Ryan expects health reform to cause cost "death spiral"

AP Photo/J. Scott Applewhite

Republican Rep. Paul Ryan, a key voice in the GOP on the issue of health care, said Thursday he expects the Supreme Court to strike down a key element of President Obama's health care reforms -- the "individual mandate," which requires every American to acquire health insurance.

But regardless of whether the Court strikes it down or not, Ryan said he expects the reform package to send health care costs into a "death spiral."

"I think [the Supreme Court] will knock down the individual mandate, but the question is severability," Ryan said at the Washington Ideas Forum, a conference hosted by the Atlantic magazine and the Aspen Institute.

The Supreme Court is expected to rule in the summer of 2012 -- just as the next presidential election is ratcheting up -- on whether the individual mandate is constitutional. By "severability," Ryan was referencing the possibility that the court could separate the mandate from the rest of the law and strike down just that provision (rather than the possibility of the court striking down the entire law).

Many have argued that the individual mandate is central to the entire law because its purpose is to hold down health care costs. Without a mandate, its proponents argue, only the sick would purchase health insurance, causing costs to go up.

Without the mandate, Ryan said, health care costs could go into a "death spiral." However, said he thinks costs will "death spiral" anyway because the mandate won't work. Rather than follow the mandate -- which goes into effect in 2014 -- people will simply wait until they get sick and pay a fine, he said.

Instead of using a mandate to encourage people to purchase insurance, Ryan has suggested an auto-enrollment mechanism coupled with tax credits for health insurance.

Asked whether the GOP-led House could pass an auto-enrollment health care bill should the Supreme Court knock down the individual mandate, Ryan responded with a chuckle, "To save the president's health care law? I don't think we'll be in the position to do that."

[levelheadedtoo]

Interesting how it works in Washington. Paul Ryans top contributors so far this year. Who do you think he is representing?

PricewaterhouseCoopers

Goldman Sachs

Northwestern Mutual

Blue Cross/Blue Shield

Massachusetts Mutual Life Insurance

Paul can't hear you through the screen that is placed in front of him by the corporations that have purchased his access. Until the people have a lobby then people like mr. Ryan will continue to shove his prepaid message to the surface.

Now that corporations can spend an unlimited amount on Super PACs and be totally in the dark, we will never again be represented by honest people. When people like Ryan, and his buddies on the hill, accept thousands on dollars from the very companies that are screwing the people for greed, we don't stand a chance to see real meaningful change in Washington.

As long a Ryan is accepting money from the healthcare industry to finance his lavish life style, he is no different than any political prostitute. He is just another corporate sell out.

[wfw3536]

If you have a small to midsized business Obamacare is eating up any profits might have. It will led to more business giving up, or cut more staff just to justify the higher cost of health insurance. What I do not understand is folks just do not get when you add more services, rules, and regulations health insurance companies are going to increase their cost. Too bad this bill was forced through congress in the dead of night. How sad for anyone trying to make a living with a business and their employees who may not have jobs as a direct result of Obamacare.

[sgt0027]

God Bless Rep. Ryan. In his simplistic reform utopia all the kids could have ponies and all the adults Ferrari's if only the market and consumerism were in play.

At 100,000 feet it is easy to say lets get rid of the employer tax deduction and give it to consumers who will be better spenders of their dollars. In a perfect market that would work but healthcare is not and never will be a perfect market and the fundamental changes required to get to this nirvana in human behavior and systemic transparency cannot happen overnight or even a few years.

This was the McCain plan from 2008 & it would have covered nearly no one new and changed nothing about how insurance is sold. Like in his Medicare Voucher plan there is no mention of the insurance reform needed to allow consumers to buy on a level playing field without age, sex and underwriting discrimination.

He avoids the major issues in the PPACA law and market that need to be addressed to work:

1) Getting a "tax credit" is fine if you pay Federal tax but what about the 47% who pay little or none simply because they have incomes <$40K. How do we cover them and allow them choice"
2) Pre-existing conditions
3) Medical underwriting
4) Free riders - how to stop Limited policies that offer low coverages and then the rest of us pay the bills for these folks
5) Core benefits for catastrophic so that the rest of us do not foot the bill for the person who buys poor coverage (like uninsured motorist)

Most notably with no understanding of how the benefits marketplace works he fails to grasp that if tomorrow all group coverage ended and 260 million people bought their own coverage directly that the insurers are incapable of dealing with it on every level from marketing, sales, service, billing, claims,web services et al. What chaos!

The group model has distinct advantages of selling once for a large population and all admin is handled thru the employer including enrollment, communication, first level problem solving (with broker help)payroll deduction.

With 256 million individual consumers we would have a huge shortage of agents/brokers in the country to handle all the needed work the carriers cannot and do not do well. They are not consumer facing businesses as they nearly always sell and service thru 3rd parties like brokers.

This is already an issue with Medicare Advantage where carriers cannot handle the consumer without the broker's help. Large numbers of options, even simply presented are still overwhelming to the buyer and a boon to good brokers.

Clearly consumerism and choice is a needed as is reform of how we all view health insurance, or non-insurance as it is quickly becoming with higher deductibles and out of pocket costs.

The real model is more like your auto insurance with catastrophic and a warranty for preventive coverage and then use the right service provider for the problem you have at a cost you want to pay.

Imagine what an oil change would cost if your auto insurer covered it in network, out of network etc? That $19.95 would be $99 in a heart beat?

Today we go to the doc for sniffles and cancer making as that is what we are accustomed to doing like a Pavlovian dog.When I was a kid we had major med and the rest my folks paid. A return to a 21st century variant on that is the answer.

Ryan's naive and utopian view of change would be very hard to achieve and at the end still leave most people uninsured and allow all the option to be under-insured if they want to be.

His plan can get employers out of the healthcare business which any sane one wants in today's world but the resulting "new world" would likely end up tilted heavily against the consumer.

Can you imagine Congress passing the laws necessary to make a truly open and transparent market possible? Look at the partisan wrangling over banking reform, consumer credit and yes PPACA and it will never happen.

[slatep]

It boggles my mind how blind Paul Ryan is to our current health care.

I am being treated at a prestigious hospital for cancer.

In the lobby of the emergency room, at the entrance to the cancer center etc, there are large signs printed in both English and Spanish stating that you cannot be turned away due to inability
to pay for medically necessary treatment; regardless of race, religion, etc..

What part of these signs does Ryan not understand.

Health care in the United states is a viciously growing circle.

Congress has allowed te drug companies to charge outrageous prices for medications that are critical to saving lives.

One of the treatments I receive (a shot) costs $4,000.!!

Individual and group health care insurance can goe up as much a $300 in one month.

This is ridiculous.!!

There is no way you can convince me that it costs $4,000 to manufacture 20cc's of liquid.

Before Obama even got into office; drug costs doubled, doctors dropped Medicare patients while other doctors raised their fees enough to be able to receive the amounts paid by Medicare initially.

Legislation should be passed to limit the mark-up on drugs necessary to preserve lives.

If your health insurance policy premium rises by $300 a month, this results diirectly in having less discretionary income.

This then reduces consumer spending which in turn reduces profits for businesses and services forcing them to raise their costs to suustain their earnings.

In what was once among the wealthiest countries in the world; just about every commodity has increased; even for the basics; food, shelter, clothing and medical care.

Seniors and the poor are now being faced with making critical decisions about all of these things.

If you can't pay your electric bill or oil or gas bills you could conceivably freeze to death, die from heat stroke or even set your house on fire using candles for light.

People are being forced to cut their much needed medicines in half in order to save money and sometimes they simply go without.

With less money to spend on food; our health is sufferinng because the prices of healthy foods have skyrocketed.

Grocery items don't go up 20 or 30 cents, they go up a $1 or more in one week.

Anyone who is fortunate to still have a job has to get to work and the cost of gasoline is obscene.

If our health care system is in it's death throes; we have no one to blame but Congress and Obama.

They passed a 2,000 page health care bill without even knowing what it contained.

In a lot of instances there are provisions in there that have absolutely nothing to do with health care.

The FDA has the final say what drugs can and cannot be placed on the market.

They should pass legislation that would require the drug copanies to disclose how much it cost them to create a medication, produce it and sell it at a reasonable profit to recoup their expenses and still have the money to research and create new drugs.

Hospital costs, medical care costs and prescription costs are all POLITICALLY created.

Since our present Congress has proved that it can barely function; it's going to be up to WE THE PEOPLE to resolve these issues .

[tsigili]

It has already led to major cost increases. In fact there was an horrific increase in my company's cost, and my own portion of it, immediately, because we were on a fiscal year basis.

It went up again, both years since, a substantial amount, as more portions of the law, took effect.