In an effort to keep pressing the ridiculous argument made by Simon Lazarus earlier this week (which I wrote about here and Ramesh wrote about here), Jonathan Chait points to what he says is an example of Paul Ryan acknowledging that his Medicare reform would contain an individual mandate. But in supposedly quoting an exchange between Ryan and a constituent, Chait leaves out the bulk of Ryan’s answer. In fact, Ryan (correctly) denies that his plan would include something analogous to Obamacare’s mandate to purchase insurance.
Q: If Medicare becomes a voucher program, would you require seniors to purchase private insurance and if so isn’t that an individual mandate? If you will not require them to purchase insurance how do you propose to prevent a situation where the costs of uninsured seniors is very expensive and gets passed on to me as a private policy holder? [...]
RYAN: Its mandate works no different than how the current Medicare law works today, which is you just select from a wide range of different plans.
But if you watch the video of the exchange, you’ll see that it actually goes like this:
Q: Your budget plan calls for replacing Medicare benefits with vouchers to buy private health insurance. If Medicare becomes a voucher program, will you require seniors to purchase private insurance and if so isn’t that an individual mandate? If you will not require them to purchase insurance how do you propose to prevent a situation where the costs of uninsured seniors is very expensive and gets passed on to me as a private policy holder?
RYAN: Sure, so it doesn’t, and it’s not a voucher program. The way a voucher program works is government gives you money and then you go off into the marketplace to buy something. That’s not how this works; this is called premium support. So just like Medicare works today, this would be a new Medicare system that would be pretty much how Medigap works today, or how Medicare Advantage works, or like the federal employee benefit plan. Where Medicare will set up a list of coverage options, of guaranteed coverage options. You can’t be denied based on preexisting conditions. And then you select the plan you want, and then Medicare subsidizes your premiums on that plan. It subsidizes it along the way I just described: less for the wealthy, more for the middle and even more for the low income person in need. They start off with $7,800 more in addition to $15,000 for the low-income senior and that would grow with inflation. So its mandate works no different than how the current Medicare law works today, which is you just select from a wide range of different plans. It literally would be like Medicare advantage, which is you pick among the plans you want and Medicare subsidizes the plan.
Ryan is right: His reformed Medicare system would be no more analogous to Obamacare’s individual mandate than today’s Medicare system—i.e., not analogous at all. The mandate consists of a penalty levied on a person for failure to comply with a requirement that he purchase health insurance. Medicare is (and would remain) a program that uses a tax on workers to fund a health-insurance benefit provided to retirees.
Who, in Lazarus’s and Chait’s analogy, is supposed to be analogous to the person subject to the individual mandate? The worker paying a payroll tax? The retiree making use of a benefit? Is the idea that workers are buying eligibility for benefits later on? (If so, Medicare doesn’t work that way—unlike Social Security, Medicare benefits are not related to the amount of taxes you paid while working—and even if it did it would not be remotely analogous). Or is this argument really just as silly as it seems?
Whatever the answer might be, the notion that Paul Ryan lent any credence to the argument is just false.