One of the storylines in the health reform debate is how the Medicare population is fighting the current reform efforts.
It’s ironic, in a way, since if the status quo continues, fiscally sustaining current Medicare benefits will be a near-impossibility.
In his regular column, The New York Times’ Ross Douthat provides some insight as to the mindset of the Medicare recipient. He says, rightly, that, “At present, Medicare gives its recipients all the benefits of socialized medicine, with few of the drawbacks. Once you hit 65, the system pays and pays, without regard for efficiency or cost-effectiveness.”
When reformers talk about savings, it “sound[s] a lot like ‘cuts’” to the elderly, and hence, their apprehension. Arguments that many of the tests and treatments can be reduced without sacrificing quality of care will not resonate. With the prevailing mentality equating better care with more care, any attempt to introduce serious cost-saving measures will meet a determined resistance from the American public.
Related posts:
- Does cutting health care costs mean spending less on the elderly?
- Fee-for-service: A barrier to health reform
- Medicare reform
- 8 recent health reform posts, August 23rd, 2009
- Physician payment reform is the key to fixing the health care system
- Primary care and the elderly
- Health reform and cognitive dissonance
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Seniors are frightened because of insurance companies that have Medicare Advantage programs have used scare tactics and an overly inflated view of the worth of this program. This is the only part of Medicare on the chopping block and that a reduction of subsidy, not by elimination. With Medicare forking out 110 to 130% of those in general Medicare with little to show for it, this makes sense. AHIP even had the temerity to call their efforts, totally corportate driven and financed, a “grass roots” operation.
As for the cornucopia of services provided by Medicare, this also is a myth in two respects. Medicare’s overhead is 3%(11 to 30% for private insurance) and the medical inflation rate is significantly lower for Medicare as opposed to the private world. As for their performance as a payer, no other than Athena Health has dubbed Medicare the “ideal payer.”
Mr. Douhat as usual is full of hot air. Remember he was an apologist for Sara Palin.
We sell everything from toothpaste to cars using the adjectives new, better and more. Why aren’t we doing the same to sell health care reform? In fact, those very words are quite appropriate in the full explanation of the necessity for reform.
It’s all public relations. You must create buzzwords that work in your favor, just as the distracters have done with phrases like death panels to further their cause.
You can’t expect the public to jump on the bandwagon for something they don’t understand. They (think they) understand better, they don’t understand cost saving.
I have a friend in remission from bladder cancer and on Medicare, who had 19 medical visits within the last 30 days, the result of new pain. All tests were negative, thank goodness, but that didn’t stop this person from speaking out against health care reform saying it would “bankrupt the middle class.” There’s a logical disconnect here, I know, but it seems to be almost everywhere. Again, it’s all in the language, and we’ve almost lost the cause to those with the loudest, meanest and least accurate words.
So help me to understand the economics here. For every $1 in costs, Medicare pays hospitals 93 cents. For Medicaid patients, it is 86 cents. Private insurers pay $1.32. That is the cost shifting that is occuring.
So if Uncle Sam now gets to decide the rates for the rest of us, no doubt they will follow the same pathway and just pay less. The $1.32 will shrink + shrink (just like it has for M + M). So where are the hospitals going to get the money?
Won’t this ultimately lead to fewer hospitals?
And no let’s cut the waste + fraud arguments – that never happens.
The problem is hypocrisy, in addition to selfishness.
Those who oppose “socialized” medical care not only expect, but demand, socialized medical care in their old age. They believe that they, and only they, are “entitled” to free health insurance and that their entitlement trumps the needs of others.
In that they are wrong. As a justice issue, those who have not yet grown old (the young) are more entitled to the healthcare that will allow them to grow old than the elderly are entitled to the healthcare that allows them to grow older.
I am a senior strongly opposed to govt provided healthcare + I want out of Medicare. Since so many of you are drs, do you know of any insurance company that will sell me private healthcare insurance for someone over age 65?
IMO, Medicare was + is a bad idea and we should we reforming healthcare to phase out of Medicare – not adding more people to govt controlled health care/insurance.
Donald Green: You have managed to assemble a mishmash of points, ranging from accusations of corruption to ad hominems (”He likes sara [sic] palin!”). None of them actually address the core of his article, which was amazingly clued in for someone in the MSM.
1) Medicare is unsustainable. “Other programs are more unsustainable” is not a defense. Sorry.
2) Medicare is politically unreformable because seniors will revolt against any attempt to decrease spending on it.
3) Republicans scoring political points now by attacking the Democrats mega-weak attempts at reining in Medicare spending are screwing themselves in the future. We are headed towards a country with “age warfare”, not “class warfare”. With disproportionate voting percentages rendering growing entitlements untouchable, eventually it’s going to be a system where the only purpose of people under 65 is to pay for elderly people to have the most expensive retirements possible.
“Why the elderly are against health reform”
I don’t think they are. At least, if someone would explain the proposed health reform to them, in terminology that they could understand, I think they would be for reform. Unfortunately the message they have been receiving, nearly every day, is that seniors will lose their own health care insurance in order to pay for everybody else’s health care. I’ve seen the junk mail my mother receives daily from Republican senators and representatives, from insurance companies and from crackpots throughout the nation, threatening to leave elderly people out in the cold without any health care at all.
My moderately senile mother believed the lies, right up to the moment she died comfortably three weeks ago in a modern hospital, her care paid for by Medicare. “They couldn’t print that (the lies) if it weren’t true,” she’d say. “Somebody would sue them for slander.”
Classof65
Alex, I did not say the insurance companies were corrupt but they are spending more under Medicare Advantage than the general Medicare population. That is an established fact. You can look it up in any search engine you wish, “Coalition To Preserve Medicare Advantage,” to see who is the sponsor. I did not say Mr. Douhat liked Sara Palin but he has defended her illogical logic. You can look this up also. My point, mishmashed in your mind, speaking of ad hominems, was that the elderly are being frightened by those who would like to maintain the status quo. As for Medicare sustainability this is a political question. Do we spend our money on guns or butter? Maybe you need to add up the waste in the private system and yes, by comparison. you will find it will fund shortfalls in Medicare and health insurance for everyone else for that matter. I am calling for deeper analysis of an issue. I am not accepting such a superficial column by Mr. Douhat. He has obviously sparked your itch for age warfare. Maybe decisions will have to be made in the future how we pay for services. This is the fate of anything that increases in cost with time What is your beef with the elderly anyway? Do you really feel they are stealing from your future?
“What is your beef with the elderly anyway? Do you really feel they are stealing from your future?”
I have no “beef” with the elderly except insofar as their interests are unfairly overrepresented relative to their share of the population. If you actually believe “waste in the private system will fund shortfalls in Medicare and health insurance for everyone else for that matter” then you just haven’t looked at the spending curve of medicare lately. This statement is simply WRONG. Medicare unchecked will eat the ENTIRE federal budget eventually.
A system where the elderly (and nobody else) get unlimited health care of infinite expense is unsustainable (and unjust). Real reform to Medicare will be necessary and anyone suggesting otherwise is ill informed or disingenuous. Nor is it having some kind of grudge against the elderly to suggest that their health care become comparable to whatever the rest of ours becomes (oh, the horror!). Thus, this article is right that playing political games that serve to make entitlement reform harder and harder is going to seriously hurt the country.
OK Alex, I will try again. Those covered by Medicare represent 50% of the health care expense. Under private insurance they pay 15% of the freight. Your so called share is being chewed up in the private arena, not by the government. The share paid to Medicare is because the elderly have 3 times the amount of illness than younger folks. The premium you pay to insurers comes tax free and is a part of your income. The outrageous overcharges means loss to you and to the government. Also part of the premium, 3%, goes to government to fund Free Care Pools when people who can’t afford insurance show up in the ER or get admitted.
Yes, you are right that Medicare will have to be brought into line as to what taxpayers are willing to support. However other things such as our defense represents a far bigger drain on the Federal budget or for that matter the and also decisions to stabilize the damage from greedy cheats on Wall Street. I’m afraid we’re all in this together and just can’t carve out a piece for ourselves without shooting ourselves in the foot.
The administrative costs of private insurance plans is double any other developed nation while delivering the same medical services. This is to the tune of $400 billion dollars a year. You are looking in the wrong place for true reforms. No one is saying there can’t be changes in Medicare but most of the cost problems are scandalous behavior of various vendors. They rip us off to the tune of billions of dollars. What is it in Medicare that you consider frills or a waste of spending?
By the way, I am with you that reform of our Federal budget is also a necessity. Unfortunately all these things hang together and the complexity of tackling it all gets us all a bit edgy. When you turn 65, where will your sentiments be then?
http://www.youtube.com/watch?v=8l2ZE4v9kw4
ya….words just can’t describe it.
Dr Green
Some of your numbers are simply incorrect. There is tremendous cost shifting going on bcs of Medicare + Medicaid low reimbursement rates. The low admin costs in Medicare result in huge fraud – approx $60-75 billion per year – no one really knows. Medicare shifts costs to the DOJ and other agencies so of course their stated admin costs are low. But in reality, they are not.
Whether it be defense dept or post office or fannie/freddie, when has a govt program come in below budget? The fed govt is no model for effiiciency; to argue that they are, defies all history and logic.
Ideally, what would you suggest for reform?
Everyone suddenly points to government as the source of their impoverishment or lack of needed services. Pulling out costs that may exist or stating “hidden costs” in government programs lacks the power of evidence to make it stand up to the barest criteria for either a legal or scientific basis.
It is not government programs that have ignited this present crisis in the economy or health care. So if we remove Medicare, Medicaid, the VA, and the Indian Health Service from the equation what is your solution to reform health care? Obviously you are aware that I think a updated and improved governmental program is necessary. Article I, Section 8 of the Constitution gives Congress the power to promote the general welfare. Health care access and affordability(health insurance) falls into this catagory and should not belong to free enterprise. I am not saying the deliverers of care should not be private and entrepreneurial but this also demands strong ethics on their part or there should be strong penalties. It is time for those opposed to government intervention to put their cards on the table. So far the proposals increase the bottom line of what we pay for health care and continue the slow decline of the general business of this nation. People overwhelmingly want reform in this country. You will have to tell me how the history of the HMO movement and other private insurances have proven their value to this country. There is no there there.
Dr Green
Your response was a non-response. No details. No specifics.
Talking about promoting the general welfare does not give one a right to someone else’s labor. What about food? What about shoes? These are extremely impt – more so than health insurance.
Those of us who oppose Obamacare do want reform – just not what he is selling.
Mackey’s op-ed was on the right track. Remove the state mandates. Allow insurance to be sold across state lines, eliminate employer paid benefit to be replaced by individuals purchase their own (with tax deductibility/ or earned income credit). The key is to break the third party payment – where the perception of free currently exists.
I would be happy to go on but you never stated any specifics. Details matter. Oh yes, this a comment forum and not a court room – if it was, your general welfare argument would not stand up to legal scrutiny either.
Well Evinx, The jig is up. The Constitution is not specific enough for you. Of course health care is a necessity for survival unless you want to drift back a few thousand years. I have cited many known statistics but you blithely set them aside. So I conclude you think our present set up is just fine. It tells me no argument will persuade you. I guess there was no harm trying. By the way we do not let people starve in this country and have programs such as food stamps and also affordable housing programs(section
sponsored by government. The problem with health care, however, is its unpredictability. This means everyone needs some kind of payment mechanism at hand to be taken care of. This can be done haphazardly and cost an arm and a leg or in a more orderly fashion by having Medicare for all. This is the only way we will get a handle on costs. I don’t think you won’t believe it until it happens. So as Thomas Paine stated: “Time makes more converts than reason.”
Dr Green,
Again, you failed to be specific on your reforms. Not surprised.
And the part of the Constitution you referred to has been debated from the time of Hamilton and Madison. Your arguments are illogical – kind of surprising as most doctors are not so emotional in their reasoning as you are.
Good Luck to you.
I first want to say that I have been following the health care debate since its inception. Dr. Green I would like to know how the proposed health plan can be anything but socialized medicine. The government will choose the people to oversee the plan and they will set the price of their plan lower than most private plans and will force hospitals to close because they can no longer subsidize the care they have to give to those on the public plan. As for the uninsured, if the demographics of the people who make up this group, the majority of them would be found to be illegal aliens to our country. I have practiced 32 years and have fought the Medicare debacle for years. How can this health care plan as written at present not force doctors to leave in droves. They are drowning in paperwork as it is. Of course if you follow the utilitarian ethics, you can truly argue that it is the best for the country. But what about those who are suffering from chronic disorders that require frequent hospitalizations, do you ration their care so some other less ill patient can get care? If you follow Obamacare that is exactly what will happen.
“A study published in today’s Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year(2007) of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.”
My reasoning seems to hold water with a super-majority of physicians. As for the Commerce Clause debates, none of it nullifies the power of Congress to institute national health insurance. The preamble to the Constitution also states as you know, “In order to form a more perfect union…..promote the general welfare…” Making our fellow citizens healthier and more prosperous is not a far fetched interpretation.
I don’t know exactly what you mean by being emotional so I will assume it is a distraction. I have actually stated what I support and why. I do not believe I used such tense language in my descriptions to be accused of being over wrought. Calling people out in that manner tells me you have some other underlying agenda, such as marginalizing people who you disagree with. In plain English, it ain’t nice.
Dear RN, First before answering you, I would like to know just how open you are to an answer. I do not deal with fears that people think will happen, but try to see if some solution can be fashioned in a discussion where concerns are addressed and acceptable conclusions drawn. In order to explain without getting slogans and contrived numbers in return I would set the following premises as the basis of an exchange. You would have to accept that there is a difference between “socialized medicine” and “social health insurance.” You would also have to accept that our present situation needs drastic overhaul or else health care expenses will gobble up our economy without achieving universal access. You would also have to understand that our current system of under insurance and no insurance results in 20,000 needless deaths a year. If you consider each of these items a reasonable foundation for dialogue, I will continue. Let me know.
My Wife and I are 73 years of age and quite frankly the only health plan we can afford is a Medicare ADVANTAGE Plan. There are people who have committed suicide because of health or / and money . Talk about losing your savings , even with a cap on out of pocket costs, this will surly do just that.
A huge number of SENIORS will not make it without the ADVANTAGE Plans.
If I understand this correctly , Medicare is unsustainable mainly
because of the ADVANTAGE Plans.
I voted for Obama because we needed change, but he never mentioned this kind of change.
I just want to touch on one change he talked about.
It must be very comforting to the past and present Government
that not to long ago a certain CEO received a $50mil. bonus
and that his company recorded a $ 40 BILLION profit in ONE QUARTER for a product that we cannot survive without.
Gasoline went from $1.79 to $ 4.79 back to $ 1.79 and then
up to $ 2.79 a gallon all in 11/2 years. Now at $2.79 a gallon
does the Government think we are getting a bargain ?
Are they that stupid or do they think that we are that stupid ?
At $ 2.79 a gallon now , if a barrel of oil goes back to $ 150.00
AGAIN , we will be paying over $ 6.00 a gallon.
It makes you wonder just what is going on that we do not know about.
If anything needs to be socialized or nationalized it is the oil to gasoline industry.
Just think if a gallon of gas was $ 1.79 and the Government
put just ONE dollar tax on top of that to make it $ 2.79 a gallon
what that would do for Social security now and in the future
I MEAN REALLY, lets face it , THE PEOPLE WHO RUN THIS
COUNTRY IS AMERICA.
The Radical right keep bringing up what the Rev. Wright said that was so wrong ” Not God bless America but God damm
AMERICA “
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