The GOP has a proposal to end Medicare

The stupid[est] wing of the already crazy Republican Party, composed in the Senate of people like Rand Paul (Ill), Jim DeMint (S.C.), Mike Lee (Utah) and others, has predictably come up with this cycle’s most expensive, dishonest, unfair and politically suicidal proposal to end and replace Medicare.

I don’t mean just “end Medicare as we know it,” so pay attention, Politifact.   They mean to flat out kill it, stone cold dead, starting in 2014.   And the craziest part of their proposal is they want to replace it with . . . an individual mandate forcing all Seniors to purchase private health insurance, with government subsidies that become less sufficient over time while health care costs rise.

I can hardly wait for the GOP leadership and Presidential candidates, not to mention President Obama and the Democrats, to figure out how to attack this.

From The Hill:

The “Congressional Health Care for Seniors Act” would allow seniors to choose from the array of plans currently offered to the four million federal employees and their dependents in the Federal Employee Health Benefit program, starting in 2014. It would also gradually increase the eligibility age for Medicare from 65 to 70 over a 20-year period.

The bill was introduced Thursday by Sen. Rand Paul (R-Ky.). South Carolina Sens. Lindsey Graham and Jim DeMint are co-sponsors, along with Sen. Mike Lee (R-Utah).

How did Sen. Lindsey Graham get in on this?  Why, he’s there to lend gravitas and to set the record for most misrepresentations packed into a single statement:

“Our goal is to [1]save Medicare from bankruptcy and ensure seniors have [2] affordable, [3]high-quality health care — a crisis President Obama has [4]only made worse during his time in office,” Graham said. “Allowing seniors access to the Federal Employee Health Benefit (FEHB) program, which members of Congress and federal employees use, will give them [5]more choices and [6]lower their out-of-pocket costs.”

Each of the items marked [ ] is essentially false or misleading, so Lindsey gets six points for dishonesty in just two sentences.   But never mind that.  Think about what they’re proposing and compare that to the structure of the Affordable Care Act.

In essence, every Senior would be required to purchase private health insurance from a list of policies defined and approved by the government, and if they can find the choices on a web page then  . . .voila!  we have an exchange!   The individual mandate would apply to everyone at age 65 (moving to 70 in a few years).  The government wouldn’t ensure you can afford necessary and sufficient health care; it would merely cover, for now, an average of 75% of your premiums for whatever the policy covers.   So as health care costs rose, so would your contributions to the premiums and non-covered care.  And how would anyone control costs?  They wouldn’t, because the Advisory Board set up in the ACA to ferret out lower costs and other means to control provider payments would be gone.  You’re on your own in a dysfunctional market.

But you wouldn’t know this from the talking points the GOP Senators used:

According to a synopsis from Paul’s office, the bill would:

• slash the deficit by $1 trillion over the first 10 years and reduce Medicare’s 75-year unfunded obligation by almost $16 trillion;

• offer seniors “richer benefits, higher quality health care, and better access to doctors and providers” while cutting their premiums to $1,900 per year — less than the $3,500 seniors currently pay for Medicare benefits and supplemental insurance, or Medigap;

• charge seniors the same premium regardless of their health status or pre-existing conditions;

Translation: Since there’s no mechanism by which the proposal could reduce actual health care costs, a $1 trillion reduction in deficits over 10 years means that the proposal shifts $1 trillion actual costs to seniors.   That also means that the claimed cut in premiums is a shell game.  You can’t reduce total premiums while shifting a $1 trillion in costs, let alone $16 trillion.  And the rule that insurers cover all comers regardless of health and pre-existing conditions is a clue we’re dealing with the same mandatory purchase model embedded in the ACA.

The WaPo’s Dana Milbanks captures the wonderful irony:

At Thursday’s news conference, Jonathan Weisman of the New York Times pointed out that the lawmakers were proposing to do with Medicare almost exactly what President Obama’s reforms do for non-retirees: Direct them into private insurance with a subsidy for those who need it most.

Paul was flummoxed. “Uh, anybody want to comment on that?” he asked, producing laughter in the Senate TV studio.

Yes, the clowns are always hilarious, as long as no one takes them seriously.  But this isn’t the circus and these people are Senators. It won’t take much more craziness for the clowns to be in charge of running the place, as they already do in the GOP-controlled House and the GOP side of the Senate.

So once again, Obama/Democrats, how are you going to explain why this is nuts?   Don’t say we didn’t warn you.

(photo: HowardLake)

New York Times reporter Robert Pear and his editors try to resurrect a zombie proposal by the anti-Medicare zealots to displace the guaranteed benefits structure of Medicare.  Its just another attempt to push Paul Ryan’s voucher system that would systematically reduce benefits and shift rising health care costs to individuals, despite the fact this flawed approach has been repeatedly rejected by Congress and opposed by the vast majorities of Americans who want to preserve, not undermine, Medicare.

Worse, Mr. Pear tells us that “some Democrats” all nameless, support this approach for which the failed Super Committee has “built the case.”

Though it reached no agreement, the special Congressional committee on deficit reduction built a case for major structural changes in Medicare that would limit the government’s open-ended financial commitment to the program, lawmakers and health policy experts say.

Members of both parties told the panel that Medicare should offer a fixed amount of money to each beneficiary to buy coverage from competing private plans, whose costs and benefits would be tightly regulated by the government.

Pear tells us what we already know, that the GOP loves this idea — they’ve always wanted to dismantle a successful national health care system –and that it’s been endorsed by Newt Gingrich and Mitt Romney.  Now there’s a validation.

So which Democrats are signing on to this pernicious GOP scheme?  Pear doesn’t cite a single Democrat by name, unless you count Barack Obama and his embrace of a similar system for non-seniors in the Affordable Care Act.  Would it be too much trouble to identity these Democrats by name so that voters can confront them when they go home?

So what’s the “case” the Super Committee “built” in support of this scheme?  Pear does a bait and switch:

Competition among private insurers has already driven down costs for prescription drug coverage under Medicare. Medicare’s drug benefit is delivered entirely by private insurers. In addition, one-fourth of the 48 million Medicare beneficiaries are in private Medicare Advantage plans, offered by companies like UnitedHealth and Humana, which cover a wide range of doctors’ services and hospital care.

It’s apparently too much trouble for the Times to inform its readers that there’s little if any evidence that “competition” has “driven down costs” of drugs for Medicare.  What we know is that the drug costs under Medicare were less than some feared, but they remain significantly higher than drug costs in other advanced nations.  They’re also higher than the drug costs faced by the more effective Veterans Administration, a highly rated, totally federally operated system with no private insurers “competing.”

As Dean Baker and others have repeatedly reminded us, the VA pays substantially less for exactly the same drugs — partly because the VA can bargain for price, but Medicare can’t (thanks to GOP and conservaDem coddling of drugsters and private insurers) — and the VA offers health care even more highly regarded than regular Medicare.  Never mind the subsidies the drug companies get from extended patents and non-compete agreements against generics, all ratified or made worse in the ACA.

To be sure, the Medicare drug benefit has been a boon to seniors, but part of the higher price we pay for its expensive private structure is to create and perpetuate a private insurance bailout scheme that becomes self perpetuating.  The drugsters and their private insurance supporters are some of the largest contributors to politicians’ campaigns.  The 99% are paying for a protection racket for the 1%.

As for evidence that competition among private insurers will drive down general health care costs, where’s the evidence?  Aside from the fact that, as Krugman (citing Ken Arrow) tells us, health insurance is not amenable to market competition, the evidence the Times/Pear cites is that lots of seniors sign on to private insurance under Medicare Advantage.  But Pear neglects to mention that the private insurers under Medicare Advantage survived and grew by receiving an average of 14 percent subsidy paid by Medicare.  When the ACA proposed to reduce that subsidy the private insurers squealed, telling seniors in scary tv commercials that Congress was taking away their Medicare.

So the single piece of evidence Pear cites doesn’t show that this scheme will reduce the federal budget, if that is the problem that needs solving; it will instead likely increase the budget costs unless the government simply limits the vouchers as costs rise and shifts those rising costs onto seniors.

It’s inexcusable that the Times cites mainly private health industry analysts and the GOP’s Jeb Hensarling (R. Texas).  Pear also sites budget hysteric Alice Rivlin, who can’t seem to grasp that the only way this “helps” the budget is by forcing seniors to pay more or make do with less health care, while actually making the health cost problem worse.  Dean Baker notes the CBO has already done the math:

The Congressional Budget Official projected that a Republican plan along these lines, that was approved by House earlier in this year, would raise the cost of Medicare equivalent polices by $34 trillion over the program’s 75-year planning horizon. While this plan would save the government money by reducing its payments for Medicare, it would mean that future generations of workers would pay far more for health care in their retirement. The cost of Medicare equivalent policies would far exceed the typical retiree’s income by 2050.

The Times couldn’t find a single supporter of maintaining Medicare’s guaranteed benefit structure, to point out how dependent many seniors are on Medicare and how that and other guaranteed federal support keeps millions out of poverty.

Nor could it find a prominent economist to explain that its not the aging population or Medicare per se that is causing the real problem.  The real problem is the rapidly rising costs of the private health care system.  If we fail to bring our private health care costs more in line with the costs paid by other nations for equal or better care, it’s the economy that tanks, not just Medicare for seniors.   Simply dumping seniors (or anyone else) into that over-priced system when we know that government-sponsored systems like Medicare and the VA consistently provide health care at a lower cost means that you don’t care about health care, don’t care about seniors and don’t care about the threat the private health care system is posing to the American economy.

More:

Paul Krugman on Paul Ryan’s flim flam budget plan.

I know, I jumped all over the media for paying so much attention to the clown car carrying the Tea-GOP Presidential wannabees. But really, when they routinely say things this mind-numblingly stupid, you have to ask, why are these people getting any serious attention? Why aren’t they universally and relentlessly ridiculed?

Today, newly announced wannabe, Rick Santorum used June 6, the anniversary of D-Day, in which thousands of people were killed, to explain that the reason the Allies stormed ashore at Normandy was to have the “freedom” not to receive adequate health care when they came home or got old. Here’s Santorum today, via TPM:

. . . Santorum said, what he and Paul Ryan want to do is “give people the resources to go out and choose for themselves choose what’s best for themselves.”

Unlike Obama, he continued, who is spitting in the face of those Americans who fought on D-Day, 67 years ago today. “Almost 60,000 average Americans had the courage to go out and charge those beaches on Normandy, to drop out of airplanes who knows where, and take on the battle for freedom,” Santorum said.

“Average Americans,” he added. “The very Americans that our government now, and this president, does not trust a to make decision on your health care plan. Those Americans risked everything so they could make that decision on their health care plan.”

Nevermind that Americans has voted repeatedly for two centuries for Congresses to provide government-backed health care for the nation’s veterans, and veterans freely choose it when given the choice.

No, according to Santorum’s “logic,” when the Democrats want to preserve the current framework of Medicare, in which those over the age of 65 can choose to be insured directly by Medicare or instead choose to have equivalent or greater coverage via private Medicare Advantage plans paid by Medicare, that is denying choice to these Americans.

But when Mr. Ryan”s plan to end Medicare limits the future elderly to a voucher that, according to the CBO, falls thousands of dollars short of the premiums needed to purchase Medicare-equivalent coverage from private insurers, and then tells them they have to purchase private insurance — and purchase only from private insurers without the choice of traditional and cheaper Medicare — then according to Santorum, that’s giving Americans the kind of freedom that thousands of Allied soldiers died to protect.

Between Sarah Palin having Paul Revere firing shots and ringing bells to warn the British that America would one day be full of very stupid politicians, and Rick Santorum telling us that denying choice and leaving health care unaffordable is why Americans died at Normandy, I fear it’s unlikely the history profession will survive the assault. Quick, everyone, memorize a history book!

Paul Krugman summed it up today:

Is it just me, or is there a remarkable absence of D-Day related stories in today’s news? Maybe editors are too busy saving Ryan’s privatization.

The inimitable Digby points us to another effort by Rep. Paul Ryan to misrepresent his deeply unpopular Medicare voucher plan. It’s not clear whether Ryan simply doesn’t understand his own proposal or is just a serial liar.

Digby links to coverage (and the video here) at Think Progress, which catches Ryan admitting that his plan requires a “mandate” but then claiming falsely that “[i]t literally would be like Medicare Advantage.”

Q: If Medicare becomes a voucher program, would you require seniors to purchase private insurance and if so isn’t that an individual mandate? If you will not require them to purchase insurance how do you propose to prevent a situation where the costs of uninsured seniors is very expensive and gets passed on to me as a private policy holder? [...]

RYAN: Its mandate works no different than how the current Medicare law works today, which is you just select from a wide range of different plans. It literally would be like Medicare Advantage…

Having shown that Ryan’s plan has a “mandate” for those who later reach 67 (yeah, he’d raise Medicare’s eligibility age, too) just as the Affordable Care Act does for those under 65, TP’s Igor Volsky then adds this:

All this tells us is that the mandate isn’t some horribly coercive policy aimed at usurping individual freedoms. Rather, it is a mechanism by which government attempts to encourage more individuals to purchase coverage and expand the size of the health care risk pool, thus spreading the costs and risks of insurance across a larger population (and bringing down health care costs). It’s simply asking able individuals to take personal responsibility for their health care expenses and it’s something Republicans have supported in the past and (apparently) still favor.

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Now that FDL’s Jon Walker has done the deliciously dirty work of exposing Paul Ryan’s anti-Medicare proposal to force America’s seniors to accept the same flawed mandate and voucher system as ObamaCare, I can’t wait to hear Mitt Romney explain why he thinks this is a terrific idea.

As Jon so subtly hints, a pig is a pig, even if it has Mitt Romney’s lipstick on it. For the affected groups, the basic outline of RomneyCare is the same as the basic outline of ObamaCare is the same as the basic outline of StupidRyanCare. Let’s review the features:

1. Force everyone in the affected group to purchase private health insurance. We’ll call that a “mandate.”

2. Require the private insurers to accept all eligible customers but do little to prevent them from discouraging/screening out sick people via poor service and marketing. Call this “the business plan.”

3. Deprive the customers of any lower-cost public alternatives, like Medicare for all, a public option, etc. Call that “choice” or “keeping the insurers honest.”

4. Allow insurance companies to become so concentrated that in 80-90 percent of the country, only one or two mega insurers control the local market and set prices, while providing minimal oversight to ensure quality of service. Allow the antitrust, anti-price fixing regulators to wither. Call that “free market competition.”

5. Require the affected group to select between this one or two insurers on an “exchange” website that allows them to find the websites for the few eligible private insurance plans. We call this, “using teh Google.”

6. Having stripped consumers of the ability to bargain collectively (via Medicare, a union, an employer) for better, cheaper, more honest private insurance, send individual consumers, including the sick and the elderly, out on their own to “bargain” with the insurance giants. Call this, “leveling the playing field.”

7. Minimize or neglect obvious efforts to rein in the costs of private health care providers, including hospitals, specialist cartels, and big PhRMA, who are allowed to merge and concentrate. Let them be shielded by too-long patents and non-compete agreements and exempt from market or regulatory cost controls or antitrust pressure. Then allow them to fix the prices that private insurers must cover and pass on to their captive customers, plus the insurers’ higher but hard-to-audit administrative costs and profits. Do “homes of the rich and famous” shows on the execs. Call this, “the invisible growing hand in your wallet.”

8. Collect payroll taxes and other revenues via government mandate to help subsidize premiums — we’ll call this “premium assistance” — but provide no mechanism to ensure that the assistance keeps up with rising care costs to make the premiums affordable. If you’re Ryan, make sure it doesn’t keep up (See Dean Baker and CBO on how this screws Seniors). Call that “fixing the budget by shifting the costs to vulnerable people on fixed incomes.”

9. Wait to see how many people die from this stupid system. Call that “fiscal responsibility” or just “evil.” (Note similarity to Wi. Gov. Walker et ilk in shifting budget costs to workers as a means to strip workers’ economic leverage.)
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