Monday, November 15, 2010

qotd: Drew Altman on hard choices for Medicare

The Fiscal Times
November 12, 2010
Health Care Takes a Hit in New Commission Plan
By Drew Altman

Three national commissions are hammering out recommendations for reducing the debt and reining in entitlement spending, putting two giant health programs that serve the elderly, disabled and low-income Americans, Medicaid and Medicare, as well as Social Security, in the crosshairs of a new policy debate.

The discussion of these issues is framed almost always in terms of "hard choices" to reduce spending, increase taxes, or both. In general, Democrats will resist cuts in these programs and Republicans will resist any new taxes. 

But these choices are also hard on legitimate policy grounds, especially when it comes to Medicare.  And the most important reason they are hard is that so many seniors and disabled people on Medicare have low incomes and already pay a significant share of those incomes for their health care today.  It will be difficult if not impossible to ask the majority of beneficiaries ––to pay more or make do with less.  That has been the missing element in the entitlement/deficit reduction debate: Warren Buffet is not the typical Medicare beneficiary.  Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent of her income on health care.  It is the people on these programs and the realities of their lives that have been left out of the discussion.

Comment:  Medicare is already an inadequate program for our seniors and for individuals with long term disabilities. The commissioners are making an egregious mistake in framing the problem as a budget deficit that needs "hard choices" to reduce federal spending by shifting more costs to Medicare beneficiaries.

Medicare does need to be improved, not by cutting benefits, but rather by expanding benefits and by eliminating financial barriers to care. Then Medicare would be a much more suitable program, not only for current beneficiaries, but for everyone else as well.

It is true that the federal budget spending would increase, but the federal budget deficit would be reduced by financing Medicare through equitable taxes, and wasn't this supposed to be all about reducing the federal budget deficit in the first place? Further, our entire national health expenditures, public and private, finally would be brought under control. As both patients and taxpayers, we couldn't ask for a better deal.

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