Friday, September 28, 2012

Giving Ryan undue credit for Wyden-Ryan

I had a faint expression of interest in response to a letter I sent the Times a week-plus ago, responding to Steven Rattner's call for some form of healthcare rationing. Frankly I can see now why they didn't run it, as I concerned myself with a tangential point, while several letters the Times did publish went for the heart of Rattner's argument (and are well worth reading). Still, mine had some political relevance, as it took Rattner to task for giving Ryan credit for cost control mechanisms he dropped from his 2013 budget.  Here it is:
To the Editor:

In prescribing tough medicine to contain costs in  the U.S. healthcare system, Steven Rattner gave Paul Ryan's Medicare reform plan scant credit for addressing costs.  But that little bit was  too much, in that it ignored changes in Mr. Ryan's latest iteration -- not to mention Mr. Romney's further gutting of its nominal cost controls.

Mr. Rattner notes that the Ryan plan, which establishes an exchange of competing plans alongside traditional Medicare, imposes an annual cap in government spending on Medicare. If the spending cap is breached, he complains, "Mr Ryan blithely says, "Congress would be required to intervene" -- a sentence he regards as toothless.

But the plan laid out in Mr. Ryan's 2013 budget does not say that. That sentence appears in a white paper that Mr. Ryan co-authored with Senator Ron Wyden, D-Oregon, released in December 2011.  The "required" intervention looks like a place-marker for the role played, in the Affordable Care Act, by the Independent Payment Advisory Board (IPAB), which is required to present Congress with a package of savings when costs exceed the cap. Congress must either accept the package as a whole or pass its own alternative offering equivalent savings.

IPAB has become a Republican whipping boy, the final locus of "death panel" paranoia. The Ryan-Wyden plan talks around it. Ryan's 2013 budget omits the mention of its function -- the required Congressional intervention -- and repeatedly bashes IPAB as "bureaucrat control."

In any case, the Romney campaign announced recently that its Medicare reform "plan" would not impose any annual spending cap.

More on the differences between the Wyden-Ryan white paper and the Medicare reform plan in Ryan's 2013 budget here.

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