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I don't get to start many arguments with "I'm old enough to remember when..." But I'm old enough to remember when the Republican Party didn't like "ObamaCare." Hated it, in fact. Thought it wouldn't work, would diminish our freedoms, would never prove sustainable. And, to be fair, they still feel that way about the Affordable Care Act. Most days, the House votes to repeal it once before breakfast and twice before lunch.
But it turns out that their skepticism of ObamaCare melts away when you're talking about applying it to seniors. In fact, it's now the official Republican plan for the over-65 group. The Ryan budget, Boehner told ABC News, "transforms Medicare into a plan that's very similar to the President's own healthcare bill." Sen. John Cornyn, head of the National Republican Senate Committee, made the same point a few weeks ago. "It's exactly like Obamacare," he said. "It is." Which raises the question: is it? And if so, what exactly did Republicans hate about the Affordable Care Act?

The Ryan budget and the ACA mirror each other in one key way: they both use tightly regulated exchanges as the main venue for the purchase of insurance. The difference between them is that this is where the Ryan budget stops and where the Obama budget begins. The Ryan budget claims gigantic, and frankly unrealistic, savings from replacing Medicare with private insurance purchased on exchanges. The Congressional Budget Office says that insurance will be more expensive than traditional Medicare, not cheaper, and Ryan's savings will come from shifting its cost onto seniors.

The ACA -- which claims less dramatic savings -- backs stronger exchanges up with a host of changes to how care is paid for and delivered, and how much of a tax break employers get for providing pricey plans, and the establishment of a new board capable of making continuous reforms to Medicare without Congress's explicit approval, and an effort to develop mounds of new research on which treatments and drugs work best and plug them into electronic medical records to help us make more cost-effective care decisions, and so on. For a fuller comparison of the two plans approach to cost control, head here. The bottom line, however, is that the Ryan plan does far less and expects far more -- at least if it's presuming to save money by doing anything but shifting costs -- while the Affordable Care Act does far more and assumes far less.

In some ways, the most appealing post-health-care reform compromise was not that the Affordable Care Act would be dismantled, but that it'd be extended to Medicaid and Medicare, where beneficiaries could then choose from the traditional government-run program or the insurance offered on the exchanges. The GOP is now engaged in the reverse of that play: take ObamaCare away from the uninsured who have nothing now, and impose it on seniors who have a system that's working pretty well, even if it, like private insurance, is projected to cost too much in the coming years. That's a hard sell. That Republicans are now saying that their idea isn't as bad as you think, it's only as bad as ObamaCare, tells you a lot about exactly how hard they're finding it.


Eric D. Schwerin
eschwerin@rosemontseneca.com

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