EagleTribune.com, North Andover, MA

August 19, 2012

Column: Medicare's future is perilous at best

Taylor Armerding
The Eagle-Tribune

---- — I have a big news bulletin for everybody: Medicare, as we know it, is going to end.

The little sub-headline to this, which President Obama and his re-election team are going to try to do their best to make sure you don’t see or hear, is that Medicare as we know it is going to end even if that extremist, white (and therefore automatically racist) Republican Congressman Paul Ryan never becomes vice president.

They want you to think that if you just re-elect Obama, everything will continue just the way it is – it will even get better, since Obamacare is going to give everybody – not just old people – all kinds of free health care stuff, and it will all be paid by sticking it to those greedy, evil rich people.

Sorry. Medicare is going to end as we know it even if the saintly, compassionate (with your money) Joe Biden remains vice president. It will end whether Obama or Republican Mitt Romney becomes president.

In fact, if preserving Medicare as we know it is the most important thing to you about the coming election, you might as well not vote. It is out of your hands – it is even out of the candidates’ hands.

If you want to debate the best way to end it as we know it, and replace it with something sustainable, that is a debate worth having, and something worth a vote.

But it cannot remain in its present form by “asking the wealthy to pay a little bit more,” as the president will say several thousand times between now and November. Even forcing the wealthy to pay a lot more, which is more like what the president really has in mind, cannot do it. The wealthy, as much as they deserve to be resented and punished for their success, simply don’t have enough wealth to cover all the goodies we have come to believe are our divine right.

That’s the way it is with the entitlement society. When you see the classic ad the Democrats ran of the Paul Ryan lookalike dumping granny from her wheelchair over a cliff, it makes you wonder if old age even existed in American before 1965, when the Medicare program started. How could it? Didn’t everybody get thrown off a cliff once they reached 65, until President Lyndon Johnson stepped in to rescue them with a stroke of his pen?

But, the hard reality is that if Ryan’s plan to end Medicare as we know it amounts to throwing granny off a cliff, you might as well put an Obama lookalike in a companion ad, because much the same thing, or worse, is going to happen if the president gets re-elected.

Yes, one version of Ryan’s plan for reforming Medicare calls for trimming it by more than $700 billion over the next decade.

But Obama is doing the same, raiding the Medicare fund by more than $700 billion to pay for Obamacare, according to the Congressional Budget Office. The president refers to those as “efficiencies and savings,” by eliminating things like “needless” procedures and tests. All of which means that government, not you and your doctor, will be deciding what is needless.

The president also doesn’t mention that those cuts are across the board and include a $156 billion reduction in payments to Medicare Advantage plans. This will require seniors – those who are 55 and older right now – to pay more for their health care in the relatively near future. Ryan’s plan would not change anything for those now 55 and older.

But again, the bottom line is that Medicare is going to end as we know it even if the Democrats run the table in November.

The reasons for this should be obvious to anyone who got through grade-school math. Medicare is eating the rest of the budget. Various economists have noted that spending on Medicare as a share of the economy is five times what it was in 1970, while all other federal spending combined (interest excluded) is 1.1 times what it was. Without reform, it will only get worse.

The Social Security and Medicare boards of trustees have predicted that Medicare’s hospital trust fund will be insolvent by 2024, thanks in part to the raid on the fund for Obamacare.

The president has promised to save money in Medicare by cutting payment rates to hospitals, but that only works for so long. Medicare’s chief actuary has warned that if the cuts are too severe, 15 percent of hospitals and nursing homes won’t be able to afford to take Medicare patients.

What good is “free” care if you can’t get anyone to provide it?

Yet, the administration is still in the “get-more, pay-less” mode, telling seniors they are entitled to a free annual checkup, and that women will have access to free breast and pelvic exams and even free contraceptives.

Of course, it ain’t free. Medicare is either going to be changed to a sustainable model that will require some sacrifice from everybody, not just the rich, or it will crash and burn when the next generation needs it.

That is the choice. That is what the debate ought to be about.

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Taylor Armerding is an independent columnist. Contact him at t.armerding@verizon.net