Miller bestows his blessing on Paul Ryan's destruction of Medicare. (photo: Ralph Alswang)

Almost any national health care debate in this country is almost entirely disconnected from real-world examples, which is tragic given that facts have a well-known liberal bias. That is why it is incredibly depressing to see a senior fellow from the Center for American Progress is using his platform to spread incoherent ignorance. I don’t know if the nonsense Op-Ed by Matt Miller is due to him being too lazy to actually research the subject or him purposely choosing to spread misinformation for ideological reasons, but either way, it is a pathetic defense of the Republicans Medicare privatization plan.

Let me explain. The consensus critique of Ryancare starts by observing that the “premium support” or voucher it would give each senior to help buy private insurance is designed to grow at a slower rate than the expected trajectory of health-care costs. Over time, as the Congressional Budget Office has noted, this gap would shift more and more premium costs to seniors, many of whom can’t afford them. That may in some bookkeeping sense “solve” the federal government’s Medicare problem, but only by leaving millions of sick grandmothers in the cold.

While this line of attack seems plausible at first — especially when Democrats have a CBO report they can wave in support — it’s actually based on two dubious premises. The first is that America’s inefficient health-care sector will be permitted to continue its spendthrift ways. The second is that premium support itself can’t be a way to help encourage the system to end them.

This is not some “dubious” assumption the CBO just came up with as part of an ideological thought experiment. It looked at decades of real-world data. Very large premium supports in private insurance exchanges, like those used for federal employees and California state employees, have not controlled costs in the decades they have been in use. Insurance costs within these system went up faster than for traditional Medicare (PDF).

The even better direct evidence is that for years we have had Medicare Advantage, a private insurance exchange that works very similar to what Ryan’s plan envisions for all seniors. In the years Medicare Advantage has been around, it has ended up being significantly less cost effective than traditional Medicare. Here is a real side-by-side comparison and it proves that moving people from traditional Medicare to private exchanges just made the health care cost problem worse.

Miller does at least acknowledge that all other industrialized countries provide universal health care for much less. This means there are proven solutions that can be replicated in other countries. Yet Miller idiotically advises Democrats to give credence to this GOP proposal that has failed repeatedly.

The correct advice if we really want to solve the problem, is to simply copy other countries more effective systems. That means adopting single payer or at the least all-payer.