Via Paul Krugman, I see that Politico honored House Budget Committee Chairman Paul Ryan (R—Wisc.) as health care policymaker of the year. Steven Benen nicely expounds the absurdity of this choice, namely that Ryan’s budget would repeal the Affordable Care Act, shift costs to families (rather than curb costs), end guaranteed Medicare coverage, and slash Medicaid funding. In fact, the Congressional Budget Office’s long-term analysis of Ryan’s fiscal year 2012 budget estimated that federal spending on Medicaid—healthcare for the disabled and poor children and seniors—would be roughly halved in the next two decades.
It’s worth adding that health policy experts widely agree the key objective for national health policy is slowing economy-wide health care cost growth. To this point, Ryan’s budget resolution would do more than shift costs—it would actually exacerbate the problem by increasing economy-wide costs. CBO’s analysis showed that Medicare is currently 11 percent cheaper than an equivalent private insurance plan. This efficiency premium compounds with time, as depicted in the figure below. By 2030, Medicare as we know it is projected to be at least 29 percent cheaper than an equivalent private sector plan (relative to CBO’s alternative fiscal scenario for the long-term budget outlook). Replacing Medicare with a voucher negates the economies of scale (and lack of a profit motive) afforded by Medicare.
Ryan’s plan would accrue budgetary savings by ending guaranteed Medicare coverage, but at the expense of increasing total health costs and only by vastly increasing beneficiaries’ costs. By 2030, the Ryan budget would reduce government expenditure for the average beneficiary by 22 percent but push the beneficiary’s out-of-pocket costs up 127 percent. Extrapolating from CBO’s analysis, Dean Baker and David Rosnick calculate that the Ryan proposal would increase national health care expenditure by $30 trillion over the next 75 years, assuming households purchase Medicare-equivalent plans. A more likely scenario would involve an increase in national health care expenditure and a decrease in the number of Americans receiving adequate health care coverage.
Politico’s award choice cited Ryan’s influence over the Republican presidential candidates and credited him with producing a “starting point” for future health care reforms. Ryan’s budget (specifically its treatment of Medicare) has indeed served as a litmus test for conservative bona fides in the GOP field, but that should be cause for concern rather than celebration among health policy experts. Eliminating Medicare and its associated cost efficiency savings would be a lousy starting point for the next round of health care reform, as it epitomizes penny wise, pound foolish budgeting.