It appears that one of the primary reasons Democrats are so tickled by the selection of Congressman Ryan as Governor Romney's vice presidential pick is that "he's known as the 'Kill Medicare!' guy." In 2008, Senator McCain creamed President Obama in the 65+ demographic. With Ryan on the Republican ticket, Obama might have a fighting chance with seniors this year.
That's one assumption. The other assumption is that Ryan (and by extension, Romney -- is that the tail wagging the dog, I see?) really intends to purposefully kill Medicare.
Let's back up. The Congressional Budget Office (CBO) analyzed Ryan's 2010 budget proposal at Ryan's request. The Center for Economic and Policy Research (CEPR) summarized that analysis in a white paper, published in April 2011. The analysis isn't pretty, and it's made for a great Democratic talking point.
In 2022, the projected cost of purchasing a Medicare equivalent plan is equal to 35 percent of the median 65-year-old’s income. By 2050 the cost is projected to rise to 68 percent of the median 65-year-old’s income...[The projected payment to buy a Medicare equivalent policy] would be equal to 200 percent of the income of the median 85-year-old.
Looks terrible, right?
Ryan has since revised his budget proposal, both in 2011 and again this year. CBO's most recent analysis, from Q1 2012, is inconclusive. But even the detailed 2011 CBO analysis of Ryan's 2010 budget admits that projections are "highly uncertain, particularly in the longer term." Everybody's crystal ball is on the blink.
That's really the crux of the matter here. Not simply that we can't accurately predict dollar figures ten, twenty, or forty years out, but that we can't accurately predict what our budgetary priorities will be in the future.
If you read the portions of Ryan's FY12 budget proposal that deal with Medicare, it's clear that (on the surface, at least) his intent is to offer a fiscally viable means of continuing Medicare.
[T]his budget will save Medicare for future generations, protecting those in and near retirement from any changes while forging for younger workers a Medicare program modeled on the system of affordable, quality health coverage options now enjoyed by members of Congress.
…This is not a voucher program, but rather a premium-support model. A Medicare premium-support payment would be paid, by Medicare, to the plan chosen by the beneficiary, subsidizing its cost.
Not so terrible, right?
Of course, there's unsubstantiated partisan jabs in the Ryan budget proposal -- specifically the claim that the ACA "raids" Medicare (refuted by PolitiFact.com) -- but that's the job of politicians, to compare and contrast themselves with the other party. But Ryan supporters and dissenters alike ought to read his proposal more closely before making broad statements about his intentions. Same goes for the ACA.
Back to the viability of the budget proposal. If CBO can't make any definitive predictions as to whether this specific plan will succeed or not, I'm wary of anybody on either side of the aisle who claims that they can.
Can we save Medicare, as both sides purport to want to do? Of course! We can do anything if it's important enough in relation to other competing budgetary priorities.
But therein lies the problem. Our priorities as a nation shift as capriciously as those of a four-year-old, and we protest just as loudly when we get what we supposedly wanted and it turns out to be not at all what we wanted. Conversely, we get so wrapped up in opposing what the other guy supposedly stands for that we're blinded to the points on which we agree.
This post is part of a weekly conversation with our Moms Matter 2012 political bloggers. To see the original question and what the other writers have to say, see Should Medicare Be Replaced by Subsidies?
Image via ProgressOhio/Flickr
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Hockeymom- that is not an accurate portrayal of HCAHPS. HCAPHS has been around since 2002 (I know- I work in the biz and I an intimately aware of when my life became a living hell). What's changing is linking pay to performance. Patient satisfaction is part of the score, but comprises 30% of the total score. The score is primarily based on what they consider "quality indicators". Practices/hospitals that have good numbers in the quality indicators will receive a bonus. Others will (after about 3 years) be penalized). Will it make things more holy hell? Yes, but probably not how you picture it.
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Think about what happens if a pediatrician suspects child abuse and reports it. Think that kid's mom is going to give good survey scores? How about a junkie in the ER unsuccessfully trying to score pain meds. Think he's going to report "My pain was adequately controlled" in his survey? Consider that hospital readmission rate is a quality indicator. Think about patients (maybe those with congestive heart failure who are constantly going in and out of the hospital for exacerbations of their conditions) or the chronically non-compliant patient (maybe some kid with asthma who's mom doesn't give him his breathing treatments as prescribed). Think any physician practice will want to have them as a patient? Actually, I think nursing staffing at hospitals may improve as having more nurses available does tend to coincide with patient satisfaction.
JAFE- the problem with access to health care in rural areas started long before Obama. For many years Medicare has reimbursed rural providers less than urban and suburban providers. Also urban and suburban providers have private insurance companies to shift the cost to; many rural providers- not so much.
The real problem here is that market forces do not work for rural providers and patients. A lot of rural providers are sole practitioners and have much higher overhead than physician groups who share office staff and billers. Rural providers have to work a lot of hours just to break even, not including charting (which is not face to face time and therefore, not billable). What young person just starting out as a physician is going to take on all that headache for less pay, especially with ruinous student loans on their back? The government has offered a portion of student loan forgiveness for years to try to entice physicians to locate in rural areas. They ain't buying it. And larger physician practices in the cities aren't interested in contracting with some doctor in the boonies who is bringing in less revenue. That's less revenue for patients who likely cost more money because they have chronic conditions and decreased access to health care.
wamom223- your Grandma being pissed about Medicare indicates nothing. I see 7 to 8 people on Medicare everyday that are pissed about it. Not saying this is your grandma but primarily I see folks pissed because they are so entitled that they think they shouldn't have to pay anything for their healthcare. I see folks everyday crabbing about paying $200.00 of a $20,000.00 bill because "My Medicare should pay for all of it." or "I think that medication costs too much- those pharmacies just want to make money. I'm not going to take it." or "Why won't Medicare pay for this $35.00 shower chair? I worked hard all my life!" So they refuse to buy the shower chair, fall in the shower or don't take their medication and have complications and BAM! Medicare is on the hook for thousands more to pay for the fracture, or nursing home care. People tend to focus on providers, but many patients cost Medicare more money because they refuse to take personal responsibility (and their caregivers, too) for their health and safety- probably because they're not paying much of the bill. My biggest problem with pay for performance (tongue somewhat firmly in cheek here) is that it penalizes providers and not patients.
Yes, Hockeymom- brief and inaccurate. I think we should be clear here that these changes predated Obama. Medicare has been compiling data on clinical quality indicators for 10 years now, toward this end. And I have to admit I laughed aloud at your statement that obstetric patients might score hospitals well. Probably because I read so many bitchy responses to the "Kennedy Assaulted Nurses" story. I can just see the bad surveys due to the nurses (following hospital policies) not letting the new mothers walk around in the hospital room with their babies in their arms.
As to maternity patients, those at least there's a shot. They are the only people who are admitted for a positive reason.
Country my comment was to Jafe not you. My Grandmother being unhappy with medicare are because of changes she says she has seen while he's in office. I am not on medicare so I do not know in detail what she is talking about. What I was indicating was my grandmother is 83 years old and has always voted democratic and now she wont, she is not the only one I know that feels that way. Also, no my grandmother is not looking for a free ride. She is a very self reliant woman that explained to me last week that the democratic party of today was not the party she grew up in. She views it now as a party of entitlement and the pursuit of a free ride at everyone else's expense.
I'm not bothering to defend anything to Country. I know what's going on. I KNOW that 2 years ago our little clinic had 9 doctors. They took medicare and they were open 3 evenings a week so farmers and working people could go till 8 at night. Now we have 4 doctors and aren't open any evenings AND don't take medicare. I'm sure it was happening "before" King Obama but it's gotten to the tragic stage now. So since our elderly and our seniors don't get to to see their own doctors anymore that's Bush's fault? Or Clinton's? Does that make it okay? Does that make it better? Is that really what you're trying to tell me?
Blame Blame Blame. I'm sick of blame. Let's go back to what we had 4 years ago. This thing of Obama's is crippling our medical care. We may as well be Canada with what we have now. Blame who you want to Country. I'm beyond blame and I want to help my fellow neighbors. To lose your family doctor that you've had for 30 years is debilitating to an 80 year old.
AND, if it's so great, why isn't his family going to have this plan?
JAFE- Calm down. You didn't see anywhere that I said it was Bush's fault, or Clinton's fault or Obama's fault. I am simply pointing out that the situation has been in the making for a long time. And frankly, you didn't see me endorsing Obamacare anywhere in that comment, either. In truth, I am rather pissed at what I perceive to have been a lost opportunity by Obama to initiate a single-payer system. I pretty much consider bringing insurance companies to the healthcare table sleeping with the enemy. Small, rural towns tend to have older populations and often more folks on Medicare and less folks with private insurance. Add to that the decreased Medicare reimbursement for docs in rural areas = single and small office practitioners are getting crushed. The same type of thing is happening in depressed, urban areas, except there its related to Medicaid. Look around you- have you not noticed how many hospital systems in the past 10 years have been building satellites in suburban areas? They're following the private insurance money. Like I said, market forces...