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Subject: qotd: Theodore Marmor on why turning Medicare into vouchers
Date: Thu, 30 Aug 2012 12:32:24 -0700
From: Don McCanne <firstname.lastname@example.org>
To: Quote-of-the-Day <email@example.com>
Tampa Bay Online
August 18, 2012
Turning Medicare into vouchers won't work
By Theodore R. Marmor
Before Medicare began in 1965, many American senior citizens — and their
children — struggled to pay for their doctor bills. Ever since,
Medicare's been an American success story.
Why, then, do so many Beltway pundits and members of Congress —
including Mitt Romney's new running mate, Rep. Paul Ryan, R-Wis. — go
Some of its critics claim that slashing Medicare is the only way to
control the deficit. Like most attacks on Medicare, this one is based on
ideology, not evidence. Medicare's critics often claim that rising
federal health care spending is America's biggest fiscal challenge. In
fact, the federal deficit is bloated today primarily due to the Bush
administration's irresponsible tax cuts, economic mismanagement, costly
wars and increased defense spending.
Of course large numbers of retiring boomers mean Medicare will need more
revenue. But Medicare costs won't need to spiral out of control. The new
Affordable Care Act includes steps to limit per-person health care price
hikes. It's already saving Medicare money. Yet Romney and Ryan promise
they would work to repeal it.
What's their alternative? The Ryan Budget Plan calls for extremely deep
cuts to Medicare, while promising more and longer-lasting tax cuts for a
few very wealthy Americans. Most House Republicans have already voted
for that. It would end Medicare as we know it, and instead force seniors
to buy private insurance with vouchers that would cover less of their
healthcare costs each year.
These vouchers would reduce seniors' choices, not their costs. Why?
Republican voucher plans assume that if government ends Medicare,
private insurance companies will start to deliver cheaper, more
efficient plans. But what's their evidence?
When the nonpartisan Congressional Budget Office analyzed vouchers, it
found that even a slight dip in future federal spending on health care
for older Americans would drive costs up. Vouchers with slowly rising
buying power would simply leave seniors and their loved ones to pay more
out of pocket for bigger medical bills.
In fact, Uncle Sam's already lost money on Medicare contracts with
competing private health insurance plans. Although they spent more per
patient, those private plans didn't improve coverage or quality of care.
Meanwhile, Medicare has shown it bargains more effectively for better
prices than most private insurers say that they can afford to do.
How are frail older people — one in three with cognitive impairments —
supposed to wade through pages of fine print to understand new,
complicated and often confusing "choices"? Is that what seniors really
want? Surveys show most people care much more about being free to choose
their doctors than to do complex comparison shopping.
Consumer choice, it turns out, is just a fig leaf that Medicare's
critics use to try to hide what would truly be in store for seniors if
Medicare were to be gutted over time: fewer benefits, higher costs and
the loss of Medicare's guarantee of access to a wide range of doctors
and hospitals. What's more, its supporters aim to mask their true aim by
grandfathering in those over 55, keeping them from having to face a
transformed Medicare program.
The Ryan Budget Plan wouldn't really control Medicare's costs. It would
simply shift them to future senior citizens and make Medicare less
There's no good reason to weaken and eventually dump a program that's
met the needs of America's seniors and disabled citizens so well for
decades. Instead of wasting time and money pushing snake oil schemes to
replace Medicare, let's tackle the real problem of rising health care
costs with sensible cost controls, paid for by taxing — not cutting
taxes for — those who can best afford it. That way, Medicare can survive
and succeed for a long time to come.
(Theodore R. Marmor is professor emeritus of public policy and political
science at Yale University and has testified before Congress about
Medicare reform. He is a member of the Scholars Strategy Network, a new
national organization that brings together many of America's leading
scholars to address pressing public challenges at the national, state
and local levels.)
Comment: Medicare is under political attack. In this article, Professor
Theodore Marmor, one of the nation's leading experts on Medicare,
explains concisely the issues and the potential consequences. It can
serve as a valuable resource for explaining to others just what is at
stake. For single payer advocates, educating the public on this debate
is a must if we are to continue to advocate for an "improved Medicare