If You’re Interested In A Little Experiment…

…you can engage in this one.

First, a little history. Paul Ryan, who has been offering ideas on Medicare reform for a long time, came up with his latest version after conversing with a Senate Democrat – Ron Wyden of Oregon.

That was last year. They offered a release of their work on December 15 of last year.

And they published their results in a book. Here’s the book’s cover…

Funny how Wyden’s name comes first, isn’t it? Usually Senators get top billing on Congressmen, but even so it’s an interesting little tidbit.

You can go to the House Budget Committee’s website and find a page about the Ryan-Wyden plan with all kinds of information.

For example, it has this quote from Wyden…

“Paul Ryan shares my belief that we don’t hold election certificates to sit on the sidelines and that the only way to tackle some of the big challenges facing our nation is to work together on big solutions.  Paul has also long-shared my view that the best way to hold down health costs is to give all Americans the ability to hire and fire their insurance company.  Guaranteeing a future for traditional Medicare is a big challenge and it is our hope that outlining areas where Democrats and Republicans can reach agreement will help Congress rise to that challenge.”

And there’s a fact sheet about their proposals – which doesn’t outline a plan that sounds much like what the Democrats are describing:

  • No changes for those in or near retirement. Americans currently over the age of 55 would see no changes to the structure of their benefits, although they would be free to opt into a private plan once the new Medicare Exchange was established in 2022.
  • More choices for seniors, including a traditional Medicare plan: Starting in 2022, Medicare would begin offering seniors a choice among Medicare-approved private plans competing alongside a traditional Medicare plan on a Medicare Exchange.
  • Premium support ensures affordable coverage: The plan would introduce a “premium support” system that would empower seniors to choose either a traditional Medicare plan or a Medicare-approved private plan.
    • More help for those who need it: Low-income seniors who qualify for Medicaid would continue to have Medicaid pay for their out-of-pocket expenses, while other low-income seniors who do not qualify for Medicaid would receive fully funded savings accounts to help offset any increased out-of-pocket costs.
    • Less help for those who don’t: Wealthier seniors who need help least would see their assistance reduced.
  • Strong consumer protections to safeguard the Medicare guarantee: This reformed Medicare program would include some of the toughest consumer protections in American government:
    • All health plans that participate in the Medicare Exchange would be required to offer benefits that are at least the actuarial equivalent of those provided by the traditional Medicare plan.
    • Premium-support payments would be risk-adjusted to ensure that those with greater health needs are guaranteed affordable coverage.
    • Participating plans cannot refuse coverage based on pre-existing conditions, nor can they charge discriminatory rates based on health status.
    • All plans would be overseen by the Centers for Medicare and Medicaid Services (CMS), which would be empowered to review plan benefits and review all marketing materials to ensure transparency and fairness.
  • Transparency, Competition Work as Powerful Cost ControlsProgram growth would be determined by the competitive bidding process – with transparency, choice and competition forcing providers to reduce costs and improve quality for seniors.
    • Transparency: Seniors would receive clear and easy-to-understand information on what plan they are currently enrolled in, the projected cost of that plan, what other plans in their area will be offered, and what the federal premium-support contribution will be.
    • Choice: Allowing seniors to choose the plan that works best for them would force providers to compete for the patient’s business, thus curbing the unsustainable rise of health care costs that is threatening both Medicare and the affordability of health care for all.
    • Competition: Allowing private plans to compete directly with a traditional Medicare plan would strengthen both by creating new incentives for plans to develop better delivery models and design better ways to care for patients with chronic illnesses.
    • Cap on Growth Serves as a Backstop: However, exceeding the cap would not trigger across-the-board bureaucratic cuts or higher premiums. Instead, Congress would be forced to do its job: Determine why the costs exceeded the cap and fix the problem.
  • A Proposal to Strengthen the Health Care Marketplace: Just as Medicare reform would give seniors more power to choose, reform is needed to free small businesses and individuals from restrictions that inhibit choice and control in health coverage.
    • Any small business with up to 100 workers would be able to offer its employees a free choice option so that they could use the amount that their employer contributes toward their health coverage to purchase their own health insurance.
    • The cost of the free choice option would be fully tax deductible to the employer, just like employer-provided health coverage.
    • Allowing individuals to keep one insurance product as they transition from their working years into retirement would ease seniors’ transition into Medicare while giving small businesses and their workers more choices and freedom.

It also has a link to a Wall Street Journal piece that the two co-authored, which was published on December 15 of last year.

Something funny has happened in the interim, though – namely that Ryan is now on the Republican ticket. And that puts Wyden in a somewhat uncomfortable position – after all, look what happened to Cory Booker. Worse for Wyden is that Mitt Romney, in touting Ryan’s ability to work across party lines, cited the Ryan-Wyden plan as an example of how his ticket could govern.

So now Wyden is running for the hills, as you might expect.

“Gov. Romney is talking nonsense. Bipartisanship requires that you not make up the facts. I did not ‘co-lead a piece of legislation.'” Wyden said. “I wrote a policy paper on options for Medicare. Several months after the paper came out, I spoke and voted against the Medicare provisions in the Ryan budget.”

Ryan and Wyden did work together in December 2011 to develop a paper outlining ways to provide for Medicare solvency, including a “premium support” model. Under premium support, Medicare would allow a menu of competing plans to offer coverage with government payments. Wyden, however, never signed on to support the House-adopted budget resolution written by Ryan that included plans for a premium support approach.

“Gov. Romney needs to learn you don’t protect seniors by makings things up, and his comments today sure won’t help promote real bipartisanship,” Wyden said.

Wyden has voted against House Republican budgets when they have received votes in the Senate. Republican aides were quick to circulate the Wyden-Ryan Medicare report after the announcement that Ryan would be joining Romney on the GOP presidential ticket.

Democrats are already reprising one of their familiar lines, saying Ryan’s budget plan would “end Medicare as we know it.” That exact phrase appeared in separate statements issued Saturday by Obama campaign manager Jim Messina, Senate Majority Leader Harry Reid (Nev.) and House Minority Whip Steny Hoyer (Md.).

The mere fact that Wyden was at one point involved in Ryan’s Medicare proposals could undermine that Democratic message – and Wyden seems to know it.

Scrambling, for certain. And he’s doing it so completely that he’s giving us a basis from which to conduct our experiment.

Specifically, if you’ll look at that front cover image you’ll see that Wyden has a page on his site one might imagine would contain the same stuff the House Budget Committee’s page has.

And there’s your experiment. Go to http://www.wyden.senate.gov/bipartisanhealthoptions and see what you find.



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