Or to not fall...

On Friday morning, I caught a chunk of the Dianne Rehm show, and was a bit disappointed at some things missed. It was talking about the Ryan plan, particularly with respect to Medicare, and I felt like a few things were missed.

The first was that one of her guests stated that the Ryan plan would have no effect on seniors 55 or older. This is fundamentally untrue, even if that's what the text of the bill says. The reason is that it would quickly reduce the number of seniors in the plan, reducing the bargaining power of the plan. So the expenses would go up, though I suppose there's some question as to who would pay the additional expenses. But there's also the matter that some doctors would decide to stop taking medicare as well, when it doesn't cover as many people. If your doctor decides to drop out of the plan, you are certainly affected.

And the fundamental matter that this brings up is that any plan dealing with medicare (and medicaid, for that matter) that doesn't deal with slowing down the rate of increase of costs is simply pie-in-the-sky thinking. The Ryan plan is actually worse than useless from this point of view, because a) all increases are pushed onto individual seniors and b) the rate of increase will actually go UP, because it will leave seniors (as one of the guests mentioned) negotiating for themselves rather than negotiating as a group (ie: medicare/medicaid doing the negotiating).

Another guest mentioned, a little earlier in the show, that the politicians are just doing what the voters want, and muddling about because of it, but that's not true either. If it were, the medicare drug plan that the Bush administration advanced would have allowed medicare to negotiate drug costs. There might be one percent of the population that thought that it was a good idea to forbid that. Maybe. This would save medicare/medicaid at least a third on drug costs. This would be an easy way to get started on reducing the rising costs of health care.

Another easy way would be to stop the drug companies from advertising directly to consumers. I don't know how much difference that would make, but I guarantee that it would help.

I was happy that they mentioned Vermont's single-payer experiment; in five years, as long as the doctors don't leave en masse, the rest of the country will be amazed at how well that works. That's another way to attack the rate of increase.

The public option would have been another way; not quite as good, but still effective.

Hmm... this actually just gave me an idea, too. Single-payer (even if not covering everyone) would actually open up a way for the government to increase the number of General Practitioners (GPs) in the country (another way to cut down on the rate of increase). They could do it the same way the military does: significantly defray costs of med school in return for X number of years working within the single-payer system. But defray them significantly more for GPs than for specialists. Or defray similarly, but require much less time within the system for GPs than for specialists.

Hopefully, some of those ideas can make it into later debates.

(And yes, if anyone's wondering, this is essentially the letter I wrote in to comment on the show.)

Update: Some actual numbers on how badly the Ryan plan fails in containing costs going forward.

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