Killing Us Quickly - Ryan's Medicare Proposal

Michael Collins

We're not worth having around after 65, says Michael Collins. Why else would they want to kill us off?

House Budget Committee Chairman Paul Ryan (R-WI) proposed a Medicare plan that combines Social Darwinism and a bailout for health insurance carriers, even larger than the one provided by the president's health care reform legislation.

The specific features of the program are less important than the overall effect. In summary, Ryan proposes a plan that will starve most of those sixty-five and older of health care. Here are the numbers, based on Congressional Budget Office projections and elaborated by Dean Baker and David Rosnick (in 2011 dollars) (Center for Economic and Policy Research, April 2011)


The Republican plan privatizes Medicare by 2022. Seniors will choose their health insurance from corporate health insurance companies. The government will make a lump sum payment ($6,097) for this purchase. Seniors will then make a beneficiary payment on their own and take responsibility for other provider payments. The beneficiary payment will represent an increasing portion of median income from 2022 through 2050. In addition, there are other provider payments estimated, like co-pays. I added a fifth column, total senior payments, beneficiary plus other payments.

Are They Kidding?

Seniors struggle now to meet their expenses, trading off essentials like medicine, winter heating costs, and other fundamentals. Where are they going to come up with the total senior payments, the fifth column of the chart? Many won't have the money.

Here's another look at the numbers, the beneficiary payments (not including other provider payments) as a percent of income by income status within the overall universe of those entering the system at 65. Almost half of income goes to those at the 40th percentile on the income over a third for those in the middle. Where will they get the money? They don't have it now. Are we looking at a resurgence of the economy? Will seniors continue working to make these payments, slaves to corporate health insurance providers? Where will they find the jobs to make these payments?


Fixin' to Die Blues

What happens when you can't afford health insurance? You can't afford health care. What happens when you can't afford health care and you get sick? It seems Chairman Ryan has taken a page or two from Søren Kierkegaard's nineteenth century classic, The Sickness Unto Death. There will be more illnesses among seniors. These illnesses will not be treated and compound suffering until the uncared for seniors will die.

Wasn't Ryan among the group that worried about death panels in the Obama health care reform package? It doesn't matter to the Fox News constituency. Whatever works at the time. Now Ryan needs to balance the budget, he thinks. How would you do that? Let's see. Deny health care to the most vulnerable sector of the population, make them sick, and when they die, you've to further savings.

The Plan has no Credibility on its Face

There is so much wrong with the Ryan plan, there should be a law against it. Here are just a few points:

The plan trades one centralized plan administrator, Medicare, into as many bureaucratic administrators as there are health insurance companies. Medicare's administrative costs are below 3% of total expenditures. Health insurance companies have three times the administrative costs plus profits. That means even deeper cuts to health care since corporate health insurance administrative costs approach 21% total expenditures.

The Ryan plan relies on hallucinogenic numbers. Take the CBO projections for government, beneficiary costs, and beneficiary other expenses for 2022 and 2030. They are $20,017 and $24,587 respectively. Now call up your insurance company and see what the health insurance cost is for a sixty-five year old? These are fully loaded costs which include premiums, deductibles, and out of pocket expenses. Congratulations if you find one today for the 2030 figure of $24,587. The numbers in the Ryan plan come straight from Fantasy Island.

The Perfecta

Ryan's Medicare plan is the perfecta for the ruling class.

It enshrines the long ago discredited Social Darwinism theory. Popular among the elite of the late 19th century, the theory argues that, "the strongest or fittest should survive and flourish in society, while the weak and unfit should be allowed to die." That's exactly the way the world looks to Paul Ryan and his patrons. Economic outcome determines existential reality. If you can't cut it, you left behind to die. But first you have to suffer a while.

The second winner for the ruling elite comes in the form of a further bailout for health insurance carriers. These are the folks who Just say no on a regular basis and have trouble processing a simple claim. President Obama's health care plan bailed out these companies by ignoring the compelling rationale for a single payer system. That wasn't enough for the elite. The Ryan plan puts them back in business with full membership in the ultimate death panel, privatized Medicare. Their profits will be endless.

A Rational Approach

A solution to the rising costs of health care is available. It requires a change in behavior on the part of all members of Congress and a rational look at helping citizens take care of their health care problems.

The behavior change is straightforward. Members of Congress and the executive branch have to actually think then translate those thoughts into words. The thinking process starts with intellectual honesty. You don't take one part of the budget, Medicare, and beat the program senseless in order to address a much larger budget.

Just a shred of intellectual honesty would move those in charge to all areas of the budget. How about a military budget that assures the nation's defense without the requirement for world domination? Lets end the current wars overseas and pledge no future preemptive invasions like Iraq.

Stop balancing the budget by forcing seniors to suffer and die needlessly.

That eruption of rational behavior and discussion would lead to some useful analysis of the soaring costs of health care.

One area not examined or discussed concerns the concentration of health care costs. The research is already there from the Agency for Healthcare Research and Policy. Nearly fifty percent of health care costs occur within just 5% of the population. The higher the age, through the 65-79 year old group (see graph below), the higher the concentration of expenditures on health care for this group.


The incumbent geniuses look at this data and produce a plan that eliminates the offending age group with extreme prejudice. Their opponents, just six degrees away on the political spectrum, are silent on the very real cost savings opportunity.

A rational approach dictates that we look at the health conditions of the 5% who use 50% of health care dollars with the goal of ameliorating or eliminating them. Diabetes, asthma, heart disease represent a large share of this 5% groups health care costs. Why not target preventative and research efforts to substantially reduce the health problems of these citizens and, as a result, reduce the costs. Cutting the 50% costs for 5% of the population to 5% is a reasonable target to start.

Putting citizens first is a foreign concept to our rulers, all of them. Taking care of people first to achieve a budget benefit, a huge budget benefit, is apparently beyond their pay grade. That makes sense when you consider who is paying them, the unreformed Social Darwinists who forget that they win every game because they write the rules, select the umpires, and control the news.


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Also see If You Want to Decrease the Budget Deficit, Decrease Health Care Costs



see my post

Bring Down Health Care Costs.

It is prescription drugs that are 13% of the Medicare budget, so when Obama pointed out reducing costs by negotiating better prices, I was thrilled (which is rare these days from team Obama) because that's a no-brainer. I'd further suggest the FDA start doing their jobs. How many of these new "still under patent protection" drugs which cost over $3 a pill end up killing people or not working any better than one which is generic, or worse?

As far as this 5%, I think something else is wrong here. In Europe and Japan there are all sorts of "bad habits" yet they don't have these problems to this degree. i.e. they eat tons of sugar, they smoke, they don't exercise....and they eat, in Europe anyway, bacon fat and duck fat.

In terms of overall health I smell a rat in the U.S. that might possibly be linked to foods allowed into the U.S. and promoted that these countries ban.

Finns, as an example, drink like fishes, yet they are in better health (and they smoke).

In terms of cost reduction, I think they have to look at the supply and not the patient. For example, did you notice knee replacement is way above average in the U.S.? Do Americans knees go out more? I doubt it, more I suspect that's highly profitable and some patients are getting a "diagnosis" based on marketing and PR "seminars to spot the signs" of a knee that needs "to be replaced".

So, I think we have MDs acting more like CFOs on where the profits are, medical supplies to drug companies giving "seminars" to hospitals and doctors to "Spot the signs" so they "diagnose" the problem as somehow needing their product, versus real health care.

Seriously, if one takes statistics on say Medicare and then let's just look at knee replacements paid for by Medicare vs. the general population and then say the world.
Normalize for age or break down the statistics per age bracket....

I could not be surprised at all to see magically people who are poor and having some sort of disability, not related to their knees, needing knee replacements in comparison to people who are not poor, yet do have a disability.

i.e. someone is chopping out people's knees to make money.

I think there are a host of examples like this because of the for profit system.

I also think we have lobbyists in our food supply, manufacturing good knows what that makes people get fat and sick much easier than other countries.

We have pharmacies these days selling your detailed prescription data to cable companies so they may do "targeted marketing"....

so I'm sure pharmacies are concerned about drug interactions, nope, that shows no respect for their customer and major privacy violations.

I think the plan goes like

I think the plan goes like this. Raise all these costs thru the roof, eliminate SS too (raise retirement age and cut the benefit). Then, pass a few laws that re-institute debtors prisons. Then pass a few more laws that say when you die, your debts are passed on to your children and that your estate has to pay all of your debts first, especially ones owed to banks. So that when you die, and have racked up tremendous health care bills that had tried to keep u alive, then all those bills stick around and your children and grandchildren (heard that phrase before, could it be related?) get the joy of working to pay off all those bills. Or maybe they have to sell that small business that's been in the family for 4 generations. Or maybe they sell dad's favorite guitar that was given to him by his mother when he was 14. Either way, somebody gets to pay all those debts and it's not gonna be the money party that suffers.

The Money Party never suffers

The save that for us. Clearly, debt is the strategy, as you note, and it's been put in place for a while. the bankruptcy reform legislation of a few years ago exempted medical related debt. How clever of them.

Social Security will require a hat trick, though. They need the payroll taxes rolling in to subsidize their favorite giveaways. Wonder ho they will do that? It's dead, no benefits, but you have to keep paying the tax;) That would be the ultimate beat down.

The Democrats should have howled from the roof tops in unison, non stop, when this was released. It's their time right? Not so. They bagged out on the Social Security and Medicare issues in 2010, not much of focus, if any real focus on this at all. Why? Because they don't care. They'll just play the dutiful role of sparing partner and take the dive when they're told. FDR, Truman, and JFK would be solid at DEFCON 4 by now. But nary a peep (in a serious and coordinated way) from the Dems.

Even the Free Marketers think Ryan's plan is a loser

Paul Ryan's Medicare 'reform' hocus pocus


The Wisconsin congressman's proposed Medicare fix sure sounds wonderful, but it would leave the average Medicare recipient befuddled at best and on a path toward financial catastrophe at worst. 

By Allan Sloan, senior editor at large

When the Wall Street Journal makes more sense

and calls bullshit on politicians, you know it's bad. They have been, good for them, but I look at it more they know the nation isn't going to make money if the people don't save money. In other words society becomes so top heavy it implodes upon itself.

a rational approach, like common sense,

is among those rarest of unitedstatesian activities. fortunately, the killerpublican debate will so confuse voters that they'll demand the status quo and put the debate to rest until the next election. on second thought, it's a jobs proposal. think of all the telemarketing jobs that will open to solicit your health insurance business?

Hey folks...

It is NOT that Ryan hates geezers, it *IS* that he likes campaign bribes from the insurance industry. $125 million last year to both parties kept single-payer off the table.

FOLLOW THE MONEY! Don't let them distract you with non-related issues. It is now and always has been cash bribes. They work!!!

Jack Lohman