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Medicare enrollments forms with Social Security card.
The Republicans' rebranding effort (thinking up new ways of making the same unpopular policy ideas sound better) keep evolving when it comes to their plans to end Medicare. Originally, Paul Ryan and crew were fine calling their "reform" plan what it was: vouchers. The general population didn't like that much, so it morphed into "premium supports." Since that hasn't gone over too well, either, they've apparently settled on a new name for the same old vouchers: "competitive bidding."

Trudy Lieberman at Columbia Journalism Review explains how Republicans are dressing up the voucher idea this time.

Proposals floating around Congress these days call for privatizing Medicare via vouchers, but they don’t use the term. In general, the proposals would encourage insurance companies to bid against each other, to produce the lowest-cost policies in the private market. Customers would receive a sum of money—aka a voucher— to help defray the cost. Tennessee Sen. Bob Corker introduced his “Dollar for Dollar Act,” and a good chunk of it deals with what he calls structurally transforming Medicare by “keeping fee-for-service Medicare in place, competing side-by-side with private options that seniors can choose instead. Utah Sen. Orin Hatch used the term “competitive bidding” and said allowing health plans “to compete with traditional fee-for-service Medicare” would reduce costs and preserve the quality of care. The plans would allow people to choose between these voucherized plans and traditional Medicare, preserving the notion of choice.
Foes of our social insurance programs have gotten savvy enough to realize that they can't privatize Medicare in one fell swoop, as Ryan's original budget (back before "vouchers" were a dirty word) envisioned. So in the next iteration, they employed the idea of "choice," of competition with traditional Medicare. That allows them to chip away at it, pulling away younger, healthier patients who might be able to get good private insurance deals and leaving the older, sicker, more expensive patients in traditional Medicare to sap the program more quickly and make killing it off entirely that much easier.

No matter what they call it, it's still the same idea: put more and more of the burden of paying for health care on seniors, and put that money in the pockets of private insurers.

Originally posted to Joan McCarter on Wed Feb 27, 2013 at 12:01 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (27+ / 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 Wed Feb 27, 2013 at 12:01:59 PM PST

  •  Unfortunately the ACA only confuses people (5+ / 0-)

    into thinking this is similar and maybe it is.  I mean I'm not so sure Democrats are committed to Medicare either.  With these Ed Rendell types running around "rerforming" us into the hands of the same fraudsters that are proposing this.

    •  As Steven Brill asked… (2+ / 0-)
      Recommended by:
      Ishmaelbychoice, Noziglia

      …in his Time cover story Bitter Pill: Why Medical Bills Are Killing Us:

      When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

      What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

      [The bills] examined line by line for this article offer a closeup window into what happens when powerless buyers…meet sellers in what is the ultimate seller’s market.

      The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

      If we cannot answer that basic question, then no health care reform will ever work or be trusted by the American people.

      Union-printed, USA-made, signs, stickers, swag for everyone:

      by DemSign on Thu Feb 28, 2013 at 08:30:40 PM PST

      [ Parent ]

      •  Single Payer (1+ / 0-)
        Recommended by:

        It is time to get insurance companies out of health care. With a single payer system there would be more central control, and streamlined service. An, yes it would be paid for with a health care tax on individuals and corporations. An, also there would be wage and price controls. This would greatly reduce the price of health care. The understanding we all must have is if are society is to prosper and get stronger, health has to be considered a right, not a means to wealth.

      •  The point (0+ / 0-)

        Brill's basic point was very simple, even if it was buried in the 36 pages of verbiage he felt he needed to be Taken Seriously.

        Health care is not a free market environment.  You fall, and break a bone.  You go to the hospital emergency room for treatment.  You don't even see the bill, much less agree to it, until afterwards.

        Even if we had a system in which you did see the bill first, how many of us would say, "that's too much.  I can't afford it, so I won't get my bone set.  I'll put out a request for bids, and wait to select the cheapest option"?

        If the consumer of health care does not have the ability to choose, then health care is not a free market.  It is what economists (honest and educated ones) call a networked good.

        Republicans admitted this when they added the individual mandate to the Obama health care plan.  They themselves said the purpose of the individual mandate was so that healthy people were forced to pay insurance companies in order to keep general rates low enough to support the system.

        That -- the Republican reasoning -- is why single payer --- or even better an American version of NHS --- is the only way to transform health care from a massive money siphon from the middle class to corporations into something that actually delivers health care.

        And as Brill says, since we are now a political system where dollars count more than votes, or the general welfare, or even simple reason, such a transformation is simply considered "too hard" and not even under consideration.

        Obama knew this, and his goal in his original health care bill was to erode the economic stranglehold health care corporations have on our country, so that at a future time we could enact the real solution.  He failed to do even that.

        In Washington, whenever anyone does something wrong, everyone else gets punished.

        by Noziglia on Fri Mar 01, 2013 at 07:00:08 AM PST

        [ Parent ]

  •  I'd like to see some Competitive Bidding (1+ / 0-)
    Recommended by:

    I'd like to see Medicaid included in the Exchanges as a buy-in, base coverage for any income level with subsidies for anyone up to 200% of poverty. Make the insurance companies compete for the broadest base of the healthiest people, young people that want only the most basic coverage.
    It would accomplish two things: increase the base of Medicaid's funding and force the Insurance companies to either forgo profit on these policies or get out of the business.
    Oh, third thing, it would de-stigmatize Medicaid and fourth, increase the number of Medicaid providers.

    If I ran this circus, things would be DIFFERENT!

    by CwV on Wed Feb 27, 2013 at 01:09:17 PM PST

  •  I say "Medicare-For-All." :-) No doubt the (4+ / 0-)

    Repubs will attempt to change Medicare to a 'voucher' program.  We can't let them succeed!

    But beware of a few Dems--like Democratic economist and former Clintonian, Alice Rivlin.  And even Democratic Senator Ron Wyden, who briefly jumped on the Ryan bandwagon.

    Not to mention that 'loose canon' [tongue-in-cheek]--former PA Governor Ed Rendell.  

    Who knows what he'll do next, LOL!

    'Vigilant' is the watchword. :-)


    "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson


    by musiccitymollie on Wed Feb 27, 2013 at 01:37:59 PM PST

    •  Beware… (1+ / 0-)
      Recommended by:

      …the hospital lobby which doesn't want you messing with their massive profits:

      According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

      Another McKinsey report found that health care providers in the U.S. conduct far more CT tests per capita than those in any other country — 71% more than in Germany, for example, where the government-run health care system offers none of those incentives for overtesting. We also pay a lot more for each test, even when it’s Medicare doing the paying. Medicare reimburses hospitals and clinics an average of four times as much as Germany does for CT scans, according to the data gathered by McKinsey.

      Medicare’s reimbursement formulas for these tests are regulated by Congress. So too are restrictions on what Medicare can do to limit the use of CT and magnetic resonance imaging (MRI) scans when they might not be medically necessary. Standing at the ready to make sure Congress keeps Medicare at bay is, among other groups, the American College of Radiology, which on Nov. 14 ran a full-page ad in the Capitol Hill–centric newspaper Politico urging Congress to pass the Diagnostic Imaging Services Access Protection Act. It’s a bill that would block efforts by Medicare to discourage doctors from ordering multiple CT scans on the same patient by paying them less per test to read multiple tests of the same patient. (In fact, six of Politico’s 12 pages of ads that day were bought by medical interests urging Congress to spend or not cut back on one of their products.)

      Union-printed, USA-made, signs, stickers, swag for everyone:

      by DemSign on Thu Feb 28, 2013 at 08:35:15 PM PST

      [ Parent ]

    •  Medicare For All sounds good to me (1+ / 0-)
      Recommended by:

      Like K-12 education for all. Because government should provide education and health care for its citizens. And a safety net.

      If you want to pay extra out of your pocket for a private school for your kids or for a Cadillac health insurance plan, that's fine.

      But every citizen should get education and health care. And food safety. And roads. Clean water. Police and Fire departments. And so on.

      "Stupid just can't keep its mouth shut." -- SweetAuntFanny's grandmother.

      by Dbug on Thu Feb 28, 2013 at 10:31:53 PM PST

      [ Parent ]

  •  Ach they're shilling for Chained CPI again (1+ / 0-)
    Recommended by:
    denise b

    on Hardball.  A "better way" to calculate Social Security according to Obama's former press Secretary who appears to have joined the scumbag screw seniors crowd.

    I mean I can get mad at Republicans but what just sets my hair totally on fire is when DEMOCRATS LIE to seniors about cuts to their benefits.

    I'm not that stupid Obama administration.  I KNOW that chained CPI will cut benefits and keep cutting benefits every year hurting me most when I am very old.


  •  Well, I think it's nice that GOPers have a new (2+ / 0-)
    Recommended by:
    JML9999, Womantrust

    name for an old loser idea.  Because the party has really changed and stuff.

  •  Washerless faucet Valves (0+ / 0-)

    They're not washers they're Gaskets and O-Rings

    I want 1 less Tiny Coffin, Why Don't You? Support The President's Gun Violence Plan.

    by JML9999 on Thu Feb 28, 2013 at 07:44:39 PM PST

  •  very simple idea (3+ / 0-)
    Recommended by:
    Eyesbright, Womantrust, Dbug

    Medicare for all. Cut out the insurance companies. Add .25 to each hamburger and hot dog sold in the US. Add .10 to every soda sold in the US. Add a dollar to every tobacco product and every beer sold and you know what, the damn thing is paid for. It ain't perfect but it gets everyone healthcare. That's the direction we need to go.

    Be involved!

    by ecthompson on Thu Feb 28, 2013 at 07:49:43 PM PST

  •  Solution? Problem? (1+ / 0-)
    Recommended by:

    Will someone ask them just how they think their idea solves the problems of paying for the health care of seniors?

    Competitive bidding?  When it's been shown that Medicare is the cheapest most efficient way to deliver these services?    

    It's like these guys are living in a parallel universe.

    "You never change things by fighting the existing reality. To change things, build a new model that makes the existing model obsolete."-Buckminster Fuller

    by NCJan on Thu Feb 28, 2013 at 07:50:45 PM PST

  •  Reduce Costs-Medicare for All (1+ / 0-)
    Recommended by:

    To reduce cost of Medicare and health care in general, simply go to a Medicare for all.  

    If not Medicare for all then simply allow Medicare to negotiate drug prices with the pharmaceutical companies.

    Poor man wants to be rich. Rich man wants to king. And the king ain't satisifed until he rules everything. B.Springsteen

    by howd on Thu Feb 28, 2013 at 07:51:54 PM PST

  •  This sounds an awful lot like how we got (1+ / 0-)
    Recommended by:

    Medicare Advantage which cost us a ton of money to subsidize private insurance companies while they shepherded gullible seniors into HMOs.

    Only in the darkness can you see the stars - Martin Luther King, Jr

    by Susan Grigsby on Thu Feb 28, 2013 at 08:13:10 PM PST

  •  competitive bidding (0+ / 0-)

    So, in other words, the person keeping you alive is the lowest bidder.  

    Comforting, isn't it.


    ... the watchword of true patriotism: "Our country - when right to be kept right; when wrong to be put right." - Carl Schurz; Oct. 17, 1899

    by NevDem on Thu Feb 28, 2013 at 10:38:12 PM PST

  •  It's interesting since sadly I had to deal with (0+ / 0-)

    veterinarians recently. Sure there is pet insurance but most people don't go that route since they pretty much over charge for it and do not insure prior problems.

    But do you get asked who your insurance is with when you call to make an appointment with a vet? Nope. Do you get told they won't do this or that because the insurance won't cover it? Nope. Will they do a payment plan? Most will.

    Sadly my cat did not make it. But at least I didn't have the added stress of a middle man who doesn't give a damn if my cat lived or died. There were no charts as to how much the middle man would pay and no one to over ride what the doctor said needed to be done. And there was no problem with my cat being treated and the vet getting payment.

    I have been through worker comp in Calif. Hell I worked for worker comp in Calif. before Arnold killed it. I could never understand how a damn pusher paper with a B.A. in anything could over-ride a person with a Doctorate in Medicine. Guess I am stupid.

    My opinion is fine to have insurance companies for objects like cars and houses where it's fixed and it's just an object. But when it comes to human lives, it's so wrong. The objective of an insurance company is to make money. Nothing else. Sure they are selling a product but they are not qualified to make medical decisions. They may hire a few nurses and doctors but those people do not see the patients.

    The deal is Medicare is to help people, not to make a profit for private industry. It's insane that this is even an issue when so many other countries have working medicine for all and we are still trying to fight off the greedy privateers.

    BTW I am on Medicare because I have had the fun of Rheumatoid Arthritis for the majority of my life. Along with a few other things. However it's only been for the last couple of years since prior to that I was what some call a "maker". Now that I am on it and need it, it's damn hard to get treatment. I still pay every month into it and have those lovely co-payments or whatever. Plus I do not have the drug coverage.

    So it's already broken but privatizing it will only make it worse. That's my shorter version of all of this.

  •  "Discount coupon", not "voucher" (1+ / 0-)
    Recommended by:
    K S LaVida

    Voucher is too much credit. People know what a discount coupon is; they seem to be half of the remaining snail mail I get. And we all know how worthless most of them are: a major headache even when they turn out to be useful.

    •  A Groupon to raise costs and kill people (0+ / 0-)

      I prefer to call it a groupon, as it's not even an honest coupon.  But in either case it buys you nothing; it requires you to pay the rest of the price or you don't get covered at all. So the real "savings" in the program are from old people who will become totally uninsured and then die early, saving the Social Security system some money.  How sweet.

      But also look at the EXCELLENT Steven Brill article that takes up most of this week's Time Magazine.  It describes how the hospital industry is raking it in, with "non-profit" CEOs making $4M/year.  They do this via a price table called the Chargemaster, which puts obscene prices on every little activity.  Most HMOs negotiate down to 35-40% of Chargemaster, though the uninsured or badly-insured pay full freight, which is totally fatuous.  Medicare however refuses to even start there; it pays a cost-based price.  Under the Republican plan, hospitals would get Chargemaster rates, or HMO-negotiated discounts, rather than cost-based rates.  This will raise their profits hugely, and thus they're paying huge money to lobby against Medicare.

  •  These "Vouchers" are a GOP decoy (0+ / 0-)

    The real goal of Republicans is to completely eliminate Social Security and Medicare and pass the savings off as more tax cuts ans subsidies for the Rich and the Corporations.

    The Republican solution will then be one if you run out of money at retirement you should just "Die Quickly."

  •  Please! (0+ / 0-)

    All of us must work as hard as we can to not let the Republicans steal Social Security and Medicare from us. Please contact your congressman and senators and let them know that these programs need to be protected and supported. Not, cut and sold off to the highest bidder. The elderly and poor need these programs and insurance companies don't care about them, no profit in it.

  •  Not going to happen (0+ / 0-)

    All of the "privatization" schemes are based on a fantasy that given their druthers, Americans of whatever age will voluntarily fork over a huge, unlimited, and increasing percentage of their modest incomes to big insurance companies. That is extremely unlikely. Medicare premiums come directly out of Social Security checks, so you don't have a choice. But if people have to shop on their own and then actually buy the insurance, my best guess is that large numbers will choose not to -- because eating and paying rent are more important.

    The same is true of the under-65s, IMO. People will vote with their feet, despite the penalties, if the premiums are just too high to pay on modest (and shrinking) incomes.

  •  "competitive bidding"? (0+ / 0-)

    Isn't that how Republicans want to negotiate drug prices with the pharmaceutical industry?

    don't always believe what you think

    by claude on Fri Mar 01, 2013 at 08:11:09 AM PST

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