Ryan Plan, Obamacare . . . What's the Difference, Really?

Dear Cheasty,I have a question about ObamaCare: What will it cost over 10 years, and how many will it cover?  I’d also like to know the same about Paul Ryan’s proposed health “reform.”

Sincerely, Captain Comparison

Dear Captain Comparison,

As I’m sure you’re aware, comparing Obama’s health reform law to the proposal by Rep. Paul Ryan is a classic case of apples and oranges. Sure, they’re both “fruit” (i.e., ways to change our health care system), but other than that, they have absolutely nothing in common. But this is an election year, so let’s lay the two out, side by side, so people can make an informed decision.

First of all, here’s where you can get information from the proverbial horse’s mouths: Paul Ryan explains his health care strategy on his website. Obama’s health law, which was signed into law in March of 2010, can be researched here.

If you took a look at either of those pages, you’re likely dizzied by numbers, statistics, legalese, and high-flying rhetoric. So let’s just boil this down to an analogy.

Obama’s approach is that of a surgeon doing open-heart surgery. Paul Ryan’s is that of a surgeon removing a leg (or two). Obama’s law is complex and detailed, and attempts to simultaneously contain spending, control costs, expand access, and increase affordability of health care for Americans. Paul Ryan, on the other hand, takes a budgetary meat cleaver to Medicaid and Medicare, which comprise the key components of government spending on health care, but does nothing to control costs or improve access.  Also, his plan does nothing to address problems in the commercial insurance market, which is a bigger share of our economy, and where costs are rising much faster than either Medicaid or Medicare. (As I’m sure you’re aware, if you’ve checked out your insurance premiums lately!)

To extend the analogy a little further, let’s imagine that Obama-the-Heart-Surgeon also prescribes strict dietary and exercise regimens to improve the cardiac health of the patient. Ryan-the-Amputator, on the other hand, does nothing to address his patient’s diabetes, which is the underlying problem that led to amputation in the first place. In the end, it all comes down to philosophy.

People can (and have!) argue(d) that Obama’s law authorizes a high degree of government oversight on what has heretofore been a largely unregulated market. But people can (and have!) argue(d) that Ryan’s plan would leave the poorest and oldest Americans vulnerable and without access to health care, while simultaneously allowing the current insurance market to spiral out of control – and out of reach –  for ordinary Americans.

Here are some statistics to help think this all through. You asked how much each plan would cost over 10 years? According to the Congressional Budget Office (sort of an impartial referee in Washington politics), Obama’s Affordable Care Act would require approximately $940 billion over the next 10 years. That’s a lot of money! But if you put it in perspective, that $938 billion is only 2% of our federal budget over the same time period, and only 3% of health care spending over all. What’s more, the CBO estimates that because of incentive programs, new taxes, and other cost saving measures, the ACA will actually reduce our federal deficit by $124 billion over the next 10 years.

Those are numbers from 2010, and are, of course, just estimates based on a series of assumptions. But the good news is that a recent updated report from the CBO estimates that overall costs will be even lower than projected two years ago.

Now let’s look at Ryan’s plan. The CBO report on the Ryan budget shows that this plan would shrink the federal government so dramatically that most functions of government (outside of Social Security, health care, and defense) would entirely disappear in 40 years. Goodbye, roads. Goodbye, national parks. Goodbye, all the things we don’t even realize the federal government pays for. (Hey, where did half of my library go?)

In the health care realm, the Ryanplan would cut Medicaid spending by 34% in the next 10 years. What’s more, by 2050, the Ryan plan would cut federal funding for all low-income health care programs by more than 75 percent.

So that’s Medicaid. What about Medicare? Ryan’s plan would replace today’s guaranteed coverage with a “premium-support voucher.”He wants to raise the age of eligibility from 65 to 67, and he would reopen the “doughnut hole” in Medicare’s coverage of prescription drugs that Obama’s plan is closing.  In sum, under Ryan’s Medicare, health care would be more expensive and would cover fewer senior citizens.

As if that weren’t frightening enough for low-income Americans and senior citizens, check out what will happen to taxes. According to recent analysis by the Center for Budget and Policy Priorities, beyond:

the trillions of dollars in spending cuts, at least 62 percent of which would come from low-income programs, the Ryan plan would enact new tax cuts that would provide huge windfalls to households at the top of the income scale…. People earning more than $1 million a year would receive an average $265,000 apiece in new tax cuts, on top of the $129,000 they would receive from the Ryan budget’s extension of President Bush’s tax cuts.

So. There you go, Captain. Open heart surgery with diet and exercise regimen? Or leg amputation and a continued life with uncontrolled diabetes. The choice is yours.

To a well and healthy Texas, Cheasty Anderson