Thursday, September 3, 2009

Medicare: Supersize it, keep it, or dump it?

Is it time to supersize it, keep it just the way it is, or dump the medicare program? I've argued that I think we should move to a single payer program similar to medicare. To achieve universal coverage we could start by lowering the medicare enrollment age from 65 to 55. In two or three years we should lower it again to 45 then later to 35, etc., you get the idea. In ten years we could have everyone covered. During that time, we would have to spend our energy and brainpower to lowering the costs of running the program. I like the idea of a bi-partisan commission directed to look at ways of making the program streamlined, correcting instances of waste, and generally finding ways to save money. This commission findings would then be presented to the congress to vote either up or down on the cost saving proposals. No cloture, no amendments, just up or down. This could be done perhaps every two years.

Additionally, most people have heard that medicare cannot sustain today's costs without increasing revenue into the system. Adding everyone in the country isn't by itself going to lower those costs right away, or raise revenue. Now, a portion of your payroll taxes are taken out to pay for medicare for our seniors. I propose dropping those taxes. (Tax cut!) One way to increase the revenues taken in for medicare would be for people to be required to "buy medicare." Just like today when part of your salary is taken out to pay the premiums for health care for private insurance companies, that would go into the medicare fund to pay for it. Everyone needs to buy in. Younger, healthier people who would use the system less would subsidize the elderly who could still get their free, or almost free medicare. (Can't take away a benefit!) The poorest of us, who could not buy insurance under any plan would also have to be subsidized. Eliminate medicaid. (Cut a government program!)

What some people may not be aware of is that on a cost basis medicare has far lower administrative costs than private insurance. Keep in mind that polls show that medicare and the VA system generally have higher approval rates than private insurance. Currently medicare has approximately 5-6% administrative costs. It is a government run program and as such, there is no profit built into this percentage. Private run insurance plans have an approximate 25-30% administrative and profit cost.

The question is "What does your private insurance plan do for you?" From what I can see, they market their plan, get you to join, collect your premiums, and then disburse those premiums to doctors and hospitals minus their administrative and profit costs. They also decide who gets what operation and who gets dropped from the plan. Currently, they do come between you and your doctor thousands of times a day. If we could eliminate the approximate 15-20% profits, maybe medicare could afford to pay doctors and hospitals a bit more. I don't see the value in having a middle man take profits out of our premiums before they are paid out. To be sure, for profit insurance companies are rightfully so out for one thing: to increase dividends and shareholder value for their investors. There's nothing wrong with that but with health care seeming to bankrupt the country, we don't have to follow this path. So my proposal is to supersize it.

There are others who want to keep medicare the way it is. They believe that we should have a public option or co-ops that would either add a new bureaucracy to our government in the form of a public insurance utility, or a co-op of groups getting together to negotiate better prices from drug manufacturers, hospitals, and doctors. I think there are some merits to these plans but they fall short of the goal of coverage to everybody and cutting costs substantially. Theoretically, who would have more leverage negotiating prices for health care than a medicare program with 310 million people? You may remember that when the Bush administration passed the prescription drug benefit for seniors there was a debate about allowing the government to negotiate with drug manufacturers for lower prices, and even talk about importing drugs from Canada where they pay less for some reason. What a horrible slap in the face to the American people that was. There are rumors today that President Obama has done the same thing for savings of $80-100 billion. If true, his is an even bigger slap in the face because he is the president who has run on reform.

Lastly I bring up the "dump it" option. If you've been paying attention to the town hall meetings this summer, you will know that many of the concerned citizens attending these meetings have been seniors. Seniors tend to vote regularly, therefore politicians pay attention. Polls indicate that seniors are the least likely to favor health care reform. They really don't want to change anything. We've seen video with them saying "health care reform is socialism", "Obamacare will ruin us", "the government is taking over society in the worst way I've seen in my whole life". But of course the kicker to all this is "But DON'T TAKE AWAY MY MEDICARE". They have been lied to by the death panel movement, the birthers movement, almost every republican (save Olympia Snowe), and the main steam media. It's reminiscent of the Harry & Louise commercials during the Clinton administration and the swiftboats for veterans commercials during the Kerry campaign. Free speech allows you to lie about something even to get something else accomplished (stopping health care reform) but it's up to the news media to report the truth. In the end if seniors can't see that health care reform as something good for the country and they don't like socialized medicine, then they really should not have medicare and should voluntarily not use it, or dump it as I say.

Finally, I don't see how this Judeo-Christian founded country of ours doesn't see the humanity or the morality in all of this. As a young Christian, I was taught in church that Jesus fed the poor, that he clothed them, that the stairway to heaven was paved not by those who spent the most, but by those who did good deeds for their fellow man (society). Do no good Christians think it is morally wrong to let people go bankrupt in this country because they cannot pay their medical bills, or worse yet, to let people die because they could not get treatment for their illness or their insurance company would not approve their claim?

Speak up! For if we do not address this now, in ten years it will be far, far worse and the scenario of seniors losing their medicare through the reality of not being able to pay for it will not be a dream but will come true. Change is hard for all of us. We need to be able to give a little to get a little. To be clear, I believe universal health care is a right, not a privilege in our rich country.

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