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old man with cane
Before the Catfood Commission II goes all crazy doing something stupid like raising the Medicare eligibility age, they have to understand this: The increase in Medicare spending is slowing, sharply, apparently in anticipation of the reforms coming under the Affordable Care Act.
Here is the truth: Both Standard & Poor's (S&P) and the Congressional Budget Office (CBO) now have 18 months of hard data showing that Medicare spending has begun to slow dramatically. Health reform legislation has not yet begun to kick in to pare Medicare payments, but something is changing on the ground. As I pointed out in an earlier post, Medicare spending began to plunge in January of 2010. After levitating by an average of 9.7 percent a year from 2000 to 2009, CBO's monthly budget reports show that Medicare pay-outs are now rising by less than 4 percent a year. (Over the year ending June 2011, Standard & Poor's reckons that the cost of Medicare claims rose by just 2.5 percent.  But S&P's Medicare index does not include Medicare Advantage, the private sector option that costs the government significantly more than traditional Medicare.)

Pessimists argue that Medicare pay-outs often fluctuate, and that this is just a short-term drop.  Moreover, the naysayers insist, over the next few years, a horde of aging Hippies will push Medicare's outlays higher. But hard numbers fly in the face of their assertions. Over 40 years, Medicare pay-outs have rarely dipped, and even a cursory glance at U.S. birth rates makes it clear that the baby-boom bulge will not have a significant impact on Medicare expenditures for another ten to fifteen years. By then, the Affordable Care Act (ACA) will have had a chance to rein in health care spending.[...]

To put the slow-down in context, consider the chart below. In the three decades prior to 2000, Medicare inflation slipped below 5 percent only twice, and the first time, it bounced back the very next year. The only sustained slow-down came at the end of the 1990s, following cutbacks in Medicare payments that were part of the Balanced Budget Act of 1997. But at the beginning of this century, Medicare's outlays once again spiraled.

EXHIBIT 1 Annual Growth Rates In Per Enrollee Payments For Personal Health Care, Medicare And Private Insurers, 1970–2000


medicare spending graph

[...]This slow-down is not a result of Congress cutting Medicare spending. Instead, as former White House health care adviser Dr. Zeke Emanuel pointed out in Part 1 of this post providers are "anticipating the Affordable Care Act kicking in 2014." They can't wait until the end of 2013, he explained: "They have to act today. Everywhere I go," Emanuel, told me, "medical schools and hospitals are asking me, 'How can we cut our costs by 10 to 15 percent?' They know that they must trim their own costs if they are going to lower the bills that they send to Medicare.'" Like Orszag, Emanuel is seeing a "shift toward value in the health sector."

It's a shift from rewarding providers by volume to rewarding them by outcome, and it appears that providers are taking this new, rational, world of health care delivery seriously and are figuring out how to make systems more efficient. Which means the rate of increase in spending in Medicare is slowing down, a lot. By comparison, the growth rate of health care costs covered by private insurers increased by 7.5 percent—3 times the rate S&P reckons for Medicare.

Which reinforces a simple point Atrios made a few days ago: Putting more people into Medicare makes a lot more sense right now than keeping people out. It also means President Obama should be fighting to preserve Medicare while touting this success of the signature policy accomplishment of his first term.

Originally posted to Joan McCarter on Thu Aug 25, 2011 at 10:10 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (18+ / 0-)

    "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

    by Joan McCarter on Thu Aug 25, 2011 at 10:10:03 AM PDT

  •  I hope Mr. Ryan reads this... (4+ / 0-)
    Recommended by:
    citizendane, Major Tom, viet vet, DrToast

    Very nice piece!

  •  They will ignore it (8+ / 0-)

    they are not and never have been interested in facts.   They have a political agenda to destroy Medicare and they will die trying.  Everyone else will die sooner because they will probably succeed.  

  •  I don't understand... (2+ / 0-)
    Recommended by:
    Sybil Liberty, samddobermann

    how does this show that President Obama is a weak-willed sellout who is only out for himself and hates all people that aren't Wall Street shills / crooks / liars?

    Isn't that the premise for all of your stories?

    "Who is John Galt?" A two dimensional character in a third rate novel.

    by Inventor on Thu Aug 25, 2011 at 10:22:37 AM PDT

    •  The sellout was to the for profit insurance (2+ / 0-)
      Recommended by:
      stewarjt, divineorder

      industry. This was a settled issue when we lost any alternative.

      •  From day 1 of LBJ's Medicare, insurance companies (0+ / 0-)

        have had their fingers in the program.

        What the hell are you talking about?

        "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

        by Sybil Liberty on Thu Aug 25, 2011 at 10:49:43 AM PDT

        [ Parent ]

        •  Simply take the insurance cos. (1+ / 1-)
          Recommended by:
          divineorder
          Hidden by:
          samddobermann

          out of the equation. We don't need them. They are the biggest driver in increased cost and less people covered. What don't you get? Do you work in the insurance industry? That would best explain your inquiry. Thank you.

          •  Obstructionist Congress (1+ / 0-)
            Recommended by:
            samddobermann

            What don't you get? LBJ was never going to get Medicare passed without "compromise".

            To suggest that I'm an insurance company shill is HR-able, asshat.

            "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

            by Sybil Liberty on Thu Aug 25, 2011 at 10:58:48 AM PDT

            [ Parent ]

            •   I never suggested that. Only that (1+ / 0-)
              Recommended by:
              divineorder

              we all have to have a job and  if I was still a licensed insurance insurance underwriter, I would defend them to the end . Fortunately, I found my conscience and left that criminal enterprise called the insurance business. I inquired if you did and get called an asshat for it. May God bless you. So HR me and reread my comment. This is one of the biggest reasons I left here for a year; your kind of personal attacks that contribute no facts.

      •  Senators were the sellouts. Lieberman, Nelson (0+ / 0-)

        and a few others that were worked hard on to pass it with a PO and then even to just pass it.

        Blame the real fuckers. Then try to elect some really good people so changes that you want can be made!

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Fri Aug 26, 2011 at 05:42:00 AM PDT

        [ Parent ]

    •  Exactly. It doesn't. (4+ / 0-)

      As a recipient, I can attest that under "ObamaCare" my Medicare services have been delivered with more efficiency and at lower cost not only to Medicare, but to me personally.

      Not that we don't have a long way to go...

      but I might have been lynched for saying as much here

      suggest following DemFromCT

      who does an amazing job

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Thu Aug 25, 2011 at 10:46:00 AM PDT

      [ Parent ]

      •  Please provide some proof. (0+ / 0-)

        You say your Medicare services have been delivered with more efficiency and at lower cost. Do you have some objective data to share? Considering "ObamaCare" (as you so distastefully term it) does not take effect until 2014, what efficiency gains and cost reductions have you experienced? Please be complete and concrete with your personal examples.

        How quickly the Pacifist becomes the Warrior when it's "our side" doing the killing.

        by edg on Thu Aug 25, 2011 at 12:16:48 PM PDT

        [ Parent ]

        •  not on your friggin' life (2+ / 0-)
          Recommended by:
          fladem, samddobermann

          I've already made the mistake of posting my personal FHA elsewhere in this toxic atmosphere on more than one occasion. Not well received:

          "You got yours. Good for you."

          If you had even bothered reading this diary, that should suffice, for even the most challenged of readers.

          The increase in Medicare spending is slowing, sharply, apparently in anticipation of the reforms coming under the Affordable Care Act.

          My HMO has opted to implement those reforms over the past year.  

          simple

          "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

          by Sybil Liberty on Thu Aug 25, 2011 at 12:42:32 PM PDT

          [ Parent ]

          •  Had you even bothered reading my recent diary ... (0+ / 0-)

            you would know that the figures cited in this diary and other similar diaries are a bunch of baloney that is easily disproved by reading the Medicare Trustee's annual reports of the past several years.

            President Bush "cut" the increase in Medicare Part A spending from 10.2% in 2005 all the way down to 4.2% in 2006. He also "cut" the increase in Part B spending from 11.6% in 2006 down to 5.9% in 2007 and all the way down to 2.5% in 2008.

            Needless to say, Bush deserves no credit for transitory fluctuations in spending, as part A rebounded with a 16% increase in 2008 and Part B jumped by 12.2% in 2009. Also needless to say, recent fluctuations are unremarkable unless sustained for several years.

            Bottom line: It is far too early to make sweeping claims about the effect of ACA on Medicare costs. There may be an effect in the future but a single year does not make a trend.

            How quickly the Pacifist becomes the Warrior when it's "our side" doing the killing.

            by edg on Thu Aug 25, 2011 at 01:01:51 PM PDT

            [ Parent ]

            •  So then, are you making your case against ACA? (0+ / 0-)
              Bottom line: It is far too early to make sweeping claims about the effect of ACA on Medicare costs. There may be an effect in the future but a single year does not make a trend.

              Or are you writing the case FOR Ryan's Great Idea?

              What better fuel for "SuperCongress" than your "bottomline"...

              "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

              by Sybil Liberty on Thu Aug 25, 2011 at 01:13:04 PM PDT

              [ Parent ]

              •  Exaggeration is not an effective strategy. (0+ / 0-)

                Telling lies about imaginary cost savings and alleged improved efficiencies does nothing to counter Ryan, it merely provides him with more ammunition when the lie is found out. Stick to the truth and you will get much further in life.

                How quickly the Pacifist becomes the Warrior when it's "our side" doing the killing.

                by edg on Fri Aug 26, 2011 at 01:28:40 PM PDT

                [ Parent ]

        •  edg, one of my doctors, when i said I needed new (0+ / 0-)

          prescriptions, just tapped in the drugs names, asked me what drugstore I used and typed that in, clicked a key and said there, that's done. Since I use a mail place for two, I would receive those in the mail. The other I had to pick up. But no scripts to mail or lose or time to wait. Plus he had the record in my record.

          Then the other doctor had to write them out, give them to me, enter them in my record and I had to take them in and wait. The electronic records are coming to make things easier and less likely to have mistakes. That is progress.

          Plus a shot for shingles is now covered on Medicare — which would have been a $160 cost!

          There are a number of other things that I know from my own knowledge, but I don't fell like writing them all out.
          Why don't you call the administrator of your local hospital and ask what changes they are making and have they reduced costs and how.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Fri Aug 26, 2011 at 05:54:27 AM PDT

          [ Parent ]

          •  Shingles now covered. (0+ / 0-)

            Does that not increase Medicare costs? I think it's great that it is now covered, but it has to be paid for.

            I agree that electronic records are a good thing. I'm a computer nerd and have advocated for them for decades.

            How quickly the Pacifist becomes the Warrior when it's "our side" doing the killing.

            by edg on Fri Aug 26, 2011 at 01:26:35 PM PDT

            [ Parent ]

            •  costs a heck of a lot less than cases of shingles (0+ / 0-)

              Doctors offices are pinnacles of backwardness. I just had dental surgery and I was impressed how well organized he was, how smooth the procedures by staff and he used.

              I had a leg injury last fall and the urgent care doc sent me for two x-rays. Then later that day at the ER they did the same two x-rays again. The first place was about 100 yards from the second. That needs to stop.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sun Aug 28, 2011 at 06:43:45 AM PDT

              [ Parent ]

  •  Are we cool with S&P now? (0+ / 0-)

    Just checking.  I mean, wasn't it just last week that this site was laughing at their numbers, and questioning credibility?

    But I guess the CBO agrees, so there's that.

  •  Won't matter to GOP supercritters (2+ / 0-)
    Recommended by:
    viet vet, Mr MadAsHell

    It's not about the deficit it's about cramming a "small government" ideology down the rest of our throats.

    In the sea, Biscayne, there prinks
    The young emerald evening star,
    Good light for drunkards, poets, widows,
    And ladies soon to be married.

    by looty on Thu Aug 25, 2011 at 10:39:19 AM PDT

  •  Now if we just got rid of (0+ / 0-)

    for profit insurance cos. or death panels as the thinking people call them. We would all pay less and sooner.

  •  a horde of aging hippies will certainly increase (6+ / 0-)

    Medicare outlays, but as Maggie points out (I have too, not over the next decade, though the boomers start entering Medicare this year.

    What this shows, which I also discussed here, is that ACA actually does work to lower Medicare costs.

    My posts and Joan's are comparable and compatible. They suggest a need to strengthen Medicare but that it is not an impossible job. And, because the numbers are looking the way they are, it need not be done today or bargained away by supercongressional Dems..

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Thu Aug 25, 2011 at 10:43:30 AM PDT

  •  They're Going To Raise (1+ / 0-)
    Recommended by:
    divineorder

    The Medicare age and cut Social Security!  The facts don't matter to these people.  The die is cast.  What is more, President Obama wants them to do it!

    Unless we stop them, they're going to do it.  Wishful thinking/hoping and sound logical arguments aren't going to persuade them.  They aren't listening to the people!  

    How many times are we going to have to learn this lesson?

    If I was a communist, rich men would fear me...And the opposite applies. The history of all hitherto existing society is the history of class struggles.

    by stewarjt on Thu Aug 25, 2011 at 10:43:34 AM PDT

  •  It's time now for Medicare for all. Everyone over (5+ / 0-)

    55 for no charge, and those under 55 a small percentage premium (5 - 10%) with a negotiated prescription drug pricing structure in place.  Supplemental insurance can be had for anyone wishing it from the private sector.

    The time has come to get real, and get health care for all.  It's a good sense idea, and it also is a sound business community benefits savings as well for job growth.

    "You can't always get what you want; but if you try sometimes...." - Rolling Stones

    by LamontCranston on Thu Aug 25, 2011 at 10:46:44 AM PDT

    •  Side Note (1+ / 0-)
      Recommended by:
      LamontCranston

      Jimmy Miller was the producer on "You Can't Always..." and other great Rolling Stones songs.  The story is that he asked for a raise and the song's title is Mick's response.

      Additionally, Jimmy Miller is, yes, you guessed it, Judith Miller's (of NY Times WMD infamy) brother.

      If I was a communist, rich men would fear me...And the opposite applies. The history of all hitherto existing society is the history of class struggles.

      by stewarjt on Thu Aug 25, 2011 at 10:50:23 AM PDT

      [ Parent ]

    •  You are making too much sense (1+ / 0-)
      Recommended by:
      LamontCranston

      Can't have any of that in the US of A.

      "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

      by noofsh on Thu Aug 25, 2011 at 12:57:44 PM PDT

      [ Parent ]

    •  Are you kidding? The premium for each person (0+ / 0-)

      on Medicare is about $100 for part B for the lowest income group (It goes up most years). At higher incomes there are higher premiums. I pay 2X the regular as does my spouse.

      The current cost for Part A is nothing if you have paid in for > 10 years. If less the the fee rises to $ 512 a month per person. The costs of part D varies as do the copays and the formularies.

      Since there is a 20% copay on everything, you need the additional gap policies.... or you could get the HMO or insurance corp Medicare Advantage plan.

      Do you really want That?

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Fri Aug 26, 2011 at 06:12:22 AM PDT

      [ Parent ]

  •  Let Medicare negoiate on drug prices (4+ / 0-)

    Do that and they can shave another $25-30 billion a year off the cost and bend that cost curve even more.

    •  New ACA does reduce Medicare drugs costs (1+ / 0-)
      Recommended by:
      Sybil Liberty

      The Pharma deal that the left kept complaining abiut in the Affordable Care Act was an agreement with Pharma to reduce drug costs for Medicare. ACA is also closing the Medicare Plan D doughnut hole.

      •  Yes, but Medicare still needs prices (0+ / 0-)

        negotiated per VA as was mandated in the original Dem version of Medicare Part-D... what turned out to be BIGPHARMA SCAM. We aren't there yet.

        "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

        by Sybil Liberty on Thu Aug 25, 2011 at 11:39:19 AM PDT

        [ Parent ]

  •  To think that analytical posters like deaniac` (5+ / 0-)

    were booed out of this place for foretelling long time back the same concept that medicare cost will come down due to ACA.

    One bitter fact is two bit hacks populate the third rate fourth estate who are truly the fifth columnists. PL poutrage lasts a week, max.
    Call the media when they Lie

    by amk for obama on Thu Aug 25, 2011 at 10:50:19 AM PDT

  •  Here's the problem: (1+ / 0-)
    Recommended by:
    divineorder

    Our wonderful progressive Democratic president has already said that raising the age limit is on the table as a bargaining chip.  Unbelievable!  he must know that us seniors have no one else to vote for.  Thanks a lot!

  •  Are fraud prosecutions helping? (1+ / 0-)
    Recommended by:
    divineorder

    I've seen reports of substantial Medicare fraud prosecutions of some megasize operations, especially in Florida. We don't know what percentage of Medicare payments are actually sheer fraud, but it's obviously some. It seems like if you thought that you had a good chance of getting caught selling fantasy wheelchairs to people who don't need them (or don't exist at all), you might choose to make your illegal money some other way and leave Medicare alone.  So kudos to the Obama-Holder team for making this a priority.

    •  Fraud is a huge issue. Wonder if ACA has (0+ / 0-)

      provisions for upping the number of investigators and installing more humans to monitor claims:

      An e-ripoff of the U.S. Disbursing public funds electronically sets up the federal government to be victimized by massive fraud.

       By Malcolm Sparrow

      August 21, 2011
      Last week, a Los Angeles jury convicted a local pastor and his wife of fraudulently claiming $14.2 million from Medicare. The culprits recruited parishioners to help run fake durable medical equipment companies, and spent the proceeds on expensive cars and other luxuries. Assistant U.S. Atty. Gen. Lanny A. Breuer described their efforts as "persistent and brazen" and said "they treated the Medicare program like a personal till."

      Around the country, a never-ending stream of Medicare and Medicaid rip-off stories suggest many people now use these programs as personal tills. In July 2010, authorities exposed and shut down a more organized scheme, charging 94 conspirators from five cities who had stolen $251 million from Medicare.

      Three months later, in October 2010, 52 members of an Armenian American organized-crime ring were arrested and charged with $163 million in fraudulent billing.

  •  Preaching to the choir obviously but ... (2+ / 0-)
    Recommended by:
    Brooke In Seattle, divineorder

    Single Payer, Single Payer, Single Payer.

    It couldn't be more clear it's the best, actually ONLY, long-term solution. It's so painful to watch decisions being made that fly in the face of irrefutable evidence to the contrary.

    KOCH INDUSTRIES: We're living your American dream so you don't have to!

    by DirtyLibrul on Thu Aug 25, 2011 at 10:56:23 AM PDT

  •   discussion about lowering the eligibility age? (1+ / 0-)
    Recommended by:
    Brooke In Seattle

    no discussion, not even a fishfood committee..

    ...this 'debate's' great framing:

    'raise eligibity, we're doomed'

     vs

      'well ok, a little bit, if that's how you fell about, supported by these right wing/corporate think tanks'

    ..squinting all the while in the glare of a culture that radiates ultraviolet consumerism and infrared celebrity...Russell Brand

    by KenBee on Thu Aug 25, 2011 at 10:57:19 AM PDT

  •  Supper Congress ? (1+ / 0-)
    Recommended by:
    divineorder

    Why don't we call them by their rightful name: the Gang of Twelve (or, perhaps, The Twelver Mafia).  We know what is going to happen, and this entertainment is just for show.

  •  Great news. Medical spending is indeed (0+ / 0-)

    the most important financial problem ahead of us. There are a lot of innovative experiments in the Healthcare Reform that could yield a lot more improvements down the road.

  •  Yep. (1+ / 0-)
    Recommended by:
    fladem

    I know a lot of people in the health care field.

    The changes happening now are monumental.

    Ideology is an excuse to ignore common sense.

    by Bush Bites on Thu Aug 25, 2011 at 11:28:43 AM PDT

  •  baby-boomers retiring now, no? (0+ / 0-)

    "... and even a cursory glance at U.S. birth rates makes it clear that the baby-boom bulge will not have a significant impact on Medicare expenditures for another ten to fifteen years."

    where can i glance at this?

    the baby boom started no later than 1946, so the boomers are retiring now.

    how can they not hit medicare for a lot of costs now?

    i agree it gets worse when they get into their 80's, but won't we start to see a substantial increase in the next 5 years?

    please walk us through this.

    •  You won't see much of an increase (0+ / 0-)

      Here's the sad truth.  Because retirement accounts eroded so much and social security pay outs stayed flat, many continued working when they should have retired for health reasons.  The end result will many lives cut short.  I know that sounds like grim reaper talk but I think it fits in with what the politicians are trying to accomplish.  Basically, they decided to fix the so called bulge by killing people off early.

      Yeah, there will an increase but not much.  You are right that if there was a significant bulge you would have seem signs of it already and yet we seen the opposite.  Sounds like scare tactics calculated to bring about a grim reaper result.  What a sad country we live in.

      "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

      by noofsh on Thu Aug 25, 2011 at 12:55:38 PM PDT

      [ Parent ]

  •  I just hope it doesn't mean that doctors (0+ / 0-)

    won't do all the things that are necessary for patients on Medicare so they can keep costs down and get paid for what they do.  

    Or maybe they gave up on doing things that weren't really necessary and that they used to do to increase their payments?

    Either way, somethings seems to be wrong here.

  •  Super Congress? (0+ / 0-)

    It should be illegal to turn over such serious decisions to a small number of people who were never chosen by the American people for this job.   Where in the U.S. Constitution does it grant this power to anyone?  Seems to me that this is unconstitutional because all branches of the U.S. government can be overturned except the Supreme Court which in a way can still be overturned when a constitutional amendment is made.

    Where in the U.S. Constitution does it say that a small number of Senators and Congressmen shall have the power to cut the budget and that they cannot be overruled by anyone?  Isn't this unconstitutional?  After all, it gives this small group the power to enforce their decisions if Congress fails to do so.

  •  What baby boomer bulge? (0+ / 0-)

    Now that is a fiction.  How many really are retiring before 65?  If so, how many will die way sooner because they really should have retired at 60 because of health reasons but held on to 65 because of health care costs.  I don't believe we will see a significant bulge even in 10 years.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

    by noofsh on Thu Aug 25, 2011 at 12:41:12 PM PDT

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