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Our big debate over Medicare boils down to a few truisms

 

Here’s the WHOLE DEAL in a nutshell:

What is Medicare? It’s a massive, government-run system of socialized medicine. It’s wildly popular, very successful, and one of the pillars of modern Democratic governance. This government-run system of socialized medicine was created by Democrats against the opposition of conservative Republicans, and it’s Democrats who’ve fought to protect it for more than a half-century.

Or to summarize, the left loves Medicare and always has; the right hates Medicare and always has. For liberals, the system is a celebrated ideal; for conservatives it’s an unconstitutional, big-government outrage in desperate need of privatization.

In 2012, once we get past all of the talking points and attack ads, we’re left with this: Romney/Ryan wants you to believe they’re the liberals. No, seriously. Think about what the Republican presidential ticket, Fox News, Krauthammer, Donald Trump, and the Republican National Committee have been saying all week: those mean, rascally Democrats cut our beloved Medicare and voters should be outraged.

In other words, the argument pushed by the most right-wing major-party ticket in a generation is that Barack Obama is a left-wing socialist who wants government-run socialized medicine and that Barack Obama is a far-right brute who wants to undermine government-run socialized medicine.

If you care about protecting the popular system of socialized medicine, the argument goes, your best bet would be to put it the hands of conservative Republicans who steadfastly oppose the very idea of a government-run system of socialized medicine.

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26 Comments

  1. This is a much better article.

    http://www.thedailybeast.com/articles/2012/08/17/how-paul-ryan-s-medicare-plan-is-coming-back-to-haunt-obama.html

    Well, in politics, not all lies are all lies. And not all truths are complete.

    Both the Romney/Ryan and Obama plans end Medicare “as we know it.” The program is running out of money as fewer people pay in than receive benefits. In just 12 years, Medicare’s hospital trust fund is predicted to become insolvent. And for the next 17½ years, 10,000 baby boomers will reach age 65 every day. So, it’s really just a question of when the end comes—for Medicare, Medicaid, and Social Security—and what happens next.

    It’s also true that the president has cut more than $700 billion from Medicare and credits it toward the cost of Obamacare. While some of those cuts are admirable—everyone wants to see fraud reduced—other cuts are in payments to providers. And it’s a bit disingenuous of Team Obama to claim these cuts won’t affect benefits. In Texas, one of the few states to track doctor drop-outs, the number of physicians accepting Medicare patients fell from 78 percent in 2000 to 58 percent in 2012—because of cuts in payments, with more cuts to come. Punishing doctors with lower, sometimes below-cost fees for treating Medicare patients means fewer doctors, decreased care, and even—yes—the potential for rationing of care.

    Ryan’s original plan also cut Medicare spending at a similar level, but through consumer choice, competition, and market forces, not punitive cost controls. And he planned to return those dollars to the Medicare trust fund. Sensing the shifting winds, Romney has stepped up the messaging battle, promising to restore the president’s cuts. Critics charge this will speed the program’s insolvency, but those arguments are moot if costs are lowered with the fixed-benefit, premium-support system he has proposed. Of course, the devil is in the details, and more are needed.

    But at some point, folks will stop listening to all those confusing details about baselines and budgets, and all of the charges and countercharges. The decision will come down to a matter of trust. Who has earned it? Who has shown leadership? Sadly, all of this could have been avoided had President Obama simply led and acted on the 2010 Simpson-Bowles plan.

    In politics, what goes around comes around. And Chicago better duck. Here comes a boomerang in a headwind.

  2. If Omaba’s cuts hurt benefits, the so do Ryan’s. It doesn’t matter where the money goes. Ryan’s cuts extend the trust fund a little. Obama’s cuts help provide insurance to other people.

  3. http://www.usnews.com/debate-club/is-the-ryan-medicare-overhaul-proposal-a-good-idea/medicare-needs-the-ryan-plans-cost-controls

    Medicare in its current form is clearly unsustainable. This isn’t rocket science—just arithmetic. A typical couple retiring last year will, on average, pay $150,000 in Medicare taxes over their lifetime, but receive more than $350,000 in benefits. As a result, the program ran a combined deficit of more than $288 billion last year. Going forward, the most optimistic scenario puts Medicare’s future unfunded liabilities at more than $35 trillion. More realistic estimates suggest that the shortfall could actually exceed $90 trillion.

    The question, therefore, isn’t whether to reform Medicare, but how.

    President Barack Obama would reform it from the top down, empowering a 15-member board of unelected bureaucrats, the Independent Payment Advisory Board to cut reimbursements to doctors and hospitals. Whether or not such cuts are successful in reducing long-term Medicare costs, they will make it more difficult for seniors to see their doctor. In fact, Medicare’s own actuaries predict that as many as 15 percent of hospitals could close, and some estimates suggest that up to 40 percent of doctors will stop seeing Medicare patients.

    In contrast, Paul Ryan would reform Medicare from the bottom up by increasing competition and consumer cost-sharing. If anything, in fact, his plan is probably too timid since it makes no changes to the system for anyone age 55 or older. Even those under age 55 would still have the option to remain in conventional Medicare if they wish to do so. However, the growth in spending under traditional Medicare would be capped at roughly the same growth rate as proposed by Obama.

    Those who wished another option, however, could choose instead to receive a voucher or premium support payment based on bids by private insurers in their area. Seniors who choose a lower-cost plan can keep the difference, while those who choose to enroll in a more expensive plan will have to pay the difference between the government payment and the premium.

    *snip*
    By increasing competition and forcing healthcare consumers to make value-based decision, the Ryan plan holds the prospect of finally restraining the growth of Medicare costs. And it does so by trusting and empowering consumers rather than government bureaucrats. It may not be perfect, but it’s a big step in the right direction.

  4. “the Ryan plan holds the prospect of finally restraining the growth of Medicare costs”

    Doc, we have different objectives. Let’s assume for the moment that the above statement is true. You like Ryan’s plan because it limits the growth of Medicare. It limits the cost to government and thus limits your taxes to pay for Medicare.

    BUT

    Limiting the cost of Medicare is not limiting the cost of health care. It merely limits the cost to government, not the cost to the American people. I want to limit the cost of healthcare, not the cost of Medicare ONLY.

  5. I have given you numerous links and posts that explain how the Ryan plan WILL decrease the cost of healthcare, including economic studies that prove it.

    Even if I agreed with you, you still lose.

    Under the current plan Medicare is done in less than 15 years.

    Jerry, why do you want to kill my grandmother?

  6. doc, why do you want to kill my children?

  7. Reducing Medicare is doing it backwards. Reduce healthcare costs and Medicare and all other health care costs will go down too. Go to the source for the solution, not just the part that your taxes pay for. We need to reduce healthcare costs, not the programs that pay for it.

  8. By the way Jerry, if you want to limit the cost of healthcare you MUST limit utilization. To be most effective this shoul include tort reform, limitations on self referral for diagnostic testing, discussing end of life issues before the end of life and putting patients in charge of their own health care dollars.

  9. I don’t want to kill your children, I want to save Medicare so they have it when they need it. If they need saving at the moment, bring them to the hospital and we will do it, whether they are insured or not.

    You really don’t get how healthcare works in this country do you Jerry?

  10. I noticed that you conveniently left out limiting fees that healthcare providers charge. That is a big part of it too.

  11. The same goes for your grandmother.

  12. So,your saying no one needs insurance. If you get sick, go the the hospital for free. That’s a really “great” solution, doc!

  13. Tort reform?!? What’s wrong, doc. Insurance payments too high. You just need more competition between insurance companies. Doctors need to take more interest in their insurance costs. Maybe we need to limit utilization of malpractice insurance.

    The problem is the companies that pay for the malpractice, not the malpractice itself. That’s the Ryan approach to healthcare. What can’t it be the approach to malpractice insurance also, instead of government mandated limits on malpractice judgements.

  14. My fees have gone down 20% over the last 3 years. And they will be limited even more next year and in years to come. Notice how that doesn’t solve the problem?
    Physician fees account for about 15% of Medicare spending.

    Now it might make you feel good, because I am sure that being a good liberal you abhor inequality of outcome in the world.

    Be careful how much you decide to limit physician fees though Jerry, you may be able to find a physician to see when you get sick. Follow the link below to understand why.

    http://articles.businessinsider.com/2012-01-31/news/31008260_1_medicare-patients-physicians-medicaid-services

  15. Tort reform is not only about money, it’s about process and perception of patients.

    Much of the diagnostic testing ordered is “CYA” not to save money on insurance but to save the time and hassle it takes to defend yourself in a lawsuit.

    But of course the Democrats would never support such reform. Too much money flowing int o their coffers from the trial lawyers association.

    http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.html

    Congressional budget analysts said Friday that lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits — 10 times more than previously estimated.

    New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but also would spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas W. Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin G. Hatch (R-Utah).

  16. You want government mandate limits on malpractice, but not on healthcare. I get it!

  17. Tort reform is more about process and perception of patients and if meaningful, would save billions of dollars for the system every year.

    As I said before, you know nothing (and I mean absolutely zero) about the practice of medicine in this country if you think there are no government mandates as it relates to health care.

    Increasing government mandates are a contributing factor to exploding costs. My practice has an entire extra non-physician employee just to help us comply with mandates in relationship to reporting, documentation and billing.

    Here is a perfect example.

    http://www.jhu.edu/jhumag/1104web/hipaa.html

    What they found was astounding. Speaking with physicians, legal counsel, administrators, information technology experts, and others, the students determined that the HIPAA privacy regulations added layers of bureaucracy, jeopardized the university’s fundraising efforts, and hampered research by restricting access to patient records.

    And the price tag was enormous. Although Johns Hopkins has estimated the cost of HIPAA-compliance expenditures in the three years prior to April 2003 at about $4.5 million, the students’ analysis found that number to be more like $4.3 million to $7.4 million.

    “What started out as a relatively small statement of intent in the law — a couple of paragraphs — grew into 1,400 pages of regulations that have a lot of unintended consequences,” says John Zeller, associate vice president of development and alumni relations and director of the Fund for Johns Hopkins Medicine. “It is an unfunded mandate, and it has a real cost to the institution across the board.”

    Richard Grossi, chief financial officer for Johns Hopkins Medicine, estimates that HIPAA could eventually cost Hopkins $10 million a year in direct and indirect costs as well as lost revenue from activities like fundraising.

  18. Of course I know there are government healthcare mandates. I never said otherwise. It is those mandates that you are trying to get rid of while at the same time advocating government mandates for tort reform.

    Hey, I have an idea. Maybe you should get CYA insurance. Why should I pay for tests when you order them only to cover your ass? Your malpractice insurance should pay for them. The tests are cheaper than a lawsuit. It should reduce your premiums and healthcare costs at the same time. Come on, doc. Be proactive. You do it instead of the government.

  19. I have a big A, it would cost too much.

    But seriously folks, I don’t order many tests, but I do benefit from those ordered by other physicians, largely primary care physicians.

    I am advocating for a reform that would cost me money Jerry, not make me more money. I wonder about your life that you are so cynical about your fellow man. Is it bathing yourself in the liberal blogosphere that does it?

    If you think your doc is ordering unnecessary tests, then refuse them and more power to you. Most often the situation is reversed in that patient demands that everything be done to either get a quicker, more certain diagnosis or to make absolutely sure that they don’t have some rare disease that their physician may see once in a lifetime.

  20. I think if a patient demands a test that the doctor does not think is necessary, then the patient should pay the cost, not the insurance.

  21. So do I, but what if the patient demands the test and the doctor stands his ground and says no.

    For instance, what if the test is a CT scan and the doctor knows the radiation may be more harmful to the patient than the potential benefit of the test or the likelihood of finding something very rare.

    But then the patient IS the once in a lifetime case where the diagnosis is missed or delayed. What happens then?

    The patient finds an eager trial lawyer, a lawsuit is filed, discovery ensues, maybe a trial with a non professional jury of his peers (read non medically educated citizens), the doctor probably wins, but might not in the end. At minimum the doctor has the negatives of worry, fear of losing (in some states personal assets), time away from work, family and a whole lot of hassle. All this for doing the right thing.

    How many times would it take before you just gave the patient what they wanted, made your customer happy, checked the box and moved on with your day?

  22. How about this? If the doctor says no, the test is not necessary. Get the test anyway. If it is negative, the patient pays. If it is positive, the insurance pays. The doctor is covered. The test was done.

    There is a problem if the patient does not have the resources to pay for the test. But is that really any different now, if the insurance does not cover the test even if the doctor is willing to order it?

    Medicare provides a basic level of care. It does not, nor should it, cover every possible test or treatment. There are a whole host of supplemental plans for people who want additional coverage and can afford it. But the American people should have a basic level of care regardless of their income or station in life. Medicare provides that for seniors.

  23. You just described tort reform.

    Currently, if the doctor says no to a test.they are at full risk for being sued if something goes wrong no matter who will or won’t pay. In fact most hospitals will not perform a test without a valid physician order. You can’t just walk in off the street and get an MRI, some medical provider needs to be responsible for ordering or not ordering any testing.

    In fact in an emergency room setting, patients must be treated regardless of their ability to pay and even if they don’t pay the doctor is fully liable for any future malpractice.

  24. I prefer tort reform that limits when a doctor can be sued rather that limiting the amount of a judgement against a convicted doctor.

  25. No problem with that. The state of Wisconsin indirectly does what you suggest. We have a a state mandated injured families and patient compensation fund that all providers pay into annually (about 1500.00 this year) that is used to pay any settlement over and above 1 million dollars. Anything less than 1 million is payed by malpractice insurance carrier.

    (You may remember the big hubbub when former Democratic Governor stole several hundred million dollars from this fund, which was replace several years later after a lawsuit by the physicians.)

    As an example (and I have never been sued) my last year practicing in Illinois I paid 57,000 for malpractice insurance and this year in Wisconsin I paid 7000.00 plus my compensation fund payment.

    It makes a big difference.

    Thanks for the lively discussion on this fine Sunday Jerry.

    Have a great night and week ahead!

    Seriously.

  26. Thanks, doc. You too.

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