Paul Krugman’s Entitlement Reform: RationCare
In his New York Times column this morning, Paul Krugman makes several misleading claims about the policies in the House Republican budget. He calls the budget’s Medicare reform proposal “Vouchercare,” even though the Congressional Budget Office notes that under the plan, “payments would go directly from the government to the plans that people selected,” making the program a premium support mechanism and NOT a voucher. Krugman also claims that the plan “would simply hand out vouchers of a fixed size,” even though the non-partisan CBO’s summary of the proposal notes that “the premium support payments would vary with the health status of the beneficiary” and “the premium support payments would also vary with the income of the beneficiary.”
More troubling than Krugman’s distortions however is the alternative he purports to put forward – which could aptly be named RationCare. Specifically, Krugman notes that “Medicare has to get serious about cost control; it has to start saying no to expensive procedures.” Granted, Krugman goes on to say that Medicare should only deny procedures “with little or no medical benefits,” but with health care becoming ever more personalized (see an article in this morning’s Wall Street Journal), how exactly will such cost containment be accomplished:
- Will seniors have to obtain permission from a government board to undergo expensive procedures?
- Will seniors be denied access to new technological innovations, as Krugman has previously argued? Such decisions by Medicare would force seniors to rely on outmoded technologies to keep them alive – keeping them locked into 20th century medical standards for the remainder of the 21st century.
- Given the article claims that Medicare “has to start saying no to expensive procedures with little or no medical benefits,” why is Medicare (by Krugman’s implication) paying all this money now in the first place – and why does Krugman advocate Medicare-for-all, seeing as how by his own logic it means more people will obtain costly procedures of no medical benefit?
Krugman has been crystal clear that a board of “experts” should be empowered to reduce Medicare spending by limiting access to new technologies. Much as he wants to criticize the House Republican budget as “Vouchercare,” he – and the Democrats who voted to create such a board in the health care law – should acknowledge their own proposal as RationCare.