Obamacare In All But Name?

by Patrick Appel

Ezra Klein calls the new Ryan-Rivlin Medicare reform plan a cousin to Obamacare:

Under the Ryan-Rivlin plan, the current Medicare program is completely dissolved and replaced by a new Medicare program that "would provide a payment – based on what the average annual per-capita expenditure is in 2021 – to purchase health insurance." You'd get the health insurance from a "Medicare Exchange", and "health plans which choose to participate in the Medicare Exchange must agree to offer insurance to all Medicare beneficiaries, thereby preventing cherry picking and ensuring that Medicare’s sickest and highest cost beneficiaries receive coverage."

Sound familiar?

Yglesias offers an unlikley compromise:

If we agree that Paul Ryan’s proposals for Medicare more-or-less amount to turning it into ObamaCare, then the stage is set for a potential bargain. That would beRepublicans stop trying to repeal the Affordable Care Act and in turn Democrats agree to phase Medicare out on Ryan’s schedule. You can further sweeten the deal by throwing in a public option and the replacement of ACA’s Medicare tax hikes with something more regressive.

This is basically “everyone takes a shot of poison” and I don’t expect it to happen, but it would better-align policy with the things people claim to care about.