Political philosophies are like beautiful roses, and when we fall in love with ideals and ideas we tend to imbue them with magic, while overlooking their less agreeable parts.
Republicans love the idea of a small government that gives people freedom to pursue their dreams without interference, believing that the free market can, almost magically, solve any problem. At the same time, Republicans tend to overlook the problems that markets create. It was from this dream that Republicans passed the budget written by Rep. Paul Ryan (R-WI) through the House of Representatives.
The Ryan Budget relies on spending cuts exclusively to achieve deficit reduction -- and in its most controversial and ultimately unpopular provision, it replaces the "Medicare as we know it" guarantee of health insurance for life with a voucher which future seniors can test for value in the free market.
We Democrats love Medicare and want to preserve it, but contrary to the view of our own experts, most of us believe almost magically, that it can be sustained without major changes. It is a core Democratic belief that government has an obligation to preserve the social safety net, and the right to affordable health care for seniors is our party's greatest achievement.
Many Democrats believe Medicare's problems are mostly manufactured by Republicans, and that by reversing the Bush tax cuts and taxing the wealthy, getting rid of subsidies for oil companies, and increasing spending on preventative medicine to keep patients out of emergency rooms, the money could be found to make the system whole.
Medicare is on an unsustainable path
The economics is straightforward and daunting: on average, Americans pay much less into the system during their working years than they use in benefits, mostly when they are old -- and Americans are moving in large numbers from the former category to the latter. The demographic shift and pace of medical cost inflation would be a problem demanding a solution even without the Bush tax cuts and two unpaid for wars.
The public wants more than it can afford
In some sense the politics of Medicare is quite simple. When it comes to Medicare and health care more broadly, the public knows what it wants: greater access to services at a lower cost. The public is particularly clear about what it does NOT want: any "cuts" in the Medicare services people (especially seniors who vote in higher numbers) believe they have already paid for, or payment increases for the costs they will pay in the future.
Preserving Medicare
Democrats can make a strong case that the starting point for reform should be provisions in the Affordable Care Act such as creation of the The Independent Payment Advisory Board. They are in a stronger position to appease the public with tweaks to Medicare in order to preserve it for future generations as compared to the Republicans who seek to dismantle the program altogether. Nevertheless, there are pitfalls ahead for anyone who tells the public that they must accept fewer services and more costs.
Armies of Politicians hurling stones from glass fortresses
This mismatch between what the public wants -- more healthcare for less money -- and what the public can afford -- less care and rising costs -- helps explain why efforts to reform health care, or more narrowly Medicare always garner increasing public opposition. We saw this in 1993 when the Democrats failed to pass "Hillary Care" and again in the 1996 election when Republicans took on Medicare reform and lost to charges they wanted the program to "wither on the vine." We saw this again when the Democrats laboriously passed "Obama Care" only to suffer heavy losses in the 2010 election, and again in 2011, when the Republicans passed a Congressional budget that would in the words of their opponents, "end Medicare as we know it."
Ryan's Budget Is Politically Toxic
Ryan's budget probably never had a chance of passing the Senate and then being signed by President Obama, but now it is so unpopular with the public that Republicans in the Senate, on the presidential trail, and even in the House that voted for it, are doing back-flips to create distance between themselves and the budget bill they just passed last month. And last night the deal was sealed when Democrat Kathy Hochul defeated Republican Jane Corwin and Tea Party candidate Jack Davis for a huge upset in a strongly Republican district, placing Republicans in full retreat on the issue.
Many Democrats, smelling blood, are calling on their party to show resolve in opposing any changes to Medicare until after the 2012 election. It is easy to understand sentiment here given the almost two year Republican "just say 'no'" policy on health reform and how shamelessly the Republicans distorted the Medicare issue in the last election. But when progressives call for a strategy of rejecting any progress for two years on one of the nation's most pressing problems just to maintain a campaign message, we risk getting too far bent out of shape toward tactics over our deeper principles.
We should be looking for real solutions not political points or magical answers. A real solution to the Medicare math problem is going to involve dealing with a lot of thorny issues, so whether you call it "Hillary Care," "wither on the vine," "Ryan Care," "ending Medicare as we know it", "Obama Care" or "Death Panels," decisions have to be made. Medicare is on an unsustainable path and it is as important that this simple fact is as well understood by those (mostly Democrats) who love Medicare and want to preserve it as by those (mostly Republicans) who have never liked Medicare and want to dismantle or replace it.
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Does It All Come Down to Medicare?
I pay into SS and Medicare on 100% of my income.
Rush, on the other hand? 10%?
Nope
5% ?
Nope
1% ?
Nope
1/2 a % ?
Nope
3/10 of a percent!
Me 100%
Rush .3%
Tell me how that's fair, please.
He didn't even let temporary tax cuts expire? What bill? How did he raise your taxes?
My taxes went *down*. Him not raising my taxes is part of my annoyance with him. We put multiple wars on the credit card instead of levying war taxes likes we should and the financing charges for this are killer. We need to pay this crap off ASAP. And he's been cutting taxes all over. extending temporary breaks, payroll tax holidays, credits for everything that moves ...
Oh, wait. Isn't that what Jesus did?
Part A 1965: will cost $9B in 25 years
Part A 1990: costs $67M
A/B 1967: will cost $12B in 23 years
A/B 1990: costs $110B
Home benefit 1988: will cost $4B in five years
Hb 1993: costs $10B
all amounts calculated for inflation
I'm glad they don't estimate for my company...we would be out of business
This statement is false. It should read, "If we do absolutely nothing to the present structure of Medicare, it will eventually run out of money, by most estimates, in 15 to 20 years."
And you're completely wrong when you claim "We Can't" correct course without radically reducing the quality and quantity of health care delivery to our seniors.
Take a look at The People's Budget. It specifies exactly what we need to do in order to not only sustain Medicare indefinitely, but also eliminate our national debt and virtually all future annual deficits.
Why didn't you really investigate the benefits of rolling back the Reagan and Bush tax giveways? That alone, by many estimates, would actually create a Medicare surplus, despite your fatuous denial.
Why didn't you mention ending the occupations of Iraq and Afghanistan? That alone is costing us roughly $500 million per day.
Why didn't you support requiring Medicare to negotiate drug prices with Big Pharma, like the Veterans Administration does? That alone would produce gargantuan savings for Medicare.
Why didn't you advocate a substantial reduction in the billions we pay to Pentagon contractors?
You see, you lack credibility when you insist that we accept this "Republican Lite" view of Medicare.
And when you ignore clearly defined alternatives, like The People's Budget, you don't have my confidence. You may sincerely mean well, but I don't think you've done your homework. Sorry. I'm not buying it.
Open Medicare to all and require employers to give employees the option to enroll in Medicare or the private plan they selected.
I'll opt into medicare.
The addition of young, healthy, people to medicare will reduce plan pay outs proportionate to plan enrollment and make it cheaper per person.
You're Welcome.
Also, it produces better outcomes for a fraction of the cost our system does so from where we are it is up.
David Cameron, the new CONSERVATIVE Prime Minister of the UK ran explicitly on the platform of increasing the amount of money to support the NHS. (Not "HHS", which just underscores your obvious ignorance.)
The NHS is widely popular in the UK. And Cameron is following through on his promises to INCREASE its budget.
It must really drive people like you bonkers to see so many examples of a state run, or state regulated, universal health care system. So much so that you have to make stuff up that has absolutely no basis in fact.
I know that you and your fellow right-wingers would LOVE to believe that all of the countries that have universal health care are switching over to a private, for-profit system like we have in the US. But wishing it were so isn't the same as reality.
And speaking of reality, we gave you a good shot of it on Tuesday night. And more is coming. Just watch...
We've been avoiding the bullet, and playing raw politics with the many solutions for few decades; in the process racking up massive debt - govt, corporate, personal.
No amount of raising revenues (taxes) reduces amount spent on healthcare.
Compared to other countries, the biggest DRIVERS OF EXCESS healthcare cost:
1. End-of-life care by highly-skilled, highly-paid workers in high-tech, costly hospitals.
2. Using high-tech round-the-clock manned ER as first-line of medical care.
3. Treating preventable illness arising from obesity, smoking, lack of exercise, etc.
4. Lack of proper care for early stage illnesses.
5. 40% of over and inappropriate treatment, delivered for a variety of reasons.
6. Management of medical complications.
7. Private corporations 20% - 30% profit margin.
I have qualms that Single Payer is a silver bullet. We have single-payer in public education; which doesn't make a profit. Yet education is neither cheap; nor are we proud of their overall quality and achievements.
Unfortunately any budget-cuts to left-wingers is bad. Their only option is raise revenues; which we have to do! To cut budget piece-meal in every department is fighting every selfish vested interest.
Other option is "stave the beast" and let vested interest determine through science and practicality how to be more efficient and cost-effective.
No we don't have anything close to "single payer" in our system of education. You apparently don't understand either single payer health care, nor how our public schools, and our state colleges and universities are funded. Do you?
If you think that kids in Scarsdale and Newton and Greenwich get the same amount of funding for their schools as the kids in Brownsville, East St. Louis, or Camden, just because they're all American citizens, you're sadly mistaken.
Read Jonathan Kozol and other educational experts before you spew out any more bizarre and laughable "analogies" between universal medical care and the convoluted mish mosh that is our system of funding education in America.
The assumptions are things that you have to have for the free market approach to work. If you don't have them, then it won't work.
Fully Informed consumers? Hah! Doctors train for years and they can't explain why some people respond differently to a given treatment than others.
Low/no barriers to entry? Nope! Piles of debt and years of training to enter medicine. And a medical guild that uses control of the number of medical colleges and the availability of residencies/accreditation to ensure a constant shortage of providers.
No participant with market power to set prices? Um, Emergency Rooms anyone? And its not much better in the general offices as many towns only have one provider.
Equal access to technologies? Puhlease. If we got rid of private insurers and the provider networks this would be better. But the local monopolies and one-price-for-them-another-for-you is absurd.
Pretty much everything free market economics need to work just doesn't apply to medicine. Trying to use the free market approach for this problem is like trying to pick up a piece of plastic with a magnet. Yes I know it picks up iron things really well *but this isn't iron so it doesn't work*.
Ever hear of monopolies, son? Tell me which industries aren't dominated by a handful of colluding firms and then we can have a discussion about real "competition".
And if you think this hoary cliche about "competition" being the "answer" to our need for universal, affordable health care, I DON'T want whatever you've been smoking!
http://conversations.psu.edu/docs/calkins_comparison.pdf
And why is it the ONLY country with any uninsured? 47 million?
That link will take you to Clinton talking to Ryan about Medicare.
As time goes on, more and more of the boomers will be retired and have lots of time to keep an eye on Medicare and Social Securtiy. I don't think our leaders are prepared for the intensity.
You never hear any of the politicians say to raise Social Security taxes or tax a surcharge to those who sent jobs overseas. They never talk of controlling prescription prices with bidding and contracts.
It is like everything else. Cut taxes, bomb another country, send more jobs overseas and trickle down.
We pay double for our medical care than other countries and are way down on the list of living longer and healthier.