About the the only satisfaction I get out of Rep. Paul Ryan’s horrible plan to voucherize Medicare is the truly ironic effect it has on the top supporters of the Affordable Care Act. For much of 2009-2010 they kept saying how vouchers to buy private health insurance on an exchange was a great idea for a 64 year old (or younger person — i.e., anyone not eligible for Medicare– when trying to sell Obamacare. Now to attack Ryan’s plan the exact same people are correctly pointing out what a horrible idea it is to offer vouchers to buy private health insurance on an exchange for those 65 years or older.

From Peter Orszag in Bloomberg:

The vast bulk of health-care costs arise from an extremely small share of patients, whose insurance will inevitably bear a substantial share of their expenses.

That’s why competition in health care doesn’t work as well as in other sectors, and it’s also why the key to keeping costs to a minimum is to encourage providers to offer better, less costly care in complex cases.

Unfortunately, proponents of moving Medicare to a private “consumer-driven” system, including Republican vice presidential hopeful Paul Ryan, seem to instead believe in a health-care competition tooth fairy — that if we just increase the patient’s share of costs and bolster competition among insurance companies, the expense will come down. As Karl Rove recently argued, “Competition will lower costs by using market forces to spur innovation and improvement.”

Calling this notion the tooth fairy is valid, but where was this Orszag back in 2010 when he was using the exact same “health-care competition tooth fairy” nonsense to sell the ACA as Obama’s Director of the Office of Management and Budget?

This statement about how competition doesn’t work well in health insurance applies equally as well to the ACA exchanges as it does to Ryan’s proposed Medicare exchange. If Orszag believed competition among private insurance companies doesn’t work in health insurance, he should have said something when he was helping to design Obama entire health care plan centered around competition only by private insurance companies. Instead Orszag worked to undermine calls for a public option saying only private insurance competition was sufficient.

The one good thing about Ryan’s Medicare plan is it has gotten the so called “policy wonks” behind Obamacare to admit the basic policy of expecting private insurance exchanges to result in competitive prices, which lies at the heart of the ACA, is stupid. I guess two years late is better than never.