Perhaps no other health issue is as important to so many Americans now and in the future as Medicare. Without it, millions of older and disabled people would not get health care. As baby boomers age, they, too, will need the program. The media have not done a stellar job covering Medicare; now that Wisconsin congressman Paul Ryan has moved Medicare to the top of the national agenda with his proposal to turn the system upside down, we hope that will change. In this new series, “Covering Medicare,” we will follow the reportage and offer Medicare beat memos from time to time.
Judy Woodruff’s interview with Rep. Paul Ryan on the NewsHour the other night didn’t do much to explain to ordinary Americans what Ryan’s proposal is all about. In a nutshell, it would convert Medicare from a social insurance program—where everyone who has paid into the system is entitled to benefits for hospital and physician services, paid for by the government—into a private insurance scheme. People would get a voucher, or a set amount of money from Medicare, to help them buy a policy from private insurers, which would then pay providers.
In the segment, Woodruff let Ryan evade many of the questions she posed; she didn’t press hard with follow-ups, either. When Woodruff asked why Ryan’s program—which would pay subsidies to private insurers—was better for seniors than the current setup, he didn’t answer the question, instead saying that private insurers were already involved in Medicare through Medicare Advantage plans, and that was nothing different from what he was talking about. “That’s part of it,” Woodruff replied, letting Ryan make the case—an inaccurate one—that Medicare is already private because “Medigap is private” and “the Part D benefit is private plans.” Yes, Medigap policies are sold by private insurers, and so is the drug benefit. But most Medicare recipients’ hospital and doctor bills are still paid by the government, a point that needed to be made.
Ryan talked a lot about increasing choice and competition, which, he said, will help “bring costs down and expand availability”—not that plenty of private options aren’t already available. In some parts of the country, beneficiaries have more than one hundred choices for covering their Medicare out-of-pocket expenses. But Ryan never exactly said why his proposal was better for seniors than the current system. Many experts say that it is not.
Woodruff failed to ask Ryan about the new report from the Congressional Budget Office (CBO) showing that seniors would pay almost two times more for their health care under Ryan’s plan. The CBO estimates that twenty years from now a typical sixty-five-year-old would have to pay 68 percent of the total cost of his or her health coverage (premiums, deductibles, and out-of-pocket costs) compared to 39 percent today.* Left unmentioned is whether they’ll be able to afford those expenses if Social Security benefits are cut, as Ryan also proposes—an important connecting of the dots. She also did not ask about his proposal to scrap a critical piece of the health reform law—the closing of the so-called “donut hole” for seniors who have very high prescription drug costs, which will give them government help in paying for their drugs. Is this an attempt to wipe out a provision of the health law that will save seniors a lot of money? They should be made aware of this.
Instead of pinning Ryan down, Woodruff let him play word games. At one point, he said:
Medicare works through private companies to deliver services to Medicare beneficiaries. So if you’re calling that privatization, then it’s already privatized. If you’re suggesting that the federal employee health benefit system is a privatized system, then this is—we’re just basically copying the federal employee system.
When Woodruff tried to get more info about that system, asking about a “cap on payments,” whatever that meant, Ryan blabbered on and finally said:
Medicare will work like the plan that I have, that congressmen and other federal employees have. That’s not a privatized system.
Instead of noting his contradiction, she moved on to another topic. FYI: Federal employees buy their insurance from private carriers, with the government acting as an employer making a premium contribution. That’s no different from General Motors, an employer, contributing to the premiums of its workers who buy their policies from Michigan Blue Cross and other private carriers. Indeed, that is a privatized system.