The co-creator of the concept that Rep. Paul Ryan (R-Wis.) is relying upon to reform Medicare no longer thinks it will work. Henry Aaron, now of the Brookings Institution, got the chance to tell Ryan exactly why at a recent Capitol Hill hearing.
Aaron and former Urban Institute president Robert Reischauer came up with the idea of "premium support" in 1995, after the failure of then-First Lady Hillary Clinton's bid to reform the health care system.
The basic idea is simple: let people pick their health insurers in the private market, subsidize the premiums, and competition will drive down costs. That's the theory behind Ryan's plan, recently endorsed by Sen. Ron Wyden (D-Ore.) in a white paper the two wrote.
It differs from Aaron's original vision -- in part because it has fewer protections for beneficiaries -- but the essential concept is the same. Aaron said this isn't the time to test it out.
"In the years since Bob Reischauer and I put this Idea forward, I've changed my mind," Aaron said at a hearing of the House Ways and Means Committee last week.
The big reason is that Aaron has seen no evidence since the two men came up with the idea that their assumptions have been borne out.
A key assumption was that the insurance industry or government would figure out how better to adjust risk among companies so that if one insurer suddenly was saddled with an unusually expensive population, it would share the costs with other insurers or the government. That would keep costs down because it removes some of the incentive to cherry-pick healthier customers or shun sicker ones.