Imagine that the 2010 health reform legislation goes into effect as planned. If the skeptics are correct and it fails to control long-term federal health spending, what could a future Congress do to modify it? There are three approaches. Congress could (1) clamp down harder on prices and payments in a probably fruitless effort, (2) sharply expand the powers of the Independent Payment Advisory Board to ratchet back payments to providers of limited care, or (3) set a real and capped budget for federal health spending. If it took the third course, Congress would be faced with another choice: how to distribute the budget. Should it allocate funds to health care providers, as in Canada or the United Kingdom, which is the essence of rationing, or provide funds to households for them to decide how the funds will be spent?
As the new health care entitlements approach full implementation over the next several years, the true costs of the law will become progressively clearer and they will further threaten the federal government’s deteriorating fiscal health.
The Heritage reform plan, advanced in Saving the American Dream, and five other reform plans differ in detail, but their main features are similar. Congress should build on this powerful consensus and craft a comprehensive reform of the Medicare program.
The future of health care in America looks grim but it does not have to be. Representative Paul Ryan (R–WI) has proposed “A Roadmap for America’s Future” the only comprehensive plan in Washington that deals with the looming fiscal and economic crisis, driven by ever-increasing government spending on health care. Ryan’s Roadmap would reduce the deficit, allow Medicare to become truly sustainable, establish equity and efficiency in the federal tax treatment of health insurance, and improve access to health care for middle-class and low-income families. Congressman Ryan’s critics have accused him of trying to destroy the Medicare system and claim that the Roadmap will increase the deficit. While they may have honed the harshness of their rhetoric, they have not offered a comparable alternative. Heritage Foundation health policy experts explain how the Ryan Roadmap would really work, and how it would benefit Americans.