The recent firestorm over Medicare has sparked the need to revisit the whole healthcare debate from the viewpoint of the working man and woman. In other words, forget all of the horrifying data related to multi-trillion-dollar deficits and percentages of GDP. While these and similar statistics keep economists and speculators of all stripes up at night, they tend to make the eyes glaze over for those who make their living by the sweat of their brow. The Ryan Plan as it has come to be called (named after Republican Wisconsin Congressman and House Budget Committee Chair Paul Ryan) has lit the fuse on the renewed debate over the role of and access to healthcare in American life.
Perhaps the most mystifying element in the current public debate is that Republicans seem so surprised that the American public appears so opposed to the specific changes advocated by the Ryan Plan. Depending on which public opinion poll one accesses, 70 to 80 percent of those surveyed oppose any such changes to Medicare. Briefly, the Ryan Plan would provide some support to defray the cost of premiums and turn citizens who reach the age of 65 loose to negotiate and purchase an individual plan on the private market. In short, the Ryan Plan would take the federal government out of the business of paying for healthcare services and turn that job over to private insurers with an accompanying stipend for each individual to soften the premium blow.
Therein lies the public relations and hence the political problem for the plan’s advocates and the apparent Republican misunderstanding. First, there is the misconception surrounding the statement heard often lately that says “healthcare is a privilege and not a right.” This is a statement that is particularly irksome to those who manage to live from paycheck to paycheck and indeed on some occasions not that long. Such a statement says to people in this category that “quality healthcare is for people of privilege. The rest of you were simply dealt a bad hand both economically and health-wise.”
Secondly, there is the myth that in America healthcare must be delivered based on the highest principles of the “free market economy.” The fact that, unlike the choice one makes when buying a car or a bottle of ketchup, one does not choose a case of leukemia, heart disease or multiple sclerosis is missed here. Simply being able to choose the doctor to treat such dreaded ailments does not replace the denial of choice when the disease was arbitrarily visited upon the recipient in the first place. He/she did not choose to enter the market, but was forced into it.
Thirdly, a system in which both the insurance companies (including HMOs, etc.) and providers of healthcare services depend totally upon the economic standing of the individual as the target for leveraging profits creates a decided mismatch for the person in need of care. To him/her such a scenario takes on the feel of two Goliaths against a single David. He/she receives denials of benefits from the insurers and collection letters from the providers, and in both cases the buck stops with the one in need of service. Given these choices the market is hardly free to the sick person.
With these notions in mind we may return to the current Medicare conundrum. When hard-working folk are privy to news about calamitous federal deficits, how could they be opposed to the Ryan Plan that would deliver them back into the individual private insurance market at the age of 65? One need simply ask that question to folks who have been working all of their lives and who having crossed over the age of 50 can see the light at the end of the working tunnel. Clearly, most who fit this category long for the day when life’s formula for economic survival changes. To this group, and this is the bulk of the population, it means that at age 65 a retirement benefit from the federal government will be landing in their mailbox each month and that Medicare takes over and makes the fight for benefit payments one between the government as insurer and the providers. The days of the individual fighting corporate attorneys and healthcare provider collection offices are all but over. And never forget that, actuarial data not withstanding, citizens firmly believe that they deserve these benefits because they have paid for them all of their working lives. Such is driving the fear and resentment of the Ryan Plan.
So should we simply continue to deny the impending disaster surrounding Medicare and its sibling Medicaid? That would be profoundly foolish. Members of both political parties must sooner rather than later sit down and deal with a number of issues related to Medicare/Medicaid and Social Security. Ideas such as gradually raising retirement ages, raising employee/employer contributions, raising caps on income for collecting social security taxes and means testing of benefits must be on the table.
Just as the partisan wars appear to be here to stay so to are social programs like Medicare/Medicaid and Social Security. History will label as winners those who establish their means of survival.