In an opinion piece for the Wall Street Journal, Drew Altman, president of the Kaiser Family Foundation discusses the possible consequences of House Speaker Paul Ryan choosing not to run for president. Altman makes the case that Ryan is likely to rally Republicans around further privatizing Medicare and Medicaid. And, it’s a compelling argument.
Republicans have long been fighting to privatize Medicare and Medicaid in ways that would cap federal spending on these programs and shift more costs onto older adults and people with disabilities. These programs now cover 121 million people and represent 23 percent of federal budget. And, that will only grow as the population ages.
Altman notes that Republicans have already come a long way in privatizing Medicare and Medicaid. Today, nearly one in three people with Medicare are enrolled in a Medicare Advantage plan. And, more than one in two are in a private Medicaid managed care plan.
To be clear, privatization not only is likely to shift more costs onto older adults and people with disabilities, but it also brings a lack of transparency to Medicare and Medicaid; commercial health plans are prone to claim that the bulk of their data is proprietary. Privatization also makes it harder for the federal government to drive large scale system change to improve health care value.
And, at least with Medicare, privatization has meant higher per capita health care costs. Commercial insurers offering Medicare Advantage plans have not been able to negotiate as good rates with providers as the Centers for Medicare and Medicaid Services and their administrative costs are far higher than the government’s.
In sum, Speaker Ryan will determine the nature of the Republican Medicare and Medicaid agendas, as well as whether Republicans will continue to try to repeal and replace the Affordable Care Act. But, so long as the President is a Democrat, Republicans should not be able to move their agenda. And, any attempts to undo traditional Medicare and impose higher costs on older adults could shift support of older adults away from Republicans.
Here’s more from Just Care:
- Four things to consider when choosing between traditional Medicare and a Medicare Advantage plan
- Medicare ratings of Medicare Advantage plans a farce
- Why does health care cost so much? Video
- Medicare is more efficient than private insurance
And, this, Medicare and Commercial Health Insurance: The Fundamental Difference, which I authored with Theodore Marmor, on the Health Affairs Blog