Steve Inskeep interviews Michael Steele the sometimes spokesweasel of the Republican Party about GOP efforts to deceive old people save Medicare. While the interview is not nearly as interesting to the non wonk as say Bill Clinton parsing the various meanings of sex, it does provide a fine example of mental and verbal gymnastics.

Right now the Republican party line is no Medicare cuts - they even want to introduce a bill to assure current seniors that nothing will ever change in their cozy little world. At the same time the old line, which some folks in the press have inconveniently chosen to remember, works like this:

What makes it a valuable program is that it is the last line of opportunity to receive health care for a lot of our seniors, and it has been now for - since the 1960s. The problem is, as we all note, that the system has been raided over the years, from time to time. It's become bloated, and in some cases efficiencies have not been maxed out. Therefore, it's running into problems where, you know, every few years we're having stories about Medicare falling apart and, you know, we've already projected it's going to be out of money in a few years.

Which is a little difficult to reconcile with the no cuts promise. Steele and others in the Republican party are short on details of how they propose to fix Medicare if they can return to power and once more lead us on to the glorious future. Wonks Anonymous can, however, provide a plan now being promoted by a moderate fellow traveler which will fill the bill.

Alain Enthoven familiar to readers of the previous posts on Health Insurance Exchanges has this to say about Medicare:

Create an insurance exchange for government-paid health care and offer beneficiaries a voucher. Help them choose among the competing subsidized plans. The exchanges would follow rules similar to the employer-funded plan exchange described in A.

Retirees would be rewarded for choosing plans that cost less than Medicare's fee-for-service plan. Medicare is wastefully subdivided into Hospital Insurance (Part A), Physician Insurance (Part and Drug Insurance (Part D). Reorganize Medicare into comprehensive care insurance, just like insurance that serves non-Medicare people. The savings would allow Congress to slow the growth in government contributions to Medicare.

Now it is a sad fact that most of the cost saving innovations that have been developed by the Health Insurance Industry follow a simple basic strategy. The less medical care you pay for the lower the cost of your health insurance plan.

Direct savings are produced when the consumer is forced to pay a high deductible before health insurance pays for anything. More direct savings are produced if the consumer is required to pay a high cost share after the deductible is met up to a higher out of pocket maximum. The typical consumer pays the insurance company and then is required to pay for most, if not all, medical care.

Indirect savings from these plans come because sick people hate them and avoid them. Sick people are expensive to insure. If you cannot refuse them directly you can always write policies that effectively turn them away. Policies that only cover the most extreme medical spending are not attractive to sick people. They do attract people who are healthy or consider themselves healthy.

So the formula for the success in the future Medicare marketplace is clear. Insurers need to offer policies that cover very little which they can easily do by adding high deductibles and high out of pocket requirements. This will draw healthy retirees and still save money when these retirees get sick. In the meantime the cost of comprehensive policies will increase as they are stuck with the ill and unattractive.

In the meantime retirees will be rewarded for going without comprehensive coverage. And if they fail to move along fast enough into this bold new entrepreneurial world then Wonks Anonymous expects that some form of punishment will be applied. Perhaps an excise tax on "luxury health plans".

But all of you folks who now get Medicare don't need to worry. Michael Steele has got your back and nothing will change for you.