Ryan’s budget and the path to single-payer health care

By Ezra Klein,
WashPost
Published: March 23

Let’s play a game: I’ll describe a health-care bill to you. Then you tell me if I’m describing President Obama’s Affordable Care Act or the budget released this week by Rep. Paul Ryan.

The bill works like this: The federal government subsidizes Americans to participate in health-insurance markets known as “exchanges.” In the exchanges, insurers can’t discriminate based on pre-existing conditions. Individuals can choose to go without insurance, but if they do so, they pay a penalty. To keep premiums down, the government ties the size of the subsidy to the second-least-expensive plan in the market — a process known as “competitive bidding,” which encourages consumers to choose cheaper plans.

This is, of course, a trick question. That paragraph describes both the Affordable Care Act and Ryan’s proposed Medicare reforms. The insurance markets in both plans are essentially identical. And for good reason.

The Affordable Care Act was based on two decades of Republican thinking about health care. The basic structure was first proposed by the conservative Heritage Foundation in 1989, first written into a bill by Senate Republicans in 1993, and first passed into law by a Republican governor by the name of Mitt Romney in 2005.

(More here.)