Paul Ryan’s radical plan to cut the deficit by gutting Medicare and Medicaid in the future has two fatal flaws that he does not address. Indeed, he ignores them entirely. First, Ryan wants to turn Medicaid into a block grant to states, a sum that would not account for increases in costs or enrollment, nor the fact that much of Medicaid pays for nursing home care. Second, he wants to change Medicare for those under the age of 55, giving those people a voucher to spend in the private insurance market.
The main justification for the original passage of Medicare was the fact that persons 65 and older were frozen out of the health insurance market because insurance companies felt that they were too great a risk to get sick. Ryan’s stupid plan to give the elderly a voucher, plus the insistence of him and his fellow Republicans that the Affordable Care Act of 2010 (the only firewall now stopping insurance companies from denying coverage because of pre-existing conditions), is a direct attack on all Americans under the age of 55, in effect telling them they are on their own, health-wise, the minute they retire.
As for Medicaid, it’s not simply a program to provide health care for some poor families. In 2009 Medicaid accounted for 43% of all long-term care spending, including nursing homes and home health care for the elderly.To qualify for Medicaid assistance in most states, the elderly cannot have assets worth more that $2,000 per person, $3,000 per couple. So, the typical nursing home Medicaid recipient has already spent down all personal assets. Additionally, whatever Social Security monthly income that person has goes to make partial payment for the nursing home cost, which can be $72,000 per year or more.
Ryan wants to cut the deficit (his “plan” doesn’t balance the budget) by attacking the poor and elderly sick Americans. He prefers that to raising taxes on millionaires or looking into the tax preferences that allow corporations like General Electric to make billions in profits and pay no taxes to the U.S. government. If Ryan is serious about “saving” Medicare, I have a couple of suggestions:
1. Raise the Medicare monthly premium for wealthier retirees. Surely, people like me and my husband are able to pay twice what retirees who have annual incomes below, say, $50,000. That still would mean I would get my health insurance for less than $200 per month.
2. Gradually eliminate the government subsidy for Medicare Advantage health plans. The argument for implementing that program was that somehow the private insurance market could provide health care more cheaply than regular Medicare. Instead, these private, for-profit plans live on by suckling at the teat of government subsidy.
3. Leave the Affordable Health Care Act alone.
4. Aggressively promote increased nurse practitioners and physicians’ assistants, plus encourage states to provide Medicaid as managed care.
5. Provide increased federal assistance for home health care, as an alternative to nursing homes.