Thread: How liberals are misleading on Medicare

No, but that's not all Medicare is. Medicare pays all legitimate claims. That's how it works. If it stops paying all legitimate claims and only pays some claims, that's a pretty huge change in the nature of the program. I don't think beneficiaries would see that as maintaining Medicare as they know it. Although I can see why to liberals, all that matters is that it's a government program.

Originally Posted by adaher

No, but that's not all Medicare is. Medicare pays all legitimate claims.

This is precisely why the phrase "Medicare as we know it" is too cute by half. Any change can be characterized as an assault on "Medicare as we know it," despite the fact that there are rather sharp diving lines between actually ending Medicare and not doing so.

A re-examination of the Medicare coverage decision-making process would not be the end of Medicare. In fact, that gets at the crux of the issue. The reason Medicare has such a process at all--the reason it makes coverage determinations--is because Medicare is a health insurance program. A proposal that seeks to abolish that health insurance program is one that literally (not as a matter of exaggerated rhetoric) ends Medicare.

We've had two major pieces of legislation that have been significant reforms to Medicare in the past years (and, indeed, substantial reforms at various other points in years past). Among other things, these recent reforms contain some of the very things I've suggested in another thread will (and may already be starting to) slow the growth in Medicare spending. Aside from a few half-hearted and, frankly, desperate political swipes, no one has claimed that Medicare no longer exists due to these reforms.

Yet we also have a proposal on the table in which enrollment in Medicare is no longer allowed and the program is left to be phased out by grandfathered enrollee attrition. The public health insurance plan that pays the medical bills of the elderly and the defined benefit it guarantees seniors are dismantled. No "as we know it" qualifier is need to describe that plan--the GOP's plan--as the end of Medicare.

The "everybody's doing it!" defense of this proposal simply rings hollow.

Originally Posted by Greenbeard

This is precisely why the phrase "Medicare as we know it" is too cute by half. Any change can be characterized as an assault on "Medicare as we know it," despite the fact that there are rather sharp diving lines between actually ending Medicare and not doing so.

But "ending Medicare as we know it" is a Democratic talking point against Republicans. They consider the public aspect to be more important than what Medicare actually does. If a private system provided all that the current system does, they'd consider that "ending Medicare as we know it" even though beneficiaries received the same service. But if services were reduced, then that would be okay, because Medicare was still public. I was just attacking how misleading it all is, since both Republican and Democratic reform ideas end Medicare as we know it.

We've had two major pieces of legislation that have been significant reforms to Medicare in the past years (and, indeed, substantial reforms at various other points in years past). Among other things, these recent reforms contain some of the very things I've suggested in another thread will (and may already be starting to) slow the growth in Medicare spending. Aside from a few half-hearted and, frankly, desperate political swipes, no one has claimed that Medicare no longer exists due to these reforms.

Yet we also have a proposal on the table in which enrollment in Medicare is no longer allowed and the program is left to be phased out by grandfathered enrollee attrition. The public health insurance plan that pays the medical bills of the elderly and the defined benefit it guarantees seniors are dismantled. No "as we know it" qualifier is need to describe that plan--the GOP's plan--as the end of Medicare.

The "everybody's doing it!" defense of this proposal simply rings hollow.

The Republican plan allows beneficiaries to decide how much coverage they want, whereas the Democratic plan just eliminates certain services for all. I fail to see the substantive difference between the two.

Originally Posted by adaher

But "ending Medicare as we know it" is a Democratic talking point against Republicans.

I know. And I think they need to simplify. The Ryan/GOP plan ends Medicare, full stop. The "as we know it" qualifier is just a nod to the fact that the GOP offers a repeal-and-replace of Medicare instead of simply a repeal.

They consider the public aspect to be more important than what Medicare actually does.

Given that both change radically under the GOP proposal, this is somewhat of a moot point.

What Ryancare is is basically the ACA. Is Obamacare so horrible that we couldn't imagine inflicting it on seniors?

What if Republicans had control of the government after 2012, and agreed to not repeal ACA on the condition it applied to all Americans, with no exceptions for the elderly?

Originally Posted by adaher

What Ryancare is is basically the ACA. Is Obamacare so horrible that we couldn't imagine inflicting it on seniors?

What if Republicans had control of the government after 2012, and agreed to not repeal ACA on the condition it applied to all Americans, with no exceptions for the elderly?

Speaking as someone who works in geriatrics, let me explain that seniors do have different healthcare needs. They are far more likely to have frequent hospitalizations, longer hospitalizations, and a need for long term care. For people that turned 65 in 2005, 79% of women will need long-term care, while 58% of men will need it; sometime before they pass away. Younger people can also qualify for Medicare after being physically disabled for a certain amount of time, because they too will often have these more specific healthcare needs.

Originally Posted by adaher

Actually, the whole point is that we DON'T ration Medicare. It's entirely open-ended. Claims are only denied if they are fraudulent. If a doctor says a patient needs something, Medicare pays for it, no matter what it is. That's a unique system, and one that only worked as long as the elderly made up a small percentage of the population. As the elderly population grows, it will no longer be possible to have Medicare work the way it's always worked.

That's simply not true. Medicare does not cover every procedure or test. I speak from experience, Medicare puts a little note in the EOB, "Medicare does not pay for this service." If medicare does not approve the payment, the supplemental coverage does not pay it. And that's the end of the story.

Originally Posted by adaher

What Ryancare is is basically the ACA. Is Obamacare so horrible that we couldn't imagine inflicting it on seniors?

The primary liberal objection to Ryancare is that it aims specifically to "save" money by replacing a guaranteed health benefit with a voucher that's designed to be increasingly inadequate to cover the cost of care. Of course that doesn't equate with actual savings, it's merely shifting costs of the federal balance sheet and onto the backs of seniors, providers, states, the safety net, and so on. Real Medicare reform must be coupled with real health care reform to actually address the cost of care; this is where the ACA's real strength is.

Now, I'll grant that just because Ryan says the vouchers will be pegged to a certain index doesn't necessarily mean much because ultimately they're set administratively--i.e. by the Secretary of HHS, although possibly influenced by Congress from time to time--so it's entirely possible they'll end up being larger than he's suggesting now to get the numbers from the CBO he wants. That is, it might go the way of Medicare Advantage, the privatized portion of Medicare that ended up costing ~14% more than its public counterpart for just that reason (a big chunk of the ACA's savings comes just from resetting the inflated benchmarks in Medicare Advantage). Certainly the pressure for that will be intense, in particular since the same political forces that prompted Ryan to kick the start date of his plan a decade down the road will still be there in ten years.

If that's the case and Ryan's vouchers do ending up covering more of the average senior's private insurance plan, seniors will be better off than they otherwise would be but the federal balance sheet will take a big hit (because private plans cost more than Medicare).

In the ACA, the value of premium subsidies is set by the market (not the bureaucrats Ryan would no doubt denounce in any other context). More than that, individuals are protected from paying more than a given percentage of their income for health insurance. That's a very different situation.

What if Republicans had control of the government after 2012, and agreed to not repeal ACA on the condition it applied to all Americans, with no exceptions for the elderly?

Well, a reasonable compromise might be a hybrid. Introduce a public option (probably the original House version, piggybacking on Medicare's existing provider network and initially paying rates at fee-for-service Medicare + 5%) into the ACA's state-based Exchanges. Similarly, allow seniors a choice of public or private plans. I'm sure there would be transition issues to work out (to what degree do we retain the Medicare tax, etc).

Now, I don't know if you'd actually put seniors in the same risk pool as younger folks, but you could certainly use the Exchange infrastructure being built in the states to connect them to (possibly senior-specific) coverage and enroll them, just as poor folks eligible to enroll in managed care plans (i.e. private Medicaid-specific insurance plans) will be able to use Exchanges to choose and enroll in a Medicaid managed care plan.