Here’s some good news on the fiscal front: projected Medicare spending over the 2011-2020 period has fallen by more than $500 billion since late 2010 — based on a comparison of the latest Congressional Budget Office (CBO) projections with those of August 2010.The Simpson-Bowles target hasn't just been met, but exceeded, without any benefits cuts or anyone's eligibility age being raised. These projections don't include deep cuts that are always looming until Congress enacts another stop gap "doc fix" to prevent those provider cuts (because Congress always does come up with the temporary fix) and also excludes potential sequestration cuts, since it's not clear as of yet whether those cuts will happen. But even without those cuts, spending on Medicare has slowed dramatically, far more dramatically than private health insurance. This could be because of the recession, and also because of the changes providers and health care systems are making to curb costs in advance of full implementation of the Affordable Care Act.
That’s important to remember because it was in late 2010—and based on CBO’s August 2010 projections—when Fiscal Commission co-chairs Erskine Bowles and Alan Simpson issued their original budget proposal, calling for slightly more than $300 billion in Medicare spending cuts through 2020. The original Bowles-Simpson proposal is often considered an appropriate starting point in evaluating whether other deficit-reduction proposals should be viewed as responsible approaches to the deficit problem.
As Van de Water says, this doesn't mean that we don't still have a massive systemic health care system problem in this country. We still spend far more for far less than any other developed nation, and that's the primary problem for Medicare. Making it harder to get, take longer to get, or more expensive to get for some seniors—all the proposals currently en vogue among Very Serious People—isn't necessary and won't solve the larger problems we face in providing affordable quality health care.