Obamacare, Ryancare, it's the Same Damn Concept!

I was listening to an episode of the Diane Rehm Show today (because I’m a senior citizen of course) and the topic was Paul Ryan’s budget.  They got into a discussion about Medicare and the “premium support” plan that Ryan’s budget would eventually implement where elderly individuals would be given a stipend to purchase insurance in health exchanges which would be regulated by the government.  You know, the policy that would “end Medicare as we know it”.  Predictably the Republican in the discussion, Grace Marie Turner of the Galen Institute, voiced strong support for Ryan’s plan, while the Democrat in the discussion, Jared Bernstein of the Center on Budget and Policy Priorities, voiced opposition.   Later on in the discussion, the topic switched to Obamacare, a plan that would give poor individuals a stipend to purchase insurance in health exchanges which would be regulated by the government.  The roles were reversed.  Jared Bernstein touted this plan, calling it “the right way” to solve America’s health care problems, while Grace Marie Turner expressed concern over Obamacare’s drastic cuts to Medicare service providers.  

Since Paul Ryan was selected as Mitt Romney’s running mate, Democrats have worked to expose the bad parts of Ryan’s premium support plan.  It will ruin the existing system as we know it and will lead to higher deficits in the future.  What are the arguments Republicans have long made against Obamacare?  That it will ruin the existing system as we know it and will lead to higher deficits in the future.  

How can we as Democrats defend Obamacare but condemn Ryancare? This doesn’t make sense to me.  Democrats rail against Ryancare about how the cost of the support stipend won’t increase each year at the rate of medical inflation, which will lead to seniors having to pay out-of-pocket for coverage they used to get for free.   But the rate of increase of the Obamacare stipend for poor people in the exchanges is tied to the poverty rate, which does not increase at the rate of medical inflation, and everyone is paying out-of-pocket for coverage already.  You know what one difference is between the two plans is?  Ryancare actually has a public option in its exchanges (Medicare).

So Paul Ryan seeks to get rid of a system with a guaranteed benefit in order to replace it with a system of government-regulated capitalism.  And Barack Obama seeks to get rid of a system of exploitative corporate shadiness in order to replace it with a system of government-regulated capitalism.  I can see that each party is motivated to defend the direction in which the proposed systems are moving, but they’re both ending up defending government-regulated capitalism using basically the same arguments for and against.  

As Ezra Klein points out, "[this] has left the two parties in a somewhat odd position: Democrats support the Republicans’ old idea for the under-65 set but oppose it for the over-65 set. Republicans support the Democrats’ new idea for the over-65 set but oppose it for the under-65 set."

This leads to confusion and hypocrisy.  Here’s the hypocrisy: the aforementioned Grace Marie Turner defends “programs that give us a great model” featuring “seniors making choices from among competing private plans”, but she also thinks Obamacare’s exchanges, which feature people making choices from among competing private plans, features too many “complex and onerous bureaucratic rules” that throw up “barriers to competition and consumer choice”.   And on the other side: Barack Obama has labeled the system that joins a mix of private insurance options with one public option (Medicare) as “thinly veiled social Darwinism”, but when he proposed creating a health insurance exchange joining a mix of private insurance policies with one public insurance policy (the Public Option), he characterized it as a system that would “provide more choice and more competition,” one that would “keep the policies affordable”.  

Is it possible for people to be both for market-based health care reforms and against market-based health care reforms?  I guess so, because everybody is.