Anyone who has told you Medicare or Medicaid will not be cut by President Obama and the 113th Congress is wrong ... and is quite possibly also a Big Pharma CEO. Medicare and Medicaid are going to be cut, because that is exactly one thing Americans elected their leaders to do.
How can we be certain MC/MA will be cut? 17.6% is why.
The United States spends more on health care, both per capita and as a share of GDP, than any other country in the world. In 2009, spending on health care reached a record high $2.5 trillion, or 17.6 percent of U.S. GDP.Massive reform of the US health care system has been a goal of progressive Americans and the Democratic Party for decades, if not for generations. Almost 20 years ago to the day Bill Clinton ran on it and won. He made it his first priority, and, 19 years ago to the day his reform effort was already dead and buried.
Four years ago President Obama and Congressional Democrats wrestled with Republicans over the Affordable Care Act. The ACA was fought for over the course of months. It finally passed by the skin of its teeth. It was immediately unpopular with the right, because it did something. It was unpopular with the left, because it did not do enough.
Now we approach 2013 with a big national Democratic victory in our pocket. Americans voted for Democrats ahead of Republicans despite the worst post-WW2 economy ever, despite ceaseless GOP obstructionism, despite Citizens United. Voters had the direct choice between Paul Ryan's Medicare elimination and Barack Obama's Medicare reform. Americans chose reform.
It's not 2011. It is almost 2013. Both the date and that Overton Window thing have moved. For the first time since LBJ's Great Society the American voter wants and expects major improvements to our nation's safety net. It is myopic to think that after all the years of hard work it took to arrive at this happy situation, that our political leaders will now casually throw it all away.
Myopic seems the apt term since some visions do not see past words such as "cuts", "pill", "bargain", or "compromise". Let us remind ourselves of something. 17.6% is roughly the same thing as one dollar our of every six going to health care. Buy a $5 sandwich from Subway and your next dollar goes towards an $11 aspirin pill down at the ER. We sent our candidates to Washington DC that they would cut down on that overhead.
Now that we have some ducks in a row a vocal minority balks at the chance. It's easy to understand why Big Pharma CEOs recoil in horror from the words cut, bargain, and compromise. Those of us who are not CEOs should look past those words to our goals. If ever there is a time to keep our eyes on the prize, certainly it's when our fingers begin to curl around the brass ring.
A few reasons why none of us should fear the word "cuts".
* We just went through a campaign during which the GOP attacked the ACA for "cutting $716 billion from Medicare". Most Americans concluded those "cuts" did nothing to undermine Medicare. We have 716,000,000,000 recent examples of why the word "cut" does not mean squat - but sure as shootin' the policy details do.
* G.W. Bush's Medicare Part D was deeply flawed as we recall. The ACA is closing the "donut hole", but Medicare still is not allowed to negotiate with Big Pharma on prescription prices. Negotiate, cut prescription costs, save money, save lives.
* For decades we have been hearing how Medicare's payment structure encourages excessive testing and over-treatment. Going to a payment structure designed around patient results has been proven internationally to reduce costs and improve outcomes. So let's cut that out.
* Every year we hear about the annual price adjustment battle waged in Congress. This is a totally artificial roadblock that causes a lot of ill-will and bad faith among health care providers. This might not be a major money-saver but cutting out this practice will produce a more affordable, stronger, more respected program.
* Home-based long-term / hospice care reform. Or safety net does not provide support for long-term care of our elderly until the family's net assets are down to under $2,000. Then Medicaid kicks in - for warehousing at a nursing home. There's no support for long-term care under the far cheaper and humane at-home option. Let's find ways to cut off corporate nursing home empires from the government trough.
In closing, Mr Trumka of the AFL/CIO has it right. Write our President and your Congressional representatives. Tell them you understand changes must be made. But be sure to tell them these changes must end up strengthening the social contract not undermining it. As always hand-written letters or postcards get noticed much more than e-mails.
Do not forget we sent these people to Washington DC to make cuts to our health care costs. We want cuts. We need cuts to health care costs. Now when the election is over we are hearing our elected officials tell us they are poised to do much of what we have worked so long to achieve.
Let's not falter now over the word cuts! Our goal is not that of preventing all change to MC/MA. Change is in itself neither good nor evil. As always the devil is in the details. Tell your officials what you expect to see. And as always, don't panic.