Messing with Medicare

Republicans are experiencing pushback as details of the House budget proposal, especially as it affects Medicare, become known to the public.

The proposal is not just tinkering. As somebody old enough to remember the Vietnam War, I recall that well-known statement attributed to the U.S. military:

“We had to destroy the village in order to save it.”

Some might say the House budget plan, written by Rep. Paul Ryan, R-Wis., and passed by the House in April, would do the same to the program that guarantees health care for older Americans. Instead of continuing the current program of direct payment from the government to health providers, the proposal adds insurance companies to the mix.

Starting in 2022 — people older than 55 and current Medicare beneficiaries would not be affected — beneficiaries would be asked to choose from a list of options, i.e., insurance plans. The plans would then receive a “Medicare premium-support payment” subsidized by the government and “adjusted” to the income of the Medicare beneficiary. Seniors would “shop” for the best plan.

Think Medicare Part D. That Bush-era law created the doughnut hole, prohibited the government from negotiating with drug companies and created yet another layer of insurance company paperwork between patient and doctor. (The new health plan signed last year by President Barack Obama will close the doughnut hole by 2020.)

The current House budget bill also states that it “offers future beneficiaries the same kind of health care options now enjoyed by members of Congress.” But there’s a major difference: The subsidies to federal employees keep up with rising health care costs. For America’s seniors, the House proposal contains no such protections.

Nobody denies the challenges facing Medicare as baby boomers hit 65 and the rest of the American population continues to age. The cost of health care in the United States — 16 percent of gross national product — is higher than in any other industrialized nation, according to Reuters. And it keeps rising.

But is Medicare the culprit? Analysts point to skyrocketing drug costs, overtreating and overscreening, but the politicians fault Medicare.

“The open-ended, blank-check nature of the Medicare subsidy drives health care inflation at an astonishing pace, threatens the solvency of this critical program, and creates inexcusable levels of waste in the system,” Ryan wrote. Not a peep about administrative or drug costs.

Asked to comment on the Ryan plan in a telephone interview, Elizabeth McNeil, of the California Medical Association, said the association is concerned about the plan, which she said would put all seniors into managed care.

“We support managed care. Some places do an excellent job. It can be a good thing, but for-profit health plans take 20 percent off the top and turn it into profit,” McNeil said. “That is taxpayer money that is not going into health care, but into private companies for profit. That is not saving money for Medicare or keeping costs down.”

That makes sense to me. And it brings to mind another saying that’s relevant here: “If it ain’t broke, don’t fix it.”

To read the House Republican’s proposal, go to

“Messing with Medicare” by Joan Aragone was originally published on for the San Mateo County Times

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