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View Diary: What are some Progressive Solutions to the "Medicare Problem"? (70 comments)

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  •  The is clearly a long-term problem with Medicare (5+ / 0-)
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    jamess, Jon Says, VClib, Lujane, Cedwyn

    People need to read the Medicare Trustees Report for 2012.

    It says that even if you assume the most favorable outcomes under the ACA with respect to reducing spending,

    Total Medicare expenditures were $549 billion in 2011. The Board projects that, under current law, expenditures will increase in future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP,  they will increase from 3.7 percent in 2011 to 6.7 percent by 2086 (based on the Trustees’ intermediate set of assumptions). If lawmakers continue to override the statutory decreases in physician  fees, and if the reduced price increases for other health services under  Medicare are not sustained and do not take full effect in the long  range, then Medicare spending would instead represent roughly  10.4 percent of GDP in 2086. Growth of this magnitude, if realized,  would substantially increase the strain on the nation’s workers, the  economy, Medicare beneficiaries, and the federal budget.
    That means that if we do the doc fix every year (which we just did again), Medicare will grow to 10% of GDP -- not 10% of the budget, 10% of GDP.  And that's assuming the most favorable outcome with respect to the ACA being able to reduce costs -- they say the lilkely outcome may well be much worse.  Read that report.

    We can't have a situation where 1 out of every dollar generated by every single person in this country goes to Medicare (not counting Medicaid, and SS, and all other government spending).  Right now, we only take in about 15% of GDP in government revenues.  We HOPE to get up to 18% of GDP -- which means that Medicare alone (not counting Medicaid, interest on the debt, Defense) will take up over half of every dollar the federal government takes in.  

    Yes, this is a LONG TERM outlook.  We probably have 10 - 15 years before the situation begins to be really problematic (right now, Medicare is projected to be solvent for 10 years or so).  But that doesn't mean we can wait 10 years to do something.  We can't wait ten years, and then tell people who are 65, ok, we're changing things for you.  If things are going to change for someone who is now 45, we need to start talking about that now so that 45 year old will know what he/she can count on and what he/she can't count on.  People don't wait until they are five or ten years away from retirement to start making SOME kind of plan, and so neither should Congress.  

    I completely agree that Ryan's premium support program is a political non-starter.  But I DO want to hear the Democratic plan for a long-term solution.

    I believe it is the obligation of our elected officials to tell us what they envision as the long-term solution for the unsustainable path for Medicare.  And I applaud anyone who asks the question of our elected officials.  It is irresponsible for an elected official to say, "I'll think about that when it happens."  

    •  so coffeetalk (2+ / 0-)
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      3goldens, Lujane

      where do you stand on the Public Option?

      seems there's an automatic 12% cost-cut right there,

      mostly taken larger from Insurance Exec salaries and bonuses,

      and those other Wendell Potter -type perks.


      Here's how the game is really Rigged.

      by jamess on Sun Jan 20, 2013 at 12:06:23 PM PST

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      •  I'd have to see the specifics of a proposal (2+ / 0-)
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        jamess, Lujane

        Any proposal is going to have some positives and some negatives, and those have to be weighed.  

        In a way, a government-run system for health care such as that Krugman proposed makes some sense.  But on the other hand, I have some concern that it would become a health care system for the poor, with anybody who is able to afford it opting to go into the private sector.  And with reimbursement rates for providers so low that only those who have no other choice agree to practice in it.  Perhaps I am jaded by my experience with the public school system in New Orleans growing up, where pretty much  anybody in the middle class -- of any race and/or religion -- opted to send their kids to the private schools, most often the Catholic schools, which provided an affordable option for many middle-class families and became the dominant high-school system here.  The public schools (except for  few magnet schools like Ben Franklin) became a "holding ground" for those families who didn't have the resources to get their children out.  And because the middle class largely didn't use the public school system, the middle class largely didn't support the public school system, and didn't want to pay for the public school system.  

        In other words, give me some specifics:  how would it be run, how would it be paid for, how do we guarantee it doesn't become a second class system for the poor and really really sick, and what would it mean for the long-term projections for Medicare?.

        But as Krugman says, that's a political non-starter.  And that's the crux of the problem.  There needs to be SOMETHING the Congressional Democrats are for -- something the Democratic leaders will support.  We know they DON'T support the Ryan plan.  Fine.  What do they support?  I'd be happy if they put forth some kind of Medicare public option -- because that would be, at the very least, an acknowledgement that there is a problem that we need to address, and it would force us to have the discussion.  

        •  That only shows how effed up (3+ / 0-)
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          jamess, Lujane, Chi

          LA is. Public schools here are generally better than any of the private ones. But we spend money on it and it is important. We don't do young earth or creationism or any of that other bullshit.

          Also I'd have to say that state medicine is far better than the private practice experiences I had. Like not even close. Our health departments are unbelievable and staffed with friendly knowledgeable people who like to answer questions.

          •  It's not all of Louisiana (1+ / 0-)
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            jamess

            I'm giving you my experience growing up in New Orleans, which in a lot of ways is not representative of al of Louisiana.  

            And the Krugman suggestion of a universal system like the VA health care system will bother some people.  The reports of the quality of the VA hospitals have been mixed at best, and problems have often been reported in the papers.  See, for example, here  and here and here.  Some people are happy with the VA system, certainly, but there are many people whose only knowledge of the quality of the system comes from those stories in the papers.

    •  There's a long-run problem with health care (2+ / 0-)
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      Chi, Cedwyn

      costs in general, not with Medicare.

      We can't wait ten years, and then tell people who are 65, ok, we're changing things for you. If things are going to change for someone who is now 45, we need to start talking about that now so that 45 year old will know what he/she can count on and what he/she can't count on.
      It sounds as though you're assuming the solution is going to involve cutting benefits or otherwise providing less care to patients. I don't assume that at all. We know it's possible to provide care for far less money because every other country is already doing it.

      We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

      by denise b on Sun Jan 20, 2013 at 08:18:04 PM PST

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