Paul Ryan: Details of HealthCare – How to Repeal ObamaCare

While we know ObamaCare is wrong, wrong, wrong, arrogant and socialistic, what do we understand about what we can do to improve health care in the U.S.? This video discussion with Congressman Paul Ryan (R-WI) puts forward what can work, and why it can work, and the pros and cons of how it affects each of us. Spend some time digesting what you hear, and when townhalls begin, you’ll know the questions to ask Republicans and Democrats about the future of health care.

Note: Ryan says the Wisconsin District he represents “went for Dukakis, Clinton, Gore and Obama,” but he has been running on the issues he discusses here for years, demonstrating that politicians can “survive” by having the

Paul Ryan

courage of their convictions and pairing that with adult conversations.

Ryan covers type of care for working Americans, Medicare and Medicaid. Health Care for Working Americans is found in a bold type heading below.

Readers, the following represents my take on the first three of four videos. It is not word for word, and please spelling errors, and my casual style. I’m out of time for more tonight. SEGMENT 4 is shown in the video below, and it covers the politics of making it it all happen.

Courtesy of Human Events, Uncommon Knowledge (Four videos, taped the end of September 2011):


1) ObamaCare gives us in two steps, 5 or 6 large insurance companies giving us different shades of the same coverage. The plan is the heart of progressivism: We pass a vague law and then give all delegate all the power and authority to bureaucrats who will micromanage our lives. This is where ObamaCare takes us.

2) Ryan says Repeal has to wait until next year because of the complications of congressional scheduling. Says we MUST repeal – the importance of the 2012 election is the most important in our time.

3) Ryan said when the health care vote was underway, it was very difficult to hold the Republican caucus together to vote against it. Now isn’t that scary. He said some wanted to vote for it to be as doing something. It took a lot of work to know the bill well enough to explain the problems.


“Patient Centered Reform Means Premium Support.” Ryan is asked to explain. “Patient Centered” means the patient is the nucleus of the care, not the government, not a bureaucrat. With Patient-Centered care, it means all providers are competing against each other for the patient’s business: doctors, hospitals, insurance companies – forced into competition with each for the patient’s benefit. Where we’ve tried this dynamic in the free economy, it has worked very, very well to bring down cost and increase quality. It has also worked well in Medicare, Part D – prescription drug benefit, patient-centered. These are plans forced to compete against each other, and people get to choose against competing plans. It has cost 41% less than projected and it is very high in satisfaction.

“Premium Support” means you’ll have a guaranteed list of coverage options available to you through Medicare, just like I as a member of Congress has a federal employee, just like Medicare Advantage works for 20% of Seniors, members of Medicare Advantage. The Senior chooses among these guaranteed list of covered options and these plans compete against each other for their business. If the Senior doesn’t like her plan this year, she can fire it and go to another plan next year. Medicare subsidizes a portion of her premium based on who she is. Is she sick, or poor or middle-income? If she is wealthy, she won’t get as much of a subsidy.

Doing it that way, according to the Clinton Commission, according to a lot of other Democrats, according to the actuaries at Health and Human Services, makes the program solvent and sustainable. This is an idea that historically has had bi-partisan support among more moderate Democrats. It’s an idea we put in our Path to Prosperity Budget, and it’s a way of saving Medicare.

You don’t have to put these kinds of reforms into the current generation. If you act now, you can prevent any change for those 55 and above. It applies to those of us 54 and below.

I argue, let’s prevent a European austerity, raising taxes, cutting currency. Let’s phase in reforms that have actually proven to work, that save the system and keep us from going off a debt cliff.

The moderator quotes the Congressional Budget Office saying that under Ryan’s plan, 10 years enactment, the federal government will be spending $240 BILLION annually, less than we are spending now, under current law. Ryan explains how the CBO know this: Because it is going from an open end defined benefit system, to a defined contribution system. Because they are defined contributions, they are quantifiable. He mentions that ObamaCare caps it globally and runs it from government.  Obama takes Medicare spending from “up here,” to “down here,” (remember that ObamaCare took $500 BILLION from Medicare) with a complicated formula, and institutes a board of 15 unelected bureaucrats, called the the Independent Payment Advisory Board the power to price-control Medicare.

Here’s the difference, we are what we are saying, run the money through the individual, based on their need, so that they have the power to decide how to run their healthcare will be delivered to them. Those costs can be charted. Not so with the Independent Payment Advisory Board.

These are very different choices. Both realized Medicare is growing at an unstainable rate. We say, let’s do it with choice and competition based around the patient. Obama says I want these 15 unelected bureaucrats I’m appointing next year to make all the decisions.

No one is suggesting that Medicare can continue to grow at the rate it is growing at now, that has a $37 Trillion unfunded liability. The difference is he wants bureaucrats to make the decisions, and we want the patients to make the decisions.

The moderator says a Weekly Standard article attacks Ryan’s plan from the Right. They say that Ryan’s plan is still the government that is establishing the “minimum floor benefit.” Ryans confirms. The articles (inaudible – sounds like IU11) has a better idea. The moderators says it does sound like a better idea.

That idea is that the government should define what it wants, the level of care it wants, as the minimum. Go out to each of the Medicare regions and invite bidding and then choose the second most inexpensive, so that on the defined contribution to the Senior, there is always within his or her reach, 1 plan that is less expensive that enables him to put money in his pocket, one plan that takes every dollar and is perfectly adequate, and then an array of plans from which he or she can choose that will cost more.

Ryan says, “that’s just an improvement upon our plan.” Our idea doesn’t preclude any of that. Our plan gives the basic framework of support for how it would work, and what it would cost. And then when you implement such a system, those are the kinds of details that you grapple with in how to design a very good functioning, premium based support system. It is completely complimentary to what we are talking about.


Medicaid: Ryan – in Medicaid, “Patient-Centered” care means block grants to state governments. Moderator asks why? Ryan – first of all there is a federalism component to this. State’s already manage Medicaid. The federal government pays for a portion of it through a complicated formula, and so there is a state’s right issue here, so why not let 50 different incubators of ideas come forward 2) what state’s could not, Tom Coburn and Devin Nunez and Richard Bird and I have championed legislation in the past, called the Patient’s Choice Act, which says, let’s just voucher out Medicaid so that people on Medicaid get additional assistance, on top of refundable tax credits, so that they too can get additional health care like everybody else.

We think that instead of having the government from the top down, say this is how this program works, and how it will be run from Washington, now it’s not. It’s run by our states. Give the states the ability to manage and reform the programs, One of the options (and I’ve talked to many Governors who like this) is to stop segregating poor people into inferior care, where they go into the doctor’s office with a “poor” stamp on their foreheads” because they are on Medicaid, and many doctors will not even see them because they lose money when they do (they get paid 60 cents on the dollar).

This is a program that is breaking – it is ripping apart at the seams. The President’s health care law just increased it by one-third, and that is going to hasten the demise of the Medicaid system. We fundamentally believe we should let the Governors come up with answers to how to fix these problems. Lots of Governors have been innovating on Medicaid. One of the ideas I think has merit, is don’t put Medicaid patients into a separate system for low income individuals. Mainline them into the health care system, so that they have choices in their care, so that the next time they go to the doctor, they are indistinguishable from anyone else.

The moderator says: “Okay, as a Conservative, I get happy about this…why?” Ryan says the federal government passes the money to the states, and the government knows what they are spending. It caps costs, because block grants are set at a fixed formula.

Moderator: George W. Bush instituted No Child Left Behind, because when it came down to it, there would always be some states who would do a terrible job with Medicaid.

Ryan says he completely disagrees. Either we have a paternalistic approach that everything will come from government because they know best – and we will trample state’s rights, or we acknowledge state’s rights as our Founders did and we are going to cut the strings and send the money to where it came from in the first place.

Ryan: I come from Wisconsin, which is different from California, which is different from Nevada, Colorada…one size does not fit all . It’s arrogant to assume that this program which is state-run now, will be better off under government control. ObamaCare will take over Medicaid. It’s not a good idea.

Health Care for Working Americans – “Patient-Centered” Reform means replacing the inefficient tax treatment of Employer Provided Health with a portable, refundable tax credit that you can take with you from job to job. Explain.

Ryan: When we get health care at our job, because of regulatory ruling going back to World War II, we don’t pay taxes on that benefit. So, our health care benefits are free, but our wages are taxed. This is one of the primary drivers of inflation in health care, because it is insulating us from the cost of our coverage. If we let the worker decide between wages and benefits, the worker will decide between wages and benefits, they will make a better decision as to what is better for them if they are both taxed at the same level. 3) The government’s benefit now is about $3.5 TRILLION from the current tax benefit over the next 10 years. What happens if you lose your job. Let people keep the money so that it is not attached to the job. What happens if you strike out on your own, and start your own business. Years ago it might have made sense because people kept their jobs for life, but it’s not that way today.

Moderator says Milton Friedman wrote about this years ago. The government established wage and price controls, and companies are fighting for labor, but the amount of a wage was controlled by the government. So employers began offering health care as a benefit, in the place of a higher salary. It became very popular, and by the time the IRS noticed there was income being shoved out in the form of health care, without being taxed, there was already political support for it.

Moderator: So the federal government screwed up 70 years ago. Ryan agrees. The moderator says: why don’t you just fix “that.”

Moderator quotes Milton Friedman:

The ideal way to [reform health care] would be to reverse past actions: repeal the tax exemption of employer-provided medical care: terminate Medicare and Medicaid…~Milton Friedman

Moderator says to Ryan: You say that horse has left the barn?

Ryan says he is a big fan of Friedman, but yes, that horse has left the barn. We are where we are. Let’s fix the system before it gets out of control. If we do not address the root drivers of health care inflation, we will have a debt crisis in this country. Without doing so, we will have to tax or borrow at unprecedented levels and we will lose the prosperity that we have come to enjoy.

The health care problem is a product of several flaws, unintended consequences, of government intervention (policy) which has given rise to the third party payment system, where you don’t know the costs, because you don’t pay the bill, because you don’t pay for it. We need to reconnect the producer and consumer, the provider and the patient, into relationships where there is a real shopping incentive.

Why not empower, bottom-up consumer revolution with 300 million Americans going to the providers and demanding price and quality competition, like we do in every other segment of our economy. In order to get to that moment, a Patient-Centered, market-driven system, you have to address these massive market imperfections that are driven by the government. That’s what I’m doing.

Paul Ryan, in depth, on the realities of health care and what we can do to make it work (video)

Linked by Scrubs and Suits – Thank You!

Posted by Maggie @ Maggie’s Notebook