Today’s New York Times hands over a portion of its op-ed page to Representative Paul Ryan (R-WI) to explain what Republicans would do to replace the Obamacare, a.k.a., Armageddon and the end of American democracy as we know it. Answer: Ryan wants a government takeover of health insurance.
In Fix Health Reform, Then Repeal It, Ryan tells us the linchpin of reform is to repeal the tax exclusion for employer-based health benefits, and thus dismantle the employer-based private insurance market and replace it with individual markets.
I helped write a plan that would replace the bias in the tax code with universal tax credits so that all Americans have the resources to purchase portable, affordable coverage that best suits their needs, with additional support provided for those with lower incomes. All these ideas, though, were dismissed early on, as they didn’t fit with the government-driven plan favored by the majority. But going forward it’s important that we reconsider this regressive tax issue.
Then, when helping Americans with pre-existing conditions obtain coverage, we should focus on innovative state-based solutions, including robust high-risk pools, reinsurance markets and risk-adjustment mechanisms. I intend to continue advancing true patient-centered reforms like attaching tax benefits to the individual rather than the job, breaking down barriers to interstate competition, and promoting transparency and consumer-friendly coverage options.
We should ensure that health care decisions are made by patients and their doctors, not by bureaucrats, whether at an insurance company or a government agency. By inviting market forces into health care, we can encourage a system where doctors, insurers and hospitals compete against one another for the business of informed consumers.
So think about what he’s saying. The Republicans would effectively dismantle the mostly unregulated employer-based insurance markets and replace them with a scheme in which private insurers (never mind consumers) would be entirely dependent on federal tax credits and subsidies. If that sounds like a radical, government dominated version of Romneycare Obamacare, that’s because it is.
These now government-subsidized insurers would then compete for your business. I assume Ryan wouldn’t, Chinese-style, abolish the Google/Yahoo, so folks could search for insurance bargains over the internet and compare prices and coverage. Government watchdogs would police for false and misleading advertising, bait and switch tactics and phony insurers, as they always have. We’ll call that an “exchange.”
What about those “innovative solutions” to the pre-existing conditions problem? Ryan’s solution is a mix of government mandates and regulations to create risk pools and a government-mandated and government-administered risk adjustment mechanism — again, all features of Romney/Obama/Ryan care. Or does he assume Wellpoint will voluntarily hand over to Kaiser Permanente any excess profits Wellpoint extracted from discriminatory underwriting practices?
Even sillier is Ryan’s claim he’d somehow put health care decisions in the hands of you and your doctor, “not by bureaucrats, whether at an insurance company or a government agency.” So, how do you make sure that insurers don’t drive those decisions? Why, it’s via government regulations taking away insurers’ discretion on underwriting — so that insurers have to cover you and they can’t charge me more than they charge you, or you more than your spouse or us old coots much more than our kids. On planet earth, we call these ideas guarantee issue, community rating and ratios, and private market insurers don’t do these things without strong government regulation.
So watch out for that Republican health care plan. It’s a massive government takeover of health care.
And don’t forget, Paul Ryan is considered one the leading intellectual lights of the Republican Party. “And then darkness fell upon the land.”