2013
I have figured out the liberal mind and Medicare presents a good example.
The new Ryan budget with its restructuring of Medicare for future beneficiaries presents an easy target for liberals. What could give our progressive friends more fodder for their sympathies than not giving our all to old sick people?
The Ryan concept of dealing with federal spending may not be to everyone’s liking or anyone for that matter, but it is a strategy not mired in pie in the sky optimistic assumptions or misguided sympathies that blind us to reality. It sets federal spending on Medicare to a budget. However, I must say that the idea that “market-driven” forces will lower competing premiums outside of traditional Medicare is a flawed concept.
Either we are going to manage federal spending and deficits in a broad based way or we are going to tax middle class Americans into oblivion. The idea that we can treat the next generation as generously as current seniors without adverse consequences for younger Americans is naive at best.
Avoiding hard reality or not questioning optimistic projections based on unproven strategies does not stop liberals from pressing forward with their misguided “we can have it all” philosophy. The problem is when you do those things it often does not sound nice. Sticky things like real budgets and spending limits get in the way. Liberals tend to look at problems and issues in isolation. They focus on one group or another with little regard for broader and longer term consequences for the population as a whole. This is not vindictive, just a simplistic view of the world.
Read the following from the Center for American Progress. Look at the concern over premiums twenty and thirty years in the future (when income and Social Security benefits have also risen). Look at the reliance on lowering health care costs because “systemic changes that are underway.” Radical changes are unnecessary?
Apparently these systematic changes make any fundamental change in Medicare unnecessary. Remember what they said about health care in Massachusetts; expanded coverage and lower costs? They now have a law limiting what can be spent on health care. If they enforce that law, it’s called rationing. By systematic changes, does CAP include further cuts in fees to Medicare providers with no adverse consequences?
Just telling people the truth would be nice for a change rather than frightening one group of Americans and pitting generations against one another.
The fact is that even if every trial program and systematic change (I hope they are not relying on ACOs) works (which they won’t, of course) to control Medicare costs, their collective impact will not keep Medicare affordable for taxpayers. Something has to give. Even the Obama budget had a goal of 25% of seniors paying higher supplemental Medicare premiums by freezing the income levels where extra premiums kick in. How does that solve much if costs keep escalating?
Whether you agree with Ryan or not, he is presenting an option to manage the federal budget. That’s his job at the moment. That means setting federal spending and being able to manage to that. One way to do that is to say, here is what we can give you each year for health care, spend it wisely. That can be true for traditional Medicare alone or with alternative choices such as already exist with Medicare Advantage Plans. Today Medicare spending is open ended, whatever cannot be paid by taxes comes from general revenue (Part B). The real question is, are we going to set a budget and stick with it or not?
One final thought. If you like wrestling with the Medicare problem, just wait. Obamacare sets up a worse scenario because the subsidies for people using the new health insurance exchanges are also open ended. As premiums rise so do the federal premium credits, as more people use the exchanges, more is automatically spent on premium credits. In five years organizations like the Center for American Progress will be calling for higher credits because premiums for lower income participants are unaffordable … assuming all the systematic changes work, if not CAP will call for changes in 2015.
Excerpt from the Center For American Progress
The fiscal year 2014 House Republican budget resolution—released today by Rep. Paul Ryan (R-WI)—is strikingly similar to last year’s plan in its treatment of our nation’s Medicare program. The misguided budget proposes replacing traditional Medicare benefits for seniors with a voucher toward the premium of an insurance plan provided by a private insurer or Medicare starting in 2024.
As our analysis of last year’s nearly identical Ryan plan illustrates, House Republicans’ premium-support plan would not only create a death spiral—in which less-healthy beneficiaries leave the traditional Medicare plan, causing premiums to rise and resulting in more beneficiaries leaving the program, causing premiums to rise again—but it would also result in substantially higher premiums for seniors, forcing them to pay as much as $1,200 more each year by 2030, and as much as $5,900 more each year by 2050.
As a Center for American Progress Action Fund report details, seniors will face steep increases in their health care costs during retirement under a Medicare premium-support plan. The first seniors hit by these changes could pay up to $59,500 more during retirement, with those who will be eligible for Medicare in 2050—and are currently 28 years old—paying up to $331,200 more.
These radical changes are unnecessary. Evidence is mounting that the growth in health care costs is slowing down, thanks in part to systemic changes that are underway. As a result, the nonpartisan Congressional Budget Office recently revised its projection for Medicare spending downward by $137 billion over the next decade.
QUINNSCOMMENTARY 
You paint a dire picture of Medicare and overall healthcare costs but you also have a dim view of most ideas that are floated to address the problem (like ACO’s, consumer driven care, tort reform, etc…). However, I have yet to read your solution. What do you believe is needed and realistically attainable to change the trjectory of healthcare cost inflation?
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Paul Ryan is the wrong man for the job and should be replaced – his budget is a hoax because it assumes the repeal of the Affordable Healthcare Act which has been attempted 32 tiimes and is not going to happen – he is a Representative who is not “representing” the people in Janesville, WI who elected him to the House, but voted for Obama – I don’t think his new pope would approve of what his proposed budget does to “the least among us” – here is more commentary from The Washington Post:
Ryan’s CPAC speech was strongly delivered and well received. The House Budget Chairman, always a fairly good speaker, got much better over the course of the presidential campaign. But content-wise, there was little new. Most of it was cribbed from the introduction to his new budget. If you’ve read that, you’ve heard this.
One neat rhetorical turn he made during the speech, though, deserves a bit more scrutiny. “We don’t see the debt as an opportunity to cut with abandon and shirk our obligations,” he said. “We see it as an opportunity to reform government, to make it more effective.”
Ryan talks often of “tough choices” — how House Republicans are making them, and Senate Democrats are dodging them. But when you listen to his speeches, or read his budget documents, none of the choices actually seem that tough. He doesn’t say that his $5 trillion-plus in cuts will end important services and kick millions on Americans off Medicaid, but that these difficult decisions are necessary to fix America’s finances. That would be a “tough choice.” But if massive cuts are just “an opportunity to reform government, to make it more effective,” that doesn’t sound so tough.
Part of this comes because a substantial portion of Ryan’s savings come from repealing Obamacare’s coverage provisions. That means 20 or 30 million people who would otherwise have health insurance over the next decade won’t. But since Obamacare hasn’t actually begun delivering that health insurance yet, the cut can remain comfortingly theoretical — it’s hard to miss insurance you don’t actually have.
But that’s not true for all of Ryan’s savings. He cuts Medicaid by more than $700 billion. That will mean millions of people lose health-care coverage. But you wouldn’t know it from reading his budget. “One way to secure the Medicaid benefit is by converting the federal share of Medicaid spending into an allotment tailored to meet each state’s needs, indexed for inflation and population growth,” he writes. Phrased like that, it sounds like he’s adding to the Medicaid budget!
His section on tax reform is similar. “By making the tax code more conducive to innovation, investment, and sustained job creation, we can safeguard the American Dream for generations to come,: Ryan enthuses. His goals require $5.7 trillion in cuts to deductions, exclusions, and other features of the tax code. That will cause a lot of pain. But you’d never know it.
“A budget is more than just a list of numbers,” Ryan said. “It’s an expression of our governing philosophy.” Thankfully, it’s also a list of numbers. Because while Ryan’s budget is all about cuts, his philosophy, at least as he explains it in public, is all about improvements. The government that emerges in his speeches sounds like it does more and does it much better. The government that emerges in his lists of numbers does much less, and real people suffer as a consequence.
Ryan’s budget makes a series of extraordinarily tough choices. But he doesn’t like to talk about them.
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