Jonathan Chait

The Contradictions Of Ryancare

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John Cornyn, as a way of diffusing opposition to Paul Ryan's Medicare voucherization plan, says that it's the same thing as Obamacare. Now, that's wrong in a lot of ways -- most notably, Ryan's plan holds the value of its vouchers well below the cost of medical care -- but it is true in certain ways.

One implication of this, as Ezra Klein notes, is that, if Ryan's plan is even close to viable, then the Affordable Care Act will work far better than its designers expect:

That said, the implications of Cornyn’s comments are interesting. As I’ve written previously, if the exchanges in RyanCare can hold health-care costs down to the rate of inflation, then the Affordable Care Act is going to work far better than anyone currently believes. They serve a population that requires less emergency care, that is more able to make decisions, and its using subsidies that are better set up for cost control.

I'll go further than that. If Ryan is right, then we don't have a health care crisis at all, and hence no Medicare crisis, and not much of a debt crisis. Ryan argues that creating an individual health care marketplace will unleash consumer shopping power and radically reduce health care costs. There's no evidence that he's correct about this. But if he is correct, then the exchanges in the ACA will already unleash this effect. And if Ryan is even close to the scale of this effect -- he assumes powers bordering on the magical -- then the additional step he proses in unnecessary. The cost savings from the ACA will ripple through the health care system.

Now, keep in mind that the ACA does not assume that its individual market will reduce health care inflation at all. That's probably correct. But the inconsistency in Ryan's assumptions is striking.

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