What’s wrong with vouchers for Medicare for American’s under the age of 55. Maybe nothing. Maybe a lot. We are hearing that everyone would be handed a voucher that would pay for the second most expensive Advantage Plan (offered by private insurers.) We just had a system that depended on private insurers. It did not cover people with a “pre-existing condition” (that’s pretty vague, a pimple could be a pre-existing condition), or people who needed expensive long term care, or people who were too poor to buy insurance, or people who were unemployed. Eventually insurers started to place “lifetime caps” on patients who were too risky and pricey to insure. People were turned into things, like houses, trucks, cars; or disasters like fires and floods. Since private insurance companies must make a profit, they will always (and should always) try to minimize risk. How do you minimize risk in the case of human health? You make crazy rules that are more and more restrictive like rules about what we can’t do if we want to be covered (i.e. can’t smoke, can’t eat sugar, can’t eat fat, can’t gain weight, can’t drink soda) – and where will that end?
The voucher plan didn’t originally include a public option, but I hear it does now. With the newest incarnation of the plan if you wish you can keep your government Medicare insurance. Critics of this plan suggest that this is where you can expect to find everyone who can’t meet the requirements of the private health insurers. This will not make the public option look very appealing to those who are essentially healthy seniors and they will stay away from it in droves, putting private insurers right back in their very powerful and profitable driver’s seat where senior health care is concerned, and will give them, once again, a monopoly on the health care business in the U.S.
I am not against business. I am not even against profits, although I am opposed to gouging. I just can’t remind everyone enough about how long it took us to learn that unregulated capitalism, while supremely prosperous for an individual who is successful in business, will always have a tendency to abuse workers in order to buck up profits. There is no moral imperative in captialism, only the motive to turn a profit. I also am not saying that that are not moral capitalists – there are, but the practice of capitalism does not require that the Golden Rule be applied.
Interestingly enough, Gail Collins, writing on the opinion page in the New York Times, reminds us that the real loser in the Ryan plan is Medicaid, which will change beyond recognition. In the interests of smaller federal government Ryan suggests that the federal government give “block” grants to states for Medicaid and that states then devise their own Medicaid programs. Many people think this would be OK because they believe that only poor people use Medicaid. However, this is not the case. When seniors need long term care, nursing home care, care for serious or final conditions they are switched from Medicare to Medicaid. This means that any one of us could be subject to the whims of our own state’s government when our health is likely to take all the fight out of us and leave us as possible victims. Right now states are experiencing less flexibility in dealing with their financial issues than we find available at the federal level because they can’t print money. If you hand them a block of money without a lot of regulations for how it can be spent, would you like them to have control over your health care, right when you are most frightened and sick?
There is much to consider in this decision. Everyone agrees that we must do something but just because Paul Ryan has come up with a ready-made plan does not mean that it is the right plan for Americans. It will put us not just back where we started, but we would be in worse shape than previously if you add Medicaid into the picture. We have a little time to look for other options. I always wanted an all public option, but I am coming to believe that right now this would leave too many people unemployed to be an appropriate choice. In spite of the fact that Republicans see Obamacare as anathema, Obama still left the private insurance companies with a big role in our health care. Obamacare seems bipartisan in that it is a plan that requires that all parties compromise their health care views, and in that it tries to walk a middle line between public and private.