More on the RyanCare v. Affordable Care Act ‘Conversation’

By Gregg A. Masters, MPH

Well Avik Roy, aka @aviksroy, who describes himself as:

a Senior Fellow at the Manhattan Institute. Healthcare policy writer for Forbes & National Review. Romney advisor. Independent healthcare investment analyst.

and the Manhattan Institute, which describes itself as:

a free market thinktank dedicated to developing/disseminating new ideas that foster greater economic choice and individual responsibility

that I have encountered most recently with respect to the disciplined work they’ve done on consumer facing healthcare initiatives including emerging ‘mhealth’ technologies, stimulated some further discussion on the blog post ‘Yes, Obamacare Cuts Medicare More Than President Romney Would.’

Judging from the page views and growing list of comments, associated replies, and ‘callouts’, Mr. Roy et al (?), may have stepped into the proverbial ‘cow patty’, which may have been his/their media intent.

As one who’s been through a few iterations to tame the healthcare beast, I can say with some experience, and associated battle fatigue that I’ve been to this public/private dance and see how these things play out both in Washington and Topeka where the ‘rubber’ always meets the road. Just remember we are witnessing 3 decades of failure to correct the dysfunction, yet there has been no lack of ‘equity extraction’ (v. sustainable community benefit) by enterprising parties, some of whom are no doubt back at the public trough for another round of wealth enhancement.

Yet, in the crossfire of the marketplace of ideas and ultimately the movement of public opinion, as the election grows near, the advantage will accrue to the party that can claim and steward the most compelling narrative. Unfortunately the end game here favors politics and the ‘virality of emotive enabled’ anger v. the calm assimilation of facts to arrive at a reasoned ‘just the facts ma’am’ conclusion.

Ergo, with the posting of the Romney/RyanCare propaganda ‘Paid In‘ video on the blog, a rather disingenuous bit of red meat served up to the foreclosed mind, we are witnessing another round of comments, and replies.

My updated comment is pasted below:

Actually, Daniel is right on while your apparent lack of understanding of the healthcare market is rather apparent. The Government overfunds the Medicare Advantage (MA) program (a private version of Medicare) to the tune of 109% to 114% compared to the standard Medicare program. The fact that various MA operators may offer more benefits than standard Medicare is no surprise given the excess funding. The Act sensibly redeploys this fiscal largesse. Private initiative should not come at a premium, but direct savings to the tax payer. Medicare Advantage contractors should add, not subtract value to the client, i.e., we the people. Waste, fraud, and abuse including unnecessary care add another large component of the targeted 10 year reductions, and in total account for the budget magic to achieve net cost reductions while adding 30+ million Americans to the insurance roster.

The Medicare program is unsustainable (as is the cost of healthcare for all Americans, not just the uninsured or under-insured) and must be retooled as well as better managed, though recent declining cost trends including a slowing in the rate of inflation are ‘encouraging’, i.e., the program may be working if for no other(s) than sentient (anticipatory) effect.

The collective tapestry of program initiatives in the Act that further address innovation are via the Centers for Medicare and Medicaid Innovation, including demonstrations and pilots in medical homes, accountable care and alternate forms of delivery. Every credible health policy wonk and thinking health care professional including physician and hospital leadership as well as entrepreneurs absent an ideological agenda both understand and grasp the collective wisdom in the Act to scale-ably address the healthcare conundrum we’ve built.

Rather than a central planing, top down cookie cutter solution, the Act preserves current benefits, extends the life of the program and marshalls in the innovation embedded in the industry to deliver on a very challenging promise. Whereas, Ryancare merely shifts costs to the beneficiary, pats them on the butt, and wishes them good luck in the open market where they are disproportionately outmatched by a healthcare borg intent upon wealth transfer. This represents a rather naive and poorly configured view of healthcare economics, the provider and payor marketplace, as well as human nature for that matter, although it resonates with the Ayn Rand elitist paradigm.

These are the facts, unfortunately they don’t play well in a media market feeding on raw emotion and more often than not ignorance of the law, since the end game is politics and the virality of the disaffected – of which there is no shortage, not knowledge.

My original reply post is here.


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