Friday, August 17, 2012

Substantive Issue: Medicare

One of the substantive issues in the upcoming election is Medicare - and it's changes.  Neither Candidate proposes leaving it as it was under George Bush the Younger.  And yes, like everything else Bush the Younger fucked this up - he added a massive new prescription medicines program without paying for it.  Thank you Georgie and the Republican government!
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Medicare gets a lot of notice in our budget because the cost is growing faster than inflation, and eating up more and more of the budget.  For our non-American friends - Medicare is the Federal Costs of Health Care for older Americans (those over 65 plus some extra-ordinary conditions of those under 65).  Medicare costs are rising because Health Costs rise faster than inflation - particularly as new procedures are developed.
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For example, when it was created in 1965 open heart surgery was just beginning - now we have robotic surgery.  So it's not just that medical costs rise, but the available options (most of them more expensive) are now available.



One other thing here - Americans do NOT have National Health Insurance, but hospitals MUST help anyone that comes in with an emergency.  The cost of running basic care through an Emergency Room is extremely high and is passed on in Health Insurance costs to people that have Health Insurance and to the Federal government for Extra Medicare costs.  The rate of cost rise is hugh.
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So, what are the candidates plans to change it?
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Well, President Obama has the new Health Care law passed, which expanded Medicare to poorer Americans making 133% of the "Poverty Level".  Everyone has to have medical insurance with insurers having to pool coverage to lower costs.  The Medicare changes are paid for with a tax on income earners above $200,000 - a charge to Health Insurers (part of the law requirers all people to get Health Insurance) and a tax on very generous Health Policies from employers (in the US the employers get a tax break for giving their employees Health Insurance - the law limits this tax break).  The Federal Government would pay for the increase cost of Medicare to the states from these new charges.  The idea here is to put all Americans into Health Insurance, and lower the costs by moving most treatment out of Emergency Rooms.  Will it work?  Maybe.  If not, it is a government program that keeps growing and eating up tax dollars.
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The Ryan Budget plan is to freeze Medicare at current funding levels, with rises only at the level of inflation.  Then move the Medicare dollars to the states as "block grants" and the states would administer this money.  In the positive side, it stops Medical costs from rising for the government.  On the negative side, there are 3 problems.  1) The funding wouldn't keep up with costs - so individual old people would be left with a larger and larger cost. 2) 20 - 40 million people that would be covered by the new Health Care law, will not be covered here - in this case the poor or near poor. 3) This doesn't address the cost drivers of US Medical Care (forced care in Emergency Rooms and Uninsured people).
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The Obama option attempts to make care more universal and affordable - at the potential cost  to tax payers and the tea-party charged "cost" of freedom (in that you can't "choose to have no coverage").  The Ryan option caps the cost to the government, but then just has the individual make up the difference or not receive treatments - regardless of the individuals ability to pay.
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Neither is my preferred option.*  The Obama plan has too many moving parts and it is easy to attack those parts piecemeal and pit some Americans vs. Others.  The Ryan plan essentially takes government off the hook, but places a bigger burden on individuals - which sounds great until you talk about Grandma not having enough money for her pills.  And what if Grandma's kids aren't working or are dead.
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But that is one of the things this election is about.
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*My option?  In the Obama plan take the extra step to set up a National Insurance plan to compete with private entities.  In the Ryan plan repeal the law that says Emergency Rooms have to treat everyone and  let people die right out in public.

2 comments:

Healthy, insured, but no kids to help me when I'm old in Wisconsin said...

THANK YOU! With your very easy to understand, complete explanation I can print this and share it with my conservative family members. It's great fodder for conversation about the options. I agree...neither option is perfect, but I kinda like the easy Nat'l Insurance Plan addition to the Obama plan (and we even have a model for it in the insurance coverage that our legislators receive as elected officials). Bam...done. Set it and forget it.

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