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1 simoom  Sun, Aug 12, 2012 7:02:18pm

I'm off to watch "Network". I didn't have much time to edit this but I'll look it over again when I'm back in an hour.

2 simoom  Sun, Aug 12, 2012 8:09:00pm

re: #1 simoom

Err, "Newsroom" that is. :P

3 simoom  Sun, Aug 12, 2012 8:34:08pm

That CBO cost projection paragraph from the AP fact-check on the current iteration of the Ryan Budget is written in an extremely confusing manner. Here's the relevant bit from the actual CBO report that they're attempting to summarize:

Under the specified path, average real (inflation-adjusted) spending for new enrollees in Medicare would rise in coming decades but at a much slower rate than would occur under the other policy scenarios that CBO has analyzed (see Figure 2). Average net Medicare spending for 65-year-olds in 2011 was $5,500. Under the baseline scenario, average spending per 66-year-old in 2030 would be $8,600 in 2011 dollars (56 percent more); under the alternative fiscal scenario, that spending would rise to $9,600 in 2011 dollars (75 percent more); and under the specified path, it would be $7,400 in 2011 dollars (35 percent more). In 2050, the corresponding spending for a 67-year-old would be, in 2011 dollars, $17,000 under the baseline scenario, $19,100 under the alternative fiscal scenario, and $11,100 under the specified path.

By 2050, spending for new enrollees under the specified path would be 35 percent below that for the baseline scenario and 42 percent below that for the alternative fiscal scenario. The implications of that substantial cut in spending relative to the other policy scenarios are unclear, because they would depend on both the specific policies that were implemented to generate that spending amount and the ways in which the nation’s health care and health insurance systems reacted to those policies. Possible consequences include the same kinds of effects noted for the baseline and alternative fiscal scenarios—reduced access to health care; diminished quality of care; increased efficiency of health care delivery; less
investment in new, high-cost technologies; or some combination of those
outcomes. In addition, beneficiaries might face higher costs, which could in turn reinforce some of the other effects. At least some of those effects would of necessity be a great deal stronger than under the baseline scenario or alternative fiscal scenario because spending would be so much lower. However, as with the other scenarios, CBO does not have the capability at this time to estimate such effects for the specified path of Medicare spending.

The "specified path" refers to the Ryan plan that was submitted for scoring.

4 simoom  Sun, Aug 12, 2012 8:41:46pm

And here's a write-up on the CBO scoring of the previous iteration of the Ryan Plan, before he added the "opt-in" for his new voucher/premium support system:


But because commercial insurers cost more to run than government plans, the Wisconsin Republican's proposal to privatize Medicare starting in 2022 would actually spark a dramatic increase in how much the nation spends on healthcare for the elderly, according to an independent analysis by the nonpartisan Congressional Budget Office.

Even as the federal government cut its own spending, seniors would end up paying almost twice as much out of their own pockets — or more than $12,510 a year, the CBO estimates. Altogether, the total cost of insurance would be higher.


Under Ryan's proposal, seniors and others on Medicare would begin receiving a set amount of money, starting in 2022, to offset the cost of buying a private insurance plan that would replace the federal government's Medicare plan.


This voucher system — or "premium support," as Ryan calls it — would give the typical 65-year-old American $8,000 annually to buy a health plan, about the same amount of money that analysts expect the Medicare program would spend on that senior in 2022 under the current program.

But the CBO report says the money won't be enough. The cost to buy private insurance, plus the projected out-of-pocket spending that the 65-year-old would have to pay for medical care in 2022, would total about $20,510 per year, according to the CBO, which both Republicans and Democrats rely on to independently evaluate the effects of proposed legislation.

That would leave the senior to pay the difference, an estimated $12,510.

By comparison, if the current Medicare program is continued, the CBO estimated that it would cost about $14,770 to provide insurance to that same 65-year old in 2022, assuming Congress did not dramatically slash payments to doctors.

That would leave the senior to pay just $6,150 out of pocket.

"A typical beneficiary would spend more for healthcare," the CBO concluded about Ryan's proposal.

A major factor in the price difference is the relative inefficiency of private health plans. Even though commercial insurers may do a better job of managing their customers' care, they are not as efficient as Medicare at controlling costs. "Both administrative costs [including profits] and payment rates to providers are higher for private plans than for Medicare," the CBO noted.

5 KingKenrod  Sun, Aug 12, 2012 9:08:35pm

It would be more correct to say the Romney/Ryan "robbed" future Medicare recipients of benefits they've already been paying for.

Calling something a cut or robbery when it's actually a much needed reform is political scumbaggery.

Now, a dose of reality - under Obamacare, I don't believe that Medicare will actually be "cut" (or slowed or whatever) $700 billion. These projections seem to rarely turn out to be true, and if quality starts to suffer (due to lack or resources, such as a sufficient number of providers willing to take less money for Medicare patients), you can bet our aging population isn't going to let that happen. And anyone who thinks you can get the same thing for significantly less money is kidding themselves. So even if the benefits are the same, it seems entirely possible quality and availability will suffer. It's going to be a real problem, and one that Romney could more honestly exploit.

6 simoom  Sun, Aug 12, 2012 9:33:25pm

re: #5 KingKenrod

It's going to be a real problem, and one that Romney could more honestly exploit.

It can't be honestly exploited though, right? Ryan kept the reductions for both iterations of his plan, each of which the House GOP voted for, and Romney has endorsed the plan multiple times.

My only other thought is that these provider payment reductions were negotiated with and agreed to by the provider groups -- it wasn't forced on them. They apparently felt the increase in insured patients would offset the payment reductions. With Republican governors attempting to stymie the Medicaid expansion though, I agree, they may be questioning their negotiating assumptions. I hope it's clear to them who exactly they should be focusing their lobbying efforts on.

7 Ogami Itto  Sun, Aug 12, 2012 10:17:01pm

Mitt Romney's® next attack ad: President Obama robbed Medicare of over 700 billion dollars so he could buy t-bone steaks!! And Cadillacs for Michelle!!

Also, is it just me, or does Reince Preibus seem like he's either drunk or stoned all of the time?

8 simoom  Mon, Aug 13, 2012 12:59:04am

re: #6 simoom

Come to think of it, on that specific issue it's even worse. The Ryan budget repeals the ACA, so no expanded insured patient pool as an offset, but keeps in place the health care provider's concession to the negotiations, in the provider payment reductions.

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