Sunday, August 2, 2009

Robbing Medicare to pay Public Option?

In a recent comment to my “Cry wolf” post, commenter Neil Moss says:

As I am retired my ral concern is that the new bill seems to make an effort to rob from medicare to support the new healtcare program. Where does that leave me after all these years, since Johnson, of payinng in?

I had kind of been hearing that but had assumed what was being discussed was the hope that Medicare would cost less once various changes were implemented. I did some checking around and it seems I have assumed incorrectly. Rich Lowry writes about it in discussing a phone conversation he had with Senator Bob Corker (R., TN):

Corker is stunned that the Finance Committee would consider taking hundreds of billions out of Medicare and not apply it to Medicare's own shortfalls. They're "taking Medicare savings and using it to leverage a whole new entitlement . . . It's like a Ponzi scheme."

Read the whole thing; Corker sounds like an interesting guy.

On the topic of Medicare cuts, the Oregonian says:

The health care bill written by House Democrats calls for $500 billion in Medicare cuts over 10 years to help offset the enormous cost of providing care to 45 million uninsured Americans. The Senate is also likely to slice deeply into Medicare to pay for its proposal.

Yet a devastating assessment Thursday by Congress' independent budget office concluded that those cuts aren't deep enough. Another $116 billion in Medicare reductions are needed to pay for expanded coverage, the Congressional Budget Office said.

You should absolutely read the whole article. It’s remarkably clearly written and in addition to the information on Medicare cuts, the article also covers one of the big problems with national health insurance (disparities between States); another of the big problems with national health insurance (it distorts or stifles States’ attempts to find a better way); and the impact on supply (of doctors willing to see Medicare patients) when a monopsony (the Medicare program) lowers the price it will pay.

There is, of course, disagreement about exactly what cuts are being proposed, who will bear them, and what impact they will have. The AP has a more reassuring take on the situation pointing out that the $500 billion over ten years cut would be partially offset by $300 billion provided “mainly to sweeten payments to doctors.” It also points out that the AARP supports the legislation and says that:

Obama and the Democrats say the cuts are needed to curb wasteful spending fattening the budgets of Medicare managed care plans, hospitals and other providers.


An analysis for the Kaiser Family Foundation found that Medicare Advantage — the part of the program operated through private insurance companies — would bear 32 percent of the overall cuts. Another 37 percent would come from hospitals and other service providers.

It looks to me like the cuts discussed above are probably found in HR3200 (aka the House health care bill, aka TriComm; aka American Affordable Health Choice Act; aka AAHCA) beginning on page 223 in “Title I: Improving Health Care Value”. (You can download a pdf of the bill here). I skimmed through part of this Title and it would take me at least 2 solid days to do all the cross-referencing and back-tracking necessary to figure out what it would do. And that doesn’t include figuring out what all the jargon means. We desperately need a simple explanation of the whole bill, tied to page numbers, Titles, Sections, and so on.

Even worse - as Neil Moss also points out - HR3200 is not the only health care/insurance bill floating around out there. We can be over here wringing our hands about what’s in the House bill only to turn around and find out that it suddenly looks like the Senate HELP Committee bill is the one being voted on. Or the Senate Finance Committee bill. Or Wyden-Bennett (although that seems sadly unlikely).

Congress and the President need to agree on a bill they can get the votes for; put together a plain English summary of it that works through each section and includes the CBO scoring for the section; post both the bill and its summary on the Internet for at least a week - I’d prefer a month; and let everyone take a look at it.

Or they can just do the right thing and put together a simple program that lets everyone who wants health insurance buy it with the government subsidizing those who can’t afford it. A 10-year-old with paper and pencil could come up with a pretty good estimate of how much that would cost and we can then figure out how much we have to tax high fructose corn syrup and artificial sweeteners to pay for it.

1 comment:

Anonymous said...

"Or they can just do the right thing and put together a simple program that lets everyone who wants health insurance buy it with the government subsidizing those who can’t afford it."

You nailed it there.

-- Texan99