Medicare, Ayn Rand and the Ryan Budget
He will also gut Medicaid and much of the social safety net.
The deficit hawks (or scolds) seem bent on cutting Medicare in the worst way. And by that I mean the WORST way.
The problem with Medicare is the same one that troubles all medical insurance, costs have been rising far faster than inflation. So simply limiting how much the Feds will give to seniors to pay their Medicare premiums is a terrible idea. Without a serious attempt to control cost, and one backed up by the force of law, so that those who follow the cost controls are not sued, we will continue to have ever more expensive medical care, until the entire system collapses. Ther collapse may be fast or slow, but it will do to our medical economy, what the collapse of 2008 did to our financial sector.
There is a better way. If we could force doctors to change the way care is provided and paid for, perhaps even capping fees, we may be able to “bend the cost curve” - and if we do, then Medicare and Medicaid are sustainable.
We did bend the cost curve maybe two decades ago. HMOs did it. Yes everyone balked, but it seemed to work, and despite the whining, a lot of high quality health care was provided. But doctors had to do what they were told, and anyone who has worked with doctors (or lawyers) knows that these are the worst and the brightest. What might be called “A” students with a vengeance.
Anyway, media chimed in with complaints (movies too, remember “As Good As It Gets?”) politicians recited “war stories” and with pressure from all sides, the HMO movement collapsed. Actually, it still exists, but the cost control have been severely limited. Of course, insurers need to make money, so they simply raised premiums to cover costs. (And no, it is not immoral.)
The current medical environment is a curious one. The government pays for roughly half of all expenses, insurers pay for much of the rest, and yet when either tries to force providers to accept a limitation on fees, the providers scream bloody murder, and manage to bring the public along with them. Within medicine, many folks doing well. Most doctors do quite well, so do labs, medical device manufacturers, drug manufacturers, and even the average nurse does ok (nurses have it harder, but nursing remains a good job to have). Many hospitals are also doing well, especially those that are part of a for-profit network. By the way, if you wonder if a hospital is doing well, just look at the entrance. If they have a Starbucks or a fancy gift shop they are doing well. If the lobby looks like a hotel lobby in a resort, they are doing very well. And then look around the neighborhood. If the hospital is surrounded by specialists’ offices, x-ray facilities, MRI facilities, and outpatient services of all sorts, then they are also probably doing well - and of course all the specialist, x-ray facilities etc are also doing well.
Then there are all the rest. The urban hospitals where the better off are on Medicaid. Some are simply too fucked up to apply. Their ERs are jumping, and outside of the hospitals you’ll see no fancy specialist’s offices. Those who can, go elsewhere. We have similar hardship in rural places, if they have a hospital at all.
A recent Time Magazine article did a good job of explaining what is wrong. It was the cover story (see above).
Look it up on the web if you missed it.
So we have private profit and public pain - lots of public money, many folks/businesses doing well for themselves, taking the choicest bits in an infrastructure mostly paid for by all of us. It is not all that different from what happened with the big banks after the 2008 collapse - some make many, and when there are losses, we pay!
So why doesn’t Ryan propose fixing Medicare? To begin with, he’s a lightweight, a windbag, listening to other windbags. And he was more or less a rich kid. I have a niece like that, private high school, college paid for, and she’s the super conservative. Go figure. When I was her age (the age she is now) I still had to put Christmas gifts on layaway. Ryan is a spoiled kid who read Ayn Rand. I was a Rand-ian when I was in college too, but we are all forgiven for our childish indiscretions. If years later, Ryan still thinks of Rand as a philosopher, well need i say more?
Ryan believes in rugged individualism. His Rand-ian beliefs mesh well with the uniquely American strain of conservatism that sees the role of government as limited to what our founders imagined. They focus on Congress’s enumerated powers, without accepting the Constitution’s larger charge that the purpose of the government is to work for the general welfare. Of course, Rand-ians choke on the notion of general welfare. In their bizarro world, altruism is the greatest evil, and selfishness the highest good. To the extent that they remember the founders at all, it is the slaveholders they remember, not the Northerners. Alexander Hamilton wanted to incentivize manufacturing and trade, and to spend money on public works. John Quincy Adams (active in Washington’s administration) wanted to support education. In fact, our founders were split, the slave holders may have wanted limited government and low taxes, but the Federalists certainly did not. It is ironic that the current day Federalist Society has picked that name. Federalists they certainly are not.
So Rand-ians, and the intellectual heirs of slaveholders have united in calling for less government and particularly less money spent on the class of lay abouts and moochers who receive Medicaid and unemployment benefits, and even have it in for future Medicare recipients. Ryan is careful not to ask current beneficiaries to take a cut, probably because they are an important part of his base. Ryan may also have a sense of decency, but if he does, he only has it for old white folks.
Oh, then there is all the money. Remember the folks who are flush. The pharmaceutical companies, specialist, for profit hospitals and such. These folks spend a lot of money on political campaigns. And they have spent well.
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