Paul Ryan Did It Again!

In an earlier post (here), I pointed out that Paul Ryan, R-WI, was the premier philosopher of the right wing and to anoint presidential candidate Newt Gingrich with this title was a great disservice to Rep. Ryan and to my home state. And, to prove my point, in the video above Mr. Gingrich comes out in support of the new Wyden-Ryan Medicare Plan (here). The video and Rep. Ryan's intellectual achievements should make clear who is the real intellectual power behind the porcelain throne.

Not to pick at details here, but Rep. Ryan's original plan for Medicare (in his brilliant Roadmap for America's Future 2.0) was surely the best way to destroy the only existing form of single-payer health insurance in the U.S. and rid the country of any European or Canadian predispositions to socialized medicine. The original analysis convincingly argued that the real reason Medicare is in trouble is not because Seniors are getting something they don't deserve (a sly sop to the left wing) but because health care costs are rising faster than anyone would have thought back in 1965 when Medicare was founded (read the history here).

From this brutally honest analysis, Rep. Ryan concludes that the simple answer is to shift the costs back to Seniors who have plenty of slack left in their over-generous Social Security checks to cover the rising cost of health care. With one intellectual flourish, the problem was solved.

Unfortunately, the howls of protest from the AARP forced Rep. Ryan to bastardize the intellectual edifice of the Roadmap and convince (here's that power behind the throne again) Rep . Ron Wyden, D-OR, to endorse the bastard child (a softer version that allowed Seniors to stay in Single Payer and, foolishly, not subject their golden years to the whims of the health care market).

Honestly, can't anyone appreciate intellectual elegance? Simple solutions such as Single Payer where payments are capped and health care providers are required to take Medicare patients without discrimination, are simply too ugly when compared to the elegance of invisible-hand solutions. At least Rep. Ryan can take pride in his intellectual achievements.

Rep. Ryan Gets a Sobering Lesson From the Netherlands

Rep. Paul Ryan, R-WI, is a conservative philosopher of the first rank. He doesn't really have to pay attention to anything that happens in the Netherlands when deducing policy recommendations from the postulates of privatization (the Netherlands, really, they smoke pot legally in coffee shops).

Unfortunately, whether it's from smoking too much weed or drinking too much neoconservative Kool-Aid, the Dutch decided to take Mr. Ryan's advice and privatize their mixed health insurance system in 2006. The rationale was that competition would reduce health care spending, enhance consumer choice and improve quality of care. In 2011, the Dutch now know that privatization was a failure.

A recent study in the New England Journal of Medicine (here) found that (1) competition has not slowed the growth of health care spending (national health expenditure is increasing faster than the rate of inflation and total costs of health insurance have increased 40% due to increases in administrative costs), (2) the number of uninsured have increased as have the number of "defaulters"--people who haven't payed their mandatory health insurance premiums for more than 6 months, (3) competition has not provided more choice (four insurance conglomerates control 90% of the insurance market, only about 4% of people change plans and 65% are dissatisfied with their coverage), and (4) the Netherlands still relies heavily on regulation (the government must still enforce global budgets, price controls and patient cost sharing).

Quoting from the study:

The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending. Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs.

What the authors of the study don't acknowledge is that scientific data has nothing to do with policy deductions made from philosophical first principles.