If we believe the political pundits, presumptive Republican presidential nominee Mitt Romney's selection of House Budget Committee Chairman Paul Ryan as his running mate has suddenly transformed the 2012 campaign into a policy wonk's dream match between opposing visions for health care reform.
In the near corner, weighing in at 2,700 pages, is the Affordable Care Act, President Barack Obama's 2010 landmark reinvention of America's health care system, already well underway. The act is complex, tends to favor the strategic use of the carrot over the stick, and, given its length, is just screaming for Ben Stein to record the audio book.
The Affordable Care Act's goal: a form of universal coverage that provides incentives for health insurance companies and health care providers to cut overhead costs, break from the expensive and inefficient fee-for-service paradigm and improve health care outcomes. The act's attempt to use the stick rather than the carrot to force states to expand Medicaid, a move designed to insure more than 30 million low-income Americans, was blocked by the Supreme Court this summer.
In the far corner, Ryan's House-approved GOP budget blueprint, based largely on his 2008 health reform proposal, "Road Map for America's Future," heads firmly in the opposite direction but is no less ambitious. It calls for Congress to transform Medicare into a voucher program and Medicaid into a system of block grants to the states.
Under Ryan's plan, beginning in 2023, people who turn 65 would receive payments from Medicare to help them purchase private health insurance on their own. The eligibility age for Medicare would also gradually rise to 67. Today's Medicare recipients would not be affected.
However, seniors and the disabled currently covered under Medicaid, including two-thirds of all nursing home residents, would immediately feel the impact of Ryan's road map. It would cut federal funding for the health care program for the poor by 20 percent over 10 years.
The stark contrast between the two approaches may not titillate the masses the way, say, John McCain's Sarah Palin pick did in 2008, but it's sure to make for grand political theater on the hustings.
Washington Post "Wonkblogger" Ezra Klein points out that the irony of all the number-crunching kung fu to follow is that President Obama's health care reform and whatever the Romney-Ryan platform turns out to be vis-a-vis Medicare work out to the same net cost, just with different results.
"These plans get at the basic disagreement between Democrats and Republicans on Medicare," Klein observes. "Democrats believe the best way to reform Medicare is to leave the program intact but vastly strengthen its ability to pay for quality. Republicans believe the best way to reform Medicare is to fracture the system between private plans and traditional Medicare and let competition do its work."
Which boils down to an even simpler choice for voters this November: Who do you trust to drive health care costs down and quality up -- your government or private business?
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