BY SETH GALINSKY
When Mitt Romney named Paul Ryan as his vice presidential running mate Aug. 11, political columnists proclaimed the race had been transformed into a "battle of ideas" that centers around Medicare, the role of government in health care, and financial "responsibility."
The debate over President Barack Obama's and Ryan's competing schemes has been sharp, but upon closer examination the differences are not as deep as the campaign rhetoric makes it seem.
According to CNN, 49.9 million people in the U.S. had no health insurance in 2010, 16.3 percent of the population. For those ages 25 to 34 the percentage climbs to 28.4 percent. More than a quarter of those who earned less than $25,000 a year are uninsured.
Looking to shore up their profits, private companies, if they offer insurance at all, look for the cheapest plans they can get and push more of the cost onto their employees.
Premiums on those plans have nearly doubled since 2000. A November 2011 report by eHealth, Inc., states that the premium for individuals now average $2,196 a year; for families it's $4,968.
Deductibles, the amount that patients have to pay before their health insurance kicks in, are also rising. According to U.S. government figures, the average family deductible jumped 30 percent in just two years. Deductibles of $2,000 or higher are more and more the norm along with increasing copays for each doctor's visit.
Roughly 96 million people receive either Medicare, the government health insurance for senior citizens, or Medicaid coverage, which provides insurance for disabled and low income people.
With or without Obamacare or Ryancare, deep cutbacks are already being implemented in Medicaid coverage, which varies state by state.
The latest is Illinois where Gov. Pat Quinn, a Democrat, cut $1.6 billion of the state's $15 billion Medicaid budget last month, eliminating most of its dental coverage except for emergency tooth extractions. While Obama's health care law ostensibly prohibits states from restricting eligibility for Medicaid before 2014, they are allowed to cut "optional benefits" like dental, vision, and drug coverage.
Growing numbers of doctors refuse to take Medicaid or Medicare patients, because they can make more money with patients who have private insurance or pay cash.
Will anything that Obama or Ryan propose change this picture of deteriorating health care for the better?
Democrats and Republicans alike highlight the annual budget deficit—more than $1 trillion for the last four years—and say it must be trimmed or disaster looms.
Obama and Ryan both start with maintaining health care as a commodity and protecting the profits of insurance and pharmaceutical companies.
Both project cuts in Medicare and Medicaid, which together account for just over 20 percent of the federal budget.
Much of the debate has focused on Medicare for the elderly. Ryan and Romney point out that under so-called Obamacare the government makes the decisions about what kind of health care people can get and how much doctors, hospitals, and other health care providers can charge. Ryan calls the Independent Payment Advisory Board, set up by Obama to control Medicare costs, "a new rationing board" that will "start price-controlling Medicare to deny access to current seniors."
Their solution? The Republican candidates favor reducing government subsidies and letting the capitalist market determine who receives what kind of care. Can't afford good health care? Don't worry, the market will work it out.
In a speech to senior citizens in The Villages, Fla., Aug. 18, Ryan said he would not make any cuts to Medicare benefits for those who are currently 55 or older.
"Our plan does not affect the benefits for people who are in or near retirement," Ryan told the crowd. But in what amounts to a two-tier plan, Ryan said that for those under 55 "you have to reform it … so it doesn't go bankrupt."
Under the Ryan plan, starting in 2023 seniors would be able to choose either Medicare coverage—which of course would cover even less than it does now—or receive a voucher or tax credit that would go toward paying for private insurance. Ryan also proposes gradually raising the Medicare eligibility age from 65 to 67 by 2033.
Obama speaks of expanding government-managed entitlement programs to more people, while reducing costs. How this can be done without accelerating the declining quality of health care working people receive is left to one's imagination.
Ryan charges that $716 billion in Medicare savings that Obama promises from reduced payments to health care providers will worsen care for seniors and be used to fund a bureaucratized Obamacare. But Ryan included those same $716 billion in "savings" in his budget proposal.
Ryan proposes "constraining Medicaid's growing cost trajectory" by giving states a "block grant," instead of the roughly matching funds under the current system.
Either way, with the Obama or Ryan scheme, workers go to the wall.
The insurance giants, who favor Obamacare, don't seem too concerned on their future. They're betting on big profits no matter which of the two capitalist parties wins the White House.
According to the New York Times, Aetna just agreed to buy Coventry Health Care, a huge provider of Medicare and Medicaid programs, for $5.7 billion. In July, WellPoint agreed to acquire Amerigroup for $5 billion.