Now that the GOP's plan for repealing and replacing Obamacare seems to be in a coma, the party has turned its attention to the 2018 federal budget.
Although specific spending details in the House committee mark-ups are still being hammered out, the GOP is back to its old script.
The GOP has a working blueprint to cut billions out of federal programs and balance the budget without tax increases. And, among other items, it still wants to privatize Medicare.
Medicare covers more than 55 million Americans. Most of them are 65 or older and millions are permanently disabled. It's the nation's second-largest government-managed single-payer plan after Medicaid, which covers some 70 million.
While Medicare provides coverage for doctors and hospitals, it also covers prescription drugs if you pay an additional premium. You also have the option to buy into private policies through Medicare Advantage -- if you don't want the fee-for-service part of basic Medicare.
The rehashed House GOP budget blueprint wants to reshape Medicare into more of a Medicare Advantage model, which now covers some 19 million Americans.
What does that mean? Funding for the guaranteed part of Medicare would be shifted into the privatized scheme. You'd receive a fixed stipend or "premium support" to buy a private policy on an exchange.
Buying private plans on an exchange? Where have we heard that before? Oh yes, that was the model for the Affordable Care Act, or Obamacare, which the GOP has spent the last seven years trying to repeal. It's been a staple of House Speaker Paul Ryan's policy platform for years.
According to the House Budget Committee blueprint:
"The Medicare improvements envisioned in this budget resolution would adopt the popular simplified coverage structure of Medicare Advantage, and allow seniors greater plan choices while reducing costs.
It would resemble the private insurance market, in which the majority of Americans select a single health care plan to cover all their medical needs."
In theory, having private insurers compete with the government to provide more coverage at a lower cost sounds like a good idea. But is it possible, given the government's massive economies of scale?
Without generous subsidies, the prospect of insurers offering a better Medicare deal is like the corner grocer trying to compete with Wal-Mart. Moreover, using Medicare Advantage as a model is a horrible idea.
Medicare Advantage insurers have been embroiled in numerous billing scams, according to the non-partisan Center for Public Integrity. The Center, an independent watchdog, has published more than two dozen pieces on this ongoing morass. Here's a summary of their findings:
"Congress created private Medicare Advantage health plans 11 years ago to help control health care spending on the elderly. But a Center for Public Integrity investigation found that billions of tax dollars are wasted every year through manipulation of a Medicare payment tool called a “risk score.”
The formula is supposed to pay health plans more for sicker patients and less for healthy people, but often it pays too much. The government has for years missed opportunities to corral tens of billions of dollars in overcharges and other billing errors tied to abuse of risk scores.
Meanwhile, the growing power of the Medicare Advantage industry has muzzled many critics in Congress, and turned others into cheerleaders for the program."
Back to the main story: What House Speaker Paul Ryan and GOP congressional leaders are proposing is to tear down and remold basic Medicare into the troubled Medicare Advantage program, which would be like throwing kerosene on a house fire.
There's even more of a muddle on how the GOP would calculate how much to give seniors for their yearly stipend to cover private premiums. What if policy costs go up double digits and the stipend doesn't keep pace with the private market?
Would private insurers offer lower rates to healthier seniors and price less-healthy Americans out of the market? Although basic Medicare would still be available, wouldn't the money diverted to premium support undermine funding for the traditional Medicare Hospital Trust Fund, which may be insolvent by 2029?
I think there's a reason why there's a billboard in Kenosha, Wisconsin -- in the heart of Ryan's Congressional District -- that shows Ryan in a robber's mask. There's an attempted theft in progress, but older Americans and the disabled will be the victims.
