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Old 04-02-2011, 08:56 AM   #31
LJT
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It's always bothered me that we do not view healthcare is not a fundamental human right, I know there is a cost issue in supplying it, but I can't help but think it is something we should all be striving for rather than using it as an ideological/political kickabout a la capitalism vs socialism.
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Old 04-04-2011, 06:54 PM   #32
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Washington Post, April 4 (Ezra Klein)
Quote:
What Paul Ryan’s budget actually does


Paul Ryan’s plan for Medicare and Paul Ryan’s plan for Medicaid rely on the same bait-and-switch: They use a reform to disguise a cut.

In Medicare’s case, the reform is privatization. The current Medicare program would be dissolved and the next generation of seniors would choose from Medicare-certified private plans on an exchange. But that wouldn’t save money. In fact, it would cost money. As the Congressional Budget Office has said, since Medicare is cheaper than private insurance, beneficiaries will see “higher premiums in the private market for a package of benefits similar to that currently provided by Medicare.”

In Medicaid’s case, the reform is block-granting. Right now, the federal government shares Medicaid costs with the states. That means their payments increase or decrease with Medicaid’s actual rate of spending. Under a block grant system, that’d stop. They’d simply give states a lump sum at the beginning of the year and that’d have to suffice. And if a recession hits and more people need Medicaid or a nasty flu descends and lots of disabled beneficiaries end up in the hospital with pneumonia? Too bad.

In both cases, what saves money is not the reform. It’s the cut. For Medicare, the cut is that the government wouldn’t cover the full cost of the private Medicare plans, and the portion they would cover is set to shrink as time goes on. In Medicaid, the block grants are set to increase more slowly than health-care costs, which is to say, the federal government will shoulder a smaller share of the costs than it currently does. The question for both plans is the same: What happens to beneficiaries?

Remember how the Affordable Care Act was really, really, really long? There was a reason for that. It was full of delivery-system reforms meant to make the health-care system cheaper and more efficient—things like bundling payments for illnesses and reducing reimbursements to hospitals with high rates of infection and creating a center tasked with seeding cost-control experiments throughout Medicare and encouraging the formation of Accountable Care Organizations. The hope is that those reforms will cut costs, which will make the rest of the bill’s cuts possible. Republicans, notably, have been skeptical that these reforms will work, and have argued that the cuts won’t stick because beneficiaries will revolt.

To my knowledge, Ryan’s budget doesn’t attempt to reform the medical-care sector. It just has cuts. The hope is that those cuts will force consumers to be smarter shoppers and doctors to be more economical and states to be more innovative. But all that’s been tried, and it hasn’t been enough. That’s why the Affordable Care Act had to go so much further, digging deep into the delivery system, and why Republicans had at least a plausible case that some of its cuts wouldn’t stick. But now the GOP needs to apply the same skepticism to their own programs: Cuts aren’t enough, and if they somehow manage to distract people from the cuts by repeating the words “block grants” and “flexibility” and “premium support” over and over again, they’ll simply end up seeing their cuts ignored when it becomes clear that they’ll mean leaving the old and the poor without health care. What Ryan has here isn’t so much a plan to control spending as a plan to cut spending, whatever the consequences.
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Old 04-06-2011, 01:51 PM   #33
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New York Times, April 5
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Representative Paul Ryan, the Wisconsin Republican who wrote the [budget/Medicare reform] plan, calls the budget deficit an “existential threat” to the United States. Then he absolves more than one-third of all adults from responsibility in dealing with that threat.

...Washington’s age bias depends on a basic misunderstanding of the budget—namely, that older people have already paid for their Medicare benefits. They haven’t. For most Americans, Medicare resembles a giant welfare program. They receive far more in government benefits than they ever pay in taxes and premiums. The gap for a typical household runs to several hundreds of thousands of dollars.

The Ryan plan would let anyone who turns 65 before 2022 continue to be part of this hugely popular welfare program. In fact, Mr. Ryan would scrap the common-sense attempts to slow costs in last year’s health bill, like the baby steps to base Medicare coverage decisions more on medical evidence. If you’re 55 or older, you get the same old Medicare, with its same soaring budget. If you’re under 55, you are excluded. You will instead receive a government subsidy to buy private insurance, and the subsidy will probably not keep pace with future increases in health costs.

Beside violating basic notions of fairness, the grandfather clause has the potential to slow economic growth. Many of today’s 55- and 60-year-olds are going to be on Medicare for a long time. If the program doesn’t change, they will run up trillions of dollars in medical bills. That money won’t be available for education, early child care, scientific research or high-tech infrastructure—all of which can lift growth. The United States already has a “particularly strong age bias” in its government spending, Julia B. Isaacs of the Brookings Institution noted in a recent analysis of affluent countries’ budgets. In the years ahead, spending on the elderly has the potential to rise higher still and to crowd out spending on the young. Eugene Steuerle, a former Treasury official in both Democratic and Republican administrations, says simply, “We have a budget for a declining nation.” ...Their results show that no cohort of Americans, with the possible exception of the very affluent, pays enough Medicare taxes and premiums to cover their costs. The gap is growing over time, too.

...By law, Medicare taxes cover mainly hospital bills, not doctors’ bills or the cost of drugs. These costs instead must be covered by the general government revenue, but there isn’t enough of that revenue. Instead, the government is running deficits—which is to say, it’s borrowing money from individuals and foreign governments and promising that future taxpayers will pay it back.

...A fairer, more fiscally conservative plan would not postpone dealing with Medicare. It would leave in place the cost control measures in the health reform bill and go even further to reward the quality of care rather than the volume. Obviously, these steps would run some risk of restricting good treatments, too. But, remember, we’re facing “an existential threat.” We can’t limit ourselves to solutions without risks. Next, the federal government would raise taxes. As countries have grown richer over time, they have historically paid higher taxes—to cover the costs of a strong military, good schools, comfortable retirements and other luxuries that the free market doesn’t provide. Affluent Americans, in particular, can afford higher taxes. They have received far larger raises in recent decades than any other income group, and their tax rates have fallen far more. Yet Mr. Ryan would reduce them further.

...[Ryan] may well be right that a solution along these lines is ultimately where health care needs to go. But it would be a lot easier to trust in the merits of his plan if he weren’t so busy promising 75 million Americans that they will never have to be a part of it.
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