Monday, April 11, 2011

Paul Ryan's Catch 22 on health care

Milo's mustache was unfortunate because the separated halves never matched; they were like Milo's disunited eyes which never looked at the same thing at the same time. Milo could see more things than most people, but he could see none of them too distinctly.

-description of Milo Minderbinder, Catch 22, by Joseph Heller.


Paul Ryan has a plan for health care, and it's based on the free market. From Fox:

Ryan offered a personal example in why he believes a market-dominated system will work in health care. He said a decade ago he spent $4,000 for LASIK eye surgery. It's an out-of-pocket expense that now costs 1/3 as much for a more technically advanced procedure. "People shouldn't tell us that health care is immune from free market principles," Ryan observed.

And this is exactly why Republicans should just stay out of the debate about health care: they cannot differentiate between a cosmetic procedure and necessary medical care. Think of health care as law enforcement or the military: necessary interventions that can only be done efficiently and justly on a large scale. Health care economics is chock full of asymmetric information and competing interests, and add to that the sheer complexity of integrating standards of care while trying to police skill levels.

LASIK surgery has about as much resemblance to health care as buying your kid's bicycle does to purchasing an F-16 Tomcat. The former is an elective purchase that can be done at your leisure while the latter must be done with expertise and perform perfectly reliably. When dad goes to the Emergency Dept with chest pain do we shop around for the lowest cost provider for his urgent cardiac catheterization?

Ryan has this conversation as a pretext for eliminating Medicare as we know it, forcing seniors to shop for health insurance with their government voucher in hand. Good luck. He also wants to save $729 billion over 10 years by repealing the Affordable Care Act thus sentencing 30 million Americans to a life without health insurance. The arithmetic says that the savings would be quite low for the amount of insurance purchased for the 30 million, not to mention the benefits of a healthier citizenry. Much more benefit than the trillions of dollars in war funding that Ryan has voted for.

Ironically, the Affordable Care Act does in fact provide market forces by requiring individuals to purchase health insurance on the open market. I have no idea what the motives of Mr. Ryan actually are, but my hunch is that he means well, so I'll give him the benefit of the doubt and assumes he's just clueless. The Collective at Esquire is not so magnanimous:

Paul Ryan believes the true mission of government is to bring as much pain to the parasites as it can because, by doing so, it can liberate the genius of those people who deserve to live. When Paul Ryan dreams of a free nation, it is one in which the seventy-two-year-old spouses of seventy-five-year-old patients are free to go out and shop in a rigged insurance market for the $100,000-plus they're going to need over a lifetime of tending to that patient....

...Look at him when he talks about dismantling the hard-won protections of the shrinking middle class. He is so positively lubricious about it that his teeth seem to be sweating. Pain (not his) purifies the nation. Pain (not his) makes us free. This is what Paul Ryan dreams of when he dreams of a free people.

So maybe the LASIK has disunited Paul Ryan's eyes, and that's the Catch 22: for all that he envisions for America, he's blind to what we really need.

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