Full text of Ryan’s speech as prepared for delivery to the Economic Club of Chicago:
The answer is simple. We have to make responsible choices today, so that our children don’t have to make painful choices tomorrow.
If you look at what’s driving our debt, the explosive growth in spending is the result of health care costs spiraling out of control.
By the time my children are raising families of their own, literally every dollar we raise in revenue will be paying for three major entitlement programs.
Some of this is demographic – every day, ten thousand baby boomers retire and start collecting Medicare and Social Security.
But a lot of it is simply due to the fact that health care costs are rising faster than the economy is growing. Revenues simply cannot keep up.
It’s basic math – we cannot solve our fiscal or economic challenges unless we get health care costs under control.
The budget passed by the House last month takes credible steps to controlling health care costs. It aims to do two things: to put our budget on a path to balance, and to put our economy on a path to prosperity.
I am here today to stress the point that these goals go hand in hand. Stable government finances are essential to a growing economy, and economic growth is essential to balancing the budget.
The name of our budget is The Path to Prosperity.
See, right now, we’re finally having a debate in Washington about how to address our fiscal problems. But we’re still not having the debate we need to have.
To an alarming degree, the budget debate has degenerated into a game of green-eyeshade arithmetic, with many in Washington – including the President – demanding that we trade ephemeral spending restraints for large, permanent tax increases.
This sets up a debate in which we are really just arguing over who to hurt and how best to manage the decline of our nation. It is a framework that accepts ever-higher taxes and bureaucratically rationed health care as givens.
I call it the “shared scarcity” mentality. The missing ingredient is economic growth.
Shared scarcity represents a deeply pessimistic vision for the future of this country – one in which we all pay more and we all get less. I believe it would leave us with a nation that is less prosperous and less free.
To begin with, chasing ever-higher spending with ever-higher tax rates will decrease the number of makers in society and increase the number of takers. Able-bodied Americans will be discouraged from working and lulled into lives of complacency and dependency.
Worse – when it becomes obvious that taxing the rich doesn’t generate nearly enough revenue to cover Washington’s empty promises – austerity will be the only course left. A debt-fueled economic crisis will force massive tax increases on everyone and indiscriminate cuts on current beneficiaries – without giving them time to prepare or adjust. And, given the expansive growth of government, many of these critical decisions will fall to bureaucrats we didn’t elect.
Shared scarcity impedes economic growth, results in harsh austerity, and ends with lost freedom.
In a recent speech he gave in response to our budget, President Obama outlined a deficit-reduction approach that, in my view, defines shared scarcity. The President’s plan begins with trillions of dollars in higher taxes, and it relies on a plan to control costs in Medicare that would give a board of 15 unelected bureaucrats in Washington the power to deeply ration care. This would disrupt the lives of those currently in retirement and lead to waiting lists for today’s seniors.
Now in criticizing the President’s policies, I should make clear that I am not disputing for a moment that he inherited a difficult fiscal situation when he took office. He did.
Millions of American families had just seen their dreams destroyed by misguided policies and irresponsible leadership that caused a financial disaster. The crisis squandered the nation’s savings and crippled its economy.
The emergency actions taken by the government in the fall of 2008 did help to arrest the ensuing panic. But subsequent interventions – such as the President’s stimulus law and the Fed’s unprecedented monetary easing – have done much more harm than good, in my judgment.
In the aftermath of the crisis, we needed government to repair the free-market foundations of the American economy, as it did under Reagan in the early 1980s, by restraining spending… keeping taxes low… enforcing reasonable, predictable regulations… and protecting the value of the dollar.
Instead, leaders in Washington embarked on an unprecedented spending spree… enacted a deeply flawed overhaul of financial rules… passed a new health care law that raised taxes by $800 billion… and encouraged a sharp departure from a rules-based monetary policy, which created even more economic uncertainty.
In the 2010 election, the voters sent a message: This isn’t working. Washington needs to try something else.
We know what that something else must be, because we know what has always made growth possible in America. We need to answer that call for new economic leadership by getting back to the four foundations of economic growth:
First, we have to stop spending money we don’t have, and ultimately that means getting health care costs under control.
Second, we have to restore common sense to the regulatory environment, so that regulations are fair, transparent, and do not inflict undue uncertainty on America’s employers.
Third, we have to keep taxes low and end the year-by-year approach to tax rates, so that job creators have incentives to invest in America; and
Fourth, we have to refocus the Federal Reserve on price stability, instead of using monetary stimulus to bail out Washington’s failures, because businesses and families need sound money.
Let me deal with each in order.
The first foundation, real spending discipline: it’s pretty simple. You can’t get real, sustainable growth by continuing to pile on the debt. More debt means more uncertainty, and more uncertainty means fewer jobs.
The rating agency S&P just downgraded the outlook on U.S. debt from “stable” to “negative.” That sends a signal to job creators. If S&P is telling them that America is a bad investment, they’re not going to expand and create jobs in America – not at the rate we need them to.
Mounting debt also threatens our poorest and most vulnerable citizens, because those who depend most on government would be hit hardest by a fiscal crisis. We have to repair our safety net programs so that they are there for those who need them most. This starts by building on the successful, bipartisan welfare reforms of the mid-1990s.
Our reforms save the social safety net by giving more power to governors to create strong, flexible programs that better serve the needs of their populations. Most important, they make these programs solvent.
As we strengthen welfare for those who need it, we propose to end it for those who don’t. We end wasteful corporate welfare for those such as Fannie Mae and Freddie Mac, big agribusinesses, and others that have gotten a free ride from the taxpayer for too long.
All of these steps are necessary to getting spending under control. But they are not enough. We cannot avert a debt crisis unless we directly address the rising cost of health care.
Getting health care costs under control is critical, both for solving our fiscal mess and for promoting growth. One reason that many people aren’t getting raises is that rising health care costs are eating into their paychecks.
The second foundation addresses the growing scourge of crony capitalism, in which Washington bureaucrats abuse the regulatory process to pick winners and losers in the private economy.
Congressional Republicans continue to advance reforms that stop regulatory bureaucrats from strangling job growth and innovation with red tape. We’ve advanced legislation to stop the EPA from imposing job-destroying energy caps on American businesses.
We’ve advanced legislation to revisit the flawed Dodd-Frank law, which actually intensifies the problem of too-big-to-fail by giving large, interconnected financial institutions advantages that small firms do not enjoy.
But most important, we propose to repeal the new health care law and its burdensome maze of new regulations. It’s bad enough that the law imposes an unconstitutional mandate on every American; it also imposes new regulations on businesses, which are stifling job creation.
Let me share with you a figure that serves as a devastating indictment of the new health care law: So far, over 1,000 businesses and organizations have been granted waivers from the law’s onerous mandates. These waivers may prevent job losses now, but they do not guarantee relief in the future, nor do they help those firms that lack the connections to lobby for waivers.
This is no way to create jobs in America. True, bipartisan health care reform starts by repealing this partisan law.
The third foundation recognizes that we cannot get our economy back on track if Washington tries to tax its way out of this mess.
The economics profession has been really clear about this – higher marginal tax rates create a drag on economic growth.
As the University of Chicago’s John Cochrane recently wrote: “No country ever solved a debt problem by raising tax rates. Countries that solved debt problems grew, so that reasonable tax rates times much higher income produced lots of tax revenue. Countries that did not grow inflated or defaulted.”
Higher taxes are not the answer.
Finally, the fourth foundation calls for rules-based monetary policy to protect working families and seniors from the threat of high inflation.
The Fed’s recent departures from rules-based monetary policy have increased economic uncertainty and endangered the central bank’s independence.
Advocates of these aggressive interventions cite the “maximum employment” aspect of the Fed’s dual mandate – its other mandate being price stability.
Congress should end the Fed’s dual mandate and task the central bank instead with the single goal of long-run price stability. The Fed should also explicitly publish and follow a monetary rule as its means to achieve this goal.
These are our four foundations of economic growth. And the House-passed budget starts the long, arduous, and necessary process of restoring these foundations and building a prosperous future.
We lift the crushing burden debt by cutting spending and reforming those government programs that drive the debt. We reduce the deficit by over a third in the first year of our budget, putting an end to the era of trillion-dollar deficits. The House-passed budget doesn’t just put the budget on a path to balance – it actually pays off the debt over time.
We can’t achieve this goal by simply rubber-stamping increases in the national debt limit without reducing spending in Washington.
Speaker Boehner made this clear in a recent speech at the Economic Club of New York: If the debt ceiling has to be raised, then we’ve got to cut spending. The House-passed budget contained $6.2 trillion in spending cuts. For every dollar the President wants to raise the debt ceiling, we can show him plenty of ways to cut far more than a dollar of spending. Given the magnitude of our debt burden, the size of the spending cuts should exceed the size of the President’s debt limit increase.
The House-passed budget also gets health care spending under control by empowering Americans to fight back against skyrocketing costs. Our budget makes no changes for those in or near retirement, and offers future generations a strengthened Medicare program they can count on, with guaranteed coverage options, less help for the wealthy, and more help for the poor and the sick.
There is widespread, bipartisan agreement that the open-ended, fee-for-service structure of Medicare is a key driver of health-care cost inflation. As my friend Jim Capretta, a noted health-care policy expert, likes to say, Medicare is not the train being pulled along by the engine of rising costs. Medicare is the engine – and the rest of us are getting taken for a ride.
The disagreement isn’t really about the problem. It’s about the solution to controlling costs in Medicare. And if I could sum up that disagreement in a couple of sentences, I would say this: Our plan is to give seniors the power to deny business to inefficient providers. Their plan is to give government the power to deny care to seniors.
We also disagree about how best to deliver the tax reform that Americans have long demanded from Washington.
Here’s a quick story about tax policy. Twenty-five years ago, GE CEO Jack Welch introduced himself to this very club by saying, “I represent a company that doesn’t pay taxes.”
I guess some things never change.
We have to broaden the tax base, so corporations cannot game the system. The House-passed budget calls for scaling back or eliminating loopholes and carve-outs in the tax code that are distorting economic incentives.
We do this, not to raise taxes, but to create space for lower tax rates and a level playing field for innovation and investment. America’s corporate tax rate is the highest in the developed world. Our businesses need a tax system that is more competitive.
A simpler, fairer tax code is needed for the individual side, too. Individuals, families, and employers spend over six billion hours and over $160 billion per year figuring out how to pay their taxes. It’s time to clear out the tangle of credits and deductions and lower tax rates to promote growth.
The House-passed budget does that by making the tax code simpler… flatter… fairer… more globally competitive… and less burdensome for working families and small businesses.
By contrast, the President says he wants to eliminate deductions, but he also wants to raise rates. That includes raising the top rate to 44.8 percent. That would amount to a $1.5 trillion tax increase on families and job creators.
The President says that only the richest people in America would be affected by his plan… Class warfare may be clever politics, but it is terrible economics. Redistributing wealth never creates more of it.
Further, the math is clear – the government cannot close its enormous fiscal gap simply by taxing the rich. This gap grows by trillions of dollars each year, representing tens of trillions in unfunded promises to future generations that the government has no plan to keep.
There’s a civic side to this as well. Sowing social unrest and class envy makes America weaker, not stronger. Playing one group against another only distracts us from the true sources of inequity in this country – corporate welfare that enriches the powerful, and empty promises that betray the powerless.
Those committed to the mindset of “shared scarcity” are telling future generations, sorry, you’re just going to have to make do with less. Your taxes will go up, because Washington can’t get government spending down.
They are telling future generations, you know, there’s just not much we can do about health care costs. Government spending on health care is going to keep going up and up and up… and when we can’t borrow or tax another dollar, we’ll have to give a board of unelected bureaucrats the power to tell you what kind of treatments you can and can’t receive.
If we succumb to this view that our problems are bigger than we are – if we surrender more control over our economy to the governing class – then we are choosing shared scarcity over renewed prosperity, and managed decline over economic growth.
That’s the real class warfare that threatens us – a class of governing elites picking winners and losers, and determining our destinies for us.
We face a choice between two futures. We can continue to go down the path toward shared scarcity, or we can choose the path of renewed prosperity.
The question before us is simple: Which path will our generation choose?
In 1979, my mentor, Jack Kemp, captured the essence of why we must choose the path to prosperity:
“We can’t progress as a society by using government to diminish one another. The only way we can all have more is by producing more, not by bickering over how to share less. Economic growth must come first… for when it does many social problems tend to take care of themselves, and the problems that remain become manageable.”
You know, there’s a question I get a lot from people at town halls. When you go around the country showing people a chart that shows that our debt is on track to cripple our economy, people start to ask you whether any plan, even a plan like the House-passed budget, can save America from a diminished future.
They say, Congressman Ryan, I know you have to sound optimistic in public. But in private, do you really think there’s anything we can do to save this country from fiscal ruin? Or should we just be bracing for the worst?
It’s a difficult question. It’s one that gives me pause. Frankly, it’s one that keeps me up at night.
But the honest answer is the one I’m about to give to you: Nobody ever got rich betting against the United States of America, and I’m not about to start.
Time and again, just when it looked like the era of American exceptionalism was coming to a close… we got back up. We brushed ourselves off. And we got back to work – rebuilding our country, advancing our society, and moving the boundaries of opportunity ever forward.
We can do it again. America was knocked down by a recession. We are threatened by a rising tide of debt. But we are not knocked out. We are America. And it is time to prove the doubters wrong once more – to show them that this exceptional nation is once again up to the challenge.
Thank you.
The problem with this is that Ryan doesn't really spell out the fact that his plan for controlling Medicare costs is to simply stop paying them over time; the 'premium support' is specifically designed to go down in value every year. Then there's a funny bit of misdirection asserting that this will lower overall health care costs. Does anyone think this is actually true?
I think this plan has several problems that go beyond the messaging. I can't see the Medicare part of it EVER flying with the electorate, and without that segment, his whole budget fails.
Reply to this commentLinkReport AbuseThe Man Who Should Be President.
Run, Paul, run!
Reply to this commentLinkReport AbuseThis was an excellent speech. Sign me up for the Draft Ryan effort. I'd love to see him debate President Obama. It wouldn't even be close. Obama would demagogue, and Ryan, in his wonkish, but pointed way, would level him.
Reply to this commentLinkReport AbuseSorry, Fish, but I think you have it backwards. Ryan's plan recognizes the widely-accepted concept that health care costs are largely driven by the problems created by the third party payor system. People who don't have any skin in the game don't focus on the cost involved. (If the govt tells me that I'm "entitled" to shoes at little or no cost to me, I want Ferragamos, thanks a bunch.) The plan assumes -- reasonably, I think -- that if the consumer of health care is empowered and incentivized to control his/her own costs, then the overall increase in health care costs will subside, thus allowing for the planned slowing of the rate of increase in premium subsidies. Add in lower premium support for the wealthy and higher support for the poor and sick, and you end up with a very viable plan.
As for public acceptance of the Ryan Medicare solvency plan, I think you will be surprised. It's a large hill to climb in terms of public education and understanding, but then so was the Obamacare debate. And we have 18 months to climb it. As for this senior who has studied the various approaches, I'll take the Ryan plan, made effective TODAY, over the IPAB approach of government- decreed rationing by a panel of unelected and unaccountable "experts" seeking a one-size-fits-all solution. Once I have a chance to visit with my fellow seniors about it, I find that they end up agreeing with me. It's an easy sale.
Reply to this commentLinkReport AbuseRUN, Ryan, Run.
Not for Senator from Wisconsin, but for President for all Americans.
And, pick a VP who is strong on both energy independence and national security.
Let's be strong again.
Reply to this commentLinkReport AbuseJennifer Rubin called this speech "optimistic, cheerful, gracious and reasoned" and I concur.
Paul Ryan is exceptionally good with the details AND the big picture. He is consistent, focused, principled, articulate, factual, straightforward and incredibly energetic. He appears not to take anything personally. He is relaxed and smiles when grilled by reporters and talking heads, yet passionate in defense of ideas and great at giving context rather than simple soundbites. He has a pleasant earnestness.
How I would love to see him debate Obama.
Reply to this commentLinkReport AbuseI'm down with this plan, even though at 52 I stand to lose more than most. It's the replication of the drug plan. Purchasing insurance from efficient suppliers will drive cost down by eliminating inefficient suppliers. There has to be a link between what health care Seniors get and what Seniors pay. Intelligent shopping will drive the costs down. Just think of a society where everyone pays for health care out of their own pocket. What would happen to demand, and then cost? Only the best suppliers get business. When 3rd parties pay, the 1st parties spend recklessly. That is what drives costs up.
Reply to this commentLinkReport Abusebtaylor,
Reply to this commentLinkReport AbuseI no sooner post mine than I see you beat me to it. Out 3rd party payment system drives costs. The link between users and price has to be established. But a single payer system would only ration care and reduce availability. The closer the link between the user's wallet and the supplier's product, the closer we are to free market, and lower, pricing.
@btaylor:
That's a heck of an assumption to make, that medical costs will drop based SOLELY on changing Medicare. I don't know that there's a lot of evidence that this is true - outside of the echo chamber, that is.
Let's say that - more realistically - Ryan's plan would SLOW cost raises, rather than eliminate them. You would still be faced with the problem of a declining value program over time - and one that got lower and lower in value when compared to health care costs, as the people who are using it get older and older. I don't understand how you can possibly sell that to the populace; it will be far too easy for the Dems to point out that people are going to be getting less and less money just when they need it more and more.
Ryan's plan hinges on a giant assumption and it is a big risk. That doesn't usually equally political success.
There's a much larger problem here, though: Ryan's plan is predicated upon the idea that Obamacare is going to be repealed. That sounds nice, until you realize that this means the ban on pre-existing conditions will also be repealed. For seniors (or those who are about to be) who have pre-existing conditions, will they even be able to find insurance that covers them? Will the declining value voucher ever cover the full costs of their condition? I really doubt it. Most who are advocating for this plan don't seem to have considered the ramifications of all the changes that would be necessary for it to actually save money.
Reply to this commentLinkReport AbuseJust to follow up on the last comment, I just now perused a bunch of polling on cutting Medicare, whether it's part of Ryan's plan or not; and the polling on the is absolutely against it. There's not much evidence that Ryan's plan is being any better received than previous attempts to do this.
We can sit around and make great arguments about why it COULD save money, but the simple fact is that it won't become law without a sea-change in public opinion - and I'm just not sure Ryan is the guy to make that happen. And I'm not sure that the 2012 candidate is ready to base his platform on cutting Medicare. This brings up all sorts of unpleasant and hard-to-reconcile political problems. I question the wisdom of pushing this plan, hard, during a time in which it seems there is zero chance it will become law, and significant electoral damage is the most likely result.
Let us not forget that the Republicans were very successful in 2010, in attacking Democrats for - wait for it - 'cutting Medicare.' Like it or not, charges of hypocrisy will flow like wine when the same people turn around and attempt to pass a plan which relies on cuts to Medicare in order to function.
Reply to this commentLinkReport AbuseWow, Fish, you raise a lot of different issues here. Let's see if I can address at least a few of them.
1. Is reducing the rate of increase in Medicare costs the key to reducing the rate of increase in overall health care costs? Most experts, including those who favor the Ryan plan and those who oppose it, seem to think so. Note that we're talking about reducing the rate of increase, not reducing the cost in absolute numbers.
2. Would a free market approach to Medicare, rather than a government-controlled one, be likely to achieve such reductions? Judging by the performance of the Medicare Part D prescription drug benefit, it seems likely. Off hand I can't think of any other government program that has come in 40% below projected cost, can you? (And that was the GOP's projected cost; at the time Dems argued strenuously that a plan which would have cost much more was essential to provide that coverage for seniors.) The Ryan plan is closely analogous to Part D -- premium support for seniors to select from a menu of different approved plans, including some contribution from recipients. Why would you think that it would not function similarly?
3. You concede that the Ryan plan would slow cost increases, but you seem to think that the premium support is designed to decrease over time. That's just not true. It's designed to increase at a slower rate -- at a rate matching the reduction in the rate of cost increases. The only people who would see any kind of reduction compared to current Medicare would be those who can easily afford to pay more. To quote John Boehner recently, "I love you, Pete [duPont], but I don't see why the taxpayers should be paying your health care premiums." Ditto Warren Buffett, etc. That's the heart of the plan -- greater premium support for the older, the sicker, the poorer beneficiaries and less support for the younger, the healthier and the richer. As a healthy (but not particularly affluent) senior, I'm fine with that.
4. You point out that Obamacare would need to be repealed. Right. But you seem to follow the polls. I assume then you are aware that more than 60% of the American people favor repeal, and that number has done nothing but grow since passage.
5. Your concern about pre-existing conditions is misplaced. Issuers of Part D policies cannot issue them selectively. If they choose to participate in the program, they must take everyone who signs up. Your post seems to suggest that seniors would receive a "voucher" and then have to go out into the marketplace on their own seeking insurance. That's just incorrect. Shopping for a Part D policy (or a Medicare Advantage policy for that matter) couldn't be easier, and there's no question about insurability.
Reply to this commentLinkReport AbuseI want to have Paul Ryan's baby.
Reply to this commentLinkReport AbuseFish,
Sorry to go on at such length, but you raised a host of issues. Let's tackle the ones concerning public acceptance of the Ryan plan.
1. You assert that current polling indicates that advocates of the plan have a bunch of work to do. Agreed! On the other hand, there was a time when public support for Obamacare was high. In a period of less than 18 months, that turned around dramatically as people learned the details. We'll have to provide enough information to people so that they don't fall for simplistic sound bytes about "cutting Medicare," "the end of Medicare as we know it," and throwing Granny under the bus. But that's eminently doable. And we can't just sit back and wait for politicians to do the work; we have to do it ourselves within our own circles of influence.
2. It would be a mistake to overestimate the amount of public resistance to the plan. Dems confidently believed that GOP congresspeople would face angry mobs at their town halls during the recent recess. It didn't happen. People came with lots of questions, but the only times any disruption occurred was in a few cases when it was clearly organized by Dems and their allies. In fact, Ryan himself has a fun story to tell about the guy who showed up at 2 of his town halls on the same day, 40 miles apart. The guy had changed clothes, apparently hoping that Ryan would not recognize him. Turns out he was a paid Dem staffer. If you have to pay people to try to gin up outrage, there's not a lot of real outrage out there.
3. There's no equation to be made between the Medicare cuts in Obamacare and the Ryan plan. Obamacare cut $500 billion from Medicare -- not to strengthen the solvency of Medicare but to fund Obamacare! The Ryan plan seeks to reform Medicare itself to make it viable over the long term so that younger people can count on the program being there for them. (As a senior myself, that's very attractive to me. I'm willing to pay a little bit more myself, as long as its reasonably affordable, in order to ensure that the program is still there for my kids and grandkids.) Dem talking points notwithstanding, the Ryan plan does not seek to "cut Medicare." It seeks to use free market mechanisms to reduce the cost of health care for all of us.
Reply to this commentLinkReport Abuse@btaylor,
Thanks for the response. A few points:
"It's designed to increase at a slower rate -- at a rate matching the reduction in the rate of cost increases."
I don't think this is accurate. I'm pretty sure that Ryan's plan ACTUALLY ties that increase to the rate of INFLATION. This has never come even close to the rate at which health care costs rise. Do you have a link to some document that supports your interpretation? You may be thinking of an earlier version of his plan.
See here:
External Link
The whole cost savings element of Ryan's plan is predicated on this fact, so I think it's important to get right.
I would also contest the idea that support for repealing Obamacare has 'done nothing but grow.' I do, as you say, follow the polls; and it seems that support for the repeal has not, in fact, consistently grown since the passage of the bill. It has remained mostly the same and in some polling has fallen somewhat. Not only that, but specific polling shows that only a very few wish a full repeal; most who are asked want to keep portions of it, while repealing others, such as the mandate. Those who know more about the issue know that's not workable, but it's false to present the situation as if a huge body of Americans want the whole thing dumped immediately.
Here:
External Link
You can see that polling is all over the place on this issue; there's no clear call for repeal or defunding.
You also didn't respond to my point, re: polling on cutting Medicare itself. That polling is horrible, if your position is that it should be cut. Big majorities against it, including lots of Republicans. That to me says that this plan is not likely to pass.
Finally, I'll say this: if Ryan's plan calls for a panel of insurers to participate in this program, who cannot turn down anyone who applies for their insurance, regardless of age or pre-existing conditions - what makes you think any company is going compete for this, when the value paid by the gov't declines over time - and is specifically designed to do so? They would be taking on clients which paid less and less while consistently costing more and more every year.
Reply to this commentLinkReport AbuseThird party payer and fixed co-pay. Years ago, my husband's medical insurance paid a fixed part of the prescription with the patient supplying the incremental cost. He called every drugstore in the area until he found where he would have to pay the least. Now his insurance requires that he pay $10 for some prescriptions and $25 for others. And I hate to say it, but we get his prescriptions at the most convenient store. What I don't understand is that the same store would sell some of his prescriptions for $4 if he did not have insurance. And I wonder, is the insurance company paying nothing toward those prescriptions or do they make $6 every time we pay $10?
Reply to this commentLinkReport AbuseFish,
Just a couple of final responses to your comments.
I think you're right that the rate of increase in Medicare premium support is a critical factor. I can't find it off hand, and it can't be derived from the 10-year budget figures because the new program would not kick in for the first 10 years. In fact, I don't think there is any one rate because part of the progressivity built into the plan is that the rate of increase would be slower for the younger, the healthier and the more affluent. But the critical point is that what we are talking about is the rate of increase. There will be no cuts to Medicare; we're only talking about how rapidly those outlays will increase.
Of course if you ask people if they support "cutting Medicare," you will find opposition. That's why it will be essential for us to get enough information out to people so that in the end they just laugh at that characterization of the issue. The Ryan plan does not propose cuts to Medicare, and we have 18 months to get that simple point across to the American people.
Finally, you ask: "if Ryan's plan calls for a panel of insurers to participate in this program, who cannot turn down anyone who applies for their insurance, regardless of age or pre-existing conditions - what makes you think any company is going compete for this, when the value paid by the gov't declines over time"?
First, the value paid by the gov't doesn't decline over time; the only issue is the rate of increase. And if the plan is successful in driving down the rate of increase in overall health care costs (as you concede it might), then this may not be at all problematic. Remember when there were loud howls from the same people that Bush was "grossly underfunding" Part D? Turned out to be wrong, didn't they?
Second, why do you think that issuers participate in Medicare Part D or in Medicare Advantage? Because there's a large market out there and they know how to compete in the marketplace. I would think that anyone who lived through the second half of the 20th century would have learned the simple lesson that markets work and central planning doesn't. Apparently not.
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