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Author Topic: Romney picks Paul Ryan as his running mate **official thread**  (Read 9143 times)
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« Reply #225 on: August 11, 2012, 09:23:18 pm »
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Marston, let me be more blunt. Under Obamacare regulations medical services are going to be rationed to death as it were. The basket will shrink. There is no escape.

Having said the above, it would be interesting to see what folks think the cost ramp up for Obamacare will be over time, both per its official numbers (which have lost most if not all of their credibility), and what outside analysts say. Is it more than 3%? 

Torie, medical services are already rationed via the ability to pay for those services. The Ryan-Wyden monstrosity simply exacerbates this for Medicare beneficiaries by gradually pricing them out of any semblance of a comprehensive care plan. In sum, they're taking out the 'guarantee' out of the Medicare guarantee.

Under the current status quo, the guarrantee itself as presently constituted no longer exists as a going concern in the future. That is why Wyden and Rivlin and other Democrats have embraced some form of premium support system.

I don't think anybody is advocating the status quo. The simple fact of the matter is that Medicare reform cannot be done without comprehensive systematic reform. Something must be done to address the over-utilization of health services in this country. Yes, some form of rationing will have to exist, regardless of the system in place - as it should. Also, the abhorrently high administrative costs associated with health insurance (which ironically range from 5-20% in the private health plans Ryan advocates throwing everyone in.) needs to be addressed. Medicare's administrative costs are only roughly about 2%, btw. The lack of focus on preventive medicine/care, the large uninsured population that waits to obtain care until their condition becomes acute and the fact that the U.S. Congress is PHrMa's whipping boy require a cure, as well. The list goes on and on, sadly.

Ryan is just attempting to reduce federal liability, not solve the actual problem. I thought it was obvious but perhaps not.   

That is because Ryan's plan is designed as a budget and not an all encompassing overhaul of healthcare. He doesn't chair the health, education and welfare committee. Tongue

Just like you don't think anyone is arguring for the status quo, well neither do I think that any one is seriously desiring to not address an overhaul of the Healthcare system, primarily focused on addressing those very rising costs you mention. In terms of real details this one is even more difficult to propose in an election year then a budget plan. The good thing is that with two "numbers guys" the chances are likely that both realize what the numbers are telling them have to be done and both Romney and Ryan have experience on the healthcare issue (one from expanding coverage, the other on the federal liability) to be able to tackle that problem. Romney does realize the problem to be sure, in his book he lemented that Romneycare didn't address the overal cost issue (expanding coverage is only a very small piece of solution pie here) and that most of which had to be addressed at the federal level.

Fair enough. I just doubt, given the Romney track-record of running away from anything healthcare related, except for promising to "...kill Obamacare dead on day one", that he'll seriously risk his political capital on healthcare reform given the disastrous effects it had on Obama, Pelosi, Reid and Co. during the 2010 midterms.  

I am a person who beleives that success is the road to recovery for the GOP, even if not immediate, but instead long term recognisable successes on important issues will lead people to embrace it long term even if they reject it in the intermediate period. The ideological battles serve a purpose in that they can help effect the process by putting the necessary people in place. At the same time they can be a detriment. In that sense Romney is indeed playing the right and that is going to send shockwaves through most conservatives on here who are more caught up in the platitudes and a dial position regarding government then actually fixing problems with conservative solutions. Most of the correct solutions have their origins on the right and that is why I adhere to them more then not, but I actually want to achieve those things rather than being a loud minority who never gets taken seriously. I would assume from what I know of Mittens that he views these things the same way.

Technocracy has to live within the Democracy and since no system is better the technocrats have work within it to get in a place to fix the problems. Romney probably will be a one term President, if elected. I am fairly certain that Obama's defeat in 2012 would be followed by a President Clinton or Cuomo in 2016. Because in the fine American tradition of say President George H.W. Bush who honed decades of experience in Washington and statemen like qualities to ensure a dramatic transition in the geopolitical world occured as quietly and peacefully as possible, only to be rewarded with the boot in 1992, Romney will probably face the same fate if and indeed he is elected.

What else is a President Romney going to do? He won't be FDR or Reagan, so he either does these things in his likely one term or he doesn't. His fate will likely be the same. This is a man who has sought the Presidency for quite some time, I would think he wants it to do something postive other than to revel in holding the title of President for four years.
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« Reply #226 on: August 11, 2012, 11:05:59 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, or an idiot. Most likely all three.
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« Reply #227 on: August 11, 2012, 11:08:24 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, or an idiot. Most likely all three.
Most of your comments make me think your at least two of those three Wink.
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« Reply #228 on: August 11, 2012, 11:11:37 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, or an idiot. Most likely all three.
Most of your comments make me think your at least two of those three Wink.

Well I may be trolling a lot of the time since your right-wing friends get a taste of their own medicine, but I'm certainly not trolling on this. This pick is one in a long line of moronic things this campaign has done and they will come to regret it soon enough. Good luck selling a plan that 74% of seniors and 54% of conservatives disapprove of...
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« Reply #229 on: August 11, 2012, 11:19:46 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, an idiot, or the Republican presidential nominee. Most likely all four.

Fixed it! Grin
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« Reply #230 on: August 11, 2012, 11:21:38 pm »
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Politics aside, Myers and Ryan are awesome!

http://abcnews.go.com/Politics/OTUS/romney-paul-ryans-pick-vp-secret/story?id=16987693
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« Reply #231 on: August 11, 2012, 11:23:14 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, or an idiot. Most likely all three.
Most of your comments make me think your at least two of those three Wink.

Well I may be trolling a lot of the time since your right-wing friends get a taste of their own medicine, but I'm certainly not trolling on this. This pick is one in a long line of moronic things this campaign has done and they will come to regret it soon enough. Good luck selling a plan that 74% of seniors and 54% of conservatives disapprove of...
I would like to apologize to you, my post was needlessly rude, and I withdraw it. I misread it in a sarcastic, and frankly, trollish manner, when you clearly were just stating your opinion, which I should respectfully disagree with, not nastily disagree with.

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« Reply #232 on: August 11, 2012, 11:24:55 pm »
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Um...

Quote
Each night they kept the most sensitive documents -- including several years of tax returns from each of the finalists -- in a safe.

What a hypocrite.
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« Reply #233 on: August 11, 2012, 11:25:23 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, an idiot, or the Republican presidential nominee. Most likely all four.

Fixed it! Grin

I wouldn't go that far. For example, they'd probably be equally likely to be the Republican vice presidential nominee. So no way can they also be most likely the Republican presidential nominee.
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« Reply #234 on: August 11, 2012, 11:26:43 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, or an idiot. Most likely all three.
Most of your comments make me think your at least two of those three Wink.

Well I may be trolling a lot of the time since your right-wing friends get a taste of their own medicine, but I'm certainly not trolling on this. This pick is one in a long line of moronic things this campaign has done and they will come to regret it soon enough. Good luck selling a plan that 74% of seniors and 54% of conservatives disapprove of...
I would like to apologize to you, my post was needlessly rude, and I withdraw it. I misread it in a sarcastic, and frankly, trollish manner, when you clearly were just stating your opinion, which I should respectfully disagree with, not nastily disagree with.



No offense taken from you. Just sort of frustrated around here when some people (not you) just troll from dawn-to-dusk.
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« Reply #235 on: August 11, 2012, 11:27:13 pm »
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This pick is lunacy. Anyone who thinks otherwise is a hack, a troll, an idiot, or the Republican presidential nominee. Most likely all four.

Fixed it! Grin

I wouldn't go that far. For example, they'd probably be equally likely to be the Republican vice presidential nominee. So no way can they also be most likely the Republican presidential nominee.

If Ryan thinks he is such a good pick, he doesn't need to run for the House.
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« Reply #236 on: August 12, 2012, 12:26:47 am »

More details on the secrecy surrounding the pick here:

http://www.reuters.com/article/2012/08/12/us-usa-campaign-romney-idUSBRE87919120120812
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« Reply #237 on: August 12, 2012, 12:30:12 am »
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Found some interesting stuff comparing ACA and Ryan's health care proposals.

This CBO letter addressed to Pelosi about the Reconciliation version of ACA claims that, from 2010-2019, the ACA would reduce the federal budget deficit by $138 billion and by .5% of GDP after that.   A detail in the letter (p. 4, paragraph 2) forces me to partially but importantly correct something I wrote above, namely, beginning in 2020, ACA will cap employer-provided insurance tax deductions for high-premium plans by indexing them to the CPI, quite similar to the Ryan plan, and it is to this mechanism that the letter attributes much of the long-term federal savings of the plan.  Note that this cap would not apply to all premiums, specifically to premiums charged for senior defined-benefit plans and for persons earning an income below a certain percentage of the FPL.
http://www.cbo.gov/sites/default/files/cbofiles/attachments/hr4872_0.pdf

The CBO letter to Ryan, by comparison, begins its projections in 2022, when the provisions effecting health care expenditures would take effect, and stretches them out to 2050.  On page 15, the letter summarizes a rough comparison of federal Medicare and Medicaid spending under ACA, which would reach 7% of GDP by 2022 and 12% of GDP by 2050, to outlays under Ryan's plan, which would place those expenditures at 5.5% of GDP by 2022 and 5% of GDP by 2050.  The letter notes that the bulk of these savings would result from converting Medicaid to a state block-grant system, indexing all premium-support reimbursements to the CPI and changing retirement populations through these decades.
http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12128/04-05-ryan_letter.pdf

The chart found here compares a variety of plans, with current law under ACA in the first column and the Ryan plan (from his budget, not the one he constructed with Wyden, which is also compared) is in the last column.  One will notice that some of the details are similar, though ACA differs from the Ryan plan mainly in keeping Medicare as a defined-benefits plan, capping beneficiary liability for catastrophic care, relatively higher subsidization levels (see link immediately below as well), more regulatory agencies to identify cost-saving strategies, and
a higher cap on total Medicare spending.
http://www.kff.org/medicare/upload/8284.pdf

In terms of benefits available to people purchasing plans in state exchanges, this AEI post finds that, while both "Obamacare" and "Ryancare" suggest broadly similar competitive bidding processes for determining what kinds of plans the government will subsidize purchases of, the degree of ACA regulation will probably reimburse a larger percentage of the actuarial value of a private plans than the Ryan plan will.
http://www.aei-ideas.org/2012/03/competitive-bidding-ryancare-vs-obamacare/

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In any event, what we have in the case of both plans, as far as long-term cost projections are concerned, are very inexact numbers based on quite variant budgetary assumptions, so I'm still not sure how valuable the figures are when compared in the lens of the federal budget.  In terms of coverage, there are some details, on close analysis, that are surprisingly similar about ACA and the Ryan plan, including the incorporation of competitive bidding exchange schemes and some pretty sharply reduced premium support reimbursement rates in some overlapping cases.  There are still sharp differences in terms of program structure and regulatory frameworks.  But, after looking at all this, I think both plans do some "cost shifting" as described by Marston above, in the sense of having beneficiaries in a number of cases pay higher costs for their plans, though the causes for these rising costs in the cases of the respective plans will differ, with the extent of procedure and meds coverage wider in the aggregate under ACA.  But I don't see much hope for either to do a lot about health care cost inflation as a whole.
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« Reply #238 on: August 12, 2012, 01:05:17 am »
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Neither are or were designed to deal with the issue of health care costs, so that is not surprising. Indeed Obama made a unholy alliance with some of the biggest culprits responsible for the cost problem (namely pharma as well as others), in order to get the ACA past. Why deal with coverage and not costs at the same time? Well because it is much easier to give something to someone then it is to take it away and the gains from doing the former without the latter are emense. 2010 was, at least in the minds of Obama's people, a failure of the benefits to reach actualization to the extent that the people would recognize it and applaud him for it. Its one of the big reasons why I don't see any promise at all from Obama going forward, he is less than useless because as far as I can tell, it has been all about him and not about what needs to get done. The same can be said of Pelosi and Reid.
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« Reply #239 on: August 12, 2012, 03:02:49 am »
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One of my biggest problems with the Ryan plan is turning over Medicare to private insurance. As has been pointed out earlier their medical loss ratio is way higher than Medicare. So just by switching from traditional Medicare to private insurance leads to a waste of money, unless we cap the medical loss ratio at 5% of premiums. This is very much possible, and do believe that is how it is done in Switzerland, but considering the complaining from insurance companies about Obamacare capping it at 15-20%, I don't know if it is likely.

Then we have the capping of premium support with growth tied to the CPI. I think there were some changes with the version Wyden endorsed but I am still unclear whether the government would negotiate with insurance companies as to how much premium they can charge for a basket of goods and then increase the rate of increase in premium support if necessary. So if all the insurance companies decide they need to increase their premiums by more than CPI (which is inevitable unless we solve the healthcare inflation issue), would the premium support also increase by that much or will seniors have to pay the difference?
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« Reply #240 on: August 12, 2012, 06:12:53 am »
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Romney is running a bad campaign and Ryan was selected because he feels that he needs a "game changer" given the weakness (especially recently) in his poll numbers.  It is very unlikely that this Hail Mary pass will work.  Good luck to the National GOP in trying to convince the middle class and older people that Ryan's budgetary turd is actually filet mignon.
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« Reply #241 on: August 12, 2012, 06:30:54 am »
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The chart found here compares a variety of plans, with current law under ACA in the first column and the Ryan plan (from his budget, not the one he constructed with Wyden, which is also compared) is in the last column.  One will notice that some of the details are similar, though ACA differs from the Ryan plan mainly in keeping Medicare as a defined-benefits plan, capping beneficiary liability for catastrophic care, relatively higher subsidization levels (see link immediately below as well), more regulatory agencies to identify cost-saving strategies, and
a higher cap on total Medicare spending.
http://www.kff.org/medicare/upload/8284.pdf


What I find interesting in the chart is how all of the alternate plans use some form of defined contribution to replace the defined benefit of the existing system. This is the health insurance equivalent to what has been happening with pensions, first in the private sector and now in the public sector. A defined benefit carries a lot of actuarial risk, some of which can be mitigated with a defined contribution which caps the government's risk. In the chart the plans seem to use private insurers as the means of sharing risk with the government.

Based on past innovation in health care which drives up cost, that shared risk is probably what really saves the government money. However, innovation is difficult to quantify in projections like those of the CBO. To the extent that the next 40 years looks like the last 40 in terms of medical advances then I would speculate that the alternate plans would save money compared to the current system.
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« Reply #242 on: August 12, 2012, 08:20:56 am »
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I'm not entirely confident that medical innovation in the U.S. over the next 40 years will look as good as the last 40.  Maybe it will to some extent for pharma.  But, my gf is a neuroscientist working at a university lab in Canada now, after having received her Ph.D. and done her post-doc in the U.S., and she would say quite emphatically that one of the reasons the U.S. is losing lots of top scientists is because of how much we've hacked up NIH grant funding in the last several decades.  In the U.S., a grant application has to finish in the top 10% of submissions, and sometimes higher, to receive funding, while applicants for a CHIR from Canada have to finish in the top 18%.  The shrinking availability of grant money combined with the tight job market are driving lots of top scientists elsewhere, or prompting them to leave their fields completely,  If we're going to bank so much on innovation in the future, then being as stingy as we've become about research grants doesn't make much sense.  In that regard, I wonder how much the really big discretionary spending squeeze the Ryan plan maps out in the coming decades will leave for research funding.  But, anyway...

And, yeah, there is also the shift to contribution plans over defined benefit ones.  We're saving money by covering less and getting sicker, while the rest of the industrialized word saves money by doing the opposite, and they do so by having much more "draconian," as I'm sure many here would waste no time in putting it, cost control measures.  And so it goes.  
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« Reply #243 on: August 12, 2012, 09:55:56 am »
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Defined contribution plans are dangerous unless there is a cap on how much patients pay. How much co-pay can be charged by the insurance companies in Ryan's plan? Is there any cap on how much is spent by patients?
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« Reply #244 on: August 12, 2012, 10:20:23 am »
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Or alternatively, instead of raising premiums when costs go above GDP+1% (which is in the latest Ryan plan version), could the insurance company just raise co-pays?
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« Reply #245 on: August 12, 2012, 10:41:53 am »
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Defined contribution plans are dangerous unless there is a cap on how much patients pay. How much co-pay can be charged by the insurance companies in Ryan's plan? Is there any cap on how much is spent by patients?

Patients are buying private plans in everyone's framework, so the companies can do whatever they want with their co-pays, I would think.  The Ryan plan places no cap on possible out-of-pocket spending by patients.  The benchmark for reimbursement in Ryan's plan is either the second-least expensive plan offered by a state exchange or the FFS premium, whichever is cheaper.  If the patient buys a more expensive plan, the patient is responsible for the difference, and if they buy a less expensive plan, they are refunded the difference.  The level of subsidization depends on one's health status and geographical location and is adjusted over time by being indexed to the CPI.  The Ryan plan makes an attempt to adjust for risk pools by penalizing plans that cover lots of low-risk seniors and giving tax incentive payments to plans with coverage of higher-risk populations.  Low income beneficiaries who are not duel eligible for Medicare and Medicaid (the latter to be decided by each state) would have a medical savings account opened on their behalf with something deposited in it to help them cover out-of-pocket expenses, premiums and co-pays, but I don't know how all this is figured.  All beneficiaries pay more for their premiums if the growth in Medicare spending exceeds GDP + .5% (odds, anyone?).  The CBO told Ryan in their letter that they expected, if all his budgetary proposals were implemented and all targets met, that some seniors could see their out-of-pocket contributions toward premiums rise from 25% in 2022 to 68% in 2030.  So, in some ways, I see the Ryan plan as an exercise as "how low can you go" in government premium-support.  Good for federal budget outlays, of course, but for patients, not so much.    
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« Reply #246 on: August 12, 2012, 11:01:42 am »
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Yeah, it looks like there are very few safeguards in preventing people slipping through the cracks. It's not even a basic safety net if that happens. Moreover it adds another layer of complexity to our healthcare system. What I found most amusing is the plan to try and ensure those who get lower risk seniors get punished and those with a higher risk pool get helped. I have an even better idea to solve that "problem", just have one damn pool! Like it is currently....

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« Reply #247 on: August 12, 2012, 12:03:38 pm »
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Defined contribution plans are dangerous unless there is a cap on how much patients pay. How much co-pay can be charged by the insurance companies in Ryan's plan? Is there any cap on how much is spent by patients?

Patients are buying private plans in everyone's framework, so the companies can do whatever they want with their co-pays, I would think.  The Ryan plan places no cap on possible out-of-pocket spending by patients.  The benchmark for reimbursement in Ryan's plan is either the second-least expensive plan offered by a state exchange or the FFS premium, whichever is cheaper.  If the patient buys a more expensive plan, the patient is responsible for the difference, and if they buy a less expensive plan, they are refunded the difference.  The level of subsidization depends on one's health status and geographical location and is adjusted over time by being indexed to the CPI.  The Ryan plan makes an attempt to adjust for risk pools by penalizing plans that cover lots of low-risk seniors and giving tax incentive payments to plans with coverage of higher-risk populations.  Low income beneficiaries who are not duel eligible for Medicare and Medicaid (the latter to be decided by each state) would have a medical savings account opened on their behalf with something deposited in it to help them cover out-of-pocket expenses, premiums and co-pays, but I don't know how all this is figured.  All beneficiaries pay more for their premiums if the growth in Medicare spending exceeds GDP + .5% (odds, anyone?).  The CBO told Ryan in their letter that they expected, if all his budgetary proposals were implemented and all targets met, that some seniors could see their out-of-pocket contributions toward premiums rise from 25% in 2022 to 68% in 2030.  So, in some ways, I see the Ryan plan as an exercise as "how low can you go" in government premium-support.  Good for federal budget outlays, of course, but for patients, not so much.    
It's hard not to see all of this as an attempt to contain health care costs by having some people consume a lot less health care, with the people in question being poor, old, and sick. That's pretty blunt, but it does seem to be the net result of the plan.
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« Reply #248 on: August 12, 2012, 02:17:11 pm »
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Here is more to throw on the pile. It seems that if the defined contribution amounts are insufficient under the Ryan plan to cover a basic benefits package, then the amounts go up based on a bidding process. If so, assuming the insurance covers avoiding granny going over a cliff, she won't be. But I see anvi has already noted that aspect above. I have not read the entire article, so it will be interesting to see if the conservative author addresses the .5% cap and soak plank that anvi mentioned. I guess in the end, you either let medical subsidies eat up more of the GDP ad infinitum, or you force folks to pay more, or you ration more. The rest is noise. Probably the most palatable way out of the box is for more "Draconian" means testing, so if you have the means, you are going to pay more - a lot more, no matter how old you are. But you probably can't say that, and carry Naples, Florida. So we aren't going there for awhile.

Putting aside the soak the rich option, in any plan of course, just what is covered and what is not, is going to be an explosive political issue, for a population, most of which, are used to getting it all, and getting it now. I see American politics being caustic and acrimonious for a long time to come, in a nation that seems to be becoming a more zero sum nation.
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« Reply #249 on: August 12, 2012, 02:54:00 pm »
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The real issue is to figure out how to get our health care spending down to the levels seen in the rest of the OECD. There is no one single answer for that. Our healthcare system is too fragmented, doctors are paid for service not outcomes and they conduct too many tests to cover their butts due to our tort laws. We also like to suck up to corporations due to our wonderful campaign financing system, and so Medicare cannot negotiate drug prices aggressively like other nations do. And there are more problems I am sure, but these are some I can see.
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