Here's a modest proposal: Let's test the idea of a combination of Medicare vouchers and a kind of Medicare coverage exchange program by setting up a "Ryan plan" program for long-term care (LTC) services.
We could call the program Medicare Plan L and reward the private insurers that have stuck with the private-long-term care insurance (LTCI) market through these bleak times by giving them some kind of privileged position in the market.
Maybe we could reward the agents, brokers and wholesalers who've stuck with the LTCI market by putting them in charge of setting up and running the exchange, through some kind of mechanism that would enable them to make more money but do less work.
Maybe we could pay for Medicare Part L subsidies by closing the Medicaid nursing home asset protection quirks that many advocates of private LTCI love to hate.
Democrats could support this proposal because it could give middle-income and upper-income workers easier access to LTCI coverage.
Republicans might be able to support this proposal because Medicare Part L would be a lot like the Medicare Advantage acute health care insurance program, which Republicans and insurers generally say they like, and because it might divert some of the resources now going into Medicaid, and into efforts to help older people make themselves artificially poor, into supporting efforts to help workers buy LTCI coverage that would come as much from the private sector as possible, under the circumstances.
If Medicare Part L worked beautifully, that would provide some vindication for Rep. Paul Ryan, R-Wis.
Democrats used dark murmuring about how Ryan was out to destroy Medicare to make him look like some kind of hateful thug, but it just seems as if Ryan had a point that anyone could understand: Maybe we could do more to cut Medicare health care spending and increase Medicare payroll tax revenue, but, at some point, we have to find some kinder, gentler way to get the enrollees themselves to help hold down the cost of the extremely valuable coverage they happen to have.
Maybe a Medicare Part L that adopted the Ryan plan approach could vindicate Ryan by staying solvent.
Really: Medicare Part L would just be a great big public or quasi-private LTCI exchange, with private insurers operating with some reinsurance help and a lot of marketing help from the government.
One challenge here is that, of course, this would involve a different kind of government involvement in the LTC market. But, who are we kidding? Governments and government-like institutions have been been involved with providing care for the old as long as there have been governments. Even Adam Smith thought that only a primitive, savage society would let the elderly and infirm die of neglect. He assumed as a matter of course that the beneficiaries of a free, or free-ish, market would provide for the support of the aged and infirm.
