A lot of pundits and conservatives--and even some democrats--have criticized the content of the GOP plan to end Medicare, yet simultaneously praise it as "brave." Andrew Sullivan, a favorite blogger of mine, jumped all over Obama and the democrats for not proposing their own plan to cut entitlements:
Yesterday, [Paul Ryan] was as livid as I remain about the rank recklessness of Obama's budget proposal...no specifics on Medicare or defense yet. Hmmm. So let Ryan propose a budget that exposes Obama's irresponsibility and complacency. Let him be the leader Obama refuses to be. Let's see the real entitlement and defense cuts the US needs if it is to avoid default or a long slide into debt-ridden stagnation. Obama has doubled down on the unseriousness of the GOP on the debt, by revealing his own total lack of concern.
The GOP has taken to describing Paul Ryan's plan to transform Medicare from a government-run health insurance program to a voucher program that lets you buy insurance on the private market as a proposal to "save Medicare" from its inevitable demise.
I am not sure how a plan that eliminates the Centers for Medicare & Medicaid Services can be construed as "saving" Medicare anymore than I would be saving my car if I scrapped it and bought a new one or could save my house by tearing it down and moving into an apartment building somewhere.
(NOTE: Yes, I know this is really long. And I don't know how to get the gaps out between the main level of list items.)
What Ryan's Medicare-Killing Plan Does
At Daily Kos, we have been treated to detailed explanations on why the Paul Ryan plan not only kills Medicare but might also kill tomorrow's senior citizens, whose wellbeing will depend on the kindness of for-profit private insurers. These are the same companies that have defended recission, booted patients with cancer and other chronic conditions from their rolls, implemented sky-high rates for patients with preexisting illness, engaged subscribers in epic battles to get lifesaving therapies reimbursed, and hiked up copayments to pad profits. (Insurers argue that patients will be more discriminating about the healthcare services they use if it affects their bottle line.)
Decades ago, I worked at a reinsurance service firm; we insured the insurers against excessive loss. Our claims adjusters audited claims for any that could/should have been denied per the terms of the patient's policy and summarized those erroneously paid claims to help insurers recapture their losses. One case involved a woman who had her hip replaced; our adjusters said since her plan did not cover prosthetics, the insurer should recapture its expenses for the woman's operation. If Ryan's plan passes, our seniors will confront these types of abuses on a daily basis.
Many senior citizens develop dementia or they receive treatments or procedures known to cause brain fog (eg, heart surgeries and chemotherapy). Ryan's plan asks these people to use their remaining time fighting with their insurer to get preapproval, appealing denials, and paying high deductibles and copayments.
Ryan's plan also rescinds nearly every provision of the Affordable Care Act so that patients with preexisting conditions are no longer protected against denials or ridiculously overpriced plans. It rescinds insurers' obligation not to maximize profits by denying essential services. In other words, we can expect our struggles today to deal with private insurers and their attempts at healthcare rationing to continue for perpetuity and be extended to the disabled and their families.
Remember the insurer who denied coverage for hearing aids as an elective expense? Ryan's plan promises more of that in the future.
As for the plan not affecting seniors today, we know (1) seniors are not greedy geezers unconcerned with the future of their own families (after all, I never hear Republicans making the same argument about the inheritance tax); and (2) it is simply not true that it will not harm today's seniors. Per the National Journal:
If Congress were to pass Ryan’s plan and repeal the law, as House Republicans want, the 3 million to 4 million seniors left in the doughnut hole each year would immediately face significant out-of-pocket costs. They and all other Medicare beneficiaries would also lose access to a host of preventative-care benefits in the health care law, including free wellness visits to physicians, mammograms, colonoscopies, and programs to help smokers quit.
Perhaps more jolting, the Republican budget would cut spending on Medicaid—health care for the poor—much of which goes to long-term care for the elderly. Some 9 million seniors qualify for both Medicare and Medicaid benefits, and about two-thirds of all nursing-home residents are covered by Medicaid. The GOP budget proposes cutting some $744 billion from Medicaid over 10 years by turning the system into block grants that limit federal contributions and give states more choice in structuring benefits. No one knows exactly which Medicaid services states would choose to cut back, but senior citizens account for a disproportionate share of Medicaid outlays and would almost certainly bear some of the burden.
So where's the bravery? Is it brave because Ryan's plan will theoretically save the government money as it leaves elderly people to pick up more of the tab themselves or go without the healthcare they need? Or is it brave because poll after poll indicates it is a politically unpopular decision? (Where I grew up, demanding your classmates' lunch money was considered bullying, not brave.)
Ultimately, it will not save money. As people witness their parents and grandparents suffering from lack of care or living in poverty due to unimaginable health expenses, as people are forced to help their loved ones pay for their medical care or to spend their time attempting to provide care themselves, and as people are forced to fight with the insurance companies on behalf of loved ones, Congress will be politically unable to sit on its hands and ignore the problem.
Where is the Democrats' Plan to Save Medicare?
The argument that the democrats have never offered a plan to save Medicare rests on the ludicrous assumption that the only way to save Medicare is to draw up a plan and specifically tell everyone, "This is a plan to save Medicare."
Instead, democrats recognize that spiraling Medicare costs are the byproduct of three larger problems: an increasing number of subscribers, more illness, and higher costs for medical care.
You don't fix the "problem" by gutting Medicare spending (the symptom) while ignoring its causes. Democrats have been attacking illness and excessive healthcare spending for decades in an effort to save Medicare.
First, short of Ryan's plan to eliminate Medicare and the Affordable Care Act so that people die younger, nothing can be done to reduce the inevitable growing number of elderly. What many democrats have tried to do--and, in some cases, have done--is implement measures to make Americans healthier so that tomorrow's Medicare subscribers need fewer healthcare services.
- The Affordable Care Act represents a major part of the democratic "Plan to save Medicare." It covers wellness visits, preventable care, and cancer screenings; and ensures coverage for adults <26 years and people with illness.
- Preventing illness is a no-brainer when it comes to saving costs.
- Early detection of cancer saves money in medical expenses and lost productivity, in turn leading to more tax revenue.
- Providing treatment for a preexisting illness can help prevent that illness from worsening and prevent costs for treating disease complications.
- Contrary to the republican notion that all Americans have healthcare coverage because they can go to an emergency room, it costs less to supply a diabetic with supplies for a year than to provide emergency heart surgery or amputate the limb of an untreated diabetic. [I say this as a diabetic.]
- The Affordable Care Act also pays for researching new, less costly payment models to replace the current fee-for-service model and provide more effective care.
- Many democrats/socialists (no, that is not a slur; go Bernie Sanders) have pushed for a single-payer option and recently passed one in Vermont.
- A single-payer plan reduces time and personnel medical establishments spend to handle multiple insurers' requirements and forms.
- Providing care from cradle to grave reduces down-the-road costs.
- A single-payer system requires less overhead; Medicare administrative costs are currently lower than those of private insurers.
- Countries with "socialized" medicine negotiate better prices from drug companies; Americans often pay nearly twice as much for the same drug as Europeans.
- Employers would be able to (1) manage expenses better and (2) hire more people if subjected to a steady tax rate, rather than ever-increasing insurance costs.
- Hospitals will no longer have to spread unpaid costs to treat uninsured/indigent patients to everyone else.
- Democrats have expanded healthcare coverage for children at state and national levels, which translates to healthier elderly citizens and ultimately less Medicare spending.
- Democrats support programs that promote prenatal care and feed hungry children, while republicans slash WIC and food stamp benefits.
- Poor childhood nutrition causes obesity and tooth decay.
- Poor maternal nutrition increases a child's likelihood of developing adult-onset diabetes.
- Poor maternal nutrition increases a mother's descendants' rate of serious health problems (obesity, cardiovascular disease, diabetes) for generations.
- Lack of prenatal care significantly increases a woman's risk of osteoporosis as an elder.
- Democrats support Title X, which funds programs that provide preventive services to women; republicans want to eliminate Title X.
- Republicans often oppose surtaxes on proven carcinogens, like tanning beds and cigarettes in the name of "personal freedom" that we all pay for
- The US obesity epidemic translates to sicker Medicare subscribers; childhood obesity has skyrocketed, and democrats like Michelle Obama encourage children to eat healthier and become active.
- These efforts are ridiculed on the right; Sarah Palin famously encouraged her slightly plump kids to partake in s'mores to stick it to Ms. Obama.
- Republicans whine that the Obama administration's plans to boost nutrition in school lunches cost too much.
- Obesity ups the risk of costly diseases and worsens outcomes for many illnesses common in the elderly (eg, heart disease, diabetes, arthritis, cancer).
- Democrats want to allow Medicare to negotiate lower prices for drugs and services, but Republicans and their corporate sponsors oppose this.
- Democrats tried to reimburse end-of-life counseling for Medicare patients, which republicans like Palin falsely called "death panels."
- Services in the last year of life account for the bulk of a patient's healthcare expenses, yet do little to improve life's duration or quality.
- Families of cancer patients given palliative care rate the last few weeks better than patients given toxic, ineffective therapy.
- Dementia or Alzheimer's patients who completed an advance directive before becoming ill can be spared unwanted resuscitation or feeding tubes.
- Obama wants more comparative studies to ensure that Medicare subscribers get effective, safe treatments; republicans (like Palin) and their pharma lobby supporters demonize this common-sense approach as healthcare rationing.
- Republicans oppose mandating coverage for mental health services and cut funding for government institutions, yet treating these illnesses at onset reduces the burden of mental illness on the system.
- Many democrats--like Robert Reich--recommend extending the income limit for Medicare/Social Security payroll taxes; republicans want it lowered from its current $106 k or so.
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If Republicans are actually interested in saving Medicare, I have some suggestions for reducing revenues that can then be used to shore up the program.
- End the Bush tax cuts for the wealthy, returning to Clinton-era tax levels.
- End the wars in Iraq and Afghanistan, which Republicans started.
- End subsidies for big oil.
- Avoid starting new wars (like republican fantasies of attacking Iran and North Korea).
- Quit implementing one stupid anti-abortion measure after another rather than creating jobs.
- Don't insist on ultrasounds, more counseling and repeat visits, which ultimately raise costs.
- Don't propose stupid measures like not teaching medical students how to execute D&C, which would cause many more infections and hospitalizations that have nothing to do with abortion.
- Don't stop pregnant women whose babies cannot survive from choosing to terminate their pregnancy, saving emotional heartache and expense for hospitalizing mother and child
- Stop trying to force minors to incur the physical and emotional trauma and expense of continuing with a pregnancy that they do not want.
- While you are at it, stop passing stupid laws to tie unemployment benefits to drug testing that the taxpayer must cover.
- Cut defense spending.
- Stop taking state helicopters to your children's baseball games or charging taxpayers per diems for sleeping at home.
- End Congress' cushy pension program, which is matched by taxpayer monies
- Stop building bridges to nowhere and using taxpayer money to fund religious themeparks
- Reinstate the estate tax.
- Did I mention, end subsidies for big oil?
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Republicans can also support some smaller but nonetheless important measures to reduce the burden of illness on the healthcare system in the United States.
- Stop demonizing science and authorize more funding to cure diseases like HIV.
- More than 100,000 Medicare subscribers have HIV/AIDS.
- Medicare accounts for 25% of HIV/AIDS spending in the United States.
- Support needle-exchange programs.
- Support reductions in air and water pollution, which will lead to lower rates of asthma and cancer.
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While Andrew Sullivan and some others like to assert that democrats have no "plan" to save Medicare, the truth is they have offered many common-sense proposals for reducing healthcare costs and improving health in the United States. They have been opposed by republicans and conservatives nearly every step of the way.
If you were to implement all the common-sense measures democrats have been proposing for DECADES, the health of Medicare subscribers and our nation would improve tremendously and healthcare costs would drop.
The subsequent boost in consumer spending by the middle class would contribute to job growth and an improved economy, which in turn would lower the deficit.
Let's Be Honest
This has never been about lowering the deficit for republicans. This is about depriving the government of tax revenue by cutting taxes to their wealthy corporate benefactors and then complaining that social programs must be cut to address the soaring deficit.
This is not just about trying to destroy Medicare as we know it; it's really about trying to destroy the government as we know it. Paul Ryan and his co-conspirators want to turn governments into something that people perceive as useless and unnecessary to the point where they resent paying any taxes since they get nothing out of it.
Why do they want to do this? That's the part I really can't figure out. Are they simply living in the moment and catering to the whims of their current constituents or is it truly part of a long-term plan to accomplish...who knows what? An evangelical Christian nation beholden to a conservative interpretation to Biblical law? A new feudalistic society?
I do know that, contrary to what they claim, it runs counter to their professed goal of preserving the nation's patriotic heritage and "restoring" the ideals of our Founding Fathers.
They've already shown they can't even tell the difference between the Constitution and the Declaration of Independence and know less about our nation's founding than your average third grader.