Tag Archives: Medicare

The impact of Obamacare cuts on Medicare Advantage Plans

31 Oct

More than 25% of Medicare beneficiaries receive their health care through a Medicare Advantage health plan (Part C). Under Obamacare payments to those plans will gradually be reduced. Whether these cuts are justified is up for debate. What is not debatable is that over time the cuts will cause higher premiums and lower benefits for MA plan participants. As you can see below in an April 2010 report from the Medicare Chief Actuary, he estimates MA enrollment will drop by 50% when the cuts are fully phased in.

Interestingly the bonuses that he mentions in the second paragraph below have been manipulated beyond the intent of the law to make higher payments to plans and payments to plans receiving lower quality marks. Here is a story about that issue.

So, do cuts to Medicare affect the benefits of at least 25% of beneficiaries, yes they do.

Under the prior law, Medicare Advantage payment benchmarks were generally in the range of 100 to 140 percent of fee-for-service costs. Section 1102 of reconciliation amendments sets the 2011 MA benchmarks equal to the benchmarks for 2010 and specifies that, ultimately, the benchmarks will equal a percentage (95, 100, 107.5, or 115 percent) of the fee-for-service rate in each county. During a transition period, the benchmarks will be based on a blend of the prior ratebook approach and the ultimate percentages. The phase-in schedule for the new benchmarks will occur over 2 to 6 years, with the longer transitions for counties with the larger benchmark decreases under the new method.

The PPACA, as amended, also introduces MA bonuses and rebate levels that are tied to the plans’ quality ratings. Beginning in 2012, benchmarks will be increased for plans that receive a 4-star or higher rating on a 5-star quality rating system. The bonuses will be 1.5 percent in 2012, 3.0 percent in 2013, and 5.0 percent in 2014 and later. An additional county bonus, which is equal to the plan bonus, will be provided on behalf of beneficiaries residing in specified counties. The percentage of the “benchmark minus bid” savings provided as a rebate, which historically has been 75 percent, will also be tied to a plan’s quality rating. In 2014, when the provision is fully phased in, the rebate share will be 50 percent for plans with a quality rating of less than 3.5 stars; 65 percent for a quality rating of 3.5 to 4.49; and 70 percent for a quality rating of 4.5 or greater.

The new provisions will generally reduce MA rebates to plans and thereby result in less generous benefit packages. We estimate that in 2017, when the MA provisions will be fully phased in, enrollment in MA plans will be lower by about 50 percent (from its projected level of 14.8 million under the prior law to 7.4 million under the new law).

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Medicare expanded to cover maintenance nursing home and home health care effectively adding substantial higher costs

26 Oct

Since the start of health insurance there has been an exclusion for care that does not treat and illness or injury, but rather maintains an individual’s status and helps with the chores of everyday living when an individual is disabled and unable to perform those chores such as bathing, dressing, etc. Medicare applies the same limitation on coverage.  While the care now covered under a recent court settlement is beyond basic custodial care, the fact care provided no longer must be associated with any improvement or recovery by the patient brings more expensive treatment within the realm of custodial.

By agreeing to a settlement in a class action lawsuit the Obama administration has effectively added custodial (maintenance) care to Medicare. The change is expected to add substantial costs to Medicare and to Medicare Advantage plans which must also comply with the settlement. There are tens of thousands, perhaps hundreds of thousands of people who will be affected and eligible for the these benefits. The significant change is that no longer must a patient be expected to show any improvement from the care received in a nursing home or through home health care. Chronic conditions like Alzheimer’s, Parkinson’s, multiple sclerosis, strokes, spinal cord injuries and brain trauma frequently require long-term, expensive care that is not active medical care likely to lead to improvement or recovery.

The New York Times characterized the settlement (expected to be approved by the judge in the case) as follows.

The lawsuit stems from a bizarre practice that arose over decades because of Medicare’s fragmented and loosely administered process for handling beneficiary claims. The Medicare law and regulations state that coverage is available for health care and therapy that is “reasonable and necessary for the diagnosis or treatment of illness or injury.”

But at lower levels of Medicare’s review process, where a vast majority of decisions on coverage are made, some Medicare contractors — companies that review and pay medical claims for the government — terminated or refused coverage if there was no prospect of patient improvement or if there were signs that the patient’s condition was deteriorating

The administration itself, in a separate case in Pennsylvania, argued that coverage for skilled nursing care required some expectation that the beneficiary will improve materially in a reasonable and generally predictable period of time. The proposed settlement will reverse this irrational and unfair approach to medical services.

Contrary to the opinion of the NYT, the current practice is neither bizarre nor irrational and unfair, it follows the long-standing practice followed by virtually all health insurance plans which is exactly why the need for separate long-term care insurance was identified. The Times further characterizes the change as humane. In fact, the new coverage lifts a huge financial burden from individuals and families, but places that burden on Medicare and Medicare beneficiaries who will pay for these costs through their premiums.  Medicare advocates are delighted with the settlement calling past practices illegal and seeing a great victory in having tens of thousands of denied claims recalculated and paid.

With Medicare facing serious fiscal problems and already knowing that a major cost factor is end of life care, expanding these benefits has the potential to greatly accelerate Medicare’s problems. The flood gates are open and ripe for abuse. Virtually all nursing home and home health care will potentially be reimbursed by Medicare as providers and families learn how to manipulate the system.  The Department of Health and Human Services is required to launch an extensive communication campaign to get the word out to both patients and providers about this change.

While the settlement does not mention long-term care or even intend to cover “long-term care” as such, the results in terms of costs to Medicare are likely to be similar…huge.  There is also no requirement to add to the number of days of skilled nursing home care under Medicare.  Humane or otherwise this change has added an expanded benefit, and added substantially to Medicare costs without any Congressional involvement.   Following are relevant sections of the settlement agreement.

Continue reading →

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Obamacare cuts to Medicare, the truth about the $716 billion in reduced Medicare spending

22 Oct

Does Obamacare cut Medicare by $716 billion dollars? Yes, but not exactly the way it is being presented by politicians.

For example the cuts are not in payments to physicians, the bulk of the cuts are to hospitals (34.8%) and Medicare Advantage Plans (30.2%). The remaining cuts are a lot smaller; extra funds to hospitals that see more uninsured patients — 5 percent in savings. Lower payments to home health providers make up another 8.8 percent. About a dozen other similar size cuts make up the balance.

Now as far as physicians are concern, there are major cuts on the horizon — sort of — but these cuts were separated from Obamacare early on. Come January 1st physician payments under Medicare may be cut by 27% but not because of Obamcare and not part of the $716 billion. Rather these cuts will be caused by the Sustainable Growth Rate (SGR) law. Here is what the CBO says. I added the bold highlight.

Medicare’s payment rates for physicians’ services are scheduled to be reduced by 27 percent in 2013, CBO estimates, under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. The SGR mechanism consists of expenditure targets, which are established by applying a growth rate (calculated by formula) to spending for physicians’ services and certain related services in a base period, and annual adjustments to the payment rates, which are designed to bring spending in line with the expenditure targets over time. In each of the past several years, legislation has been enacted to override the SGR and to either maintain or increase those payment rates when they were otherwise scheduled to decrease.

And in a separate report CBO says this:

The Congressional Budget Office (CBO) projects that, under current law, payment rates for physician services will be reduced by 29.4 percent in 2012. That large reduction called for under current law follows several years of legislative action to either maintain or increase physician payment rates under the Medicare program when those rates were otherwise scheduled to decrease under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. Such legislative actions have overridden the SGR.

As of now, Congress has not acted on changing the SGR to once again prevent these cuts or mitigate them, but who knows what will happen by year end.

In any case while it is true that there are no cuts to Medicare benefits, it is also true that all these cuts will have consequences. Some hospitals will not be able to deal with the cuts, eventually Medicare Advantage Plans will have to make up the lost revenue (now being offset mostly by performance bonuses HHS is paying) which means higher premium or a cut back of the extra benefits often provided by these plans. If the physician cuts go into effect Medicare beneficiary access to care may be affected and/or more cost-shifting to the non-Medicare population is likely.

If you would like to read the AMAs position on the physician payment cuts here it is from their website:

Continue reading →

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Medicare fraud

13 Oct

Have you heard the reports lately of massive fraud against health insurance companies, even fraud collectively equal to $400,000,000 or so? No, I wonder why?

Have you heard of massive fraud against Medicare? Yes?

Now tell me again about the low administrative costs and efficiency of a massive bureaucracy. There are reasons why Medicare is so susceptible to fraud and abuse. They simply do not invest in the claim monitoring, medical necessity review and other measures common in private insurance.

But more important participants in the system, that is patients, providers and administrators don’t care (he said with a measure of tongue in cheek). It’s not like it’s their money after all, there is no profit to worry about, no one is really accountable for not catching the fraud before it continues for years on end.

We’ve heard a great deal about too big to fail and too big to reasonably manage. Here is a perfect example. No massive bureaucracy is efficient and responsive.

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Poll shows diverse opinions on Medicare reform

12 Oct

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Medicare is one of the most emotional and politically sensitive issues facing America.

On one side we have an approach that relies primarily on reducing payments to health care providers and Medicare Advantage health plans coupled with scores of trial programs attempting to make the delivery of health care more efficient.  If all else fails a board of fifteen people will make additional recommendations to trim Medicare costs (but not the benefits). On the other side is a plan that gradually takes the direct approach of simply limiting what the government will spend (adjusted for inflation).  The hope is that market forces will place competitive pressure on the system to manage costs.

The introduction of the so-called Ryan plan to reform Medicare got me to thinking.  What is the average person’s opinion on Medicare reform?  To find an answer to this question I placed a poll question on quinnscommentary.com  No, this poll is not scientifically accurate, but I believe it provides a reasonable indication of where people stand on this question. The poll was open to anyone around the Country who wanted to participate; people could not vote twice.

Here is the simple question: What is your opinion of the Ryan plan for Medicare?   [you can see current results on the poll page on this blog]

I was a bit surprised at the responses to this poll (from 1,073 people) because the opinions are fairly balanced which may mean that Americans are as confused as our politicians about what to do.

Some forty-two percent of voters support the Ryan-Widen approach.

Thirty-six percent appear to think not much should be done to change Medicare and twenty-four percent think the President’s current approach is better than the Ryan approach.

Following is the detailed breakdown (rounded) of the responses:

Strong medicine but necessary 17%

I support it (Ryan plan) 24%

Too radical, not necessary 4%

It will destroy Medicare 11%

I paid for my benefits, leave Medicare alone 21%

Obama plan is better 24%

It seems to me we should be a bit concerned with the attitude “I paid for my benefits leave Medicare alone” because Medicare cannot be left as is.  And, current beneficiaries did not pay for their benefits, their payroll taxes paid for the benefits of the people who were on Medicare while these folks were still working.  Likewise the 41% of people who support the Ryan-Widen approach, essentially a defined contribution with multiple choices for beneficiaries, indicates there is fairly wide-spread understanding of the scope of the problem. The hospital trust fund is running out of money, and the Part B benefits are continuously adding to the federal deficit.

Beneficiaries pay only 25% of the cost of Part B with the rest coming from general revenue (and the people who pay Social Security income taxes) with no limit on what can be spent. Even though Medicare sets what it will pay for a given service, we have pretty much given the health care system a blank check when it comes to the number and type of services provided.  If we want to preserve Medicare for future generations, we must find a way to make it sustainable.

Whether we have found the answer in any strategy to date remains to be seen.

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Medicare premiums for higher income people

2 Oct

Medicare beneficiaries with higher than average incomes pay the standard Part B premium plus an additional amount based on the total income (Modified Adjusted Gross Income (MAGI) meaning that income not subject to income taxes such as municipal bond interest still counts in the MAGI).

The same is true for Medicare Part D, higher income beneficiaries pay the standard premium for the plan they select, plus the additional premium. The additional premium for Part D also applies to individuals in employer operated Part D plans call Employer Group Waiver Plans. These plans have increased in number as a result of Obamacare changing the tax status of the retiree prescription drug rebate provided to employers who maintained prescription benefits in lieu of Medicare.

Obamacare made another change affecting Medicare premiums by freezing the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reducing the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Here is a screen shot from the Medicare website showing the additional premiums applicable in 2012.

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Who will save Medicare? Note to AARP… Nobody yet

27 Sep

Here is what the President said about Medicare to an AARP gathering today:

Obama rejected Ryan’s contention that the law takes $716 billion out of Medicare.

“What we did was, we went after waste and fraud and overcharging by insurance companies for example. Those savings do come out to $716 million dollars,” Obama said.

Okay they are making a big deal over fraud and waste, whether that has anything to do with reform or whether it is significant in the scope of the fiscal problem facing Medicare is another matter. Regardless, reducing fraud and waste is a given administering any government program … we wish.

Now as far as the old tune against insurance companies goes … blah, blah, blah. What insurance companies, the Medicare Advantage Plans that Congress decided to pay 14% more than traditional Medicare to shift risk from Medicare and encourage enrollment? It’s true Obamcare does cut payments to these organizations … and the rest of the story is … check out the articles under the Medicare section of this blog.

In fact, the bulk of the cuts come from reduced payments to doctors, hospitals and other health care providers. And oh yes, he forgot to mention those “savings” were spent elsewhere.

Here we have the President pandering to senior citizens with the same old “everything is hunky dory and you won’t be affected” story. Even the Medicare Trustees and actuary have raised concerns about the realistic cost saving affects of the Obamacare changes the President so readily touts

What a sad state of affairs indeed.

9-21-12

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Does Medicare really have exceptionally low administrative costs … ah, not so much

17 Sep

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We have all heard the claim the Medicare is more efficient than private insurers with administrative costs running around 3%. This is then used to make the case that government-run health care is more efficient as well. Not so fast on this one.

First, the 3% number is a percentage of claims. We all know that seniors have higher claim costs and a great majority of that is hospital bills. So let’s do the math. If it costs $600 a year in total administrative expenses and your claims are $5,000 you have admin costs equal to 12%. However, if your claim costs are $50,000 your admin costs are just 1.2%. In other words because of high claim costs for the average beneficiary, Medicare looks more efficient. On the other hand, some studies have found that on a per person basis, Medicare is actually more expensive to operate.

But there is more. Medicare does not include the expense incurred by other government agencies related to Medicare.

For example, the Internal Revenue Service collects the taxes that fund the program; the Social Security Administration helps collect some of the premiums paid by beneficiaries; the Department of Health and Human Services helps with accounting, auditing, and fraud issues and pays for marketing costs, building costs, and more. In addition, private insurers pay state premium taxes which are part of their overhead costs.

And then we have my favorite reality check; fraud and abuse. Medicare pays just about every claim submitted with a covered service code with no or very little review for medical necessity, or appropriateness of the service. Ask your doctor which coverage pays with the least hassle. But all that hassle free claim paying leads to fraud and abuse on the part of both patients and providers, higher than may be justified claims, higher premiums for Part B of Medicare and, of course, the appearance of low administrative costs as a percentage of claims.

Medicare is so huge it should have low administrative costs, but at least we should compare apples to apples.

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“This is the beginning of the end of Medicare as we know it.” Nancy Pelosi

10 Sep

 

“Most seniors will be worse off,” Representative Nancy Pelosi, the House Democratic leader, said on the House floor. “This is the beginning of the end of Medicare as we know it.”

Senator Tom Harkin, Democrat of Iowa, said: “We hear the claim that private-sector competition will drive down costs and save Medicare. Nonsense!”

Are Democrats at it again bashing Ryan on Medicare? Nope, these quotes are from 2003 when they were bashing the new private sector operated Medicare drug benefit that turned out to be 30% less expensive than predicted by the CBO and which provides about 25-30 plan choices for each senior…… and this is the benefit that Democrats improved in 2010 with no thought to bringing it under the government- run portion of Medicare… Ooops!

Before we jump for joy over the success of competition; buying and selling prescription drugs is not the same as receiving health care. The Part D plans dispense the drugs, they are not the ones ordering the prescription and prescribing what drug will be used or how it will be used and that’s a big difference. Further, these companies have tools not applicable to basic health care like generic drugs and formularies. On the other hand, a managed care plan under Medicare Part C that controls utilization because it is an HMO and health care provider may also be able to leverage pricing or even own expensive diagnostic equipment thereby controlling costs.

Competition in some aspects in health care has its place, but until the competition generated is among health care providers (doctors and hospitals) competing for our business, it is not the solution. For the foreseeable future providers are in the drivers seat and may be more so as demand for their services grows and the number in their ranks does not. Oh wait, free markets do work.

P.S. It is Pelosi and most other a democrats, including the President who tell us that competition among insurance companies in the health insurance exchanges will not only lower costs, but improve the quality of health care as well. Perhaps they didn’t read either piece of legislation.

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Fixing Medicare – regardless of the method, the result is the same… Medicare as we know it cannot continue!

7 Sep

Benefit Security Card .. HALF of the U.S live ...

HALF of the U.S live in households that receive government benefits

There is a lot of controversy these days about Medicare. The only consistent truth is that Medicare can’t survive left as is, as we know it if you will. The 2012 Trustees Report says the hospital fund will be exhausted in 2024 and that Part B costs will grow at an annual rate of 7.6%. The funding for Part B comes from general revenue and Part B premiums. In other words adding to the national debt and placing greater pressure on Medicare premiums. This growth rate is likely because the Trustees assume that the 30% cut in payments scheduled for 2013 will not go into effect while noting dire consequences if it does.

The current structure of Medicare allows beneficiaries to choose between traditional fee-for-service Medicare and Medicare Advantage Plans (Part C).  This is private, for profit coverage.  Over 25% of Americans with Medicare have opted for Part C. The Ryan plan continues the choice approach with one big difference, the growth in the government’s contribution toward premiums would be limited rather than increase as costs increase on an open-ended basis. Initially the premium support would be based on the lower of the cost for traditional Medicare or the second lowest cost competing plan. However, overall costs for Medicare could not exceed a benchmark based on growth in Gross Domestic Product for the US. In other words shifting from a defined benefit to a defined contribution approach to limit government spending.

Under the Affordable Care Act choice between traditional Medicare and competing plans under Part C remains. However, the government contribution toward Part C plans is gradually being reduced to levels closer to the cost of traditional Medicare. Over time this likely will mean higher premiums for Medicare Advantage Plans and/or reduced benefits. Not unlike the Ryan plan, current law sets spending targets for Medicare. If those targets are exceeded, cuts are required. This is accomplished through the Independent Payment Advisory Board established by the Affordable Care Act beginning in 2015. To meet the spending limits the IPAB must make recommendations but cannot reduce benefits or raise premiums and as a result is fairly limited to recommending further reductions in payments to health care providers. The Medicare Trustees Report says it is unlikely the already scheduled cuts will be allowed by Congress because they have not been allowed to go into effect in the past. In any case, it is hard to see how the system can withstand these cuts and any further cuts necessitated by the IPAB.

The fundamental difference between these two approaches is the way spending targets are reached. The Ryan plan sets hard caps and allows beneficiaries to adjust to rising costs by choosing among competing plans. The Affordable Care Act cuts payments to health care providers and competing plans, but ultimately relies on an appointed board to make further cuts in payments to providers.

Ultimately both approaches affect Medicare beneficiaries with higher costs. This may come from higher premiums, lower benefits or simply higher out-of-pocket costs because it will be more difficult to find a doctor accepting Medicare. Addressing Medicare’s long-term costs primarily by squeezing health care providers has consequences for the non-Medicare population as well because reducing already low payment levels will cause more shifting of costs.

Fixing Medicare means shared pain regardless of the approach. The question is how best to share that burden among all Americans and the health care system.

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Shooting the messenger … listen to the truth about Social Security and Medicare

4 Sep

A few years ago I saw a video of Gov Christie of New Jersey giving a talk to a group of state union members. He was talking about their pensions and benefits. As you may suspect he was roundly and loudly booed, so much so he could not say much.

He finally said, why are you booing me, I’m telling you the truth. The people who promised you all these benefits we can’t afford and that they didn’t fund are the ones you should be mad at.

For the most part, the audience didn’t want to hear that. All they knew was here was the Governor telling them he was going to cut benefits and charge them more.

If I substituted Paul Ryan for Christie and all Americans for the union members in the audience it would be the same story only now we are talking about Medicare and Social Security.

For years politicians have “improved” these benefits, set their costs on auto pilot escalation, promised us the world and failed to fund (meaning tax us) these obligations that now have liabilities in the trillions of dollars. The Social Security trust fund is being depleted, and the Medicare health insurance trust will be gone in a few years.

Rather than shoot the messenger it’s time we listened to the message and demand real solutions not only to keep the United States from sliding further into mediocrity, but equally important to assure that our children and grandchildren have a future with opportunity rather than one of debt and taxes the likes of which we have not seen.

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Why I support Ryan plan for Medicare … or any other viable plan, BUT …

2 Sep

Ignoring the problem doesn’t make it go away.

While I support Paul Ryan or anyone else coming up with ideas to actually fix Medicare and the federal budget, we still must scrutinize such plans and ask questions aimed at considering unintended consequences. Writing in the August 15, 2012 WSJ Carl Rove says this:

Mr. Ryan’s plan has a different approach. While there would be no changes in Medicare for those 55 or older, starting in 10 years younger Americans would have a choice. They could either pick traditional Medicare or use the average amount of money the government spends on each Medicare enrollee to buy private insurance. The reasoning is based on a reliable truth: Competition will lower costs by using market forces to spur innovation and improvement.

Competition, what competition? The only competition that will lower health care cost is competition among health care providers. Given that the increase in Americans with health insurance will increase demand for health care with no commensurate increase in physicians it seems to me that health care providers will be in the driver’s seat. Of course, if he is talking about competition among insurance companies he doesn’t know what he is talking about.

There is another problem that also needs scrutiny. As any benefits manager knows, when you offer a choice among many health plans there is the risk of adverse selection. That is, the healthy take the plan with the lower benefits and lower cost; the sick take the plan with most generous benefits and fewest restrictions. There is a real chance that under the Ryan plan the adverse selection could be directed toward traditional Medicare.

None of the above changes the fact that Medicare needs some radical changes and the Ryan plan is a place to start serious discussion.

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What is your opinion of the Ryan plan for Medicare?

26 Aug

The split in opinion about the plans to reform Medicare is somewhat surprising, but we need more people to speak up.

Please take a few seconds to add your opinion to our poll shown on the right side of this page.

Cast your vote on this important poll

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Ryan plan for Medicare and you …

13 Aug

Let’s start with some facts. Under the Ryan plan for Medicare unless we manage to control the rate of increase in health care costs, in the future those on Medicare (not anyone now on Medicare or over age 55) will pay more out of pocket and the federal government’s share of the cost will be limited in its growth. In other words, there is an attempt to slow the growth in the federal debt for the benefit of all Americans while possibly requiring some seniors to pay more depending on the coverage they select.

While pundits like this guy are already railing against the plan and insurance companies, they offer no viable alternative. Of course, the concept could be made simple, just leave Medicare as is and limit the rate of growth in the government’s contribution and the rest goes to beneficiaries to pay … same result.

Fact two: a disproportionate percentage of our Country’s resources go to senior citizens in the form of Social Security, Medicare and other benefits for older Americans. This tremendous drain on our economy has and will continue to have adverse affects on younger Americans and their families. Something has to give, as desirable and simplistic the idea may sound the 1% or even the 5% cannot support the rest of the population.

To get an accurate assessment of our current situation take a look at the Purple Plans (meaning bi-partisan) linked to this blog. They were prepared by Prof Larry Kotlikoff an economist at Boston University. Note especially the “generational imbalance plan.”

Fact three: no viable alternative to a radical approach to controlling Medicare’s costs has to date been put forward. Obamacare has scores of projects aimed at that goal, some may help others may not, but even if they all succeed they don’t solve the problem and in the process create more cost shifting to the private sector. Obamacare sets up the Independent Payment Advisory Board (absurdly and incorrectly labeled the “death panel” by no nothing’s on the extreme right) to recommend changes in Medicare if costs cross a certain level. However, the Board is so limited in what it can recommend as to be ineffectual other than cutting payments to health care providers.

Fact four: to solve the problems of Medicare and Social Security all Americans need to pay more or get less or both. Should we tax young families more to benefit those of us who had a lifetime to prepare for old age? Should we ask seniors to pay more of their health care costs? Who deserves more government support, if any, the family of four earning $40,000 a year or the couple in their seventies earning $30,000 (much of which is tax free)?

The key to success here is not figuring out where to shift costs as both the Ryan plan and Obamacare do, but rather to find a way to see the growth in health care costs aligned with general inflation and at the same time change the American attitude that health care expenses are somehow not like any other life expense.

Health care is not “free” and it cannot be paid by someone else all the time. Virtually every American makes choices in how they spend what money they have. Routine care (not catastrophic care) needs to be part of that mix. Until we are of that mindset health care costs will consume an ever increasing portion of our resources in the form of insurance premiums, taxes or as part of our compensation.

The Ryan plan may seem radical, even harsh but it is a reflection of the hard choices we face and should not push to the next generation. Politicians who claim we can avoid the harsh reality are treating us as fools.

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Hold on to your seats folks, Ryan and Medicare ads are coming at you

11 Aug

With the announcement that Rep Paul Ryan will be Romney’s running mate as VP, there is no doubt the wheels are turning at the AARP and the Democratic SuperPacs.

Ah, the destroyer of Medicare is running for the second highest office in the land. Senior citizens run for the hills … after you vote for the other guy.

You may not like or agree with Paul Ryan or his proposals, but you should listen to his message on the budget and deficit. Putting our collective heads in the sand is not going to make the significant problems go away and neither is rhetoric or taxing the “wealthy.”

And for the record, Ryan’s plan for Medicare has nothing to do with current Medicare beneficiaries or those near Medicare eligibility. It does, however, have a lot to do with the economic future of our children and grandchildren. There may be alternatives to Ryan’s plan, but there are no alternatives that are easy or painless and anyone who tells you otherwise is a liar.

UPDATE

YIKES how right I was. I just received an e-mail from the Obama campaign:

With Mitt Romney’s support, Ryan would end Medicare as we know it and slash the investments we need to keep our economy growing — all while cutting taxes for those at the very top.

ANOTHER UPDATE: Just received a text message from Obama campaign on the same topic. Ain’t communication grand?

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