Wednesday, April 27, 2011

Paul Ryan’s Solution: Death Markets, not Death Panels


Nowhere are Repukes exposed as bigger hypocrites than in the current deficit spending cut struggle which their new budget has hyped as the be-all and end-all of ”saving America” (mainly by killing Medicare). People may recall they are the ones who kept screaming “Death panels!” when Obama’s health reform was first unveiled, but they appear to turn a blind eye to their own Budget Maestro’s (Paul Ryan’s) Death Market Policy! What the hell is wrong with their brains, anyway? Where is their reasoning ability? How about the ability to even have one rudimentary thought?

The bunkum put forward by these morons (who must take most Americans for morons) is that they offer a “market solution”. Thus, their Medicare voucher plan will work because it will force dozens of health insurance companies to compete for senior health dollars, thereby lowering costs for all. Thus, seniors will be able to purchase more affordable packages of health care in the private markets, while government spending will be cut enormously since the government will no longer be the payer of last resort

Of course this is all horse pockey. First, NO health insurance companies are going to compete for senior health care! They only do it now because the Medicare Advantage plans are paid more for their services than the government pays in standard Medicare. Hence, contributing to the standard program’s insolvency. Leave out the government’s higher payments-premiums, and merely give people vouchers (pathetic at that, at only $15,000/yr.) and the reimbursement factor is much less than standard Medicare so there’ll be essentially no incentive to take any elder patient. Worse, why compete for a pool of citizens which is basically going to be sickly most of the time? This is self-evident. Even now health insurance companies factor in the medical loss ratio (the ratio of unhealthy subscribers to the healthy ones that support them via fees, costs) as the most important in getting continued profits. That means they already know that any private plans for seniors on the open market would have vast medical loss ratios meaning the proportion of insurers' profits would be next to nil. Thus, seniors will clearly be shut out, translating to a no win situation for them. (No Medicare, and no private insurer to take them)

Secondly, competition per se doesn’t mean prices coming down. This is a myth that capitalists repeat over and over but there’s precious little evidence to support it. See all those gas stations out there competing with each other, ostensibly? You see any of them lowering their prices significantly more than any others in their vicinity? I don’t!

How about prescription drugs? Despite the number of pharma companies do you see the costs of these drugs going down? Say for statins, or even simple positive ion meds like aciphex, which I have to take for gastro-esophogeal reflux? Hell no! Indeed, my meds just went up in cost by over 33% in the past year! That's despite all the supposed and alleged "competition"! Where do you think all the PhrmA profits are being allocated? On research for new drugs? You're dreaming! All the drug makers do is make tiny, incremental adjustments to existing drugs to warrant new patents! Their profits are pouring into the thousands of drug ads which blare over the TV networks each week! Drug costs, even including many generics, are now rising from 9-14% a year despite so-called competition!

How about cable TV companies? You see them lowering their rates compared to their competitors? Hell no! And why is this? Because the 1996 Telecommunications Act actually encouraged more consolidation and as we know that is antithetic to lowered prices. Why do you think your cable bill has continually risen the last ten years or more?

As a recent TIME columnist pointed out (‘The Market Can’t Cure Medicare’, May 2): “Nowhere in Adam Smith’s rule book does it say prices have to come down every time competitors show up”.

And what about health care? Well, first it isn’t like buying a car, or i-pod or TV. The elements of objective and cool rational choice aren’t available mainly because the time when people most need health care is when their lives may be on the line: after a serious auto accident or fall, or appendicitis, or contracting pneumonia. Then, they simply need care and cost may not factor into it given that we know costs vary across large geographical regions. They’re not standardized as in the case of most common consumer products. For seniors this is even more greatly exacerbated, often because they're included in one large risk pool with many of the same problems (cancers, hip fractures, etc.) THIS is exactly what has led Yale School of Management Professor Fiona Scott Morton to call out Ryan’s plan for exactly what it is: a demand shedding plan. As she puts it, “there’s no evidence many companies will be rushing in to provide health coverage to ailing boomers with competition that ought to lower any premiums”

Also:

“The Republican plan is not solving the problem. It’s solving the problem of the cost of government health care. You have people who can’t afford it and they’ll just die. Economists call that demand shedding”.

Thus the “market solution” proffered by Ryan is NOT to engender market competition to "lower health premiums for seniors", but to shed market demand (by seniors) so they'll be unable to enter or access any private health care, period. And since no government help or insurance will be available (other than a meager voucher to try and purchase private insurance in an open market with seniors the only and largest risk pool) the senior will have no choice but to die. Anyone who disputes this is either an incompetent fool, a twit divorced from economic reality or some combination thereof.

Thus, we have a death policy and there's no gaming it with euphemisms or trying to put any lipstick on this pig. Seniors now confronting Ryan in his town hall meetings have every right to be angry and voice fulminations, even call this imp a damned liar. He is deceiving them if he tries to peddle his "death plan" as something for their benefit and the nation's. Ultimately, the only way to ensure seniors' long term health security and that of future generations, is to raise taxes as Steven Rattner pointed out in his Financial Times column yesterday ('Only Tax Increases Can Fix America's Budget Mess'). And these need not even be ginormous increases, merely rescinding all the Bush Tax cuts next year, and adding a higher level (of about $250k) to the FICA-payroll tax threshold. As Rattner notes:

"Those (Bush) tax cuts were not justifiable when introduced, and at a cost of about $3 trillion over 10 years, and they are not justifiable now. Tax rates during the Clinton era were still among the lowest in modern American history. The economy boomed and all workers saw their incomes rise. What's so bad about that?

What people need to ask Herr Ryan at his Town Hall meetings is why he's prepared to confer even more riches on the wealthiest via these same tax cuts, while he's in effect prepared to toss fixed income and poor elderly to the dogs for bone meal.

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