HERE WE GO AGAIN

Republicans have realized their most fervent wish:  control over all three branches of government.  And, in their rush to obliterate the progressive gains of the last eighty plus years, they are as busy as a hive of little worker bees.  Do not be surprised to see more activity by the Right in one day than they have produced cumulatively in the last eight years.

Paul Ryan has gleefully resurrected his plan to transform Medicare:  first turn it into a voucher program and then do away with it completely by the year 2022.   Most of us are probably pretty familiar with this government program. It’s certainly one that enjoys widespread popularity.  But it is also frightening to realize how many recipients of its benefits don’t really understand much about Medicare. Apparently many Americans don’t even understand that it’s a government program!  The goal of this article is to touch on some of the serious impacts the changes Mr. Ryan is suggesting will have.

First, there’s Medicare’s impact on longevity.  Just based on observation, doesn’t it seem that people today are living longer than in the past?  When you were a child, how many of the elderly were living well into their eighties, even into their nineties?  Every day we hear of more and more people who have attained the age of 100!  Is the implementation of Medicare alone responsible for this trend?  Probably not:  advances in technology and changes to life style in general have had an impact.  “Data on age-specific death probabilities every 10 years since 1900, that is, before as well as after Medicare was enacted, provide an alternative way to test for the effect of Medicare on longevity. They also provide strong support for the hypothesis that Medicare increased the survival rate of the elderly, by about 13 percent”  (Effects of Medicare on Health Care Utilization and Outcomes).  Since that article was published in 1998, there have been even more advances.  But the bottom line is that new, lifespan-increasing technologies will do no good if people cannot access them!

But longevity is only a piece of the picture. Here are some of the most harmful changes the Republican proposal may entail. 

1. In January, the GOP will be in a position to repeal the Affordable Care Act, something they have tried unsuccessfully to do over fifty times:  this time they may finally get their wish.  The demise of the ACA may affect the benefits included with Medicare also:
   1. Depending on what the provisions of the “reform” include, insurance companies may once again be able to refuse to cover people with pre-existing conditions. If the “premium support” program does not also require a minimum level of benefits for those eligible for Medicare, many seniors may not be able to buy health insurance at all since many of them will be deemed to have a pre-existing condition. As in the past, those with pre-existing conditions people might be offered mediocre health insurance in high-risk pools and at very high costs. 
   2. The many free screenings for serious health conditions currently provided by Medicare may also be eliminated if the reform Ryan proposes and passes fails to specify what insurance plans for Medicare must cover.
   3. The ACA included provisions to close the so-called ‘donut hole’ in prescription drug coverage. Since the inception of the ACA, the percentage of cost paid by the insured while in the gap has been decreasing:  it is now at 45%. But under the “reformed” Medicare plan, the gap could revert to its original format; e.g., the insured might have to pay 100% of the drug cost while in the ‘donut hole.’
   4. There are also a variety of cost-saving measures built into the ACA, such as the elimination of lifetime caps on benefits, that will probably no longer be available.
2. In a voucher program, each Medicare beneficiary receives a financial promise in some form from the government. The recipient will then take the promised funds into the health insurance marketplace to purchase a policy.  To put it mildly, this arena can be a snake-pit, full of peril at every turn.  The search for high quality and affordable health insurance will be exceedingly difficult, especially since there may be little help for seniors navigating these dangerous waters.  When last discussed, the amount of the voucher was somewhere between $8,000 and $9,000.  While some might think this is a windfall, beware the Trojan horse.  If coverage is available at all, premiums for high-risk (those with pre-existing conditions) people will be very expensive.  There is a good chance the senior looking for insurance will have to spend all, or most, of their voucher to obtain coverage.  In many cases, the voucher will not even cover a full year’s insurance premium. 
3. Deductibles and co-pays are likely to be very high.  Medicare has controlled not only how much will be paid for specific benefits, but also what portion of these amounts become the responsibility of the insured.  All of these protections will be gone.  If lifetime caps on benefits are allowed to return, seniors could easily outlive their benefits.  People tend to be casual consumers of health care, and, because insurance has paid for so much, have only a rudimentary idea of how much these benefits actually cost.  Many will not be able to afford even minimal basic care; others will be wiped out financially in their attempt to remain healthy.

A few years ago, an ad showed a man pushing an elderly woman in a wheelchair off a cliff. It was intended as a frightening metaphor for the proposed changes to Medicare. What the Republicans propose is tantamount to geriatricide.  Perhaps Paul Ryan should wonder how his own mother will fare under these draconian changes.