The issue I wish to discuss is a sub-issue within the overall context of the budget plan proposed (and voted on by the House as a whole) by Representative Paul Ryan, and that is Medicare “reform”. There are a number of concerns about Mr. Ryan's "budget" but Medicare has received the most attention and for good reason: his plan would totally revamp the program into something unrecognizable to today's Medicare recipients.
Today's recipients participate in a "single-payer system" in which bills are submitted to one organization (in this case, the federal government), and bills are paid from that single source. Participants, contrary to what you might have heard, do pay premiums to participate, although compared with other insurance policies, these premiums are relatively low. Mr. Ryan's plan would abolish that single-payer system and replace it with--and you can take your pick of terms--either a "premium-support system" or a "voucher" system. I myself prefer the "voucher" term because Mr. Ryan's plan does nothing to contain costs but instead shifts the costs from the government to the individual. He would start with a base voucher of $15,000/year and the senior citizen would then take that voucher and shop for their own insurance on the private market. There are any number of concerns about this: among other things, the CBO (Congressional Budget Office--the non-partisan arm of Congress that provides costs to legislatures on any proposed legislation) has estimated the average senior citizen would pay an addition $6,000/year for the same amount of coverage they now get under the traditional Medicare. That may sound good--until you realize the same CBO states the average senior citizen's income is around $20,000/year.
To keep this short, what follows is a letter I wrote to my Congressional delegation (all Republican, I might add) detailing just two of the issues I have with this proposal. One has received a great deal of national attention, the other hasn't been mentioned at all, so far as I can tell.
I have a number of questions I would like answered before I decide either way whether to support Rep. Ryan’s plan or not. (My mind is still open, although I’m a bit skeptical Mr. Ryan’s plan will achieve what it sets out to do.)
First item: I know of no business model that says private insurance companies can make a profit from insuring older Americans, especially when those same Americans are likely to have a number of pre-existing conditions. There is a reason we have Medicare after all: pre-1964, our seniors were doing without health care because they couldn’t find affordable health care insurance and, as a result, were dying prematurely—or suffering needlessly. (Go check out the history if you don’t want to take my word for it.) Unless there’s a clause for declaring “pre-existing conditions” as illegal for denying coverage, I can’t see any insurance company willing to insure seniors who are likely to have long-term conditions like Parkinson’s disease, dementia, etc. If pre-existing conditions are illegal under the Ryan plan, unless you have an “individual mandate”, how can any insurance company make a profit helping to pay for the medical expenses incurred without raising premiums to the point of unaffordability/unavailability??. Somebody, anybody, please explain how a private insurance company would make a profit off people with Parkinson’s disease, Diabetes Type II, etc..
Second item: nobody, but nobody, is discussing this so far as I know, but it’s an important issue, and that’s one of confusion. I have known people who have been afflicted with dementia, or have had strokes, which results in ultimately a total disconnect from reality. Is there anything in Mr. Ryan’s plan which designates who makes those choices for such people, especially when there might not be family around to look out for the senior’s best interests?? I don’t trust insurance companies, whose primary reason for existence is to make a profit for shareholders---not to care for individuals in their sunset years. So far as I can tell, this presents an inherent “conflict of interest”. (By the way, there’s nothing wrong with insurance companies making a profit—it’s the rather obscene 20-40% profit rates that are outrageous. I’m old enough to remember when a 10% profit was considered very good.) How does Mr. Ryan’s plan resolve such an apparent conflict?? Is there any guidance whatsoever in Mr. Ryan’s plan that gives consumers or their respective caregivers some framework in which to choose One of the “joys” about Medicare: most seniors, regardless of medical condition, appreciate is its relative simplicity. Most seniors don’t want to spend several hours contemplating legalese and complexity at a stage in life where simplicity is a priority, especially when you’re in your mid-eighties. There’s very little paperwork hassles in Medicare; just show your card and file the reports in the home filing system as they come in. That’s it: no claim forms to fill out, no bills to pay. (I don’t know if you have any familiarity with Medicare, but my 83-year-old Mom does pay a “premium” every month—and that’s it!!)
Third item:: the old 80-20 rule. 80% of work done in any given institution is done by 20% of the work force. There are obviously exceptions to that rule, but there’s a reason that’s considered a “rule”. In Medicare, 80% of Medicare’s major medical expenses are incurred by the sickest 20% of the senior population—and that’s usually in the last year of life. I have seen nothing in the discussion overall and over the past year, that addresses that little “problem”. Furthermore, I don’t have a solution, either. It’s an intractable problem so far as I can tell, and the best that can be done is to make judgment calls. I suppose approaching things from a financial standpoint is a logical place to start, but it’s a hell of a note, considering that we, as a society, place a great deal on the value of life itself.
I was appalled at the heated rhetoric involved in Mr. Obama’s “Affordable Health Care Act” and I refuse to indulge in such. It doesn’t do any good to indulge in such rhetoric in discussing Mr. Ryan’s plan, either. I couldn’t believe the “death panel” nonsense when, so far as I can tell, Mr. Obama tried to apply some sort of sensible solution to the “80-20” rule in his “Best Medical Practices” panel. I’m not sure, but I think he was addressing the feasibility of a hip replacement operation on someone in their 90’s, for example. My impression is Mr. Ryan is trying to “force Americans” to “grow up” about medical costs, which is a good thing and to be encouraged. But instead of trying to “revamp” the entire system—and scaring already frightened and angry people, while you’re at it—why not try more of an educational approach?? Why not go for the “quality of life”, not the “quantity of years” when someone reaches their eighties? To follow up on the previous example, Instead of a hip replacement surgery, why not suggest other solutions towards making the individual more comfortable under the circumstances??
There are other aspects of Mr. Ryan's "federal budget" that don't necessarily make a whole lot of sense either; however, it is Medicare which is receiving the most attention at the moment, aside from the "silliness" that happens occasionally. (Congress is, after all, made up of fallible human beings, something we should all remember.) These are serious issues and all of us need to be sober and thinking (as opposed to reacting and emoting, which is different from actual thinking) about these issues.
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