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Public Theology: Pastors, Tell Truth to Elders: Paul Ryan Will Kill Medicare
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Pastors, Tell Truth to Elders: Paul Ryan Will Kill Medicare
The Medicare debate has become complicated, Ryan has two plans, and he and Mitt Romney are not being honest about their own approach.

By Ed Knudson

The debate over Medicare has become much more complex over the past several months, especially after Mitt Romney chose Paul Ryan as his running mate. I am here going to discuss the issue in a way hopefully helpful to pastors who may not have had time to look beneath the soundbites. There are two Ryan health care plans, an earlier one in 2011 and a later one in 2012 which was developed with Oregon Senator Ron Wyden. Both have been passed by the House of Representatives so both can be considered "Ryan plans." The fact that that second is done with Wyden represents a political calcualation by Ryan, that something he can claim to be "bi-partison" will gain greater acceptance. But if Ryan were truly to do what he himself wanted to do it is better to look to his earlier plan.

The earlier plan is a voucher system. Seniors would not have their health care payed for directly by Midcare. They would receive a voucher for a given amount and then have a "choice" of what private health insurance to buy for themselves. This means that a hugely expensive system of private health insurace companies would stand between seniors and their health care providers rather than a single source of direct payments from the government through Medicare. The latter is much more efficient use of health care dollars than the voucher system. What Ryan wants to do is have government fund private companies because he ideologically doesn't believe that government can do anything efficiently.

Also, every study of the voucher plan finds that the voucher will soon not cover all the health care costs of seniors. As health care costs increase, seniors will have to pay the difference between these costs and the voucher they receive. And this amount will grow each year so that eventually many, many seniors will not be able to afford their health care. We will slowly move toward the situation where seniors are literally dying due to inability to afford health care, the reason Medicare was established in the first place in the Great Society legislation of the 1960s. But this is how Ryan's plan seeks to save money for Medicare, by expecting seniors to pay more and more for their health care. If pastors want to tell the truth about the Ryan plan about Medicare they will have to tell them that the Ryan plan will substantially increase their health care costs. Ryan wants to kill Medicare in this way. He is lying when he and now Romney claim that they want to save it. The only reason Ryan and Romney are now saying they want to save Medicare is because the program is so popular and so good for seniors. People that really want to promote life should not support a plan that will result in widespread death of elderly people in our society.

The primary change in the plan proposed with Wyden has to do with how the voucher is calculated; it would be based on a complicated formula equal to the second lowest cost among the private plans each year. This is called "premium support". Seniors could buy more expensive plans beyond the voucher with their own money if they have it. Let me say that even trying to read carefully how this plan would work leads into such terrible complexities that it is very difficult to understand and one can imagine the administrative nightmares of trying to keep all this straight, let alone the confusion of individual seniors who are expected to learn about all this and try to make decisions for themselves. Now, Medicare is a direct payment program easily understood; the administrative costs of Medicare are way below the costs associated with vast private health insurance through multiple companies in different states. The claim that seniors want the "choices" among health care insurance carriers is a false claim, I believe. They want choices among providers, not who pays for it. To claim health insurance is like buying a can of soup at the grocery store is ridiculous. Most seniors would be completely confused by the Ryan system; it would only require a whole new industry of health insurance brokers who themselves would take more out of the health care dollar.

In the second Ryan plan it is possible for seniors to sign up for Medicare as it is and so Ryan can claim that he doesn't want to destroy it. But immense costs would be associated with setting up this big system of multiple insurance carriers and since conservatives are ideologically opposed to Medicare if they are the ones creating the program it will not be long before Medicare, as a direct payment program, is gone.

Because Medicare is so popular Republicans must say they support it. They literally cannot win elections if their real views were known. Ryan has in his recent stump speech said that he welcomes the argument about Medicare because he can win it. But I have noticed when he says this he does not then explain his Medicare program, he doesn't talk about the vouchers, he just says generally he wants to provide choices to seniors, the details are left out. He likes to emphasize that his proposals will not apply to people over 55 years old, only younger folks. Again, that is because Medicare as it is now is so popular for seniors. But this is a very strange argument and an extremely divisive one, creating a two-tier health system based on age, one very popular which really helps seniors, and one which will became increasingly costly for younger folks as they age.

But Ryan believes that competition among health care insurance providers will reduce costs, that a "market" for health insurance will automatically lead to reductions in the cost of health care. This is another strange concept which can only be argued by free market ideologues. The fact is that costs of health care are generated by the providers, not the insurers. We already have a "free market" among providers, the doctors and hospitals that actually provide the services. Most of these are private companies or non-profit organizations. Costs have been going up because of the general increase of medical expenses in the delivery system, not the insurance system. To expect changes in the insurance system to save money for the taxpayer for health care is a strange idea. What needs to happen is adjustment to the costs of medical care itself.

And here is where we have to understand clearly that medical services are not a sphere of activity amenable to free market competition. If I have a heart attack, I need a hospital right now, I am in no condition to start negotiating for the best price. Health care prices are going up because the demand for "life" is completely open-ended. All of use want the best of whatever health care service is possible for our family members, there is no limit. But, of course, there must be limits, none of us will live forever, none of us deserve to command inordinate resources for small benefits. We as a society must find ways to make the decisions necessary about who receives what level of health care; this is being demanded by the vast increase in human knowledge through science and health care technology.

And here is where, in general, the conservative movement in Tea Party organizations and right wing religion and the Republican Party have been doing a huge disservice to society by acting in highly irresponsible ways. They have engaged in political sloganeering about the "rationing" of health care and attacking the Obama healthcare bill as promoting "death panels". The Obama health care plan establishes an independent board to carefully monitor costs for various services and make decisions about levels and types of services to be provided based on best practices around the country. This would help determine how to gain the most possible benefit for citizens of health care dollars. But this board is attacked by the right wing as a death panel. a terrible government agency, a threat to the future of the country. But what do they offer in place of this, faith in a totally abstract and theoretical "free market" based on choices of health care consumers.

Now, I do not reject the role of the free market in the economic realm. But the free market can only function within a larger cultural and political context of law. And health care if not an arena that can be left to consumer choice alone. Consumers do not know and cannot know the wealth of options available in health care, that is why we have professionals dedicated to the discovery of and use of health care knowledge and technology. The doctor-patient relation is a deeply complicated one. To create the best possible systems for the greatest number of people requires a careful, rational, deliberative process taking into account the most important values of human life, including the political process by which decisions are made in a democracy. It is the democratic process that must be the arena of making health care decisions as well as the free market.

But the Republican Party is right now engaged in deliberate irrationality related to health care in how they are speaking about this issue. Paul Ryan and Mitt Romney have both said recently that Obama has "stolen" 716 billion dollars from Medicare and given it to "Obamacare." They are saying that Obama is stealing money from seniors and "giving" it to the supposedly undeserving persons who will benefit from the expanded health care provisions of the Obama health care plan. This type of nasty rhetoric is related to how Republicans speak of "welfare", that it is stealing from those who work to give money to those who don't work. This type of talk against the welfare state has been used especially since Ronald Reagan attacked welfare queens, which includes an implication of racial prejudice. All of this is "irrational", an appeal to the worst stereotypes and emotional orientations of people for the purpose of getting elected.

The fact is that even Ryan in his health plan transfers the $716 from Medicare so that he is engaging in an open and obvious lie on this matter. He knows that Obama plan does not take $716 from actual benefits to seniors but that this money reflects changes in payments to providers and how the whole system functions, and that the Obama health care plan itself actually saves seniors substantial amounts by closing the doughnut hole in prescription benefits. In fact, the level of lies being told by Ryan and Romney is simply astounding, as anyone who is seriously involved in health care policy planning is aware. The only way they can get by with this is that the whole issue is extremely complex and they must be relying on their assumption that most people simply will not believe that they would lie so completely about such an important thing. Pastors need the courage to tell the truth to the seniors of their congregations not only for their benefit but for the sake of all those who need the highest quality of health care now and in the future. We are talking here about human life and healing for all God's people.

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Date Added: 9/1/2012 Date Revised: 9/1/2012 7:20:31 PM

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