Even so, there will be fewer federal dollars available for senior medical care, relative to trend, under both approaches. One of two things can happen. Either seniors will supplement the reduced federal payment by paying more out of their own pockets, or providers will have to provide lower-cost care. This latter possibility will certainly mean fewer amenities (e.g., no private rooms, fewer inpatient menu choices, etc.) and will also probably mean a lower quality of care.
To prevent this unpleasant outcome, both plans need three things neither plan has. First, they need a way for young people to save, tax free, during their working years so they have funds set aside to supplement the federal government's increasingly smaller contribution. Second, both plans need to start freeing the Medicare system immediately — encouraging doctors and hospitals to repackage and reprice their services so that care can be provided more efficiently. Finally, both need to do something Capitol Hill has resolutely resisted year after year: pass the kind of reforms that will reduce health care spending overall.
On the sociology of reform, what can I say? Columns by Alan Blinder, Paul Krugman, Ezra Klein, Uwe Reinhardt and others excoriate Ryan and his colleagues because the proposed Medicare “premium-support credits” would be indexed to consumer inflation, not health costs. Yet the ObamaCare Medicare plan also has spending growing at a rate well below overall health care costs and these same columnists have uttered not a peep of protest about that in the year since its passage. On the other side are columnists who can offer only praise for Ryan.
It’s hard to escape the conclusion that quite a few op-ed writers and bloggers are more concerned with doing the bidding of the two parties rather than finding workable solutions to difficult problems. Gail Wilensky and Timothy Jost are two of the very few commentators with a balanced approach.
Health reform ideas are good or bad in their own right. They do not become more or less desirable because of the people or political parties who support or oppose them.