These thoughts are repeated from Paleo's Diary on Max Baucas' selling out.
Substantively, the biggest problem with the bill is that it allows for an alternative to traditional medicare by permitting a small number of "experiments" with managed medicare alternatives.
Why is that a problem?
Like school vouchers, medicare works because everyone is in it. If the healthiest of patients leave the system allowing for the insurance company managed care 'experiments' to demonstrate cost savings (as they must, because healthy patients cost less to take care of, plus the bill gives them a built-in subsidy), then not only do the sicker patients left cost the system more, in comparison they seem inefficient. This then lends itself to argue for more managed care experiments hastening the end of medicare as it is currently known.
Unfortunately, when everyone is out of traditional medicare, the managed medicare alternative stops looking so good. Insurance companies can still refuse you. Costs will be higher because there's sicker people to take care of. And the private comnpanies can and will do what they do now... profit from the change-over.
However, it does achieve the goal that the GOP has been working on for decades... shift to paying private companies to take care of seniors, not the government.
Put another way, if you like HMOs, you'll love the GOP approach to medicare. And social security. And school vouchers.
The bill seems to have some advantages. For very poor seniors, the prescription drug plan will save them momey. But now you can see why the AARP membership (which doesn't want HMO medicare) is ready to lynch the former Nixon aide who endorsed the plan on their behalf.
This is going to be very interesting. The first vote is tonight.
Also there's this take and summary from
Robert Kuttner ( from The American Prospect) who pretty much agrees with me:
Consider its provisions:
* Skimpy drug benefits. The administration refused to confront the pricing power of drug companies. So the government would be billed at exorbitant prices, and the new $40 billion a year in benefits would cover only a fraction of consumers' drug expenses.
Under the formula, if you incurred $3,600 of annual drug costs, the program would cover only $1,285, leaving you to pay $2,735 out-of-pocket and in premiums. (It covers 95% after $3,600, but many would not participate at all because they couldn't afford the upfront costs.)
* Capped Benefits. The administration's real goal is to shift Medicare from a public program to a private one, with the government's contribution capped. For the right, it's a three-fer: contain government's costs, shift risks to consumers and let private industry cash in. Healthier and wealthier people could supplement the voucher with their own resources. Poorer and sicker ones would get diminished coverage.
The bill authorizes "experiments" in six metropolitan areas, where private insurers subsidized by the government could lure healthy seniors away from traditional Medicare. However, past experiments with Medicare HMOs demonstrate that they are far less efficient than public Medicare and leave government holding the bag for the sickest patients.
Medicare works because it is a universal insurance pool. Fragmenting that pool can only raise costs, divert profits and compromise care.
* Means-testing. The bill subjects poorer seniors to an assets test and raises Medicare premiums for middle- and upper-income seniors. It also effectively bans drug imports from Canada. And it actually reduces drug benefits for people on Medicaid and those with private retiree coverage.