Since the GOP has endorsed Rep. Paul Ryan’s (R-WI) plan to completely privatize Medicare, some Republicans have abandoned their claim that the Affordable Care Act would lead to single payer government health care and begun arguing that Ryan’s reforms are very similar to the exchange structure in the ACA. “It’s exactly like Obamacare,” said NRSC chairman Sen. John Cornyn (R-TX) in the Capitol several weeks ago. “It is. It’s exactly like it. Which strikes me as bizarre that you’re seeing so much pushback [from Democrats].”

This afternoon, during an appearance on ‘Point of View,’ Gohmert attempted to balance these two completely contradictory arguments by arguing that the ACA would lead to more private competition and a government takeover simultaneously:

GOHMERT: But with regard to Medicare, it actually does what Obamacare does, but it does so far more efficiently. It gives patients far more control and that is it gives money in order to provide what’s needed to buy private health insurance. That would be far better than having the government takeover the health insurance business which is what we’ve been told what we’re all about here with Obamacare.

Listen here:

While there are certain structural similarities between the ACA and Ryan proposals, the GOP budget would move seniors from a comprehensive system into one that is decidedly less efficient and more costly. As the Congressional Budget Office (CBO) has pointed out in its analysis of the Ryan proposal, “a typical beneficiary would spend more for health care….[because] private plans would cost more than traditional Medicare because of the net effect of differences in payment rates for providers, administrative costs, and utilization of health care services.”

Likely presidential candidate Rick Santorum (R-PA) tried to shore-up his conservative credentials yesterday by telling Fox News Sunday’s Chris Wallace that he should have voted against the Medicare prescription drug bill in 2003 because the measure was not paid for. “I would say that that was a mistake,” Santorum said. “We did two things that were wrong in the bill. Number one we made it universal…number two, we should have paid for it.”

But Santorum praised the measure as recently as February 2011, when, during an appearance on Fox News, he called the law “a good allocation of money” and even went so far as to defend Republicans for creating the now infamous Medicare doughnut hole of coverage:

SANTORUM: They got an expansion of the Medicare Prescription Drug Program, but that program was designed to do two things: take care of seniors who were poor and needed drug coverage and those who are high users of prescription drugs. It did both. It left a little hole in the middle for those, who frankly could afford to do it. And that was a good allocation of money.

Watch it:

Little may be in the eye of the beholder. Under the Medicare Modernization Act of 2003, enrollees enter the doughnut hole when their total drug spending equals $2,830 and receive no Medicare coverage until they reach $6,440 in total drug spending. Almost three and half million, or 26 percent, of Medicare Part D enrollees reached this coverage gap in 2007 and those who couldn’t afford to pay for their medications stopped taking medicines altogether.

Santorum’s positions may be a bit all over the map, but they all point in one direction: less benefits for seniors. He is now running on a platform that says: fewer seniors should benefit from prescription drug coverage and that today’s Medicare program should be radically restructured so that seniors have to buy coverage from a private health insurer.

Last week, Mississippi Governor and potential presidential candidate Haley Barbour (R) — who vigorously opposes expanding the state’s Medicaid program — tried to minimize his state’s health care access crisis by arguing, “There’s nobody in Mississippi who does not have access to health care.” Barbour maintained that hospitals and doctors routinely provide charitable care and said that residents without reliable access to health insurance received care from clinics.

Barbour may be technically correct — the 1986 Emergency Medical Treatment and Active Labor Act requires hospitals to treat emergency conditions — but as Aaron Carroll and Austin Frakt of the Incidental Economist point out, the emergency room is not a good place for patients with chronic conditions:

Over 25 million people in the United States have diabetes, requiring regular access to medication to stay alive. They can’t get insulin in an emergency room. They can’t get needed eye exams or kidney function tests in the emergency room. They can’t get a checkup in the emergency room. But once they go into hypoglycemic shock or once their feet become gangrenous, then they can get examined and treated. Does that sound like access to health care?

About 20 million people in the United States have asthma. They can’t get their prescription refills in an emergency room. They can’t get the equipment then need, like nebulizers or inhalers or spacers in an emergency room. They also can’t get checkups in an emergency room. Once they have an attack so bad that they could die they can get examined and treated, but that’s not access to health care.

Over 200,000 women were diagnosed with breast cancer in 2010. Not a single one of them could get a mammogram in an emergency room. Over 140,000 people were diagnosed with colorectal cancer in 2010. Not a single one of them could get a colonoscopy in the emergency room.

Nearly one in 100 children have Autism, and not a single one of them can get any treatment at all in the emergency room. More than 5 million children have attention deficit hyperactivity disorder (ADHD), and not a single one of them can get any treatment at all in the emergency room. Around ten percent of all children may qualify for interventions for developmental delay, but few get them, and not a single one of them get them from an emergency department.

Americans often think of health care as acute care — you have a condition that requires emergency surgery, so you go into one of the country’s state-of-the-art health centers and undergo the needed procedure. Most of health care is far more simple. It’s not about complex surgery or fancy technology: it’s about keeping patients healthy, managing their chronic conditions so they don’t worsen, and preventing them from needing that surgery in the first place.

You can’t find that kind of care in an emergency room, particularly when the availability of good emergency room care is in decline. In 2006, 119 million visits were made to ERs, up from 90 million in 1996. At the same time, the number of hospital ERs dropped to fewer than 4,600, from nearly 4,900, causing wait times to also increase.

CMS Head Don Berwick

Republicans have spent the lat two years going after CMS head Don Berwick for allegedly trying to ration care and establish some sort of centralized health care system, but now the man the GOP has labeled Obama’s ‘Health Rationing Czar‘ is telling Politico’s Jennifer Haberkorn that Rep. Paul Ryan’s (R-WI) proposals to voucherize the Medicare program and block grant Medicaid would withhold care from people:

“It is paradoxical really that with all this talk of rationing, the proposal we hear about how to fix American health care is to take it away from people. That’s from the very people who are crying rationing,” Don Berwick, the administrator of CMS, said in a wide-ranging interview with POLITICO. “If you look at the proposed withdrawals of support to Medicare beneficiaries and Medicaid, it’s withholding care from the people who need the care. You tell me what that is?” [...]

“When I read proposals for reform that say, ‘Sorry kid, you’re on your own,’ that’s the not the country I want to be in,” he said. “And I don’t think that’s the country the public wants to be in.”

In particular, he said the idea of block-granting Medicaid — an idea endorsed by most of the likely Republican presidential nominees — has short-term attraction as governors deal with crushing budgets but is “unsound” in the long-term.

“Block grants are throwing the states out on their own,” Berwick said. “If we block grant and the next immense influenza epidemic arrives or a major recession comes back, what do we say? ‘Sorry states, you’re on your own?’”

It’s worth noting that the Affordable Care Act also cuts Medicare, but those savings would slow the growth in the program by removing approximately $500 billion from future spending over the next 10 years. It eliminates overpayments to private insurers and slowly phases-in payment adjustments that encourage providers to deliver care more efficiently. The law also gives Berwick and his agency greater discretion to experiment with alternative payment systems — so that providers are compensated for delivering care more efficiently, rather than just ordering more tests — and establishes an innovation center for payment reform.

In other words, the ACA eliminates the inefficiencies in the health care system without sacrificing guaranteed benefits. Ryan, on the other hand, keeps a lot of the waste in the system and simply cuts the federal contribution to Medicare, passing on more of the cost of coverage to seniors without looking at ways to make the program more efficient. He would force Americans under 55 years of age into less efficient private coverage and would then leave it up to those insurers to deny treatment and benefits.