Ryan Health Plan Is Simple: Let The Poor Die

Ryan health plan

Paul Ryan has been presenting plans to kill or at least ignore the poor since his wee days.


Our new Republican majority will move to repeal ObamaCare and replace it with commonsense alternatives.” – Eric Cantor, 2010

Obamacare has long been the biggest thorn in the GOP’s side, and that’s saying a lot considering the rose bush that has been arguably America’s most successful progressive in modern history. Perhaps it’s partially the idea that every American is entitled to health care, which is a step towards communism, especially since health is  just another commodity. Perhaps it’s partially the fact that it was put up and pushed through by a Democrat. Or perhaps it’s because the GOP has struggled to come up with an alternative ever since the ACA was first hammered out and then passed. So should go the preamble to the Ryan health plan.

Since its implementation, President Obama’s signature achievement has defied all the naysayers by not only surviving but thriving. It has delivered health care to 20 million people who previously had no insurance. And while still very flawed, it was the largest step towards universal health care since the ancient Medi- safety nets.

Of course this only rankled the Republican establishment, which claimed Obama’s new law would result in rampant death and a general deterioration of America (or at the least of the American health care system). Since before the ACA passed, the right has been promising an alternative, “repeal and replace” emerging as the newest R-alliteration slogan since “reduce, reuse, recycle.” But just like recycling has emerged as the poster-boy of acting locally, only one word out of the new slogan has taken hold: repeal, often backed with dire prognostications. In contrast, replace has been a hodgepodge of tax credits and merit-based care, a rehashing of the laissez-faire philosophy that says benefits for the poor and unlucky promotes laziness, with a healthy chaser of threats that subsidized health care will lead to the end of cancer research, a re-emergence of the Black Plague and eventually Marx’s ghost will take up the West Wing.

But Paul Ryan, the man who in just a few years went from out of touch right wing wack job to the GOP’s voice of reason, has finally presented the Republican plan to replace Obamacare. And like a shiny trinket whipped out at just the right moment to distract the kids from the most immediately pressing issue (i.e. the Democrats sitting on the floor of the House to try to press a discussion on gun rights as Ryan turns off the light and decides to take his July 4th vacation a week early) it’s got all the shine without any of the substance.

The Great White Hope

Paul Ryan emerged from the Trump-induced GOP wasteland a few weeks ago with a list of items to prove the GOP isn’t just a party of rejection and racism, no, we stand for much more. A new direction, a Better Way as it’s titled.

I even wrote about how his mission statement might actually provide a first step towards regaining a political Right that, if still somewhat disdainful of the indigent and lower-middle-class, at least isn’t an embarrassment to modern civilization. Then he made an about-face to endorse Trump, thereby losing all credibility for his claim of wanting to build a conservative block that isn’t built on a mixture of racism, xenophobia and men gone tumescent for boom sticks.

His most recent proposal — sorry, plan — is a list of moves to replace Obamacare.

So what exactly does his “plan” entail?

Obamacare Light?

When you brush over it, it seems innocuous. Almost a redress of the ACA. Especially when you look at the clauses that speak to the most-liked components of Obamacare.

There’s the “keep on your parents insurance until you’re 26” component.

Then the pre-existing conditions clause, the one that prevents a person from being denied coverage for pre-existing conditions. And the clause that prevents the sickest people from being kicked off their insurance when their sickness goes chronic.

And the cap on employer-based write-offs similar to Obama’s “Cadillac Tax.”

Medicaid expansion will stay in place for states that embraced the Obamacare expansion and it would replace Obamacare subsidies with tax credits. And of course Medicare would be kept.

So this seems not too disastrous, right?

Read The Fine Print Of The Ryan Health Plan, Americans

There’s the rub, the dark secret. Ryan’s new GOP plan won’t keep those most-popular clauses as they currently exist. It will twist them into fucked-up mutants of limited health benefits for the most needy, Toxic Avengers of medical reform designed to trick the populist powers into embracing the modern GOP goal of punishing the poor for not being rich.

The pre-existing conditions clause? According to the Ryan plan you’ll have carte blanche to sign up AT FIRST. But should you miss initial enrollment, or lose your health care and have to start anew? You best hope there’s no history of cancer or debilitating illness or substance dependency in your past.

The sickest people clause? Ryan says they’ll create a $25B pool for high-risk pools patients. Essentially this means there will be a limited fund ($25B is nothing when annual health care for the sickest amounts to well into the 6 figures for the sickest patients)(the top 5% of sickest patients make up 50% of our nation’s annual health care spending, that being $2.9T, so the top 5% of sickest people would have to cover $1.45T a year in health care needs). Even more, this will create a Lepers Colony in American health care where they’ll put the most at-need patients, a new twist on the beautiful old belief in “separate but equal.”

The caps on tax benefits for employer-provided health care? They will be combined with a push towards employers adopting HSAs. For those who don’t fully understand, a HSA is basically a savings account for health options. Essentially it’s a special account to save for out-of-pocket health expenses. The average hospital stay costs $10 grand. So you’ll have to  save $10 G’s in a special savings account for that one trip to the hospital. God forbid you get cancer, or a longterm illness like Krohn’s where meds cost tens of thousands of dollars. Basically, HSAs are only good for … wound treatment? No, even in that case should you get MRSA or some staph infection you’ll drain your account. And that’s if you can somehow put away thousands of dollars when many Americans are struggling to get a couple hundred ahead of their bills.

And Medicaid Medicaid. Oh man, where the bill really shines is in its gutting of health care for the poor and aging. Are you old? Paul Ryan wants to fuck you too.

If you get sick, America, the Republican health care plan is this: ‘Die quickly.'” – Alan Grayson, D-Rep Florida

Bring Me Your poor, Your Old, Your Sick… And Let Them Die Quickly

Paul Ryan will allow the states to keep their Medicaid enhancements. Except in his world, Medicaid will be in the form of state block grants and/or individual per-case alottments. So there will be more control given to smaller governments to oversee public facilities for the poor, which we’ve seen works out well. In some cases, states may need more money but in God’s country, to fight for more funds would be seen as sacrificing state sovereignty.  Refusing to request more federal funds during health emergencies will save face for them and buy into the Republican idea of cutting out Federal outlays but will leave millions of people without health care. That doesn’t even mention Ryan’s proposal of making Medicare based on population. So in my state of Wyoming, with a population of about 600,000, imagine how little money will go to the many people suffering from the adverse effects of coal-mining and natural-gas production, not to mention the simple effects of a life lived in extreme and rural conditions with few top-quality hospitals.

Speaking of life without health care, want to know Ryan’s greatest Medicaid clause? The crowning achievement of the Ryan health plan? The work clause. That’s right, since all people out of work are only in that condition because they’re lazy, if you don’t have a job, you don’t get Medicaid. This is literally saying “If you’re not employable, you don’t have a right to live.” Think Trump’s rural unskilled laborer-supporters will appreciate this? No, though they’re too enchanted by the idea of bounty hunting Muslims and standing atop the Game of Thrones wall and pissing down on starving Mexicans to read the fine print in any actual GOP proposals. Or seemingly, to read anything. Like ever.

But what about Medicare? Not everybody will be poor but surely most people will grow old. And they might want to pay attention to clauses such as the raising of the Medicare age to 67 from 65. And how the limit of benefits for LTSS claims (long-term health issues) will lead many people to head into old age with already-weak health (seemingly the idea is that they’ll die before reaching Medicare age) and then they’ll hit a mutated Medicare (Paul loves mutating shit, like Stan Lee but less talented and more out of touch with reality). What do I mean mutated? Well Ryan’s plan pushes for privatization of elderly care, with credits for private care taking front and center, giving old people choices to throw off the shackles of the US gubmint. But basically, this proposal is aimed at destroying Medicare.

His plan calls to “Give options for Medicare with private exchanges and credits” — a step to privatization. He would also cap federal spending and raise subsidies for lower-income elderly but lower them for wealthier ones, which almost seems egalitarian until you realize the main point is the get the most people off Medicare and into private insurance because, you know, you can trust big corporations to always put people first. Finally, Medicare recipients would get a capped amount for benefits instead of a percentage. Right now people on Medicare get a percentage towards their treatment. In Ryan’s plan they get a set amount. So if your drugs costs $100 or $5000 you’ll get about the same help. God help you when it balloons to the tens of thousands through federal loosening of regulations on pharma companies and hospitals (a cornerstone to any GOP proposal for anything, ever).

But that’s the big buzzword in the Ryan health plan, the beating heart to this magnificent beast of medical reform — credits.

Importantly, the tax credit would not be geared to the second-cheapest plan in a given locality, à la Obamacare, but rather to an actual dollar amount. That way, insurers and health care providers are forced to be accountable for the prices they charge, and for keeping those prices accessible to consumers and taxpayers.” – Forbes

What does “credits” mean?

Here is where it gets vague. The plan is constantly pointing to “credits” and other intangibles like “speed up FDA approval.” But mostly it’s a lot of (paraphrasing) “give tax credits instead of subsidies” or “give credits for private insurance to replace Medicare.” But it doesn’t mention how many credits. Perhaps that’s because there’s little substance or analysis behind this? Perhaps it’s because if they proposed too many credits they’d get eviscerated by “tighten-our-belts” Republican pseudo-economists and if they propose too few, they risk alienating the many millions of rural poor that have proven VIA Trump to be the majority of the GOP base and who can’t afford treatment for black lung out of pocket.

Another great vague statement? The plan will limit doctor liability. So does this mean that people can’t sue if Dr. Johnson has a drinking problem, goes into surgery two-sheets to the wind and leaves his Rolex where an erupted pancreas used to be? There’s something about not able to sue for charges above medical expenses so does that mean that if Dr. Nick Riviera amputates the wrong leg, the only punishment is that you don’t have to spend $50 grand to pay for the unnecessary surgery that made you a full paraplegic?

And there’s the many moral clauses. There will be “permanent protections for life and conscience.” For example, let’s say a woman has been in a braindead coma for years and her family decides to ease her suffering by pulling the plug? This clause says doctors and nurses don’t have to allow that. And of course there is a portion that specifically says taxpayer dollars will not be used for “abortion.” And since “abortion” is synonymous with Planned Parenthood for the GOP talking heads, this means a defunding of women’s health programs. Poor girl gets raped by her uncle? Fuck you, you’re a mom. Teenager has sex with her boyfirend and believes him when he says you don’t need a condom, you can’t get pregnant your first time? Fuck you, time to trade in Pre-Calc for “What to Expect.” Teenage boy gets genital warts? Get ready to be Typhoid Marty Papilloma Virus.

Life Without Conscience

The ultimate irony in this proposal is that it mentions a conscience clause. Because this “plan” speaks to a lack of conscience from Paul Ryan and anybody who supports it. Now it’s long been a part of American laissez faire economics that conscience has no place in fiscal matters. Apparently it does when it comes to women’s health but everything else? Nahhhhh.

For example, the idea that credits will lead to competition among insurance companies and in that way absolve Ryan from the death of anybody who simply can’t afford $400 a month even after a measly $40 tax credit (that’s okay, you’re not required to have insurance in Ryan’s plan, problem solved, now please don’t die anywhere too public)? Because it doesn’t work like that and everybody knows it. We had a system like that before — it was called the American insurance industry. And its high premiums, sketchy operations and policies that disinclined all except the golden few who could afford top-tier plans ensured that many Americans had to face dying physically from illness or dying financially from medical costs. There’s no benefit for insurance companies to compete for users. It’s much better to only cater to the people who can afford $600 a month, most of whom probably also live in nice new houses without asbestos or the threat of stray corner-boy bullets, and ignore the folks who can only pay $200.

I speak from experience to the flaw of expecting conscience to propel private companies to take care of folks because I’m one of the few middle-class Americans who was royally fucked by a similar policy in Obamacare. You see, there’s a “glitch” in there that if one person in a family is insured through his or her work, the remaining members can’t qualify for subsidies. And while my personal insurance is covered by my workplace, to add my wife and son is costing me $700 a month. The idea, I think, was that this would push people to push their jobs to add their spouses and even more it would make companies add the spouses as a recruitment tool. But the President overlooked the greed of private insurance interests and corporations, just as the Ryan health plan would. But instead of there being one small subsidy loophole, there would be a massive loophole affecting everybody looking to get health care.

Here’s the thing: Obamacare isn’t perfect. But it’s as perfect a plan as could be pushed with insurance lobbies dominating congressional buffets and a political class that believes our acquiescence of the universal healthcare offered by every other developed nation (which, might I add, all have better health rates than our own). And Hillary will be pushing it forward, no doubt addressing the family care glitch and a few other glaring shortcomings that will be small beans after getting the ACA passed in the first place.

On the other side, while the Ryan plan is short on details, the broad strokes point to one simple fact: this insurance “Overhaul” isn’t a step forward. It’s a return to life before 20 million new people got insured. Actually it’s worse because it guts all safety net programs. So this is a move not to before Obamacare but to before Medicare, before Medicaid. And if the GOP can refuse any discussion about gun control on the grounds that it’s all just an excuse to take away Americans’ guns, it’s not a big leap for the Dems to see this as a move towards a primitive world when only the richest could get adequate medical care, but man will they live for-fucking-ever. A return to a world where the average American lifespan was a decade-and-a-half shorter than that of the wealthiest (see: the 1950s).

Paul Ryan’s plan is so short on details it won’t move beyond the sniffing butt stage. But as a mission statement it shows everybody advocating for the poor and sick that the scariest thing about Trump isn’t his intolerance or his lack of governance experience. It’s that he’s made behavior previously seen as the soulless apathy of the right seem “moderate.” And Ryan has  shown that the GOP is just as ready as ever to see the poor die as long as the rich can live longer, healthier lives.



Ryan Ariano

Born and raised in Baltimore, Ryan has been kicking around the west since the first Clinton White House. Having worked all over SoCal in the surf industry, Hollywood, marketing, journalism and finance, he now hangs his hat just outside Jackson Hole where he can fulfill an addiction to ascending and descending mountains.

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