Vouchers and Medicare

In a few weeks House Republicans are expected to release their budget plan for the coming year. It is not 100% clear now whether it will include a comprehensive overhaul of entitlement programs like Medicare and Social Security. I am hearing that it will not.

However, Rep. Paul Ryan, the Chairman of the House Budget Committee is to be commended for his willingness to take on the issues that are central to our long-run fiscal imbalance -- Social Security and Medicare. More specifically, Medicare. Because health care spending is the biggest issue. You can read more about that in a previous blog post.

Ryan's solution to Medicare's funding problem is to transform the system into a voucher program.

Future retirees would get a voucher -- effectively a check -- to cover a portion of the cost of buying their health insurance. Those making more money would get a smaller voucher. Lower income beneficiaries would get a larger voucher. If the price of buying medical coverage rises faster than the voucher, beneficiaries would pay more out of pocket. Here is how the Congressional Budget Office described the impact in a letter to Ryan:

Beneficiaries would . . . face higher premiums in the private market for a package of benefits similar to that currently provided by Medicare. Moreover, the value of the voucher would grow significantly more slowly than CBO expects that Medicare spending per enrollee would grow under current law. Beneficiaries would therefore be likely to purchase less comprehensive health plans or plans more heavily managed than traditional Medicare, resulting in some combination of less use of health care services and less use of technologically advanced treatments than under current law. Beneficiaries would also bear the financial risk for the cost of buying insurance policies or the cost of obtaining health care services beyond what would be covered by their insurance.

This is a fundamentally different approach to Medicare, but one that holds the promise of trimming spending dramatically. If beneficiaries saw more of the true cost of their health insurance, they are likely to demand more cost savings from providers. Or they will trim spending on treatments they deem discretionary.

So why isn't Ryan likely to propose this plan next month? Because the public already doesn't want any part of it. A recent poll by the Pew Research Center found most Americans don't want Congress to cut spending on Medicare.

We're still caught in a world where the public sees the fiscal cure as being worse than the disease of living beyond our national means.

Source: http://www.pbs.org/nbr/blog/2011/03/vouchers_and_medicare.html

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