Actually there isn't a single quote I can pull from it, which is kind of the point. The entire document is a guide on how to build/determine actuarial equivalence between plans while staying within some required guidelines. Note that I've never claimed there are no guides or boundaries, I said that you were not guaranteed that the second-cheapest plan would offer directly equivalent benefits to Medicare. Gbaji has spun this off to some strawman arguments ("bottle of generic painkillers and a 20% off casket gift certificate") but the reality is that there's many ways to tweak what the plans offer while staying within the requirements but not necessarily giving the same benefits as you receive with Medicare. That's the entire point of a guide detailing the tests that will be used to judge the plans. And that's just a guide for prescription drugs where there isn't a ton of flexibility, it's not even getting into doctor visits, hospital stays, surgery (critical or elective), hospice care, well being care, medical devices, etc.
There's nothing innately wrong with this -- someone might value some benefits over others, but it's patently false to state that you'll be guaranteed the same benefits.
Ok. That's actually quite reasonable. But, as I already pointed out earlier in this thread, the ability of those plans to deviate is the same as the ability of the existing medicare coverage to deviate, right? I mean, at some point, there's just a set of guidelines that medicare follows to decide what the exact coverage it provides at any given time is. The same guidelines would have to be followed by any of the alternative plans as well. So while I suppose we can say they aren't guaranteed to be "exactly the same", the same can be said of medicare itself (I know I made this point already). And we certainly can't make any assumptions that one will be worse than another.
IMO, it's a meaningless point because the standard you're using is itself not "exact" either. It's unfair to point to the proposed alternative plans and assume they'd somehow screw people over, but then insist that medicare, operating under the same set of guidelines, is some sort of magically perfect standard simply because it happens to be named "medicare". Even medicare doesn't guarantee that in 15 years, it'll provide the "exact same care". It only guarantees that the care it provides will meet the guidelines. I'm struggling to see why we'd assume one would result in any better care than another.
Imagine if the government created a set of guidelines for a basic "people's car", with requirements involving number of passengers, safety features, cargo room, mpg, etc and the government currently provides them to people at a cost of $20k. Then someone comes along and says that if we opened the car market to competition and allow private companies to make cars they could find ways to make cars that meet all the requirements for less than what the government charges (like say $18k). Quite reasonable (and historically shown to be true). But you're arguing that this will result in a lower quality car because they're only required to meet a set of requirements and they might find ways to cheat or something. I just think that's an incredibly weak argument. And if history is any indication, introducing a competitive market will not only reduce the cost of the cars over time, but will usually dramatically improve the quality as well.
While I'll freely admit that health care isn't the same as building cars, the basic market argument is the same. By introducing competition, it provides an incentive for private companies to figure out ways to provide the same coverage at a lower price. And we often find that when we do this, we find that costs can be reduced quite easily. It's not like anyone doesn't agree that costs can be reduced. Heck. Obama's own plan (and the justification for his cuts to medicare) assume that he can find ways to reduce waste, fraud, and abuse. But which is more likely to find and eliminate that? A government program created to audit the health care industry to find where it's overcharging medicare? Or a set of free market players, each with a financial incentive to force the care providers to give them the best deal possible in a competitive bidding situation?
Let's not forget that both the Ryan plan *and* the Obama plan cut medicare. Obama's actually cuts more. But does anyone seriously think that the government method of reducing costs will work anywhere near as well as the private market method? Ryan's plan is far more likely to actually be able to cut the costs for the care itself equal to (or greater than!) the amount he proposes to reduce the budget for medicare by. Obama's is basically just wishful thinking. He cuts the budget for medicare, but proposes some magical fantasy method of reducing costs. One of those is a realistic and workable plan. The other is just plain not. Edited, Aug 16th 2012 7:24pm by gbaji