Monday, May 30, 2011

Whatever Shall We Do About the Medicare Problem?

"Oh dear, oh dear, whatever shall we do?"

Sounds just like Miss Katie Scarlett in "Gone With the Wind," doesn't it? "Rhett! Rhett! Where shall I go? What shall I do?"

"Frankly my dear, I don't give a damn!"

Yes. Well. The Medicare issue has dominated Beltway conversation since that nasty little scamp from Wisconsin, Paul Ryan, introduced his Bold And Courageous Republican Budget which eliminated Medicare (as we know it) and the House voted to approve it.

Well. Whatever shall we do now?

The House has voted to eliminate Medicare (as we know it.) Thus, Medicare (as we know it) must be eliminated. Eventually.

The public doesn't seem to be much gratified or amused by this change of affairs, but then, the South didn't much like their defeat either. Didn't like any of their defeats.

The public be damned. Especially the old, the halt, and the lame. They take up too much space and demand too many benefits anyway. Be done with them. To the precipice with them! They don't need Medicare, and even if they did, it costs too much. We can't afford it. Too bad if they can't pick up the short fall on their own. They should have saved for their Old Age in the first place! Not our problem if they didn't.

This harsh "reality" has become an article of faith among our Ruling Class, their sycophants, their retainers and their courtiers.

Like most articles of faith, it's based on mythologies, bullshit and lies. But countering it has proved impossible so far. The Ruling Class has adopted it as Unshakable Doctrine, and those who will be taken to the Precipice and thrown off for their failure to prepare properly for a future they could not foresee are voiceless in the matter.

Those who would oppose the Ruling Class Doctrine on this topic -- as on so many others -- start from Ruling Class premise. The premise is that it costs too damn much to provide medical care to the Old, the Halt, and the Lame, and the answer is to make them pay for their own damn medical care -- or to go without.

The "opposition" says, "Well, maybe it does cost too much, but we are a generous people, so we should maintain the status quo, don't you think, and tweak the costs downward bit by bitty bit, or at least not allow them to skyrocket out of control forever. Yes?"

Of course, the response of the Ruling Class, is, "No, you sorry excuse for a twit. If you agree that it costs too much for Government to pay for the medical expenses of the Old, Halt, and Lame -- as you just did -- the correct answer is not to 'tweak' any damn thing. The answer is plain as day: Make the Old, the Halt and the Lame pay their own damn medical costs; tough shit, losers, if they can't afford it."

The "opposition" wrings its hankie, not so much like Miss Scarlett but more like Miss Melly, and responds, "Oh, dear no!"

And around and around it goes.

What is the dénouement?

Of course, the Ruling Class gets its way and that nasty little bugger, Paul Ryan, is hailed the Hero by the Ruling Class for boldly going where no one dared go before and "telling it like it is" for the rest of us poor fools.

That's the cruel direction all this is going.

If we Demand Better, however, we can begin to move things in a different direction. It will not be easy, and it does mean actually sticking to it and not immediately yielding to the pressure and demands of the Ruling Class. Our Political Class is not used to that, so they will resist any calls Demanding Better, and they will typically ignore the People's outcry.

But shifting the parameters of the dialogue on Medicare -- and so much else in our lives -- must occur if we are ever regain our future.

First, recognize that these Cries of Doom for Medicare have been routine among the rabidly reactionary pretty much since the inauguration of the program all those long years ago. Not only is the Program Doomed, it costs too much.

Digby helpfully linked to the Health Beat Litany of Medicare Doom the other day, and it is worth reviewing:

You may have seen the headline: “DIRE FORECAST SPARKS NEW MEDICARE DEBATE TRUSTEES' REPORT USED AS FODDER FOR POLITICAL SALVOS BY BOTH SIDES,” but the date may come as a surprise: June 6, 1996.

At the time, the Chicago Tribune warned its readers: “Medicare trustees reported Wednesday that the program's financial outlook is getting worse, touching off a new round of debate over the future of the federal health insurance system for the elderly and disabled. According to the trustees, who give the program a fiscal checkup every year, the fund that pays Medicare hospital bills dipped into the red last year and will go broke in early 2001. That's a year earlier than they predicted in 1995.”

Sound familiar? How about these warnings:

Chicago Tribune July 2, 1969: “The Medicare hospital trust fund faces bankruptcy by 1976 and taxes must either be raised or benefits reduced the senate finance committee was told today.”

Washington Post, April 1, 1986: “The Medicare hospital insurance program faces bankruptcy by 1996, two years earlier than projected last year.”

New York Times, January 20, 1985: In the last few years, when it appeared that the Medicare trust fund would run out of money in 1987-89... But the need seemed less urgent after the Congressional Budget Office issued new estimates last September indicating that the Medicare trust fund would not go bankrupt until 1994.

(Hat tip to Chicago Tribune columnist Eric Zorn who culled eighteen stories from the Tribune, the Washington Post and the New York Times over a period of four decades, each predicting that the Medicare Hospital Insurance Fund was teetering on the brink of disaster.)

But of course Medicare didn’t “run out of money” in 1994, and it won’t go belly-up now, in large part thanks to health care reform legislation. According to the Congressional Budget Office (CBO), the Affordable Care Act (ACA) raises and saves over $950 billion. (Below, I spell out how the legislation generates those dollars). In the process, as the Medicare Trustees’ Report 2011 points out, the ACA reduces Medicare spending “by 25 percent”—without cutting health benefits, or shifting costs to seniors.

More changes will be needed, but Zorn is relatively optimistic. After citing the many times we have been told that Medicare is careening toward bankruptcy, he recalls the story of “The Boy Who Cried Wolf.” Zorn acknowledges that “just because officials and politicians have been predicting Medicare's imminent bankruptcy for more than 40 years doesn't mean that one day they won't be right, but, more likely,” he suggests, “we will turn the knobs and twiddle the dials in order to keep the overwhelmingly popular program solvent, but not so solvent that, between five and 12 years from now, another set of politicians won't grimly inform us that it's going under in between five and 12 years.”

Exaggerating the Size of the Problem

Wait a minute: in the last week both the New York Times and the Wall Street Journal have warned that in 2024 the Medicare fund that pays hospital bills will be “exhausted.” I checked my dictionary—just to be sure—and it confirmed that when “exhausted” is used in a financial context, it means “to use up or consume completely; expend the whole of: He exhausted a fortune in stock-market speculation.”
If this is so, how can we possibly fix the problem by “twiddling a few dials”?

We couldn’t. But the truth is that the Times, the Wall Street Journal, and most of the mainstream media have been, well, exaggerating—telling a tale that the Tribune rightly calls “A shaggy wolf story that’s getting a little long in the tooth.”

So in other words, the Medicare Doom Scare is of a very early early date, as is the constant "costs too much" cry.

The irony is that Medicare is the most cost-efficient element of our overall healthcare picture. But then the little punks like Ryan and his devotees within the Beltway know that full well -- and that's what they hate about it.

There are not enough profits for the providers, you see. And rather than having Government -- ie: the People as a whole -- pick up the tab for profit shortfalls (as is the case with Obamacare for the non-elderly multitudes) the Ryan plan is to make the Old and the Halt and the Lame pay for it directly out of their pockets by forcing them to purchase unaffordable (and quite likely unavailable) private insurance coverage, and forcing them to pay any difference between the cost of private insurance and the "premium support" they receive in lieu of Medicare (which, BTW, is not nearly as generous to patients as it is made out to be).

Genius! Once they get that enacted, they then transform Obamacare the same way.

Everybody in the Palace is happy. Never mind if the rabble protests -- or can't pay. That, as we know, is their problem~! Suckers!

Medicare has lots of problems -- as anyone who's dealt with it knows. For patients, it's not -- at all -- comprehensive coverage for their medical needs. Medicare premiums are quite high compared to Social Security benefits from which they are deducted, given the fact that most recipients have been paying for it all their working lives through payroll deductions, and there seems to be a level of fraud in the program that would be mindboggling if it weren't for the fact that providers often feel they have to double bill or keep billing for services and equipment not received or vastly inflate their costs in order to "break even" given Medicare's legendary stinginess.

Still, it's better than nothing. And for the most part, it is far more efficient for everyone involved, and far less costly administratively, than any private health insurance.

So, punks like Ryan, just like his many predecessors listed above, set out to get rid of it. It's what they do.

What we all need and should be demanding is comprehensive health care access and coverage at an affordable cost. For everyone.

We get there by adapting Medicare to the needs of All the People.

In other words, the status quo isn't good enough. We Demand Better!

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