Columns » Ernest Dumas

Medicare's appeal

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That most Americans, not merely the indigent elderly, care so much about Medicare that it will decide their vote seems to have come as a shock to Republican lawmakers, including Arkansas's, although many owe their offices to that fact.

In one of the nation's most reliably Republican congressional districts, a Democratic county clerk upset a rich Republican lawmaker and the single issue was Medicare. The Republican said she would have voted with all the other Republican House members for the Paul Ryan budget, which would scrap Medicare in 10 years and replace it with a voucher system where the elderly and disabled would need to buy private insurance policies to cover their hospital and doctor expenses or pay for everything out of their own pockets.

The congressional victory dramatically changed the calculus for the 2012 elections. Democrats are accorded good shots at scores of Republican-held seats, including two in Arkansas where Republicans won last year with the help of considerable Medicare demagoguery.

The election, along with polls, has had a sobering effect on many in the GOP, but the mainline strategy is to keep trying to hornswoggle the voters into believing that Democrats, the fathers of Medicare, are out to destroy it and the Republicans, who fought it from the first, are its saviors. So simple is the Ryan equation that voters are not going to be easily duped again.

In spite of all their experience, Republicans still can't quite believe that a government-run program can really be popular with people, especially those who are not yet in it. But nearly everyone has parents, relatives or friends who are on Medicare and are relieved they no longer have to fight the insurance company or worry about the bills.

Republicans had ample evidence of the issue's vitality with voters in 2009 and 2010. Having to beat a health-insurance law bill that was based on Republican principles and precedents, they took a page from the Democratic playbook. Tell people their Medicare benefits were going to be cut under the Democratic bill and that the government was going to "ration" medical treatment. That's what Frank Luntz's polling told them would work.

Actually, Medicare benefits were going to be expanded under "Obamacare" and there was to be no rationing, but the idea was an easy sell because no one understood the massive reform bill and timid Democrats like those in Arkansas made no effort to counter the lie. Polls showed that in much of the country, including Arkansas, people over 55 overwhelmingly opposed the reform bill because they thought it cut Medicare. Angry tea-partiers at public forums raged about losing Medicare.

That is the justification for the Ryan plan. It's supposed to "save" Medicare by turning it over to the insurance market.

But the difference is that anyone can instantly figure out how the Republican plan will affect him. It doesn't require even a triple-digit IQ. The government will end its obligation to insure your medical expenses, you will need to buy a policy from an insurance company to cover them, the government is going to help you buy the policy less and less each year, and you know that the insurance companies must cover their large administrative costs and also make a profit with your premiums. That means you are going to get less care or else you are going to have to pay a lot, lot more for it, or both.

The nonpartisan Congressional Budget Office calculated that under the Republican plan by 2050 a 75-year-old man would have to pay $52,000 a year in current dollars to buy a currently adequate plan and the government would give him a mere $10,000 to buy it.

If that is not an end to Medicare as we know it, what would it look like?

Now the strategy is that privatizing Medicare would save it from the rationing that the new health law plans for beneficiaries. People are terrified of rationing.

Rationing is what we have now in its most extreme form. Those who can't afford insurance or are denied it for pre-existing conditions or chronic and acute illnesses are rationed out, except for emergency-room care.

Ryan was on Fox News last week accusing the Affordable Care Act of setting up rationing through the Independent Payment Advisory Board, about which you are going to hear a lot the next two years—probably little of it true. Ryan said the president was going to take $500 billion out of Medicare and give it to the board so it could ration medical care among patients. Nonsense.

The independent board—Congress would accept or reject all its decisions—is the Affordable Care Act's biggest effort to restrain Medicare growth, the united goal of both parties for three decades. The board of medical experts and economists will find legitimate savings in the compensation rates of medical providers and ferret out procedures that are needless or don't work but chew up billions of Medicare dollars. The law bars the board from cutting patient care or eligibility—the rationing that Ryan speaks of.

The board is supposed to produce better care at lower cost, which Medicare is now trying to do by setting up a rigorous review of hospital treatment records. That is exactly what the most common private insurance plans—the HMOs and PPOs—are supposed to do: they control access to procedures and regulate payments in a way to hold down costs, such as paying less to doctors and hospitals that are "out of network." You presume that Ryan's insurance companies wouldt try to do that, too.

But if insurance companies did it, see, you would not call it rationing.

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