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Photo of man who supports obamacare at the supreme court in washington dc on 6/28/12.
Democrats are coalescing in opposition to raising the eligibility age for Medicare as a sweetener to get Republicans to even start talking about revenue increases. That's fantastic, as far as it goes.

But there's good reason to leave Medicare and Medicaid completely off of the budget chopping block for the time being, and to be patient in considering reforms. Jon Cohn explains why here.

Contrary to what conservatives say and even many centrists seem to believe, the high cost of Medicare and Medicaid isn’t a by-product of government inefficiency. On the contrary, Medicare historically has held down costs as well as, if not better than, private insurance on a per capita basis. That’s thanks, in part, to the administrative advantages of a centralized government program and Medicare’s enormous power to set prices. Medicaid is cheaper still, to the point where, honestly, it's underfunded. The programs keep getting more expensive, relative to inflation, because medical care keeps getting more expensive—and, in the case of Medicare, because of the increase in the number of people coming on the program.
The Affordable Care Act addresses, to an extent, the increasing costs of medical care—costs which are rising much more quickly in the private sector than in Medicare and Medicaid. And Obamacare is cutting costs for Medicare. Let the Affordable Care Act do its job and see how much it can do to contain Medicare spending.

But they don't have to stop at doing nothing about Medicare, if they really want to reduce health care costs. There's no reason not to put really progressive solutions into the mix. Like Medicare buy-in for people 55 and older, a younger, generally healthier cohort that would be paying premiums into the program. And why not finally allow Medicare to use its bargaining power to make prescription drugs for seniors cheaper to purchase, or at the very least allowing importation of cheaper medicines from Canada. Those are two, big-ticket possibilities.

And they can do it, as Greg Dworkin reminded us on Sunday, by citing the Very Serious Peoples' favorite Very Serious catfood commissioners Erskine Bowles and Alan Simpson. They included Medicare buy-in in their recommendations for strengthening the program. We know how much everyone loves Simpson-Bowles, so how about all of their suggestions being on the table?

Originally posted to Joan McCarter on Mon Dec 03, 2012 at 02:45 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Every day that they stall, take something off. (8+ / 0-)

    Just keep taking shit off that table, one by one. If they don't like it, shut the fuck up and jump!

  •  Agreed Joan. It is Bush's expansions of military (10+ / 0-)

    and tax cuts that busted Clinton surplus budget, fix it with adjustments to these.

    Democrats will play into the hands of the Reagan - Atewater plan, publicly praised by Bush and Karl Rove to use defense expansions and tax cuts to create a "debt crisis" Republicans would use to cripple social spending, specifically Social Spending and Medicare.

    Any Democrat who aid and abet this treacherous effort will not only be stupid but betray our middle class and poor base and deal a catastrophic blow to our hard fought and won party unity in what might be seen as the political blunder of the century.

    I have not studied it yet, but Ive read that Howard Dean is saying the sequestration cuts may be the best we are going to get as they are half to military spending, instead of all focused on social spending.  Is the $450 billion of Medicare improvements of Obama's proposal just the non-defense half of sequestration? If so I'd rather have sequestration, let the Bush tax cuts expire as well as the Social Security payroll deductions and then fight separately for a middle class tax cut even larger than Bush to make up for the Social Security deductions.

    The Republicans will only be too happy to undermine the Social Security Trust Fund that used to be solvent until 2037 but is still solvent now until 2034.  

    We can win the doctors fix as a stand alone with the help of the AMA, Health providers and insurance companies, it would be suicide for the GOP to fight against that.

    And, we will have to fight the debt ceiling fight in February when the optics will be on our side, as the GOP threatens to cut off all government checks harming our country and people.

    The Treasury has flexibility to delay higher tax holdings on January 1 on the presumption that we will win a pure middle class tax cut battle without all the smoke and mirror distractions of "entitlements"

    I'm increasingly convinced that the "grand bargain" is nothing but an opportunity for the Republicans and some Democrats to dupe the rest of the Democrats into agreeing to totally unnecessary and damaging Medicare and Medicaid cuts that would never be acceptable if looked at clearly.

    We are not getting enough and do not need to do it this way despite how convenient it may look like on the surface.

    After it is analyzed there will be no "Lincoln-like" bipartisan glory points here, only as complete  fracturing of our now unified Democratic Party.

    This will not be "Serving Mankind" because with regard to this "grand bargain" - "It's a cookbook!" Serving up progressives, the poor, the middleclass, and Medicare recipients to protect military spending which is at a record high.

    The means is the ends in the process of becoming. - Mahatma Gandhi

    by HoundDog on Mon Dec 03, 2012 at 03:15:32 PM PST

    •  Just Think of the Timing. Lame Duck After Election (3+ / 0-)
      Recommended by:
      Progressive Pen, kurt, HoundDog

      is the very safest time of the entire political cycle to screw the voters. Some of the politicians are leaving and the rest have at least 2 years for voters to forget or become distracted.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Mon Dec 03, 2012 at 03:28:21 PM PST

      [ Parent ]

    •  Boom. (2+ / 0-)
      Recommended by:
      kurt, HoundDog

      If any 'Grand Bargain' passes in the mold of what the Centrists, Republicans, corporatists, conservatives, and neoliberals want, the Democratic would totally be wrecked.

      This fiscal cliff nonsense is likely that group's last chance to go full bore with their austerity in one big shot. That's why David Gregory, Andrea Mitchell-Greenspan, Ed Rendell, the No Labels people, and various other Villagers have been repeating the 'shared sacrifice', 'pain', and other disguised tropes for their paymaster's wishes of keeping those low taxes on the rich while shredding the Social Safety Net.

      The Obama Administration initially had me quite worried (with good reason). They've stood up and haven't taken any of the Republicans proposals seriously, a welcome change. But it seems as if the Grand Bargain will be dead come 1/1/13. At least for a while, anyway. It's a zombie that won't go away.

      The Grand Bargain must be stopped at all costs to protect the 99%.

      by cybrestrike on Mon Dec 03, 2012 at 04:26:00 PM PST

      [ Parent ]

    •  i was surprised that howard dean supports (2+ / 0-)
      Recommended by:
      kurt, blueoasis

      austerity for deficit/debt reduction.  that is totally insane, imo.

      it would be a massive tax increase on the middle class during a weak economy, plus stupid untargeted cuts, which he acknowledges would drive the economy into recession.  driving the economy into recession means the effect on deficit/debt reduction is not very big.

      debt reduction is also not important when government can borrow at negative interest rates.

      •  The sequestration cuts are less than a trillion (0+ / 0-)

        half coming from the military.  It appears the other half of social spending cuts especially to health care programs are already being included in President Obama's proposal.

        I have to check several things to make sure, but as long as we do the middle class tax cuts the sequestration part may merely be would we like to include any defense spending cuts to the trillion in government spending that is on the table.

        Please see my latest post on the possible caving of Republicans on the :doomsday plan" where there are increasing numbers suggesting that give us the vote on middle class tax cuts and all vote "present" so we do not even have to get 26 cross overs.

        The means is the ends in the process of becoming. - Mahatma Gandhi

        by HoundDog on Mon Dec 03, 2012 at 06:24:09 PM PST

        [ Parent ]

    •  Absolutely (0+ / 0-)

      This whole grand bargain is a joke and just a way to rob us blind and give further tax cuts for the rich.

  •  I'm still crossing my fingers... n/t (1+ / 0-)
    Recommended by:
    smiley7
  •  If Medicare didn't cover so many sick people (11+ / 0-)

    we'd save a lot of money.

    Also, maybe all these old people should stop choosing to get old and sick.

    If only people would stop getting so old and sick, we wouldn't have to spend all this money taking care of the old and the sick.

  •  Austerity is best practiced when times are good, (6+ / 0-)

    not while the country is still in recovery and times are tough. They had ample opportunity to get serious about debt and ignored it, some actually scoffed at the idea, but now that a Democrat sits in the White House the sky is falling? Not really, it's just politics as usual.

    If they hadn't received a pay raise since 1970, they'd be on the opposite side of this debate.

    "The human eye is a wonderful device. With a little effort, it can fail to see even the most glaring injustice." Richard K. Morgan

    by sceptical observer on Mon Dec 03, 2012 at 03:23:33 PM PST

  •  Thanks HoundDog (2+ / 0-)
    Recommended by:
    kurt, blueoasis
    After it is analyzed there will be no "Lincoln-like" bipartisan glory points here, only as complete  fracturing of our now unified Democratic Party.
  •  It'd Also be a Huge Jobs Program. (6+ / 0-)

    Of some 80 million boomers now approaching retirement, there'd be several million people who'd buy-in and leave jobs either to retire or to self-employ, once they could afford health care.

    That's why Howard Dean proposed this during campaign 08 and during the transition period before the inauguration.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Mon Dec 03, 2012 at 03:26:14 PM PST

    •  Completely agree (1+ / 0-)
      Recommended by:
      winsock

      ( have many friends in that situation, being in that age bracket) and also a lot that would go out and start a new business, instead of working at a grind-job that they hate but it comes with health insurance.

      We just have no idea how much the whole employer-provided health insurance thing is warping our whole economy. It's keeping people in jobs they hate, and keeping employers from adding more workers.

      For me, it might mean actually having access to affordable decent coverage, before the ACA kicks in.

  •  Yes, we have choices that are better than (4+ / 0-)
    Recommended by:
    avsp, Progressive Pen, kurt, blueoasis

    limiting spending for some ideological bat-tub bullshit that threatens the fabric of our society.

    "Lets show the rascals what Citizens United really means."

    by smiley7 on Mon Dec 03, 2012 at 03:33:13 PM PST

  •  Luv the Medicare buy in approach (3+ / 0-)
    Recommended by:
    winsock, SycamoreRich, lotlizard

    That sort of change will rally progressives.

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

    by noofsh on Tue Dec 04, 2012 at 07:38:17 PM PST

  •  why 55? (3+ / 0-)
    Recommended by:
    winsock, SycamoreRich, lotlizard

    I don't understand why people keep suggesting any kind of age limit for Medicare buy-in.

    Just open it to everyone.

    There's no need to pre-compromise.

    •  Agreed - It's hugely profitable (0+ / 0-)

      Medicare adds 3% to health care.  Private Insurance adds 21%.  If we just split the difference, charging say 10% less than private insurance, and kept the difference, Medicare would make trillions in profit.

  •  Off the table. (0+ / 0-)

    Stuff that could affect rich republicans (i.e. the impeachment of George W. Bush, putting Wall-Street criminals etc.) will be the only stuff kept off the table.

  •  why is it that Republicans use every excuse in the (1+ / 0-)
    Recommended by:
    lotlizard

    book to try to cut programs for people that need them the most?

    No matter what they problem, they're always trying to cut money from senior citizens who need it the most, in Social Security or Medicare...or Medicaid, or money in programs for the poor who need it the most.

    We need to stop the Republican insanity of...insanely starting budget cuts to programs for people who need it the most.

    And...since Republicans are the ones who have forced these unnecessary cuts and created this bogu "fiscal cliff" to begin with, why are people not telling them...ok...lets start with the easy stuff, then.

    The easy stuff to cut: in addition to eliminating the tax cuts for the filthy rich who don't need them, how about also cutting all of those billions and billions and billions and billions of dollars in defense welfare...military programs and systems that the Pentagon doesn't even want.

    How about cutting out all of the tax subsidies for oil companies. They have made record profits year after year and have no need for tax subsidies.

    Those things alone: eliminating tax cuts for the filthy rich, cutting out military programs that the military doesn't even want or need and cutting oil subsidies...would...pretty much be all that is necessary to eventually bring our budget into balance and reduce the deficit.

    And it's all easy...it hurts virtually nobody (except for those most able to afford it and who would hardly miss it if it were gone...) and will not harm struggling middle class or poor folks at all.

  •  QUESTION: Why aren't Dems screaming loudly (1+ / 0-)
    Recommended by:
    lotlizard

    about allowing bargaining for prescription drugs? This part is a freaking no-brainer, and yet only Bernie Sanders seems to bring it up constantly. and, of course, he's no Dem....

    "Bargaining for prescription drugs" should be as much of a mantra as "No tax cut extensions for people making $250000 and over".

    "There's no ideology [t]here [on the right]. It's just about being a dick." Bill Maher, June 22, 2012.

    by caseynm on Tue Dec 04, 2012 at 07:46:10 PM PST

  •  The problem is that there is no . . . (1+ / 0-)
    Recommended by:
    lotlizard

       oversight of the hospital corporations, clinic corporations, pharmaceutical corporations, medical equipment corporations, and individual doctors, if there are any left. The beneficiaries are what they are. They are either sick or not. The problem is what it is.  You can't regulate the sick people. You can't tell them "Don't get sick". The providers are what need regulation. It's impossible to provide for the needs of the sick people and give the plutocrats what they demand. We have to have government regulation of the medical industry or people will continue to die needlessly.

  •  Take a look at Medicaide/Medicare costs (0+ / 0-)

    since 1965.

    You are an intelligent woman, Joan.  So look at the graphs that show the growth rate of costs in these two programs, and tell me...no...tell US...how would you decribe the growth curve?

    Exponential?  Yes, I believe that's the term.  It isn't hyperbole.  It's algebra.

    Okay...Now look at the concentration of wealth, and the stagnation in wages, and...ohhh...the lowering birth rate.

    That is the REAL fiscal cliff.  Less people, supporting a growing number of retirees, who have a diminishing prospect of finding good paying jobs.  

    We joke about Millenials not leaving home and living in their parents' basements...But Boomers are stuck helping out their elderly parents and supporting their underemployed kids.

    When those kids are 60, if the trend continues, they are up Shit Creek.  They won't be in any position to help their aged parents, if in fact they have ever moved out, and if they managed to bring some more kids into the world along the way, they'll probably be looking to the grandparents as well.

    I don't look forward to the next 15 years.  But I really feel for anyone who is about 35 or 45 right now...because you are in for a real shit storm.

    Oregon: Sure...it's cold. But it's a damp cold.

    by Keith930 on Tue Dec 04, 2012 at 08:00:14 PM PST

    •  Such detailed concern.. (1+ / 0-)
      Recommended by:
      lotlizard

      But nary a mention of our runaway military spending or America's recent orgy of tax-cuts for the wealthy!

      Or our corrupt political culture which manifests itself in many ways, from indefensible subsidies to oil companies to corporate freebies(free spectrum/discount oil/mining leases/interest free loans to banks/etc.)

      Nope, it's all Medicare/Medicaid and...
      low birth rates?

      That's what's holding us back?

  •  Why not change Medicare prescription negotiation (0+ / 0-)

    NOW?  President Obama proposes $400 billion in savings to Medicare; 42% of that savings would come from changing Medicare's prescription drug negotiation to the same negotiation that Medicaid uses.

    Medicare added its prescription coverage option in 2006, Medicare Part D. Their drug procurement processes work differently: Each private Part D plan negotiates with a drug manufacturer to obtain their own, lower rates. There’s no set discount, however, like there is in Medicaid. The HHS Office of the Inspector General estimates that the Medicare Part D program gets a 19 percent discount on drugs, compared to the 45 percent discount that Medicaid negotiates.
    link

    From what I can tell so far, nothing in President Obama's proposal cuts benefits.

    I don't understand why we should not support/endorse these cost savings. This claim that Medicare shouldn't be touched at all now... just reminds me of teabaggers shouting "Keep govmint out of my Medicare".

    The sh*t those people [republicans] say just makes me weep for humanity! - Woody Harrelson

    by SoCalSal on Tue Dec 04, 2012 at 08:18:50 PM PST

  •  How are other industrialized nations coping (1+ / 0-)
    Recommended by:
    lakehillsliberal

    with this problem and how does the U.S. compair?  Other than Canada I have no clue.  

    •  Medicare for All (2+ / 0-)
      Recommended by:
      This old man, lotlizard

      They have Medicare for everyone.  Medicare adds 3% on top of healthcare costs, while private health insurance adds 21%.  Since other countries have Medicare for everyone, their overall costs (healthcare + health insurance) are much, much lower.

    •  An aging population is a problem in many countries (1+ / 0-)
      Recommended by:
      This old man

      but health care costs are more tightly controlled.  Our medical care costs are driven sky high by people that have little or no health care until they reach Medicare age and then their lifetime of bad health becomes incredibly expensive.  We also have a medical system that is rewarded for finding and curing disease, so they find and cure non-existent cancers....wella....early detection and cures for microscopic cells that may or may not turn into cancer.  They scare people to death, poison them and call it a miracle and charge hundreds of thousands of dollars. ....it is a hell of a bad system.   We also fail to coordinate care which means, your specialist gives you a medication and then you never see them again, your primary fails to monitor and you end up being made incredibly ill by the side effects of the medication.   I have recently seen two cases of this and it is expensive and very damaging.  You have seniors taking 10 medications, what they hell would you need 10 medications for.  They just keep piling them on instead of addressing the problem.  Yes, there are people with special conditions that need all the meds but the "average" old person has a counter full of crap, all expensive and paid for by Medicare.  

  •  "Love it ! Improve it ! Medicare for all !" (0+ / 0-)

    That has rhythm! That would make a fine chant. People who take part in assemblies and gatherings take note.

    The Dutch kids' chorus Kinderen voor Kinderen wishes all the world's children freedom from hunger, ignorance, and war.

    by lotlizard on Wed Dec 05, 2012 at 12:00:01 AM PST

  •  I want Medicare on the table. Medicare for all. nt (0+ / 0-)
  •  Absolutely (0+ / 0-)
    Let the Affordable Care Act do its job and see how much it can do to contain Medicare spending.
    If you have the time to read this Sen. Sheldon Whitehouse Report, you can find out about cost cutting in ACA.
  •  I just watched Claire McCaskill assure (0+ / 0-)

    Morning Joe that Dems WILL crompromise on "entitlement reform." :(

  •  The pragmatic argument (0+ / 0-)

    The GOP have a long habit of conflating cost-shifting with cost-saving, and discussions about yielding on this give in to the same thinking.
    No one seems to address the fact that, if we do raise the eligibility age, we have - for the first time in some 50 years - 65- and 66-year-olds without health insurance. It's foolish to think a significant portion of them could afford private insurance out of pocket, which puts us in the same mess for them as for all our nation's uninsured - catching them with a patchwork of state programs or absorbing the cost of delayed (and therefore necessarily more serious) care, and of ER visits for, well, everything.
    I've seen numbers - and I can't attest to them, so someone please check me on it - that raising the age to 67 would save about $5.7 billion dollars, but add an estimated $9+ billion in costs for states and the private sector. That money, of course, will be paid by the same families, the same small businesses, that are ponying up the $5.7 billion now - so where's the savings? Human costs aside, this is a net money-loser.

    “If you are irritated by every rub, how will your mirror be polished?” - Rumi

    by Jaxpagan on Wed Dec 05, 2012 at 06:05:42 AM PST

  •  We can't negotiate drugs but we can raise the age? (1+ / 0-)
    Recommended by:
    weinerschnauzer

    The GOP doesn't want to allow Medicare to negotiate better prices for drugs, which would save as much as $50 billion per year, but they are fine with raising the retirement age.  This should be the number one point that the Dems make, the GOP is fine asking you wait longer to retire, but they can't stomach cutting the money flowing from the taxpayers to drug companies.  

    The difficulty lies not so much in developing new ideas as in escaping from old ones! - John Maynard Keynes

    by Do Something on Wed Dec 05, 2012 at 07:38:40 AM PST

  •  Raise the FICA Income Limit... (0+ / 0-)

    It's presently $110,100 and by raising it to $150,000 or $200,000 it will only affect the highest earners and go a long way toward making Medicare and Social Security solvent.  To call these programs entitlements is bogus - people pay into these, their employers' contributions are in fact part of their compensation. People earn these benefits. The only entitlement - is to a fair exchange.

    Also all earners have parents, grandparents, relatives, disabled family members (even if distant) neighbors in their community who use or will use these programs. To pay into these programs is part of our social contract, is part of living in community, in a healthy society.

    "Life can only be understood backwards, but it must be lived forwards." ~Soren Kierkegaard

    by Beastly Fool on Wed Dec 05, 2012 at 10:55:14 AM PST

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