from nyc

Paul Ryan needs to move to China, they have the Utopia that he so badly needs.

Mar. 22 2012 10:23 AM

The third world is filled with nations where there is no social safety net, where the gap between rich and poor is inhumane, where corruption rules, where global corps poison the water with impunity. This is the GOP future. Profit über alles, and the drones keep marching on.

Mar. 22 2012 10:00 AM

Quite a few liberal economists warned of a housing bubble well in advance of the financial collapse in 2007/08. But Paul Ryan, conservatives, moderates and a grossly anti-investigative media did not. They now plead "surprise" and say "nobody" saw it coming. Ryan is loudly among this group. They're lying.

The Congressional Budget Office, charged with maintaining a non-partisan position, has analyzed Ryan's 'proposal' —

The CBO notes that mandatory spending (outside Medicare, Medicaid, CHIP, and Social Security) and _all_ discretionary would drop from 12.5% of GDP in 2011 to 5.75% of GDP in 2030 and then to 3.75% of GDP in 2050.

How to pay for what's left? Well, it's the old Reagan trickle down theory. Lower taxes. BUT if the Laffer Curve were right (and in principle it is) and if decades of Reaganesque tax decreases have NOT increased revenue (and in FACT they have not), then it MUST be the case that further tax cuts will fail to increase revenue. Simple logic from Laffer's own argument.

Moreover, military spending is to be kept at roughly 4% of GDP. Simple math strictly implies that Ryan plans ZERO discretionary spending on non-military items. No education, no parks, no roads — nothing. This is exactly the minimal, night-watchman state that right-wing extremists like Dick Cheney have been advocating for 30 years.

It is _monstrously_ irresponsible. Only right-wing economists like Douglas Holtz-Eakin or Thomas Sowell endorse it. No moderate, no liberal economist thinks that the US economy can be sustained at all under such plan. N. Gregory Mankiw — conservative Harvard economist, consulting for Mitt Romney — rejects the Ryan nonsense.

Again, NO economist outside the most right-wing extreme contingent takes Ryan's proposal seriously. Why is Ryan given so much credibility by the media?

Mar. 22 2012 09:35 AM
Martin Chuzzlewit from Manhattan

GELINAS: How does Ryan’s compare to Barry’s budget? LOL, trick question because BHO doesn’t have one!
Ryan gets put on the spot because the cowardly COMMUNITY AGITATOR and his PUPPET MASTER Axelrod won’t submit a serious budget and exert real leadership. The “President” prefers to act as if HE is the challenger and just play “gotcha” with the proposals of others. Barry is such a PUNK.

Watch the mustachioed Message Massager stumble and fumble yesterday in the video below. “Well, uhh, Bret, uhhh, it’s complicated, uhhh, uhhh, you know, uhh…” LOL !!!

On FOX News last night, senior Obama advisor David Axelrod was unable to explain why Senate Democrats have refused to produce a budget resolution for what is now 1,057 days. He initially tried to suggest that "dynamics in the Senate" were to blame, but as anchor Bret Baier pointed out, budgets are privileged documents that only require a simple majority to pass.”

Mar. 22 2012 07:24 AM

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