Thursday, May 26, 2011

Medicare Semantics

Democrats are arguing that Paul Ryan's approach to replace the current Medicare system with one of vouchers for private insurance for seniors kills Medicare. Republicans respond that this is a falsehood meant to scare older voters. Many reports in the media label Ryan's proposal as an attempt to "fix" Medicare, that is, not to do away with it, but to keep it in a different form. Democrats argue that the form is the essence of what it is and such a radically different system is not Medicare, but something else. Who is right here?

Medicare is a government run, single-payer system in which the costs of helath-care (with the exception of some prescription drugs) is covered directly by the government. Ryan's system is one in which a fixed amount is given to seniors in the form of vouchers and seniors then go out on the open market and purchase their own coverage through insurance companies. If their costs outrun their voucher amount, seniors are on the hook for the rest. So, unlike the current system, not all medical bills will necessarily be covered for standard, required care.

The question then is which of the follow three possibilities is the correct one:

1) "Saving Medicare" Ryan's plan is a form of Medicare, just one with a different internal structure. If one had a manuscript and a copy editor made some adjustments to the prose, so it flowed better and was grammatically correct, one would never say that the edited manuscript is a different book. Rather, it is a better version of the original book. In the same way, Republicans are arguing that Ryan is not ending Medicare or replacing Medicare, just making some adjustments within it. Medicare may make radical changes, but it is the program that changes and so the program exists before and after the alteration. Medicare has gone nowhere, it just has been restructured.

2) "Changing Medicare" The picture here is that the two are not identical, but similar enough to be grouped together. Where the first option considers both to be the same thing, number 2 takes the name "Medicare" to be one in which a book is adapted to a screenplay. If one can argue that the first Harry Potter book and the first Harry Potter movie are the same story, then one could argue that the Ryan plan and Medicare are the same program. "Medicare" means any government run and funded program that helps seniors pay for medical expenses and while the current program and the Ryan plan are different programs, they both fit under the heading "Medicare."

3) "Ending Medicare" The Democrats' line is that the single-payer non-market-based approach is the defninitional element of Medicare, remove that and what you have is no longer Medicare. They look at the Ryan plan as undermining the nature of Medicare and while you could call the Ryan plan by the name "Medicare," it isn't. It would be like buying every copy of War and Peace and burning it, then buying every copy of Moby Dick and pasting a sticker with the words "War and Peace" on the cover. You could not claim that War and Peace still exists by pointing to the altered editions of Moby Dick. Moby Dick is not War and Peace just because you've decided to now call it that. In the same way, Ryan's plan is not Medicare, they argue, even if you want to call it "Medicare."

So, which is the most accurate description, 1, 2, or 3?