Left-leaning groups and liberal lawmakers say that combining Medicare’s doctor and hospital coverage would saddle beneficiaries with higher costs. The idea has attracted support from leading Republicans, and given Obama’s receptiveness, the policy could receive significant attention in the next round of deficit-reduction talks.
Medicare was designed 50 years ago, based on the standard private plans in vogue at the time. That is the origin of deductibles, 80% coverage (20% out of pocket co-pay), and separate schedules for hospital and office visits. That is why there was a need to allow Medicare supplemental policies, to cover these gaps in coverage. That is why there was a need for allowing Medicare Part D policies to pay for medicines, even with its idiotic “doughnut hole.”
So it is good that people raise questions about making the system more cost-effective. At some point you need to dismantle a Rube Goldberg contraption and replace it with a simpler design.
At the same time you have to consider how conditions have changed since 1933 and 1965. Social Security went from being a program to supplement other retirement income to being the primary or only source of income for the vast majority of retirees. Doctors are being driven from private practice into salaried employment by hospitals, clinics and corporations. The increasing use of the VA-Kaiser-HMO model broke the bond between the patient and his family doctor. And the emergency room became the primary care clinic, as a patient could not time his illnesses to fit his doctor’s schedule.
So to argue over whether Medicare beneficiaries will pay more or less under the present or a reformed system reduces to a useless question about which pocket the money will come from, because as far as the government is concerned in all cases it comes the same one place. Even when retirees are double-dipping by getting a pension from some kind of government service, the money still comes from the same one place, just a different line item on the ledger.
From the average retired patient’s point of view, you have to consider that Medicare Part A and B already costs $105 per month. It already goes up every year, as the government implicitly admits it is still driving inflation with its irresponsible fiscal and monetary policies. Depending on the insurer and the policy you select, a Medicare supplemental policy can easily cost well over $200 a month, and Part D can easily exceed $100 — plus co-pays and deductibles.
That’s already $400+ from the average monthly Social Security benefit payment of $1200. It leaves $800 for food, housing, etc. So it is understandable why many people choose to be penny wise and pound foolish, forsaking full coverage. Sometimes you also have to service and repair your car, if you have one. Sometimes you just might want to eat.
At the same time, everybody is ignoring fundamental market forces that assert themselves under any system or theory of economics, whether free market, regulated monopolies or all-out communism. Here we have a system with a rising demand and a guaranteed payer that is none other than the government with its power to tax — and we wonder why costs are going up and up and up. Every year the system cuts payments for services, thereby driving more and more providers out of business — and we wonder why costs are going up and up and up. The system imposes huge and hugely expensive record keeping requirements, then further imposes electronic record keeping that converts doctors to typists and computer operators, and changes their job function from talking to and healing patients to poking at a keyboard and correcting persistent errors in the database — and we wonder why the availability and quality of service is going down and down and down.
It takes the arrogance and closed minded power madness of a politician not to understand this.
So let me spell it out.
The government has made a commitment to the elderly since 1933 to help with their pension and since 1965 to help with their medical care. The government shall keep that promise in full to CURRENT retirees.
At the same time it is obvious that the system as currently operated is not sustainable. Therefore reforms shall effect a gradual transition to solutions more compatible with the FREE MARKET :
Current workers must be allowed and seriously incentivized to SAVE for their own retirement benefits and health care needs. That means no limit on how much is set aside, tax free, from each paycheck — with forced deductions, if necessary, the amount to be prorated for age and income.
It will be the saver’s choice, without the government’s “advice,” regulation or other interference, how this money is invested and managed.
The government guarantees for retirement and medical payments to a particular beneficiary shall be prorated according to the age, with higher amounts for workers close to retirement age and decreasing amounts for younger workers. The goal is to ramp down the government’s guarantees to ZERO (for people just entering the workforce, just entering school, about to be born, whatever), leaving in place only the minimum provisions necessary for a safety net for the catastrophically unfortunate.
This isn’t rocket science. But anything less than this will only guarantee that we will go the way of the USSR or Greece, collapsing under the weight of economically unbearable commitments made in the name of economically unsound and poisonous marxist theory.
If THAT is the goal of some of our current leaders and politicians, they should be man enough to say so (oh, wait, Alinsky and Cloward-Pliven already did…) so we can do something about it, before it’s too late; we already blew FOUR chances, in 2006, 2008, 2010 and 2012.
TEA Party, TEA Party, wherefore art thou, TEA Party…?