Scott Brown No Longer Backs Paul Ryan's Medicare Plan

Senator Scott Brown (R-MA) wrote an op-ed in Politico today Why I don't back Paul Ryan's Medicare plan. TPM rips him for flip-flopping, Walkback Complete: Scott Brown Now Attacks GOP Medicare Plan He Recently Praised. While I obviously agree with him (now) that Ryan's plan is awful, I'll attack Brown on the content of his piece.

"As part of the 2012 budget discussions, Congress is dealing with Medicare reform. This debate is long overdue, since its increasing cost must be addressed if we are serious about the nation’s growing $14 trillion debt and $1.6 trillion annual deficit. President Barack Obama unfortunately missed an opportunity to deal with this when he filed his budget. House Budget Committee Chairman Paul Ryan (R-Wis.) offered a plan that at least finally jumpstarted the debate."

Really, Congress is dealing with long overdue Medicare reform and Obama missed it in his budget? It's not like Obama and the Democrats having been trying to deal with Medicare and overall healthcare reform since they got into office. Remember, the right was ripping into them for changes to Medicare which they deemed "death panels". But I guess now the Republicans have the House we can finally deal with Medicare.

"First, I fear that as health inflation rises, the cost of private plans will outgrow the government premium support— and the elderly will be forced to pay ever higher deductibles and co-pays. Protecting those who have been counting on the current system their entire adult lives should be the key principle of reform."

Well yes, that's been a problem with the Ryan plan since the beginning, have you only just read it? The other problem is of course which private insurers will actually offer insurance to seniors? I like the phrasing of "their entire adult lives", does that include 25 year olds?

"Second, Medicare has already taken significant cuts to help pay for Obama’s health care plan. The president and Congress cut a half trillion dollars to the private side of Medicare — meaning seniors are at risk of losing their Medicare Advantage coverage."

Seriously?!? He can't really be saying this can he? The $500 billion is over 10 years, he leaves that part out. It's not so much cuts as much controlling the growth by 7% over that timeframe. Only about $130 billion of that is from Medicare Advantage which is an optional program that uses private insurance to provide Medicare coverage to about 10 million participants. It's more costly than the equivalent regular Medicare coverage so we're cutting payments to it over 10 years to save money. The Act is saving money by eliminating waste because the private sector is more expensive. But Republicans just can't get their heads around that.

See this Kaiser Health News article from October and this factcheck.org one. But if all you read is the Heritage Foundation, you understand it incorrectly.

Here's Obama on this, "Here -- here's what's going to happen. These are essentially private HMOs who are getting, on average -- and this is not my estimate, this is Democrats and Republicans, experts have said -- they're getting, on average, about 14 percent more over payments, basically subsidies from taxpayers for a program that ordinary Medicare does just as good, if not better, at keeping people healthy. Now, they package these things in ways that, in some cases, may make it more convenient for some consumers, but they're overcharging massively for it. There's no competitive bidding under the process. And so what we've said is instead of spending $17 billion, $18 billion a year, $177 billion over 10 years on that, why wouldn’t we use that to close the donut hole so the people are actually getting better prescription drugs."

Back to Brown, "The Government Accountability Office has estimated that nearly 10 percent, or $47 billion, of annual Medicare spending is nothing but waste, fraud or abuse. Attorney General Eric Holder has put the number higher — at $60 billion. We need Medicare administrators to work to prevent these improper payments — instead of the existing “pay and chase” model that makes the system so susceptible to fraud."

While both sides argue about Medicare administrative costs, it's not clear if they're better or worse than private insurance. Ezra Klein has a good primer on this. I certainly agree that we should be investigating Medicare fraud, but my understanding is that funding for doing so has been cut by Republicans. I've had a hard time finding references to this. This is the best I've seen, Medicare Fraud Fight Would Be Harmed by House GOP Cuts, CMS Says. If you have something better let me know.

The rest was pretty banal. "improve quality", "tort reform", "work with people" in either party, "not the time for finger pointing", blah blah blah.

So yeah, he seems to be closer to my views, great. I'm not sure what convinced him though I'd guess a lot of constituent calls. Now it would be great if he could convince some other Republicans, or maybe even the leadership to do a better job.