Wednesday, August 15, 2012

Managed Competition

Vouchercare, Premium Support, Managed competition.

Ah yes Ryan is trying to link his flaky plan to the longstanding premium support proposal (via his less flaky no money saving House Budget Resolution proposal).

Wonkblog notes Joseph Rago noting the longish intellectual family tree of Ryan Care*

"Premium support was first proposed by Stanford economist Alain Enthoven in the New England Journal of Medicine in 1978. He observed that the pervasive methods of direct economic regulation of health care did not contain costs and suggested that “managed competition” would do a better job" Ah yes managed competition. Note the brief summary of a brief summary of the history doesn't mention that it has been tried since 1978. Managed competition in practice means Medicare Advantage too now post Gingrich revolution (remember that). It didn't do a better job. It didn't do as good a job as no reform. It cost a ton of money. That episode has had no effect on Ryan's thought (even though he counted the ACA savings from cutting Medicare Advantage extra payments in his budget resolution).

But managed competition made me think of a third reformer who was as enthusiastic about it as Ryan and Gingrich -- Ira Magaziner. The secret to how ClintonCare was supposed to increase access with lower spending was managed competition. It was quite the buzz word(s) in 1993 and 1994 as well as in the following years.

So my question is this: Ryan, Gingrich, and Magaziner are ducks lined up in a row. Why hasn't Brad DeLong blasted them ?

I think that the ACA has cured his unhealthy obsessive Magazinerphobia.

* While most journalists talk about the horse race when they claim to be talking about policy, Klein snuck a link to a discussion of a decades long bipartisan discussion of optimal policy into a post allegedly about polls "Wonkbook: Parsing the polls on Ryan" Ezra Klein is a wonks fantasy of what a wonk sounds like (most wonks couldn't write as he does to save their lives and don't even mention the Jezebel list of the 10 hottest guys whose jobs aren't about being hot).

But what I was thinking is that this puts

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