• Some campaign clarifications on medicare

    I thought it was worth making a couple of suggestions and clarifications about Medicare:

    1) When we discuss reducing Medicare spending, that doesn’t have to mean actually spending less next year than this year. It can mean spending less next year than we planned to otherwise.

    2) When you believe that if we don’t reduce Medicare spending right now the trust fund will go bankrupt, then repealing laws that will reduce that spending will make it go bankrupt sooner.

    3) When you campaign on the other guy not being serious about Medicare, you then can’t attack him for reducing spending more than you.

    4) Unless you plan to stop passing the doc fix, don’t just say the other guy won’t and then use it to bash his plan.

    5) If you use a certain study to claim that too few docs will take new patients with Medicaid, and that same study shows that more docs take new patients with Medicare than private insurance, you can’t suddenly forget about that study and claim that doctors won’t take patients with Medicare.

    6) If you are afraid to cut Medicare for seniors right now, or for anyone 55-65, then maybe you’re afraid to cut Medicare, period Medicare spending isn’t the immediate crisis that you say it is.

    7) If you plan to cut Medicaid in the next few years, and millions of seniors benefit from Medicaid, then maybe your health care reforms will affect current seniors.

    8) If you plan to repeal a law that has closed the donut hole, reduced payments for some visits, and increased payments to docs for some types of visits for seniors, then you are for cutting Medicare right now.

    As I said before, I think it would be great to have a debate over (a) how much we can cut from Medicare, (b) the best way to do it, and (c) how much of those cuts should be borne by different stakeholders. None of the above has anything to do with that.

    If you think I’m missing any, let me know in comments. I’m sure some of you can suggest some I’ve missed. I’m sure my more conservative friends will have their own lists, too.


    • #2) From a real dollar point of view, the Government is going to have put more assets into health care spending due to the trust fund fiction. As CBO notes, the trust fund accounting system extends life of Part A, but we’re going to need more real dollars to pay for it. That means carving out more of other govt spending or higher taxes or higher borrowing.

      5) If you’re arguing about whether providers will accept new patients, then a study that only looks at current day and ignores future rate payments is meaningless. You can’t use today’s acceptance rates as a proxy for the future, when medicare rates are lower.

      • 2) I don’t see how that renders my complaint any less true.

        5) I agree completely, and made that point in my post that I wrote on that (follow the link). My complaint here is with the hypocrisy. If you use that study to bash Medicaid, then you can’t ignore it to bash Medicare.

    • In the world of politics:
      Yes you can say all that.
      In fact you must.
      The first one to tell the truth loses.

      And this is why the politicians will continue to borrow more money until people stop lending it too them.

    • There is one way to cure the ‘doc fix’ problem for once and for all.

      That is to terminate Medicare Plan B in terms of government paying any claims at all.

      Close down the fee schedule completely.

      Give each senior a debit card of $2500 to help pay for office visits, diagnostic tests, and simple outpatient procedures.

      A doctor could charge whatever he or she wanted. The debit card would pay the doctor in 30 seconds.

      No claims to file, no claims to contest and deny. Medical clinics could lay off thousands of clerical employees ( not pleasant, but it would slash the cost of care. Insurance companies could also do layottfs.

      For diagnostic tests, a “Medicare-recommended fee” could be published on the internet. Anyone who charged a senior $2500 for a $400 MRI could be accused of price gouging.

      This would really hurt hospitals that depend on overpriced outpatient procedures, but they have been doing price gouging themselves for 25 years and it has to end sometime.

      I realize that this is sort of like Paul Ryan meeting David Himmelstein, but so be it. Fiscally it would work.

      Bob Hertz, The Health Care Crusade

    • If your health card plan for the majority of Americans is contains premium support, don’t bash premium support for senionrs – who after all if we are talking about the “wealthy” the ederly as a group are one one of the more wealthy strata in our society.

      • It would be more accurate to say the elderly are the most schizoid strata of our society in terms of wealth.

        While a very large percentage of the wealth of the US is held by the elderly, and many elderly are wealthy or very wealthy, very large numbers of elderly are low income.

        The median income for all elderly is around $25,000 a year. The median income for elderly women is less than $16,000 a year. Median retirement savings are less than $45,000. This means that for every Mitt Romney there is a woman living deep in poverty.

        Well over half of seniors are low income people, many are unhealthy, and few have any hope or options for changing their lives for the better. In the wake of the current recession that is getting worse, not better. Programs that expect them to pay substantial amounts toward their own health care are actually programs to make health care inaccessible for large numbers of elderly people.

      • …and another thing:

        There is a world of difference between offering a premium support program in a setting in which people have been getting no help at all with their health care costs and replacing an existing comprehensive guaranteed benefit program with a premium support program designed to transfer large shares of health care costs to the individual enrollee.

    • Except that the Ryan plan in its current expression would allow everyone now on Medicare to continue guaranteed benefits, and in fact would allow everyone who will turn age 65 for the next ten years to have guaranteed benefits for the rest of their lives also.

      In other words, the elderly poor and the near-elderly poor –who are indeed numerous — are totally protected.

      The Ryan plan dumps the real cold water on persons who are 55 and under right now — it tells them that their lives will be harsh indeed unless they save more money. That is no easy trick when so many are being laid off and downsized.

      • Two problems: the Cinderella effect proposed by the Ryan plan means that in ten years the process of withholding health care from low income and even middle income seniors will begin. In addition the notion that Medicare will hold steady for people over 55 is unlikely to survive the light of day when the huge budget deficits inherent in Ryan’s tax cut plans begin to take effect and the demise of the Part 1 trust occurs in four to five years following Romney’s promised end to Obama-ACA cost controls. Alteration of current Medicare is inevitable unless deficits much larger than even the recent ones are allowed to happen or everything else — including the military budget — is cut to the bone and beyond.

        The curtain is beginning to rise on this, as on Sunday a Romney campaign official told Fox News that Romney-Ryan would raise the age of access to Medicare to 67 as part of their program.

    • All good points, Pat. Two items to note:

      a. Raising the Medicare age to 67 is a terrible idea, but even Obama has been open to it. This blog has had good coverage of how little this saves, and the havoc it would cause among those who are 65 to 67 and would have to take overpriced private junk insurance, or no insurance at all.

      b. Maybe this is just quibbling on words, but I do not use phrases like
      ‘the government will start withholding health care from seniors.’

      Every other industrial nation besides America has some things that it does not buy for seniors. And I am including social-democratic nations which are far to the left of the USA.

      When governments do not pay for transplants or dialysis or bypass surgery at very old ages,they are making a decision that some things are not affordable even if they do save a life.

      If a nation like Britain provides free home health aides to make the lives of the elderly more pleasant, and if as a consequence there is no money in the budget for heart transplants, I am not scandalized.

      There is an economist named Arnold Kling who may be to the right of you and I, but he writes rather well about this kind of public choice.