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I’ve often find Ezra Klein’s writing about health care policy confusing because from blog post to blog post there is often a jarring disconnect that can best be described at policy schizophrenia. The issue is most pronounced in his alternating from defender of health insurance exchanges, mostly when defending Obama, and his acknowledging they have been a proven failure, mostly when criticizing Republicans.
Take for example these two posts literally days apart. Today, Klein called the Republican plan to save money by turning Medicare into a private insurance exchange voucher program, “a plan that has never worked,” with examples to prove his case.
What they’ve got in mind already exists in Medicare. “Our premium-support plan is modeled after the Medicare Part D prescription-drug program,” Paul Ryan (R-Wis.) told me. But Part D hasn’t controlled costs. Instead, premiums have risen by 57 percent since 2006, and the program is expected to see nearly 10 percent growth in annual costs over the next decade.
Moreover, this isn’t the first time we’ve tried to let private insurers into Medicare to work their magic. The Medicare Advantage program, which invited private insurers to offer managed-care options to Medicare beneficiaries, was expected to save money, but it ended up costing about 120 percent of what Medicare costs.
Klein has established not only that purely private health insurance exchanges fail to control cost but expand them into our public health programs has also proven to be a costly failure.
Yet, less than 24 hours earlier, while defending Obama, that Klein again argued in support of effectively eliminate Medicare and Medicaid by folding them into the state based insurance exchanges created by the Affordable Car Act.
The major difference is that the Affordable Care Act doesn’t roll Medicare and Medicaid into the exchanges, though that’s something that many of the law’s advocates — myself included — would eventually like to see happen.
So, Klein both believes health insurance exchanges are an idea that has “never worked” at controlling cost but also an idea that should be radically expanded.
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You cannot control costs in a wholly-privatized system without cutting into the profits of one or more corporate friends. If you control drug costs, you cut into profits at Big Pharma. If you control hospital costs, you cut into the profits of Big Hospital companies, like HCA and Tenet. If you control insurance costs you cut into the profits of Aetna and United HealthCare. If you control use of expensive machines, you cut into the profits of the owners of MRIs and CAT scanners.
If you cut into payments to doctors, you will drive the marginal practitioner into retirement, and others into the arms of HMOs and similar corporate practices. Then those corporations want profits.
This is the logic of a privatized system: everything moves to the extremes, including usage of the system and profits.
Agreed, though it depends what Ezra means by moving Medicare and Medicaid onto the exchanges. If that effectively creates a strong public option, it could work.
Also, as I mentioned to dday, Part D and Medicare Advantage could work if the government could negotiate directly from manufacturers, and the payments for Advantage were reduced to the level of traditional Medicare. I don’t believe Advantage is inherently a bad program. It works very well at Kaiser, where it’s a cash cow because the government overpays.
Yes, there is an obvious inconsistency. I think Ezra is a cheerleader for exchanges under PPACA because that’s the best we’ve got or are gonna get without a public option or single payer, whereas with Medicare, well it’s kind of obvious why we don’t want to privatize a system that’s already more efficient when administered by the government.