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The Burr/Coburn Medicare Plan: 10 Deceptions - and a Free-Market "Death Panel"

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There's a new "Medicare" proposal -- sorta. It's really the same old bait-and-switch we've seen a dozen times. Still, you gotta hand it to 'em: Republican Sens. Tom Coburn and Richard Burr have taken the usual right-wing think-tank-designed buzzwords, deceptive packaging, and sleights of hand to new heights.

These foundation-forged assaults on the middle class may be old, battered ideas that have been debunked a dozen times, but still they just won't die. Like the old Terminators, they keep coming back with the same mission: Must. Kill. Medicare.

Coburn and Burr don't even pretend to show how their anti-Medicare plan - excuse me, "choice" plan -- will save money. They just say this:

We do not yet have a concrete, specific amount of "savings" outlined, but we believe our proposal could save between $200 billion and $500 billion over a decade.

Well, I do not yet have a concrete, specific schedule, but I believe that "monkeys" will fly out of my butt any moment now, and that there will be somewhere between two hundred and eight hundred of these aeronautical primates by the time the process concludes.

Burr and Coburn want you to believe that they can raise the Medicare eligibility age, make you pay more in premiums, turn your health care over to the same insurers that are bankrupting you before you're sixty-five (if you're lucky enough to have insurance) -- and that somehow you'll save money!

Here are ten deceptions in the Coburn/Burr plan -- plus a bonus: your "Free-Market Death Panel" explained.

1. Privatizing Medicare will lower costs.

The record's already in, and it ain't pretty: Private health insurers offer less and charge more every year, and the profit motive is driving the US health system's costs through the roof.

Private health insurance's costs are roughly 22 percent higher than Medicare's, and are projected to grow even more quickly. That's why Coburn and Burr don't even pretend to offer an analysis of its impact.

Monkeys, start your engines.

Coburn and Burr would even eliminate the agency that's been created to manage provider payment costs, the Independent Payment Advisory Board (IPAB). They explain that move by saying -- well, see what you can make of their explanation:

We realize that the nonpartisan Congressional Budget Office has estimated the IPAB will reduce Medicare expenditures in the long run. However, we do not believe the IPAB is a tenable way to manage the Medicare program's spending growth. Instead, we believe that empowering seniors with more meaningful, transparent choices ...

Ever notice how, whenever it's time to get specific, conservatives suddenly start talking like pot-smoking psychotherapists from the 1970s?

... will go a long way towards achieving meaningful savings and putting Medicare spending on a more sustainable path over the long-term ...

To someone who is not a professional in the health financing field, that may sound like gibberish. Fortunately, I am a professional in the health financing field, and I know: the only way to decode a tangled, deadly, paragraph like this is very, very, carefully, like you're dismantling a bomb. So, after careful actuarial interpretation, some post-Derrida deconstruction, and by slowly disconnecting the red wire from the green wire, I was able to come up with a professional insurance underwriting assessment of that paragraph:

It is gibberish.

Do not attempt this at home.

2. It's "grown up" to propose dismantling Medicare.

This one must've tested great in the focus groups because the Peterson crowd keeps recycling it: Whenever they introduce an anti-middle class idea that is both harmful, unpopular, and destructive, they congratulate themselves for having a "grown-up" conversation. (See "For Adults Only.")

The idea is to make it look as if our social contract is a fantasy, that everyone else is too frightened to admit it, and they're the brave ones willing to tell the truth. It's not a fantasy -- but fixing it will require changing a uniquely greedy healthcare system that's driven by profits rather than health, and which therefore costs far more than any other in the world.

3. Proposals like theirs are about "choice."

Choice? No, they're about destroying Medicare. Why? Because Medicare's good for the public, but it's bad for profiteering health companies. The Coburn/Burr proposal would fragment Medicare's population and reduce its ability (that is, our ability as citizens) to use our leverage to get the best deals possible from drug companies and medical instrument manufacturers.

Subsidizing inefficient for-profit insurers isn't "offering choice." It's hosing the public and raiding the treasury.

Coburn and Burr write that "Our proposal preserves choice in the Medicare program, compared to the Patient Protection and Affordable Care Act which included reductions to Medicare Advantage plans so large that the Actuary of the program projects enrollment in MA plans will be cut in half by 2017."

Right. If you stop paying private, for-profit health insurers an extra 18 percent so they can still make money while being less efficient than Medicare, people won't want to join their plans anymore. Eliminating corporate welfare from the Medicare system is not reducing choice. It's eliminating corporate welfare. Let's do it now, please

As a former health insurance person, I know that private health insurers will immediately start "cherry-picking" Medicare enrollees, luring away the healthiest among them so that Medicare becomes financially unsustainable.

Once it's destroyed, they'll stick it to the rest of us even more -- and we'll have no "choice" but to take it.

4. "Under our proposal, seniors will have a new limit on their medical out-of-pocket costs."

Sounds good -- until you read the fine print (which is only a paragraph away from this statement), where it says that "the essence of premium support is that seniors all receive the same basic government contribution to choose a plan that meets their needs." But as we've seen with the Ryan plan, that will soon leave seniors paying $41,000 per year if they want Medicare-like coverage.

So although they say there will be a new limit on out of pocket costs, according to their own explanation there won't be any such thing. They even admit it elsewhere in their Q&A document: "The crucial cornerstone of our reform proposal is to move Medicare from a defined-benefit to a defined contribution by adopting a premium support model."

In other words, here's your Ryan voucher: You can use it to buy an ever-dwindling program administered by the government, or to buy an ever-dwindling one administered by private insurers. That's the opposite of "a new limit on their medical out-of-pocket costs."

It's not even Medicare.

5. Joe Lieberman and Alice Rivlin Don't Make a Proposal "Bipartisan"

And please, guys, stop throwing around the word "bipartisan"! First of all, the public doesn't care about your idea of "bipartisanship." That word's only a tool for self-congratulation Beltway insiders use when doing the bidding of their corporate and billionaire patrons -- and yes, that patronage truly can be "bipartisan."

Rivlin's been serving anti-government billionaire Pete Peterson for years. Peterson's the former Nixon Commerce Secretary who's been trying to cut Medicare and Social Security for twenty years.

And Lieberman is Lieberman.

Throwing Ron Wyden's name won't help either, after his embarrassing and shameful debacle with Paul Ryan late last year. They were so eager for content-free headlines that they tossed out a press release without even drafting a proposal!

So you found three registered Democrats willing to sign on to proposals that will keep the (contributions/media appearances/consulting work) flowing? Three swallows don't make a spring, as the old saying goes. (I think that's how it goes.)

Know what's really bipartisan? Not cutting Social Security or Medicare. Max Richtman offered the latest figures in an editorial for the Baltimore Sun: "94 percent of Democrats, 82 percent of independents and 64 percent of Republicans prefer raising taxes on the richest 2 percent of income earners rather than cutting benefits" for those programs.

I got yer bipartisanship right here, pal.

But since they're defying the public's wishes instead, it's no wonder they need to keep peddling that snake oil. Speaking of which:

6. Only "millionaires," who should pay more, will see an increase in costs.

"There currently are roughly 60,000 individual seniors on Medicare with annual incomes of $1 million or more," say Cobun and Burr, "but taxpayers are forced to continue to subsidize these super-wealthy seniors like they do higher-income earning seniors in Medicare."

So their plan would limit benefits for millionaires only, right? Just 60,000 people?

Well, no. They plan to cut benefits for people with much less money. How much less? When the conservative Concord Coalition first proposed this kind of means-testing for Social Security, they made the mistake of being honest about what kinds of "high earners" would see cuts: anybody with a lifetime earnings average above $20,000 per year.

If you want to make the "super-wealthy" pay their fair share, why wouldn't Coburn and Burr just raise their taxes? It's simpler, cheaper, and easier to administer. Oh, right -- it would actually work.

They can't say that of course. Their attempt to explain why they don't just tax millionaires led them to tell four outright lies, getting us to the round number of ten. (There are more, even in just their sketchy announcement materials, but we're running out of space).

7. "Individual payroll taxes only fund roughly 40 cents of every dollar in Medicare benefits. So merely increasing payroll taxes does not solve Medicare's significant funding shortfall for all beneficiaries."

True, but payroll taxes plus premiums fund 57 cents out of every dollar. When they start out playing games with you, it's not going anywhere good.

Here's a big part of the problem: Radical upward distribution of wealth to the 1 percent has been the primary cause of payroll tax shortfalls, causing revenue to fall from the intended 90 percent down to about 83 percent of total earnings in the US. Lifting the payroll tax cap altogether would mean that it was being collected on 100 percent of earnings in this country. That would bring current funding up to 65 cents on the dollar (using their 40 percent figure).

That's impressive -- and it's a lot more concrete than, "we do not yet have a concrete, specific amount of 'savings' outlined, but we believe ..."

8. "Because money is fungible, increasing payroll or others taxes does not mean that those taxes would actually will fund Medicare. In fact, there is no guarantee that Congress would use increased revenue to fund Medicare, instead of waste it on new bureaucratic programs."

Translation: We're hard at work trying to steal your Social Security money. Let's give your Medicare money to someone who can hold it for us so we can't steal that too. How about that guy over there in the shiny convertible?

9. "Depending on the type of tax envisioned, wealthier Americans who might be subject to a tax also are the ones who are most able to hire accountants to find loopholes, move around income, and reduce their tax liability."

Because that's how we write laws here in Washington, and we don't plan to change.

10. "Tax hikes can have a negative effect on economic growth."

But going broke -- or dying -- because you can't afford medical care doesn't have a negative effect on economic growth.

And now, as promised, here comes your bonus:

Free-Market Death Panel, Explained

Coburn and Burr write that "beneficiary premiums, rather than payroll taxes, are more likely to have an impact on helping curb overutilization. Therefore, increasing premiums for wealthier seniors is more likely to restrain overutilization than hiking their ... common sense Medicare reforms, like income-adjusted premiums ...will help ensure patients are seeking appropriate care."

Translation: Our plan's designed to make it unaffordable to get medical care, because that will reduce "overutilization" ... or as the rest of us like to think of it, "medical care."

Studies show that people do without needed care when they're put under financial pressure. Coburn/Burr will therefore prevent people from getting needed care But, you ask, don't doctors and other medical providers prescribe medical treatments? Don't they have more control over utilization than patients do? Right you are. And isn't it providers, rather than patients, who have a financial incentive to overtreat? Right again.

Then, you ask, why are Coburn and Burr squeezing patients? We don't know. And what are they planning to do about those provider incentives? Here's what: They're planning to eliminate the Board that was created to improve them.

Before people had Medicare, you correctly note, mortality rates for seniors were 13 percent higher. That was because they couldn't afford care -- excuse me, I mean, because they didn't "overutilize." Won't death rates go up again if this bill becomes law?

Ladies and gentlemen, you've just met the real Death Panel. Its members are Greed, Deregulation, and Corporate Politics. You've known the members of that panel for a long, long time. Sure, politicians like Coburn and Burr can dress them up, but you'd recognize those death's-head grins anywhere.

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