Initially I was going to disagree with you about the "double dip" you mention above. But others made posts disagreeing with you so I didn't bother.
Now, I'm beginning to agree with you although, perhaps, for reasons you haven't expressed above.
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First wanna say I give Paul Ryan credit for trying. I think he's sincere and is working hard to improve things. Working hard to come up ideas etc. Problem is, I like very few of them.
In general, I have no problem with trying new things to improve govt services.
In general, I have no problem with letting states try to handle some of the services now provided by the federal govt. I'm a fan of the whole "states are little laboratories" concept embedded in the Constitution.
But at this point I think his idea is a bad one for a number of reasons:
1. Many here see this as the govt model versus the private model and of course often the private model outperforms the govt model.
But that's not what this is. To evaluate his proposal on that basis is erroneous.
In the typical private model customers are free to purchase or not. Customers evaluate the product etc and make the decision to give the business their money in exchange for the good or service. If the company performs poorly the customer will not return and the market will take of the poor performer: They will go out of business.
That's not the case here. The business gets the money from the govt, not the customer. IMO, that's very important. In the true private business model the customer will not acquire the product if they think it's overpriced. In Paul's 'hybrid model' why would the customer care if the product was overpriced? They're not paying for it, Uncle Sam is. (I think this a big problem is our HC system: The customer doesn't pay, the insurance company does etc.)
Well, how is the federal govt to watch and ensure 'customer satisfaction' and cost efficient delivery of service? They're going to have to develop a layer of bureaucracy for this purpose.
2. Fraud. Paul's proposed model is
very similar to Medicare/Medicaid. Non-profit or for-profit organizations provide the service to customers and are paid by the govt. Everyone is aware of the fraud. Back in 2009 AG Holder said it was $60
billion a year.
http://www.cbsnews.com/news/medicare-fraud-a-60-billion-crime-23-10-2009/
I.e., another layer of federal bureaucracy will be required to combat this.
3. Cronyism. Anybody wanna bet that political insiders won't be setting up private companies to get fat, overpaid, govt contracts from their politician friends? And let the lobbying money flow.
In too many ways the elements present in the private business model don't exist here. Therefor, I don't expect the benefits to exist either.
Fern