Medicare visions: A skunk in the GOP's woodpile

“Did you hear that Obamacare is taking away billions from Medicare?” my husband exclaimed, with a tinge of  panic in his voice.

“Where have you been? I have heard that one repeated every year since Obamacare was proposed”, I, the family consumer advocate,  retorted. “Look, I said, we both are one of 28% on Medicare Advantage   that combines Medicare and Medigap.   But most likely we will see no change, Medicare Advantage will continue. At least that is what a survey made by the Kaiser Family Foundation (KFF) found. Regardless, our Medicare benefits will not change, either.”

“ Won’t our Medicare Advantage premiums go up?”  he countered.

“  I am not sure because as KFF reported, there are many elements that go into determining costs.They only went up a tiny bit this year, like in past years..  What I am sure of is that the Medicare Advantage insurance providers had been raking in more from the government  than it cost for government  to administer Medicare . Those excessive subsidies were cut . Even Rep. Paul Ryan, the GOP House guru on budgets, kept cuts to Medicare Advantage in his  2012 planning. Besides, did you notice you had lower co-pays  for your prescriptions, and no copays for  checkups and cancer screenings? That was one of the Obamacare  benefits to seniors, closing the donut hole,  and repeal would put us back to where we were before.

“  Medicare patients were getting charged for   repeat tests and unnecessary readmissions .  Now hospitals have to share test records electronically and since 2012 they  had to pay penalties for excessive readmissions.  Readmission rates have taken a dive.   That  cuts costs to Medicare.

“In fact,  Congress’ own independent  Congressional Budget Office predicted  all of these measures will add a decade of life to Medicare. Those who want to repeal Obamacare  will just be making the time sooner  when we must do something to prop Medicare up.

Hubby: “So what happens when Medicare goes broke…shouldn’t we make some changes now? What about privatizing Medicare and making people pay more for premiums, giving them money to go buy their own insurance, and cut out government administration?

“ There’s a skunk in that woodpile”, I answered.  “Ryan’s  newest plan (passed by the House this April); DOA in the Senate) would have given seniors of a choice between keeping Medicare and vouchers (premium support) and not guarantee any of that would keep up with inflating medical costs, increase the retirement age, and the wealthy would not qualify for benefits.  We know from Obamacare, even private insurance had sticker shock. Health insurance companies  are allowed  by law to collude to set prices and benefits, making free market competition  no guarantee of lower prices. Ryan claims savings (meaning cuts) to Medicare would be $129 billion over 10 years.

“Privatizing Medicare is  not the only way to go. Simpson Bowles deficit reduction  Commission proposed keeping Obamacare and  government provided Medicare that would keep up with costs. Like Ryan’s, though, they would increase the retirement age and not provide benefits to the wealthy.

“ Don’t worry, though, no politician would ever make changes affecting those already having Medicare or near retirement age; they want your vote”.

Sources tapped for the comments above:

http://kff.org/medicare/issue-brief/medicare-advantage-2014-spotlight-plan-availability-and-premiums/  

Washington Post, February 27,2013, “Health law’s rules help hospitals cut patient readmission rate”

http://www.thedailybeast.com/articles/2014/04/08

Who speaks for the poor? Not the GOP; not the loudest are the Democrats; bless the ones that do.

WHO SPEAKS FOR THE POOR

When Rep. Paul Ryan first proposed weakening the social safety net in a budget proposal in 20,12    ,the Catholic Bishops called it “immoral”.  That was even before Pope Francis reset priorities of the Catholic Church to care about the poor. Ryan’s newest budget passed by the House this month (and DOA in the Senate), reduces food stamps by $125 billion  and restricts access of the near poor to health care by repealing Obamacare and reducing Medicaid.If his first proposal was immoral, the 2014 version  is beyond immoral. Who is speaking for the poor these days?,

  Not The GOP, many of whom oppose even raising the minimum wage, so low now even full time workers live in poverty. Not Republicans who support    laws making  it harder for the poor without affordable  and easy access to drivers’ licenses and birth certificates or convenient voting hours to raise their voices .Not the GOP House members including the GOP Colorado Representatives who voted for Ryan budget this month, that would have  cut  food stamps while cutting  taxes for the rich.

 Growing  up in Oklahoma in the 1950’s, I  heard many  rationalize opposing government assistance  by blaming  the poor themselves,  opining African Americans  were lazy or undeserving.. Racist attitudes coloring opposition to  welfare still linger into recent times  per  a study of  many public opinion polls reviewed by Arizona State University.

 Pres. Johnson’s  War on Poverty  and civil rights legislation were  the reaction  to the injustice and  fueled by the long hot summer riots of the late 1960’s . America learned that the poor could get attention even if they did not have a political voice. But there were also abuses as some gamed the  new welfare system .

  Reality check: Welfare reform in the 1990’s  put more  to work. Those left receiving  food stamps now, per the US Department of Agriculture, are mostly kids  (47 percent are under age 18)and elderly (8%). . Three-quarters of food stamp recipients are families with children.    

  The charity community is  doing what they can , but sometimes the food bank cupboard is bare..Hunger plagues 1 out of 5 kids who do not know where the next meal is coming from and government through school lunch programs and food stamps make up part of the  difference.  

 Many of the states with the largest number of poor have  state houses dominated by the GOP yet whose budgets are the most dependent on federal money for social programs. They have  the greatest need and the least will to provide .Leaving   states to use their own resources with federal block grants masking diminished federal contributions to Medicaid, as Ryan’s budget does, would  further divide this country  between the have  and  have nots..

 Even the Democratic Party has  focused priorities  on issues supporting the middle class.

 The voice of the poor was further overwhelmed by recent Supreme Court decisions that  gave corporations the same right as individuals to contribute political campaigns (Citizen's United), and a recent decision (McCutcheon v FEC) that made it much easier for the wealthy to  spread their  influence around.

So who is left as the strongest voice for the poor? Some in the  faith community and Pope Francis and God bless them.

Sources tapped for this blog:

http://www.catholicculture.org/news/headlines/index.cfm?storyid=14247

http://www.washingtonpost.com/blogs/wonkblog/post/what-paul-ryans-budget-actually-cuts--and-by-how-much/2012/03/20/gIQAL43vPS_blog.html

http://www.washingtontimes.com/news/2014/apr/1/paul-ryans-final-federal-budget-cuts-5-trillion/ http://www.asu.edu/mpa/Bartels.pdf

 http://www.washingtonpost.com/wp-dyn/content/article/2010/11/19/AR2010111906872.html  http://www.cnn.com/2011/11/23/us/cnnheroes-hungry-children/

Obamacare...again?

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Last week Rep. Paul Ryan kicked off budget discussions by inserting a poison pill into any compromise with Democrats: making repeal of Obamacare part of budget negotiations.

With Democrats holding the Senate and the presidency, the GOP's attempt to repeal Obamacare is DOA.

The GOP has always argued for a status quo, which is neither free market, cheap, nor successful. Worse, last week House Budget Chair Ryan proposed keeping Obamacare's tax increases and ending Medicare Advantage while eliminating the benefits and cost savings of Obamacare.

With Ryan's plan, the uninsured would remain uninsured. The rest of us would still pay for insurance that continues to screw consumers with lifetime caps, no coverage of pre-existing conditions, and kids over 18 kicked off their parents' insurance.

Like a bad penny arguments for and against Obamacare keep turning up long after the Supreme Court upheld it and Congressional attempts to repeal it withstood more than 30 attempts.

The arguments the GOP has used against Obamacare are that it is government control that overturns the free market health care system and runs up the deficit so let the free market take care of the problem.

What free market? I know a free market when I see it. Our family imports and distributes an over the counter pharmaceutical in a market with 2,000 competitors. Consumers have the opportunity to buy it if they like the product and the price. Not so with health care. A very small handful of insurers control the market across state boundaries through their wholly owned subsidiaries and they are not subject to anti-trust laws. Those employed by small businesses or self-employed have a choice of either buying unaffordable insurance or going without. Their physician, insurer, or ambulance choose hospitals for them — hardly free markets at work.

The Obamacare exchanges from which the uninsured get their affordable policies are comprised of private insurers openly competing against one another that offer required minimum benefits and more. Subscribers get access to a freer private sector market than we have now.

The GOP's newest approach speculates most employers will stop providing insurance, opting to pay the fine instead, even though the Congressional Budget Office predicts that will not happen to any significant extent. This would be expensive, Republicans claim, because the exchanges subsidize the insurance policies. That point is deceptive. Consumers using exchanges will pay per their income levels and employed consumers would be less likely to get subsidies than the unemployed.

Cheap? Our costs per-capita are two and a half times more than any other industrialized country. The U.S. ranks in the bottom 40s in the list of any measure of outcome when compared to the rest of the industrialized world, mostly because the lack of access to health care of so many drags down the average. Why? Those who have insurance get preventative care; the rest who rely on high priced emergency rooms do not.

Private health providers get away with markups that are many times what even the government Medicare and Medicaid reimburses, per an investigative report in Time Magazine, March 4. One reason Medicare Advantage was scrapped was that insurers charged 12 percent more than government spends doing it itself.

Our system now pays providers fees for each service. The more tests given; the more re-admissions into hospitals, the more providers get paid. Outdated record-keeping cannot keep track of duplicative tests. Obamacare reduces charity care costs shifts by providing health insurance for the 30 million uninsured, changing the payment basis, and modernizing record keeping. The Congressional Budget Office estimates a $700 billion-plus savings to Medicare over 10 years and still Obamacare is deficit neutral.  It is these kinds of savings to the health care system Ryan's budget would eliminate.

This is my column that appeared in the Sky Hi Daily News today.