So it’s budget guy. Interesting choice, governor. At least we know where he stands (even if your position is still a little vague). We’ve apparently reached a pass in American politics where an unapologetic acolyte of Ayn Rand can be put forward as a candidate for vice president. This may have been unthinkable a year ago, when the Occupy Wall Street movement was in full swing, at least in terms of media coverage. Now that the “austerians,” as Tom Tomorrow calls them, have once again found their full-throated voice, Ryan can be seen as a serious contender for high office. Though they are backing away from the details of his Medicare proposal like it’s a live grenade, concentrating instead on Medicare reductions in the Affordable Care Act – reductions that are included in Ryan’s budget, incidentally.

My favorite dodge, though, is the one about sparing current retirees and near-retirees from painful cuts. Everyone 55 and over will keep the same system as current law, they claim; people younger than that can expect a voucher. Maybe that will buy some time with the elderly, I don’t know. But it seems to me that they’re risking pissing off people in the 45-55 bracket (namely, people like me), who have been in the private health insurance market their entire lives and have seen the magic of the marketplace at work first-hand. After decades of that, I can tell you that the notion of being handed a voucher when I’m finally allowed to retire is unacceptable.

Let’s take a closer look at Ryan’s competitive healthcare marketplace that will somehow work for seniors now better than it did prior to the advent of Medicare in the 1960s. The fact is, we’ve had competition in health insurance basically forever with respect to people under 65. Has the price gone down at all? Next question. If competition results in skyrocketing premiums for younger, relatively healthier people whose healthcare costs tend to be  more manageable, what will happen with elderly people who inevitably incur higher costs due to deteriorating health, age-related illness, palliative care, etc? That’s the reason why Medicare was created in the first place as a government guarantee of coverage for elderly people. Pushing more of its costs onto the people it’s supposed to be protecting is hardly a solution.

Same deal with Ryan’s Medicaid brainstorm. The super-genius wants to whittle that down by replacing it with block grants and reducing it by a third. People hear Medicaid and they think poor people (and, therefore, get apathetic about it). But when it comes to being elderly and needing nursing home care, practically everyone is poor… poor enough to need Medicaid. That’s where a good deal of custodial care funding comes from. Ask someone with elderly parents or someone who has done basic estate planning. Only the Romneys of the world need not rely on some kind of insurance support in their dotage.

This is a good conversation to have, frankly. Let’s have it, and make certain the elderly and the near-elderly understand what’s at stake before the November election.

luv u,

jp