Althouse: "The threat to Medicare is a big reason why [voters] reject Obamacare."

April 6, 2011

"The threat to Medicare is a big reason why [voters] reject Obamacare."

"So the GOP strategy is to replace Medicare with something that looks a lot like the private insurance exchanges in Obamacare. Huh?"

66 comments:

Carol_Herman said...: Republicans are just a rubber stamp once they get to Congress.

"Medicare" became slap happy ... with the way they just handed out tickets.

The best suggestion is to raise the age to 66. And, then, to 67.

Instead, you have dopey 2 year crews ... who are setting a 10 year agenda. With Boehner "leading."

What can I say? Republicans should be given Special Olympics helmets when they go out to play politics.

Everyone of these stinkers in congress is in love with "single payer," anyway. (It wasn't just Bill Clinton!); 4/6/11, 10:48 PM
Dustin said...: It's true, it's a very risky political idea, but it's a great solution to a serious problem.

The hard fact is that we're out of money. We're going to have to overhaul entitlements, one after the other. just wait until we have to figure out a way to pay for social security, boomers!

One solution is to pretend there is no problem, while mocking a solution as painful. Oh wait... I don't think that solves anything, actually.

The fact is that Obama's plan is to completely defund social security and medicare and pell grants and post offices everything else the government pays for, because his plan is to go bankrupt after Obama is out of office. Not that Obama didn't take $500 billion away from this program for Obamacare, but the status quo democrats are on a path towards complete financial collapse.

but the politics make avoiding collapse pretty hard.; 4/6/11, 10:51 PM
I'm Full of Soup said...: Kaus views himself as a big thinker and big picture guy. But he ain't. Trooper would disagree with me though since Kaus co-founded Blogginheads and Trooper just loves that Blogginheads.; 4/6/11, 10:52 PM
Sprezzatura said...: "So the GOP strategy is to replace Medicare with something that looks a lot like the private insurance exchanges in Obamacare. Huh?"

Kaus is so dumb.

The GOP exchanges will be funded w/ tax dollars being sent to private sector companies, not private sector dollars being used to pay for private sector health care, which folks get to choose for themselves. So, obviously, it's a free market, GOP thing when the gov funnels money to corporations.

It's called payback. Don't forget that corporations are people too. Silly BHO thinks it's best when America's wealth isn't overwhelmingly (and increasingly) funneled to the richest of the rich. But, our non-carbon based citizens, our ultra-rich carbon based citizens, folks like JoeTP (with pipe dreams and/or high levels of gullibility when flim-flammed w/ trickle down econ theories), and the GOP like to use the gov to funnel money to corporations and rich folks. Direct payments really are the most efficient form for this redistribution.

Duh.; 4/6/11, 11:07 PM
Placeholder said...: The Republicans have never been serious about controlling spending, balancing budgets, or reforming the medical system.

Clinton was serious about the first two, and did a great job on them, but didn't have a clue when it came to health care. Obama doesn't either.

So, now the system is heading straight off the cliff.; 4/6/11, 11:09 PM
reader_iam said...: Question: Does the GOP/Ryan plan mandate that seniors WILL/MUST be approved for coverage That is, putting aside for a moment the voucher issues and all the sub-issues having to do with cost and so forth, will insurers be prohibited from denying coverage based on pre-existing conditions and so forth?

It seems to be this a key point to make as crystal clear as it's possible to make crystal clear in order to even think about comparing Obamacare to Medicare, Medicare to Ryan/GOPcare and so forth.

This needs to be stated as flat-out, plainly and simply as possible.

So, what's the deal?; 4/6/11, 11:15 PM
Placeholder said...: "Get your filthy government hands off my Medicare!"

- Teabagger, 2009; 4/6/11, 11:26 PM
reader_iam said...: Screw ideology. Here's a principle that transcends ideology: Before folks sign on to ANY contract, they ought to know the precise, exact details of the deal they're supposed to be signing on to.

So bring 'em, those details, and most specifically for those now 54 and under, and it'd nice if--as a side dish--people would acknowledge the difference between being 54 at this precise moment and being 24, 34, and maybe even 44.; 4/6/11, 11:26 PM
Chip S. said...: PB&J said: The GOP exchanges will be funded w/ tax dollars being sent to private sector companies, not private sector dollars being used to pay for private sector health care, which folks get to choose for themselves.

I've got to say that I stand in awe of PB&J's facility with Newspeak. But the reality is that it makes no sense to talk about exchanges (which are essentially lists of insurance-policy prices and coverage) as being "funded" by anybody. And it's a dishonest rhetorical trick to talk about "tax dollars being sent to private sector companies" when what you're referring to is the use of tax-financed vouchers that would replace direct government payments to health-care providers with spending decisions made at the discretion of individuals.

It's a really good try, though. I expect to encounter those same talking points all over the blogosphere by tomorrow.; 4/6/11, 11:27 PM
JAL said...: Read the comment on Kaus's file @10:07 AM by Jess81.; 4/6/11, 11:32 PM
reader_iam said...: A side observation:

I find it fascinating that among the most critical of the current system (which lord knows is unsustainable, as it has been known to be unsustainable for at **at least** 20 years)--now--are those who it appears will remain entirely exempt from paying a price for reforming it. The only thing I find more fascinating is that from among those who are most critical, one often hears the "this is the result of 40 [+whatever] years of profligacy!", among other things.

Well, shit, 85-year-old, you were 45 then; 75-year-old, you were 35; 65-year-old, you were 25. Where was all that wisdom and criticism THEN? So convenient, how it's working out now! And how, it seems, you're going to live out your entire lives without paying a price either for what you advocated then, by commission and/or omission, or what you're advocating now, by both.

I agree we need a serious overhaul; there is no escaping that reality.

What I don't agree with is the scope and breadth of people whom we're exempting from having to pay some sort of price for it--and yes, that includes my own family a generation or so up.

There, I said it.; 4/6/11, 11:40 PM
Dustin said...: "
Clinton was serious about the first two, and did a great job on them"

LOL. Cult of personality, much?

The GOP balanced the budget (almost). Read the constitution some time. The truth is that there was no balanced budget, except in guesses made before the year (we ran a deficit every year Clinton was president).

Regardless, it's pretty pathetic to credit Clinton for something he didn't do. Democrats do that an awful, awful lot. This is why we call it "Obamacare" so much. We realize you will refuse to associate it with Obama if you can blame it on Republicans.

Hell, if Paul Ryan's budget becomes law, of course the democrats will say it was Obama's budget too.

Just endless shilling and hero worship.

If Clinton's spending levels are so great, then you should be donating cash to Paul Ryan right now to fight Obama's spending levels. Right? Instead, you're opposing an attempt to reduce spending from catastrophic levels while praising someone for being a fiscal hawk they weren't.; 4/6/11, 11:44 PM
Sprezzatura said...: Chip,

You can claim that Ryan's health insurance company protection plan doesn't add a profit taking (though some are non-profit, but they're still an added expense compared to direct payments; and a small number are huge co-op like companies where the dough is essentially going directly to the providers, but these are only sustainable in large markets, and they could become monopolistic) "middle man" between the gov funded Medicare payments and providers. But, you'd be fibbing. If you're a supporter, you really ought to support the product, rather than fib about what the product is.

BTW, this experiment has already been run. Medicare Advantage cost more and provided less care than traditional fee for service Medicare.

Not that Medicare doesn't need a huge revamp. I get that docs whine about not getting enough dough. And, fee for service incentivizes more service, not necessarily better care. And, the users of care are too removed from the actual costs of care.

But, it's unwise to mandate a profit taking "middle man," while simultaneously removing the truly cost cutting (as demonstrated in practice) direct reimbursement system as a competitor to the profit seeking "middle men." But, it will make the GOP's corporate sponsors happy and rich, which will help the GOP stay in power, which will allow the GOP to make it's corporate sponsors happy and rich, which will help the GOP stay in power, which will.......; 4/6/11, 11:56 PM
Placeholder said...: LOL. Cult of personality, much?

I was never in anyone's personality cult. Clinton posted good numbers.

we ran a deficit every year Clinton was president

False. The feds ran surpluses in the final three years of Clinton's term.; 4/6/11, 11:58 PM
Sprezzatura said...: place,

There's an issue w/ intergovernmental debt.

If it's included there was one year where WJC was close enough (for gov work) to a true zero debt fiscal year.

Cons love to harp on this, as if it proves WJC was awful.

[Just don't mention that Reagan tripled the debt and doubled the deficit (as a percentage of GDP). That is a buzz kill for them. And, very ironically, many of these same cons like to talk about how Social Security is currently broke and running a deficit. Here they completely pretend that the stockpiled social security iou's don't exist, which would mean that WJC did have three years w/o a deficit. Funny stuff.]; 4/7/11, 12:12 AM
Chip S. said...: PB&J:

You seem to think that profits are some sort of add-on to costs, so that non-profits are lower-cost providers of any product. It follows from your logic that government is the lowest-cost provider of all.

But consider this: If consumers are choosing between Aetna and Blue Cross, and if they pick the provider that offers the best combination of price and coverage, how can for-profit Aetna lure customers away from non-profit Blue Cross if it's charging higher prices for comparable policies? Hint: It can't. Profit is not an add-on to cost, it's a residual after cost is subtracted from revenue.

The "data" about administrative efficiencies you invoke is only persuasive to people who know almost nothing about either management or cost accounting. For one thing, administrative costs will be a lower percentage of total costs in any program that covers a disproportionately elderly clientele, simply because their claims tend to involve much higher medical costs than for younger people. Also, it's very easy to keep claim-processing costs low by simply imposing sweeping rules governing what's allowed or disallowed, as Medicare does but a private insurer does not do because it offers its customers a range of coverage options up front.

If for-profit insurers can survive in the marketplace while offering policies that involve higher administrative costs, then those policies must have higher value to consumers (because of the specificity of coverage that can be chosen) in order for those costs to be covered by higher premiums. That's the nature of a marketplace that offers free choice in anything. It's a feature, not a bug.; 4/7/11, 12:21 AM
john marzan said...: the changes in Medicare won't affect those 55 yrs old and above.; 4/7/11, 12:37 AM
themightypuck said...: I agree with reader i am. Things are setting up for a Logan's Run future when the poor young get sick of subsidizing the rich old.; 4/7/11, 12:40 AM
Anonymous said...: It seems to me that Ryan's plan is part of a whole and the whole sounds find; the Obama Medicare theft was just that.; 4/7/11, 12:50 AM
Placeholder said...: If for-profit insurers can survive in the marketplace while offering policies that involve higher administrative costs, then those policies must have higher value to consumers (because of the specificity of coverage that can be chosen) in order for those costs to be covered by higher premiums. That's the nature of a marketplace that offers free choice in anything. It's a feature, not a bug.

This is the wrong model, and so is single payer. The more I look at this, the more I realize that neither political party cares about health care. All they care about is staying in power and fighting over whatever scraps are left.; 4/7/11, 12:54 AM
Chip S. said...: @Placeholder, If you really think that good things only happen to you when strangers really, really care about you, I'd like to introduce you to Professor Adam Smith:

It is not from the benevolence of the butcher, the brewer, or the baker, that we can expect our dinner, but from their regard to their own interest.; 4/7/11, 1:10 AM
Jim said...: This is the wrong model, and so is single payer.

This is the GENIUS of the argument here: everything is wrong. But he has no realistic solution to offer. Just a bunch of carping about how EVERYONE ELSE is doing it wrong.

"Fee for service" is an AWFUL idea. Period. Just ask anyone trying to make a living in the medical profession. The reason insurance costs keep going up is because non-Medicare/Medicaid patients have to subsidize the losses that are incurred EVERY time one of them visits the doctor/emergency room. Take away the subsidy and you have a profession which operates at a loss and there is ZERO incentive to spend all those years and incur all that debt only to become a government wage slave the day you become a doctor.

The ONLY reason we have the best doctors in the world is because our best and brightest see a lucrative pot of gold at the end of the rainbow by entering the field. Take away the pot of gold, and you wind up with the misery of "single payer" in the USSR where being a doctor or nurse was no better than being a janitor or orderly.

But hey, don't let the fact that single payer has ultimately failed when left in place long enough EVERYWHERE it has been tried. (See: USSR, Eastern Europe, present-day UK) get in your way. Don't let the fact that "fee for service" drives up the health care costs for everyone else. Don't let the fact that the excellence of our system DEPENDS on the profit motive of those in it.

Stay in your LaLADreamLand where you have solved all the world's problem just sitting around your dorm room smoking a doob where EVERYONE ELSE was just too stupid to realize what your stoner mind discovered.

Far too many people in this country never matured beyond that dorm room and understood that THERE ARE VERY GOOD REASONS that their pie-in-the-sky-everybody-gets-an-equal-share-no-matter-what society has NEVER EVER WORKED and NEVER WILL.

And every time the health care debate comes up, the same immature "I solved this whole problem in my head when I was stoned in college and still haven't figured out the real world to this day" tools show up with the same old "already been tried and it failed miserably" ideas.

Do us a favor and grow up. Come back when you learn some history and actually have a new idea for a change.; 4/7/11, 1:29 AM
sarge said...: sarge here is it sarge our is these fitz thar walker an thar ryan 4 of of the ugliest irish dominionists ever concieved (seemingly) of the tender loins of women? sarge wonders if these boys ever seen how privitization worked fer the real irland irish but hell obviously they do know how clusterfucks r made; 4/7/11, 4:27 AM
Terrye said...: I think Mickey is missing something here. The threat in Obamacare is that it takes away from Medicare to give to some other federal program that people do not want..nothing is saved...however, Ryan is talking about changing the way the program is implemented so that it does not collapse under its own weight.; 4/7/11, 5:51 AM
Brian Brown said...: Clinton was serious about the first two, and did a great job on them,

You are delusional.

Clinton vetoed Republican budgets over, and over.

He also had no intention of cutting spending until the Republicans won in 1994.; 4/7/11, 6:18 AM
Unknown said...: ZeroCare bleeds Medicare white, so
Ryan's idea at least preserves it.

The fact the Kos trolls hate it means it's got merit.

Placeholder said...

The Republicans have never been serious about controlling spending, balancing budgets, or reforming the medical system.

Clinton was serious about the first two, and did a great job on them

Newt was serious about them. Willie sulked and pouted and stuck his lower lip out until he realized he couldn't sustain a veto for the thing and then signed it.

PS Place (I think shiloh/PB&J/some phony folksy has found a new persona) must be sitting at the kiddie table at Kos.; 4/7/11, 6:19 AM
Brian Brown said...: Silly BHO thinks it's best when America's wealth isn't overwhelmingly (and increasingly) funneled to the richest of the rich.

Silly you thinks that "wealth" (a term you don't understand by the way) can be "funneled" by anyone.; 4/7/11, 6:19 AM
Brian Brown said...: The more I look at this, the more I realize that neither political party cares about health care.

The more I read your silly, ignorant comments, the more I realize you don't know anything about "health care"

Further, neither party should have a vested interest in "health care" because it isn't something the federal government should be involved in.; 4/7/11, 6:21 AM
Brian Brown said...: False. The feds ran surpluses in the final three years of Clinton's term.

Um, note that was a) With Republicans writing the budget and b) after Clinton signed tax cut legislation in 1997.

But I think you should go on Pretending Clinton did it all on his own.; 4/7/11, 6:25 AM
The Drill SGT said...: @ The Grand Inquisitor said...10:52

I agree; 4/7/11, 6:47 AM
Anonymous said...: "False. The feds ran surpluses in the final three years of Clinton's term.

Um, note that was a) With Republicans writing the budget and b) after Clinton signed tax cut legislation in 1997.

But I think you should go on Pretending Clinton did it all on his own."

I too am tired of this lame adulation of WJC budget balancer. He was the direct beneficiary of post cold War demobilization. Bush I would have reaped this but for Gulf I. But don't believe me; check out the size of the Army, Marines, and Air force during Bush I versus Clinton I.; 4/7/11, 6:48 AM
GMay said...: "False. The feds ran surpluses in the final three years of Clinton's term."

Man, I'm tired of posting this link.; 4/7/11, 6:51 AM
KCFleming said...: "By blackening the skies with crisscrossing dollars, ...the welfare state manages people's perceptions of its costs and benefits to encourage them to believe an impossibility: that every household can be a net importer of the wealth redistributed by the government.

..."[B]ecause compassion is an emotional response rather than a moral principle, it defeats every attempt to make wise choices about which sufferers do and don't deserve governmentally dispensed solace."

Never Enough: America’s Limitless Welfare State, by William Voegeli; 4/7/11, 7:02 AM
Anonymous said...: There are two camps when it comes to Obamacare...

- Those who oppose it.

-Those who support it, but are exempt from it.

Waivercare; 4/7/11, 7:47 AM
The Drill SGT said...: It's time to end this thread with:

Margaret Thatcher: "The trouble with Socialism is, sooner or later you run out of other people's money."

if we haven't reach that point yet, honest people can clearly see that within our children's lifetimes.

Most Liberals on the other hand seem to believe that unicorn farts will somehow transmute into pots of gold...

This belief, unchecked will result in granny eating out of garbage cans and paying for bread with wheelbarrows full of dollars

The Liberal Politicans aren't idiots, but just cynical enough to know that it won't collapse before they are out of office and power. e.g. somebody elses problem...; 4/7/11, 7:52 AM
Calypso Facto said...: For all the people I've met who oppose Obamacare, none of them have mentioned the "threat to Medicare" as a primary reason for it. But leave it to the naysayers and those who profit form the corrupt and bankrupt current system to stand back and howl about any proposed change rather than seeking a workable solution.

GMay: Thanks for beating me to the debt post. Sad how pernicious and tenacious that Clinton lie is.; 4/7/11, 8:04 AM
Hoosier Daddy said...: I mentioned in the other thread that this isn't going anywhere. Ryan is simply setting the stage to where Congress will simply raise the Medicare tax to keep it solvent. Anyone who thinks that GOP or Democrat congressmen are going to eliminate this program in favor of some voucher system are deluded.

The money is out there and they're simply going to take it because even if its a huge 5% increase its still peanuts in the big picture and the AARP screams louder than the taxpayer does. Plus in a few more years there will be more Medicare recipients than people who pay taxes anyway.

Same thing for the deficit. We won't collapse because the safety net is rasing marginal rates back up to Clinton era or higher. Toss in a 5-10% VAT and all is good. That's what is inevitable because, quite simply, there is no alternative. They aren't going to let the economy collapse on itself because LeBron James won't pay his fair share or greedy middle class families think deducting mortgage interest is a God given right.; 4/7/11, 8:05 AM
Brian Brown said...: Man, I'm tired of posting this link.

Yes, the federal debt increased every year of the Clinton Presidency.

It is amusing watching these leftist, who vote for a party refusing to cut $60 billion in spending from a 3.7 trillion dollar budget, pretent they support budget balancing.; 4/7/11, 8:08 AM
I'm Full of Soup said...: Reader:
I read that Ryan's plan allows for larger vouchers to people with pre-existing conditions.

Re your broader point as ty why the 55-85 year olds who caused this insolvency, I'd support a tax surcharge on FIT to cure the insolvency and it could be levied by age bracket [i.e the older you are the higher your surcharge rate].

Lastly, the long serving Congress critters who watched as this country went broke should be shamed into a mass resignation.; 4/7/11, 8:11 AM
Hoosier Daddy said...: Things are setting up for a Logan's Run future when the poor young get sick of subsidizing the rich old.

Um.. its been like that for probably the last half century,; 4/7/11, 8:22 AM
Wince said...: Isn't the distinction the following?

The GOP plan is to use the private purchasing exchanges to make an existing entitlement, Medicare, less expensive.

The premise of Obamacare budgeting is to poach the resources of that existing entitlement to fund a new entitlement.; 4/7/11, 8:24 AM
KCFleming said...: This comment has been removed by the author.; 4/7/11, 8:24 AM
KCFleming said...: I agree, Hoosier that in the end they'll just raise taxes.

But the economics are unsustainable. The question is whether we'll last another 10 years, or another 30.

But it's not possible to continue indefinitely.; 4/7/11, 8:27 AM
Henry said...: Remember when Obamacare was going to be deficit-neutral by dramatically cutting Medicare? It is to laugh.

What Kaus knows, and Obama knows, is that voters don't give a damn that we're totally bankrupt. But for Ryan we're being governed by Toonces.; 4/7/11, 8:27 AM
Hoosier Daddy said...: The reason insurance costs keep going up is because non-Medicare/Medicaid patients have to subsidize the losses that are incurred EVERY time one of them visits the doctor/emergency room.
This is partially the cause. The bigger cause (and I have harped on this before) is that we don’t have health insurance, we have health payment plans. Every doc visit or test he/she sends you on, x-ray, etc. gets covered to extent or another, largely by your insurance carrier while you foot a nominal co-pay. If you filed claims on your auto and homeowners in the same manner as you do with health insurance for what amounts to ‘maintenance’, then we’d have a crisis in those areas of insurance as well.

A partial solution to the ‘health insurance crisis’ would have been to create a Federally mandated catastrophic care coverage that either the Fed provided or did through insurance carriers. This would have eliminated the whole ‘uninsured’, people are going bankrupt because of illness or injury meme. Cat care would cover those types of incidents whereas the insured would foot the bill for going to the doc for the flu.; 4/7/11, 8:30 AM
I'm Full of Soup said...: Or we can enact a temporary tax to help plug this deficit gap. You know, like the tax they enacted to pay for the Johnstown, PA flood which was like 95 years ago. That tax is still being collected I think.; 4/7/11, 8:31 AM
Bob_R said...: There are lots of reasons to read (or link to) Mickey Kaus. His insight into the reactions of the American people isn't one of them. He doesn't exactly have his finger on the nation's pulse.; 4/7/11, 8:42 AM
Rialby said...: Several smart people said it at the time of the Obamacare jamdown - Republicans are demagoguing on the issue of medicare and this will bite them.

And here we are... someone comes along who wants to initiate real reform (not a giveaway to 10s of millions of people) and he'll be taken down by the very language his compatriots used.; 4/7/11, 8:44 AM
Lem Vibe Bandit said...: ot..

There is an impeach Obama letter going around.

ARTICLE OF IMPEACHMENT OF PRESIDENT BARACK HUSSEIN OBAMA
.

There is Nothing about Obamas place of birth..

(count me out for support ;); 4/7/11, 8:45 AM
Hoosier Daddy said...: But, our non-carbon based citizens, our ultra-rich carbon based citizens, folks like JoeTP (with pipe dreams and/or high levels of gullibility when flim-flammed w/ trickle down econ theories)

Just curious as to whether we can apply your sentiment to all those immigrants (legal and illegal) who come here with pipe dreams and/or high levels of gullibility when flim-flammed w/ stories of this being the land of opportunity?
Or do you just save that sentiment for a certain demographic that dare challenge your preferred candidates?; 4/7/11, 8:46 AM
Sofa King said...: The politics of failure have failed. We need to make them work again.; 4/7/11, 8:50 AM
Simon said...: Voters also like ponies, bacon, and free rides. Tough. Voters need to get real and realize that we can no longer afford this boondoggle, and just because they like it doesn't mean it can or should be allowed to lumber slobberingly forward. To defend the status quo is to proudly proclaim "Hi! I'm innumerate!"; 4/7/11, 9:26 AM
bagoh20 said...: ""Get your filthy government hands off my Medicare!"

- Teabagger, 2009"

"I won't have to worry about putting gas in my car. I won't have to worry about paying my mortgage… If I help [Obama], he's gonna help me."

- Obama supporter, 2008

So what's your point again?; 4/7/11, 9:32 AM
Thorley Winston said...: The "data" about administrative efficiencies you invoke is only persuasive to people who know almost nothing about either management or cost accounting. For one thing, administrative costs will be a lower percentage of total costs in any program that covers a disproportionately elderly clientele, simply because their claims tend to involve much higher medical costs than for younger people. Also, it's very easy to keep claim-processing costs low by simply imposing sweeping rules governing what's allowed or disallowed, as Medicare does but a private insurer does not do because it offers its customers a range of coverage options up front.

In addition, most of Medicare’s actual administrative costs (e.g. their accounts payable is basically handled by the IRS and gets counted as part of the Department of the Treasury’s budget rather than HHS’) are found in other agencies whereas private insurance companies use activities based costing when allocating overhead. Moreover there’s a tradeoff between (a) administrative overhead and (b) fraudulent claims. If Medicare and Medicaid spend less on overhead but pay out more fraudulent claims, it’s hard to see this as being a good deal for the taxpayer.; 4/7/11, 10:00 AM
Thorley Winston said...: I think Mickey is missing something here. The threat in Obamacare is that it takes away from Medicare to give to some other federal program that people do not want..nothing is saved...however, Ryan is talking about changing the way the program is implemented so that it does not collapse under its own weight.

Well put, I attended a townhall meeting with my Congressman when Obamacare was being debated and raised the point that assuming that Congress or whoever actually does cut $500 billion in waste, fraud and abuse from Medicare – how does diverting those savings to fund a new entitlement program rather than using them to shore up Medicare (whose unfunded liabilities is in the Trillions) actually make Medicare more solvent?

As I said in the previous thread, I can live with paying for some sort of subsidy so that those who truly need and cannot afford health care receive it – up to a point. Medicare in its current form isn’t the solution because (a) it’s essentially a blank check and (b) the people on it are generally wealthier than the people paying for it. Ryan’s voucher proposal acknowledges the reality that we’re not going to and nor should we spend an unlimited amount of money on health care services. And by decentralizing the decision-making through competition and individual decision-making, we might actually fix some of the problems of fraud and distortions created by fifty years of failed attempts at central planning.

My only critique at this point is that means-testing and raising the retirement age need to be on the table as well. It’s an unconscionable injustice that a waitress making minimum wage is paying part of her paycheck so that Warren Buffet doesn’t have to pay for his own health care when he can well afford it. We also need to realize that both the economic realities and the improvements in longevity and geriatrics don’t make it practical (or defensible) to force some people to work until they’re in their 70s or later so that others (barring some physical disability) can retire at 62 or 65 on the taxpayer’s dime.; 4/7/11, 10:11 AM
William said...: I am on Medicare. One of my physicians dropped me because of the lower reimbursement rates. I pay several thousand dollars more for my prescriptions under the current plan than I did with my previous Medicare Advantage plan. Perhaps someone somewhere benefits from the new plan, but I definitely do not.....In the AARP magazine and other places I read about how wonderful the new Medicare plan is. You don't have to pony up a $15 copay for a wellness check up. What a relief! The truth is you simply cannot cut hundreds of billions of dollars from the Medicare program without screwing somebody, e.g. me.....I won't die broke. I'm not complaining about the extra money I now pay. The thought occurs to me, however, that if physicians get paid 10% less to treat me than they receive for their other patients, I will receive 20% less care to compensate for the loweer reimbursement rates. I won't die broke, but neither will my doctor.; 4/7/11, 10:16 AM
Hagar said...: 20 years ago I figured out that I did not really have to go to my doctor's office to get her advice to "go home, rest, keep warm, and drink plenty of liquids until you feel better," and I have not seen a doctor since.

I would be interested in buying medical disaster insurance, but my understanding is that Congress made it illegal for insurance companies to sell that long ago.

As Reagan said, the scariest words in the English language are: "Hi there! We are from the Federal Government, and we are here to help you!; 4/7/11, 10:17 AM
cubanbob said...: pbAndj said...
Chip,

You can claim that Ryan's health insurance company protection plan doesn't add a profit taking (though some are non-profit, but they're still an added expense compared to direct payments; and a small number are huge co-op like companies where the dough is essentially going directly to the providers, but these are only sustainable in large markets, and they could become monopolistic) "middle man" between the gov funded Medicare payments and providers. But, you'd be fibbing. If you're a supporter, you really ought to support the product, rather than fib about what the product is.

BTW, this experiment has already been run. Medicare Advantage cost more and provided less care than traditional fee for service Medicare.

Not that Medicare doesn't need a huge revamp. I get that docs whine about not getting enough dough. And, fee for service incentivizes more service, not necessarily better care. And, the users of care are too removed from the actual costs of care.

But, it's unwise to mandate a profit taking "middle man," while simultaneously removing the truly cost cutting (as demonstrated in practice) direct reimbursement system as a competitor to the profit seeking "middle men." But, it will make the GOP's corporate sponsors happy and rich, which will help the GOP stay in power, which will allow the GOP to make it's corporate sponsors happy and rich, which will help the GOP stay in power, which will.......

4/6/11 11:56 PM

FRAUD. The amount of FRAUD in medicare and medicaid far exceeds the overhead costs and profits of the carriers. One small example of the incompetence of medicaid and medicare is that malpractice attorneys never have a problem getting billing records from medical insurance companies and they get the records immediately. The reason being in any recovery the carrier gets reimbursed. Medicare and and medicaid the lawyers often wait for more than a year, sometimes years to get the same information, and that is for the government to get back the money it laid out. So basically your entire point is pure crap. If the schmucks running the current government system can't even bother themselves to do that you seriously believe these incompetents are going to be cheaper than the insurance companies?; 4/7/11, 10:20 AM
cubanbob said...: Hoosier Daddy said...
The reason insurance costs keep going up is because non-Medicare/Medicaid patients have to subsidize the losses that are incurred EVERY time one of them visits the doctor/emergency room.
This is partially the cause. The bigger cause (and I have harped on this before) is that we don’t have health insurance, we have health payment plans. Every doc visit or test he/she sends you on, x-ray, etc. gets covered to extent or another, largely by your insurance carrier while you foot a nominal co-pay. If you filed claims on your auto and homeowners in the same manner as you do with health insurance for what amounts to ‘maintenance’, then we’d have a crisis in those areas of insurance as well.

A partial solution to the ‘health insurance crisis’ would have been to create a Federally mandated catastrophic care coverage that either the Fed provided or did through insurance carriers. This would have eliminated the whole ‘uninsured’, people are going bankrupt because of illness or injury meme. Cat care would cover those types of incidents whereas the insured would foot the bill for going to the doc for the flu.

4/7/11 8:30 AM

It would be nice if the republicans were to push to open medical insurance to be sold across state lines and sell policies that don't mandate chiropractors, acupuncture, viagra and birth control pills and other mandate items. Just simple basic catastrophe policies as the base and offer different plans depending on the needs and finances of the policy holder just like every other kind of insurance.

With policies like these in place medicine would become a lot more affordable overall (if the medicaid/medicare subsidy problem could be resolved). Such plans would be far cheaper than the current plans with their prepaid medical service component that most people really don't use. Usually most people see their primary care doctor instead of specialist for most of their care. It would be cheaper and better to pay that doctor a thousand a year so you can see him whenever you need to see him without the long wait time to book an appointment. He has a guaranteed income, doesn't need to run a factory, can provide better care and even paying out of pocket up to the catastrophe plan's deductible would be cheaper than purchasing the current plans available. But that is too simple for most democrats. No patronage in it for them.; 4/7/11, 10:47 AM
Phil 314 said...: Isn't it obvious by the tepid response by Republicans to Ryan's proposals that there's no enthusiasm for cutting entitlements for the elderly. Maybe its possible that Ryan honestly feels that someone has to get the ball rolling and that any proposal will need a heavy dose of political realism.

As for Medicare, it WILL go broke. It can only be "fixed" if:
-consumers feel some of the pain of the costs.
-it has a managed care structure (i.e. real prior authorization, utilization management and not just ever reducing reimbursement)
-health care costs as a whole go down

I read about how wonderful the new Medicare plan is. You don't have to pony up a $15 copay for a wellness check up.

This is a prime example of why Medicare will fail. Its running out of money and its recipients are intolerant of a $15 co-pay.; 4/7/11, 11:21 AM
Hoosier Daddy said...: As for Medicare, it WILL go broke. It can only be "fixed" if:
-consumers feel some of the pain of the costs.
-it has a managed care structure (i.e. real prior authorization, utilization management and not just ever reducing reimbursement)
-health care costs as a whole go down

Nonsense. It will be fixed with an increase of the current Medicare tax of an additional 1-2%. That's what will happen before your pipe dreams of restructuring the program.; 4/7/11, 12:10 PM
Placeholder said...: I would be interested in buying medical disaster insurance, but my understanding is that Congress made it illegal for insurance companies to sell that long ago.

Maybe you need to get out of the house more often. You're wrong. You can buy catastrophic coverage if you want it.; 4/7/11, 12:22 PM
Placeholder said...: Newt was serious about them. Willie sulked and pouted and stuck his lower lip out until he realized he couldn't sustain a veto for the thing and then signed it.

Newt and Willie were "serious" about only one thing, and it wasn't government.; 4/7/11, 12:25 PM
roesch-voltaire said...: For a serious discussion on this subject, you might start with the current issue of NEJM and the article entitled, "Women and Children Last.... Why not explore what doctors think about the issues?; 4/7/11, 1:58 PM
Methadras said...: Why all of this bullshit tinkering. Open up the ability for insurance companies to sell their policies nationwide without state border restrictions and watch what happens.; 4/7/11, 2:42 PM
Jeremy said...: Even as the federal government cut its own spending, seniors would end up paying almost twice as much out of their own pockets — or more than $12,510 a year, the CBO estimates. Altogether, the total cost of insurance would be higher.

Ryan's office did not respond to repeated requests for comment about the CBO analysis. But the congressman has repeatedly said that applying what he calls "free-market principles" to the insurance market is the best way to control costs.

"We can drive innovation, productivity improvements and performance in healthcare," Ryan said Tuesday in a presentation to the conservative American Enterprise Institute in Washington.

Under Ryan's proposal, seniors and others on Medicare would begin receiving a set amount of money, starting in 2022, to offset the cost of buying a private insurance plan that would replace the federal government's Medicare plan.

Wealthier and healthier seniors would receive less, while poorer and sicker beneficiaries would get more.

This voucher system — or "premium support," as Ryan calls it — would give the typical 65-year-old American $8,000 annually to buy a health plan, about the same amount of money that analysts expect the Medicare program would spend on that senior in 2022 under the current program.

But the CBO report says the money won't be enough. The cost to buy private insurance, plus the projected out-of-pocket spending that the 65-year-old would have to pay for medical care in 2022, would total about $20,510 per year, according to the CBO, which both Republicans and Democrats rely on to independently evaluate the effects of proposed legislation.

That would leave the senior to pay the difference, an estimated $12,510.

By comparison, if the current Medicare program is continued, the CBO estimated that it would cost about $14,770 to provide insurance to that same 65-year old in 2022, assuming Congress did not dramatically slash payments to doctors.

That would leave the senior to pay just $6,150 out of pocket.

"A typical beneficiary would spend more for healthcare," the CBO concluded about Ryan's proposal.; 4/8/11, 12:50 PM