If the GOP were smart, it would direct campaign dollars into flooding the market with television ads of this video to combat the disinformation and scare tactics of the Dems. Use the daytime hours when seniors are bombarded with pharmaceutical ads in programming. The investment in promoting these ads would prevent the Mediscare propaganda that apparently cost the GOP the NY-26 election.

The Dems think that they have discovered a method to retake Congress with blatant emotional appeals. It's time to treat the voters to some well-presented facts like Ryan's video.

Put the emphasis on assuring that their health concerns will be between themselves and their health provider in a cost-conscious way. Ask frustrated seniors if they have ever had an unsatisfying telephone conversation with a CMS bureaucrat or clerk. Let them know that the Ryan plan allows them to have more personal control than would be allowed when unelected panels determine their health futures.

SteveM has an obligation to prove his assertions. I find that I have to remind some, most notably those whose comments are shall we say leftward in orientation, that proof is required these days.

Further, it seems that SteveM is making some assumptions. Those should be stated clearly and the underlying thought process explained. Assumptions can be fraught with danger but sometimes they are the only viable tool for estimating the future.

so let's see some proof, let's discuss the assumptions. In short let's have an honest debate.

Paul Ryan for King of the World!

Re: complete curmudgeon

No assumptions are necessary. Merely common sense.

If a senior submits an application for insurance and it suggests a need for high cost service or pharmaceuticals, that cost will either be priced into the policy or excluded out.

Try applying for insurance now with a pre-existing condition and see what quotes come back at you.

Moreover, it's common knowledge that insurance companies fight tooth and nail now with physicians and customers to deny claims and coverage. You think that adversarial model is going to go away under the Ryan plan?

Re: TheFish,

Good points. And Re: "minimizes the extent of coercion/compulsion involved in the allocation."

I've been coerced and compelled over the years to hand over my tax dollars to support trillion dollar Wars to Nowhere in Islamic Land.

If the government is going to spend that kind of money, I'd rather it be spent here.

TheFish:

Again, there is a failure to understand the most basic fundamentals of economics here. Your point is that patients have incomplete information. No one disputes that. But the point of allocating resources is that they should go to where they are most valuable, and you bid for resources by bidding up their price. If you're willing to pay more for it (and there are no externalities involved), it should go to you rather than to me, because that's efficient.

As to the Ryan plan being indefensible, you and the Dems can keep demagoguing and lying about that. The fact of the matter is that the plan seeks to solve one of the most serious market failures in health care provision -- the agency problem -- by making consumers the residual claimants. Doing so has two effects. First, it gives consumers the incentive to demand higher quality at a lower price (currently they have only the former, not the latter). Second, it lowers total expenditures.

Thus, your final point comes down to saying that it only lowers total expenditures by lowering total expenditures.

Guilty as charged.

Go ahead and make that argument to the electorate. I think we've all finally seen through the "free lunch" stories where we lower total expenditures by raising total expenditures.

SteveM:
Careful with that talk about calling paying taxes as coercion and compulsion. You'll be ostracized from your progressive circles for that kind of talk.

But of course, you don't calling paying the taxes coercion and compulsion.

It's how they're spend that you call coercion and compulsion.

My friend, that's called living with the results of an election. A chief executive was elected who you didn't vote for and who made decisions you didn't like.

And you call that cooercion and compulsion, in the same sense that Obamacare would coerce and compel some people, and not others, to receive life saving treatmentns.

Right.

Sure.

If that makes sense to you, you've been living in a world of carnival mirrors for too long.

TheFish:

Buddy, the whole problem here is that you want to sit around throwing money that we don't have.

What part of "unlimited desires" and "finite resources" is unclear to you??

Let me try again to make it clearer. We cannot just keep writing a blank check. It doesn't work. The money doesn't exist, pal!

The status quo is not a choice going forward. It is, to use a favorite descriptor of you progressives, not sustainable. Very seriously not sustainable.

There are only two choices as to how the expenditures can be lowered. CHoice 1: the government rations care. That will be, at best, arbitrary. What it will really be is that medical care will be directed according to nepotism and corruption of a level you're not going to believe. You think people got corrupt for money? Wait until you see what happens when life itself can be directed by a bureaucrat. Choice 2: do what you can try to eliminate the agency problem that is at the heart of much of the over-utilization (eliminate the tax benefit of receiving health care benefits, make consumers residual claimants, etc.)

I really wish that R's can articulate this point to the people. That's the real choice. I know that progressives like you will always respond with demagoguery about throwing grandma under the bus. I wish you wouldn't be so disingenuous, but I'll accept it. It's up to the rest of us to have the electorate at large behave responsibly.

And make no mistake, that's what this is about.

It's very easy to keep voting yourself candy and roses and champagne.

You know the only problem with socialism?

Sooner or later you run out of other people's money.

Before you continue to spew what you think is really sophisticated economic jargon, can I also suggest that you go back and take some basic economics classes to learn about moral hazard, the agency problem (principal-agent) and adverse selection?

Your most recent post has removed any doubt I had earlier that you are a proud, wilful, economic illiterate.

As such, you're now on ignore.

I can only pray that the electorate at large also -- finally -- ignores the kind of wildly irresponsible, and economically destructive, hysterical caterwauling that you've come up with.

OK, as someone who spent his entire career in health care finance, I've got to jump in.

First, if Ryan's plan can't be sold, then God help us, because it's the only solution I've seen that has a prayer of working. We've tried price controls with Medicare and Medicaid at least since the inception of DRG payments to hospitals in the 80's. All that's brought us is increasing volume, as providers compensate for the price caps, unchecked by any incentive on the patient's part. For a preview of where that leads, just check on Medicaid here in California, where it borders on impossible in many areas for a beneficiary to find a specialist willing to follow him.

Second, economics does apply to health care, at least in my experience. In the early 90's I was responsible for running the organization our hospital and medical staff developed for providing care under Medicare's +Choice program, the precursor to Medicare Advantage, and the likely type of insurance to be offered under Ryan's plan. We took care of roughly half of the seniors in our service area under +Choice and did better financially with that group than the other half, which were under the traditional fee-for-service system, despite receiving only 95% of what Medicare was paying under fee for service and sharing the money with an insurance company. How? By putting the doctors in charge of paying themselves and putting them financially at risk for the hospital's results. With those incentives abuse (unnecessary diagnostics and procedures) was eliminated and fraud non-existent.

I'll give you one particularly egregious example. We did not have an oncology program locally, so had to purchase those services from the nearby group that had traditionally served our market. Their costs were huge, and when we looked into them, it was because chemo was being provided right up until the patient's death, to no one's benefit (except the group's finances). We shopped around and found another group, with better quality, who did not follow that practice, at enormous savings. This sort of behavior simply doesn't exist under the existing system. A point that Ryan doesn't make, probably because it's too subtle, is that it isn't the patient who consumes most of the services, it's the physician, on the patient's behalf.

From what I've read in the Trustee report, we've got something like a $50 trillion unfunded liability with Medicare, and the Trustee reports, in my experience, almost always understate future costs. Not only is this a bigger problem than Social Security just on the numbers, but it is also qualitatively much worse -- we can always print money for SS, but we can't print the doctors and nurses we've promised for Medicare

OK, end of rant

Unless you've worked in health care, you have no idea how prevalent those factors are. Of course, AARP, which did not have such a program but is the biggest player in the supplemental plans that competed with +Choice, effectively lobbied the program out of existence.

Sigh.

I'll break my promise to myself to ignore "TheFish".

Just this one time. I promise.

OK, so you have no understanding whatsoever of economics, and believe that people don't respond to incentives.

Let's leave aside for the nonce how on earth that kind of outlook makes you a conservative rather than the progressive you deny being.

You find my arguments uncompelling and unconvincing. Mr. Fish -- that is no different than a man jumping off the top floor of the Empire State Building shouting out as he passes floor 65 on his way down that the argument that this jump would splatter him dead is uncompelling and unconvincing.

The whole reason that leadership is hard is that you have to lead the public. Now this is not at all hard It's not hard if the public is already inclined to go where you want to lead.

It's very very easy to keep pandering to people's desires to vote themselves candy, roses, champagne and Cadillacs with other people's money.

That's the key here Fish -- people want all the healthcare stuff the way that it is now, but they don't want to pay the price that results -- they want someone else to pay.

That simply doesn't add up.

You either have to keep robbing Peter to keep CAT scanning Paul, or you have to ration care.

Can you understand that?

If your only responses are to say that people don't like that, all I can say is "NO DUH!"

Do you have a kid?

What happens when you tell them to stop playing and do homework? Or eat their veggies and protein before dessert? Do they like it?

Same way with voters.

You cannot run a country simply according to polls.

There are no principles there. It's the agency problem run amok -- it's irresitible to vote yourself a raise if you can make the other guy pay for it.

But the trouble is that (a) sooner or later the other guy won't stand for it any longer and stops generating the surplus that you've been appropriating, and (b) at some point the music has to stop. Ponzi schemes can only go on so long.

Your most recent post made clear that all you have to offer are pearls of wisdom on the cold blooded exercise of how to pander to voters to obtain 51% of the vote.

That's not a profound contribution. It's easy to get 51% of the vote if you don't care about what's right: just pander! Heck, look at all the certified morons, from both parties, who've gotten that point (and who are, thus, responsible for where we are now).

Nor is it the kind of shallow and unprincipled thinking that one expects from a conservative, let alone a Buckley follower.

OK. Back to ignoring you. For real this time.

Maybe SteveM and TheFish know another Paul Ryan. The congressman from WI has been brutally honest and upfront that his plan means the end of pretending that you can have candy forever.

But, let me say this too.

SteveM and TheFish are clearly Dem operatives.

They'd really have us believe that political salesmanship is all that matters, and to be better salespeople of the Ryan plan, what he have to do is upfront, highlight the unpleasant aspects of it.

Oh right.

That'd work.

For the DEMS!!

What Ryan has does very honestly and effectively is to point out something that SteveM and TheFish don't get.

He has very honestly and directly made clear that the status quo is not a choice.

The only choice is whether you want rationing through a government bureaucracy (i.e. Obamacare) or whether you want a consumer-centric approach.

Guys -- it's that simple.

Stop pretending that you can have the status quo. People have to get over it. That party is OVER. Can't pay for those good times any longer -- the bill has come due.

As to Social Darwinism. Wow, what a dead giveaway that you're a progressive. Only progressives use that expression.

So what does that mean though?

That I believe that as a society we should bake as large a pie as possible?

Guilty.

That I believe that you cannot expect to have people do the work they need to do to help bake the largest pie possible unless you compensate them enough for that work?

Guilty.

Does any of that mean that you, as someone who is doing well, have no responsibility to take care of your fellow man? To give of your earnings charitably?

Heck no.

But I'd rather have control over what charities I give to. And I know this -- the government is as inefficient a distributor and director of charity funds as you can imagine.

I'll bet you dollars to donuts that I gave more to charity over each of the last 5 years that either of you guys. Probably both you guys put together.

You guys crack me up.

Having utterly destroyed all those European countries with your fantastic socialist statist Rube Goldberg machines, progressives now need to destroy America, huh?