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Paul Abrams

Paul Abrams

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Saving Medicare From "Private-izing" Ryan.

Posted: 04/16/11 12:49 PM ET

As this was being written, House Republicans passed the Ryan Budget, Medicare scam and all.

Here are some of the false and misleading claims in Ryan's Medicare Scheme:
1. It will save money for the government and for individuals.
2. Private insurance will provide coverage to all the elderly at reasonable prices.
3. It is the same plan members of Congress have, and it works for them.
4. If the plan is so great, why wait 10 years before imposing it?
5. The plan is good for young people.

False Claim #1. It will save money. "Private-izing" Ryan would have us believe that, because the government does not have the money to pay all future Medicare costs if healthcare costs keep rising at current rates, switching to private insurance will somehow pay for all needed healthcare. [Dirty little secret: the insurance companies do not have the money either].

But, unlike, say, Stealth Fighters that one can either build (spend money) or not (save money), people will become ill, at no greater or lesser a rate regardless of the system (assuming no prevention that the president has in the Affordable Care Act that Ryan would repeal). Thus, unless "private-izing" Ryan's stealth goal is to deliver less total healthcare (does one hear rationing?), shifting payments from taxes to private insurance premiums will not reduce total costs. If anything, as indicated in #2 below, total costs, and costs to all individuals, will rise. Whether one has a premium payment deducted monthly from one's bank account or as taxes from salary, the net free cash one has is the same (or, more likely, considerably less after premium payments).

Ryan's plan reduces over time the percentage of premium costs the vouchers pay. The individual pays the increasing difference between the voucher and the premium. The total is the same. [If "C" is the total premium cost, "A" the amount paid by the voucher, and "B" the amount paid by the individual, then A+B = C. As "C" rises with the increase in healthcare costs, and "A" rises by a lesser rate, "B" increases to make up the difference. Ryan has no mechanism to control "C" and deliberately holds down "A"; indeed, by repealing the Affordable Health Care Act that does have some mechanisms to control "C", the percent of our total national expenditure spent on healthcare rises without providing any better outcomes.

Savings from "private-izing" Ryan's plan do not exist.

With the pending retirement of 78 million baby-boomers, health care costs for the elderly as a percent of GDP will continue to rise no matter what is done, because more people will require health care. As the president reminded us, the choice made by the disastrous Bush administration to beggar the nation with tax cuts for the wealthy, as that retirement wave was soon to begin, was crazy and cruel. [Lesson: It matters if major policies are based on lies or lunacy].

In this decade and beyond, we will be paying for Bush's catastrophic policies, also based on false and misleading claims, and with Ryan as a willing accomplice. But, we should not be following Bush's accomplice into further folly, especially based upon further false and misleading claims.

False Claim #2. Private insurance will provide coverage to all the elderly at reasonable rates. "Private-izing" Ryan's plan to throw the elderly into the private insurance market with vouchers of declining value over time compared to premium costs assumes that there are insurance companies that will cover elderly patients who often have more than one chronic disease. Or, if the president's Affordable Health Care Act magically survived Ryan's axe and insurance companies could not deny coverage based on pre-existing illnesses, premiums for the elderly would either be stratospheric or, if age discrimination were also disallowed, the premium costs of everyone would skyrocket.

Today, Medicare covers ~98% of senior citizens. Among people under 65, private insurance today does not cover about 47 million people. That was one of the key reasons to enact the Affordable Care Act whose coverage provisions will be triggered in 2014 and still will only cover 30 of those 47 million.

What, then, is Ryan's basis for suggesting that all seniors will get insurance coverage from the same private market that today does not, and even with reforms, will not, cover all those under 65?

And, because there would be substantial doubt that one's parents will even receive coverage from private insurers, young couples will be faced with the same choices as they were pre-Medicare -- prepare for the crushing financial burden of paying for your parents' healthcare. Savings, what savings, Mr Ryan?

Imagine, moreover, the attraction to scam artists of people in their declining years having to select among a variety of plans -- assuming, of course, that any such plans were available in the first place, and assuming that millions of senior citizens will pour over competing plans and be able to choose the one best suited to themselves. Perhaps, Ryan would like to buy the bridge I am selling....

False Claim #3. Seniors can be certain this will work because it is the same plan members of Congress give themselves, and it works for them. The argument is that members of Congress have the same voucher system, and they make up the difference in premiums, so the elderly can too. Not only is that misleading (Congress, always looking out for themselves first, adjusts its vouchers upwards, not downwards over time), but members of Congress also give themselves fat $174,000 annual salaries, plus some juicy pensions. Perhaps I missed it, but I saw nothing in the Republican budget suggesting similar payments to seniors. If Republicans do intend to provide seniors the same annual salaries as members get, then this objection is withdrawn, with apologies for my oversight.

Misleading Claim #4. Question: if this plan is so desirable, why wait 10 years before switching to it? That is, why are they not including people 55 years old and above? Whenever they talk about the plan, they trip over themselves to remind the 55-and-older crowd, "don't worry, this will not impact you". If it is so wonderful, why do they not, instead, lament that it will not be instituted for 10 years, and pledge to do all they can to accelerate it?

If that is not a sure sign that the plan is a fraud, what is?

True, it might take a little time to implement any new plan properly, but a full decade? If this is so wonderful, wouldn't the Republicans sweep the presidency and both Houses by immediately implementing it, even if in stages, as the elderly, who vote in large numbers, flock to the polls to reward their benefactors?

Private-izing Ryan and his Republican fellow travelers know full well that both the current Medicare population, and those slated to relinquish the bonds of their private insurance within a decade, would have electoral bladder and bowel incontinence if they became subject to the Ryan plan. Thus, if they did propose to start implementation immediately, they would lose the 2012 elections in tsunami.

And so, this supposedly wonderful plan to care for seniors is put off to an age group that is not yet thinking with any immediacy about what healthcare will be like for them when they become senior citizens, and those who would think very concretely about it, because it is about to happen to them, are spared.

Clever. Diabolically clever, because it attempts subterfuge about one of the most critical public policy issues that will touch everyone's lives. What kind of person deliberately deceives and misleads hundreds of millions of people into accepting a fairy-tale for their future health coverage -- and would leave them powerless to do anything about it?

False Claim #5. "Private-izing" Ryan's plan is better for young people who otherwise might have to pay higher taxes to cover rising Medicare costs. Actually, Ryan's plan is even worse for young people than it is for their parents , and a disaster for entrepreneurship and jobs. Today, one does not have to worry about how one's parents will pay for medical care when they hit 65. Under "private-izing" Ryan's plan, there is no guarantee that one's parents will be able to get coverage at all, and so the costs of a parent's illness may wipe out not only the parents, but their children as well. Or, if they can get coverage, that their premium costs will be reasonable, and require support from their still working children. Or, that their children's own premiums will not rise even higher because there are now expensive elderly covered in one's insurance pool.

This is not to say that Medicare does not need to be improved to deliver better outcomes and reduce costs. It does, and there are many thoughtful ways to do that. For example, about 2/3 of Medicare's annual expenses are on 10% of the Medicare population. Improving the delivery of care to this discrete subset could save an enormous amount of money over time without decreasing benefits. For example, properly organizing health providers to this group can reduce hospitalizations by 25%. That is, the patients are better AND it costs Medicare much less.

If Paul Ryan (R-WI) were CEO of a publicly-traded corporation, his claims for privatizing Medicare would be subject to shareholders' lawsuits as fraud-on-the-market. If he were a drug manufacturer making the claims he does in a package insert about his Medicare prescription, he would go to jail. Fortunately for Mr. Ryan, members of Congress are not held to the same standards of truth as CEOs.

For your own good, for the good of generations of your family, and for the good of the nation.... Save Medicare from private-izing Ryan.

 
 
 
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Medicine13ear
Joy cometh in the morning.
10:12 AM on 04/26/2011
Why do they want to pull the plug on Gramma's Medicare?
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Paul Abrams
02:13 PM on 04/26/2011
to provide tax breaks to the wealthy.
12:29 PM on 04/23/2011
Everyone should be put on Medicare ... Adults and Children under age 18, the Elderly & All Members of Congress should as well as al Federal and State Employees. should be put on Medicare ..... 8% deduction from each paycheck with the exception of Congress who would pay 10% from each paycheck because they're overpaid and whine too much.. The wealthy would be required to pay 10& of their gross yearly income. Walmart would be required to pay 100% of it's employee' and family plan premiums. All Military Personnel & Families would be exempt while on active duty. Retired Military Personnel would pay 5% of their monthly income for a family plan. Disabled and Retired Persons would remain under the current plan. All categories offered Part D Drug Insurance for an additional 3% payroll deduction with the exception of Retired, Elderly and Disabled persons who pay $0.

Any person has the right to refuse coverage, however, without a Medicare or Medicare Prescription Drug Card they will be denied access to Emergency Rooms and Private Physicians Services as well as all Pharmacy Medications.
11:56 AM on 04/18/2011
Many people buy private insurance. If competition worked, then their insurance should be going down, not up. It isn't.
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Medicine13ear
Joy cometh in the morning.
10:14 AM on 04/26/2011
Ah, if only we lived in a land where logic and common sense had value.
05:43 PM on 04/17/2011
and yet another blogger suggested competition will lower the costs of procedures as it has cut the cost for Lasik surgery.
Your questions bring to mind,this other question. Wasn't it odd that Democrats refused flat out to impose upon themselves the same health care plan they forced on us.
Ryan is not being disingenuous and it is disingenuous to say he is. It was the Democrats who put 500 BILLION worth of cuts from Medicare and refused to recind the cuts with an amendment to the Healthcare bill. Now, they pretend to care.
11:52 AM on 04/18/2011
The $500 billion cuts were from subsidizing the Medicare Advantage plan. These plans which sometimes replace original Medicare were being reimbursed for something like 18% more on the Medicare part.

If you are in Medicare you can choose original Medicare, plus a supplemental that helps pay what Medicare doesn't and a drug plan separately.

All the supplementals and drug plans are by private insurance. The Advantage plan is by private insurance too. Our Medicare helps the companies pay for their costs, though. That could be good or bad.
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Paul Abrams
09:15 AM on 04/22/2011
The lasik surgery argument can only be made by someone who has absolutely no idea what they are talking about. Lasik surgery is a completely ELECTIVE procedure, and appears simple enough to be "shopped" in malls. (I, for one, would never have such procedure done on my eyes, by anyone...but, that's me, I'm only a physician).
So, you are having crushing chest pain--what are you going to do, tool around town until you find a sign for a place that "treats potential heart attacks at rock bottom prices"? Or, you develop cancer--again, what about "chemotherapy without side effects and lower costs" (because they only give you one-tenth of the dose you need).
The free market does not work for the entire economy. Just some parts. It also doesn't generate basic research.
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lasjazzman
Stress = perfectionist + lousy typist!
04:59 AM on 04/17/2011
Praise be!!!!!!!! Another voice of sanity! Thank you Mr. Abrams - not only one of the most well thought out and articulated refutations of the Tea Party infected GOP's insanity - but also best article title of the last several months!!! Bless you, sir!!!
01:43 AM on 04/17/2011
Starting this year your child (or children) cannot be denied coverage simply because they have a pre-existing health condition. If you don't have insurance for you and your children search "Penny Health Insurance" online they are the best.
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Paul Abrams
02:00 AM on 04/17/2011
Yes, because of the President's Affordable Care Act. But, Ryan wants to repeal that.
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Cleverboots
03:58 PM on 04/16/2011
Great Post Paul! We need more like this to expose Paul Ryan and his followers for the liars and frauds they are.
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Paul Abrams
02:07 AM on 04/17/2011
Thank you, I neglected to add that everyone (old, young, middle-aged) who needs kidney dialysis is covered by Medicare. If Ryan's plan were instituted, all these people would be left to try to find an insurance company that would cover their 3X weekly, or even daily-at-home, dialysis. That is, most of them would bankrupt themselves and their families very quickly and then, without coverage, would die.
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Cleverboots
01:16 PM on 04/17/2011
I'm quite familiar with dialysis as my Father-in-law was on it for 5 years before he died. This was in the 60's when they really had death panels. Dialysis was in it's infancy and was only available in a few hospitals. The bulk of treatment 2 days a week 10 hours per day-was done at home. My father-in-law had tp PROVE his life was worth saving because treatment facilities were so scarce. I guess we haven't progressed all that far after all if the Repubs get their way. Thanks for your response!
02:54 PM on 04/16/2011
People who support the Ryan plan are: private insurance companies, politicians working for the insurance companies, People who hate society and believe everyone should be left on their own or members of a vicious extreme capitalist religious cult that worship greed or in other words a modern day republican.
iridium53
Semper Fi
02:36 PM on 04/16/2011
Wisconsinites love him. They keep voting him in.

They want to throw their Mommas into the snow.

Ezek. 22:29,31. "The people of the land have practiced oppression and committed robbery, and they have wronged the poor and needy and have oppressed the sojourner without justice... Thus I have poured out My indignation on them; I have consumed them with the fire of My wrath; their way I have brought upon their heads," declares the Lord GOD.
11:59 AM on 04/18/2011
Republican leaders and Corporate Democrats twist the truth and people don't know they are voting for the devil's disciple.

Conrad and Warner are corporate democrats. DINOs Republicans.