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Ezra Klein Interviews Rep. Paul Ryan

Morgen on February 2, 2010 at 8:28 pm

As much as we have criticized Washington Post blogger Ezra Klein in the past, I have a grudging respect for his willingness to engage issues on a substantive basis and the fact that he (mostly) does not pander to his largely liberal readership. Today rising liberal star Klein interviewed rising Republican star Rep. Paul Ryan (WI). Here are the highlights (Klein’s questions in bold):

A word we should bring into play here is “rationing.”

Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?

That ends up being the interesting question. The theory of the Medicare system, of the European systems, is that the best way to do this is to have the government fund research to discover the effectiveness of treatments and then use its purchasing power the same way Wal-Mart would – to drive prices down. Medicare, as the CBO said in its report to you, pays less than private insurance.

But Medicare is growing at an unsustainable rate. And yet it underpays doctors.

But private insurance is growing that quickly as well. And this question of underpayment is doctors and hospitals making less than they expect to make. What you’re talking about, bringing Medicare spending down very sharply, is even more vulnerable to that critique. You do it on the patient side, not the provider side, but they will feel they’re getting vouchers that aren’t generous enough to keep up with health-care costs.

So what I’m saying is that rather than having government ration care to manage decline, let’s take those market signals that work in every sector of the economy to reduce cost and improve competition. I got Lasik in 2000. That’s a cash surgery. It cost me $2,000 an eye. Since then, it’s been revolutionized three times and now costs $800 an eye. This sector isn’t immune from free-market principles.

Then let’s back up to the Senate bill. Some of the things in that bill, like exchanges and redoing the market, are in your bill. I know you don’t agree with it. But if you were paring it back, what would you keep?

The whole premise of it is wrong, in my opinion. It’s to have a more government-centric system.

What’s government-centric about it exactly?

You’re erecting a bureaucracy to determine how this happens. Federalizing the regulation of health insurance in Washington. You’re having a person design how insurance can be sold. You’re mandating people buy it. It will stifle innovation and competition in health care. If we were talking about Wyden’s plan, I could give 15 things I like. But this isn’t that.

For all of the denials, and frankly ridicule, coming from the President over conservative claims that his reform plan will lead to a government takeover of the healthcare system, this last response by Ryan really frames this issue well I think. Regardless of the industry, if the government has the absolute power to mandate the nature of the product or service you can sell, where you can sell it, who you can sell it to, and ultimately how much you can sell it for…at this point does the distinction between the public and private sector even matter?

What this exchange also highlights is the vast difference between liberal and conservative philosophies for healthcare reform. Given the magnitude of these differences, obviously any genuine attempt at bi-partisanship  would have required meeting somewhere closer to the middle. Not just tacking a few token Republican amendments on to the big government framework devised by liberal strategists to ultimately shift the whole system towards a single-payer model.

There was never a sincere attempt at bipartisanship, a fact which is largely responsible for the political predicament that Democrats find themselves in this year. Even now the Democrat leadership in conjunction with the White House is devising a scheme to pass the bulk of their plan using the budget reconciliation process, thus bypassing Republican opposition in the Senate (and the will of voters in MA). We can only hope they are unsuccessful.

How fantastic would it be if a year from now a Republican-controlled congress is pushing an alternative health care agenda centered on Rep. Ryan’s ideas? If Scott Brown’s election in Massachusetts is any indication, this is within the realm of possibility. What a great turn of events this would be.

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Category: Health & Education |

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