Yes, Paul Ryan, Tom Price & the GOP *do* plan to throw grandma off a cliff...after picking her pocket first.

UPDATE: Denis Byron, in the comments below, claims that Ryan Cooper's story (and therefore, mine) is "incredibly deceptive" and that I should be "ashamed" of myself for basing this entry on it. I've contacted Cooper about Byron's claims and will update the article if Cooper responds. Byron is correct that I am by no means a Medicare expert, so I'll leave it at that for the moment.

Five years ago, a political action committee called "The Agenda Project" released the TV ad above, warning of GOP House Speaker Paul Ryan's plan to privatize Medicare, wiping out the current system and basically replacing it with a far worse version of...Obamacare, ironically. The short version is that instead of being enrolled in Medicare (the program covered around 46 million at the time but is up to over 55 million today...roughly 17% of the country), in the future, seniors would be given a flat dollar voucher amount and thrown to the wolves of the (now deregulated) private insurance market:

Under the proposal, the government would give Medicare beneficiaries vouchers for private coverage instead of directly reimbursing hospitals for seniors' care, which it does today. In such a defined contribution plan, instead of the current defined benefit plan, seniors could end up paying a lot more out of their own pockets, liberal critics of the plan say.

There was much hooting and hollering on the part of Republicans at the time, of course; partly because of the substance of the ad (nitpicking over whether the GOP plan would "actually" wipe out Medicare since, technically speaking, there would still be an (entirely different) federal program called "Medicare"), but mainly because, you know, the image of a young Paul Ryan-lookalike literally throwing an elderly lady off a cliff upset their delicate sensibilities.

Well, five years later, over at The Week, Ryan Cooper has one hell of an ugly story explaining one of the main reasons why Republicans--and prospective HHS Secretary appointee Tom Price in particular--are licking their chops over the prospect of screwing around with Medicare, whether or not Ryan's privatization option makes it through:

The Republican plot to devour retirees' nest eggs

...A great many medical providers adjust their prices based on how defenseless the patient is, and bleed the weakest ones for every last red cent, often with preposterously inflated charges for things like aspirin and bandages. A 2015 study looked at the worst price gougers in the country and found 50 hospitals that charged uninsured people roughly 10 times the actual cost of care.

Key to this practice is something called "balance billing," and it's why the American Medical Association is strongly supporting Donald Trump's pick of Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services, which oversees Medicare. Balance billing is forbidden for Medicare enrollees, but Price wants to allow it — thus allowing doctors and hospitals to devour the nest eggs of thousands of American seniors.

So what is balance billing? It's the practice of billing the patient for the difference between the sticker price and what insurance will pay. So if a hospital visit costs $1,000, but your insurance will only cover $300, some providers will "balance bill" you for $700.

For unscrupulous providers, the method of exploitation is obvious: When doing any sort of expensive procedure, take a rough estimate of the absolute maximum the patient can pay, and jack up the price so the balance hits it. Or if you're short on time, just bill them into the stratosphere, and you'll get whatever the patient has during the bankruptcy proceeding.

Oh, and this isn't just about Medicare, by the way: It ties in with the Affordable Care Act (and Medicaid) as well:

Balance billing is basically illegal for Medicare patients, and heavily restricted for Medicaid patients. It was restricted under the Affordable Care Act as well, but only partially.

...it pales in comparison to the gravy train they might get if they can bring balance billing to Medicare. Seniors use far more care than the younger exchange population, and there are a lot more of them — 55.5 million, versus 12.7 million people on the exchanges.t the prospect of being able to devour those nest eggs.

...That brings me back to Tom Price and the AMA. In 2011, Price (an orthopedic surgeon himself) introduced a Medicare "reform" bill in Congress that, among other things, would have brought balance billing to the program.

Read the whole piece. It's pretty appalling. My own father was a family physician who would've been disgusted by this bill and the AMA's support of Price for HHS. Then again, my dad was an Osteopath (D.O., not M.D.), so he belonged to the AOA anyway.

Of course, the Republican Party is smart enough to recognize that screwing over 55 million reliable voters too obviously probably isn't the smartest idea, so Ryan's workaround (both then and now, I believe) is to simply include an exemption for current Medicare enrollees. If you're already enrolled, you get to keep the current system...it's just your children and grandchildren who are utterly screwed. In short, the GOP is betting that older folks are selfish hypocrites who care not one whit about the next generation. Which, sadly, could be a reasonable bet. If Price's "balance billing" scheme goes through, though, they could start picking the pockets of current Medicare enrollees as well.