Medicare

Here’s a newsflash; I’m not opposed to making cuts to medicare. I believe that we can cut medicare spending significantly, while improving services for medicare recipients. One of the really good aspects of the health reform bill was how cuts to medicare were made. I wholeheartedly agreed with cutting funding to medicare advantage.

If you’re not familiar with medicare advantage, let me give you the broad strokes. It was an experiment that Bill Clinton tried, where he outsourced medicare to private insurance companies. The idea was the old republican mantra that private companies can “do it” more efficiently than government can. I believe it was an experiment worth trying. But fifteen years into it, the results were in; not only did it cost 14% more than traditional medicare, but it didn’t deliver better results. It was a nice try, but it failed. Defunding it and getting our 14% back made all the sense in the world.

I believe that there are similar cuts that can be made. I’ll get to those later.

Paul Ryan put this out yesterday:

Apparently, he’s decided that instead of back peddling out of his disastrous plan to fuck seniors, he’s going to double down. I’m not sure if he’s going for an Oscar a la Al Gore, but I wouldn’t waste my time lobbying the nominating committee if I were him.

Bear with me while I go through this point for point, because it’s not all bullshit.

The first point that he makes is that Americans spend fifty times more on healthcare today, than we did in 1960. Yes Paul, that’s because we have a system run by private corporations. He fails to mention that we pay more than double (per capita) for health insurance than other countries with nationalized health care systems do.

Next he talks about how medicare spending will nearly double in the next ten years. The actual increase amount is 86%, but I can see how “double” has a more dramatic effect. Those figures are true. What he didn’t say is that in relation to GDP, this represents a growth difference from 3.6% of GDP now, to 4.1% of GDP in 2020. Yes, the amount of spending is going to explode, but a little bit of relative perspective goes a long way. By the way, I love it how everyone acts like no one saw the number of baby boomers coming. What the fuck? You couldn’t count all of the births from sixty-five years ago, and predict how many medicare recipients there would be today? If we’d been making incremental adjustments all along, there wouldn’t be a “crisis” now. Shut the fuck up with your crisis nonsense, especially if you’ve been in the house for over twenty years.

The next point he makes is actually a good one. We have a system that pays for procedures, rather than results. It’s referred to as “fee for service”. This system doesn’t encourage curing a patient. It incentivizes doctors to rob the system by running tests in perpetuity so that they can get paid for each test. We should absolutely change the system so that it pays for results. This is the type of cost savings measure I can get behind. But I have to say that his line about, …” A patient is very disconnected from the cost” made me vomit in my mouth a little. Do you really think that if a patient knew what each procedure cost, they would know enough to pass on an MRI that may or may not be necessary? How the fuck are they supposed to know if it’s necessary? People go to school for nine years to learn if the MRI is necessary. The implication is that the patient is glutting themselves on health care as if it’s a luxury item, because they don’t know how much it costs. Asshat.

Then he makes the tired, lame ass comment that medicare costs are going up because there’s no competition. Hey asshole, go back to the numbers at the beginning of your presentation and see how much “competition” had helped out with health care costs in the past sixty years. Also, review the cost difference between medicare and medicare advantage. You might be able to make this point if private insurance costs were growing at a significantly lower rate than medicare costs are. They’re not. They’re growing at a much faster rate, even with a much younger population in the private system. The only reason why medicare is in “crisis” is because of exploding enrollment numbers, not exploding profit margins. And by the way, in which universe are private insurance companies clamoring to grab that “hip replacement” segment of the US demographic? Let me reiterate, asshat.

Then he goes into how his plan is going to “save” medicare. This is the most comical statement of them all. Here’s how you know that he’s not saving medicare: right now when grandma goes to the doctor, that doctor gets paid with a check from medicare. Under Ryan’s plan, there will be no more checks from medicare. The doctor will ostensibly be paid with a check from the private insurance company that is chomping at the bit to get grandma’s business. Good god, there are so many things wrong with that last sentence. But the bottom line is that there will be no medicare. His plan will give seniors vouchers for $15,000 per year to go buy their own insurance. There will be medicare in the sense that those deductions will still come out of your paychecks for your entire working lives. But at the end of it, that money will ultimately get paid out to private companies. Do I even need to break down how fucking stupid that is?

Fortunately, Americans seem to viscerally understand that Paul Ryan’s plan blows. But the downside is that everyone is caught up in black or white thinking. The choice is either leave it alone or kill it. Neither of those will work. We need to take a critical look at the system and make smart cuts that improve the system and ensure its longevity. Unfortunately, I don’t think that we’re going to make it that far into the national conversation. My prediction is that we’re going to be plagues with “medicare crisis” talk for the next couple of decades.

That should be fun.