Truth and Lies About Medicare ( AKA Rmoney & Ryan LIE )

**pickel** · August 18th, 2012, 04:35 PM

http://www.nytimes.com/2012/08/19/op...pagewanted=all

Republican attacks on President Obama’s plans for Medicare are growing more heated and inaccurate by the day. Both Mitt Romney and Paul Ryan made statements last week implying that the Affordable Care Act would eviscerate Medicare when in fact the law should shore up the program’s finances.

Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say. Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending.

The likelihood that they would stand by that irresponsible pledge after the election is close to zero. And the likelihood that they would be better able than Democrats to preserve Medicare for the future (through a risky voucher system that may not work well for many beneficiaries) is not much better. THE ALLEGED “RAID ON MEDICARE” A Republican attack ad says that the reform law has “cut” $716 billion from Medicare, with the money used to expand coverage to low-
income people who are currently uninsured. “So now the money you paid for your guaranteed health care is going to a massive new government program that’s not for you,” the ad warns.

What the Republicans fail to say is that the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.

In reality, the $716 billion is not a “cut” in benefits but rather the savings in costs that the Congressional Budget Office projects over the next decade from wholly reasonable provisions in the reform law.

One big chunk of money will be saved by reducing unjustifiably high subsidies to private Medicare Advantage plans that enroll many beneficiaries at a higher average cost than traditional Medicare. Another will come from reducing the annual increases in federal reimbursements to health care providers — like hospitals, nursing homes and home health agencies — to force the notoriously inefficient system to find ways to improve productivity.

And a further chunk will come from fees or taxes imposed on drug makers, device makers and insurers — fees that they can surely afford since expanded coverage for the uninsured will increase their markets and their revenues.

NO HARM TO SENIORS The Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare. But if Mr. Romney and Mr. Ryan were able to repeal the reform law, as they have pledged to do, that would drive up costs for many seniors — namely those with high prescription drug costs, who are already receiving subsidies under the reform law, and those who are receiving preventive services, like colonoscopies, mammograms and immunizations, with no cost sharing.

Mr. Romney argued on Friday that the $716 billion in cuts will harm beneficiaries because those who get discounts or extra benefits in the heavily subsidized Medicare Advantage plans will lose them and because reduced payments to hospitals and other providers could cause some providers to stop accepting Medicare patients.

If he thinks that will be a major problem, Mr. Romney should leave the reform law in place: it has many provisions designed to make the delivery of health care more efficient and cheaper, so that hospitals and others will be better able to survive on smaller payments.

NO BANKRUPTCY LOOMING The Republicans also argue that the reform law will weaken Medicare and that by preventing the cuts and ultimately turning to vouchers they will enhance the program’s solvency. But Medicare is not in danger of going “bankrupt”; the issue is whether the trust fund that pays hospital bills will run out of money in 2024, as now projected, and require the program to live on the annual payroll tax revenues it receives.

The Affordable Care Act helped push back the insolvency date by eight years, so repealing the act would actually bring the trust fund closer to insolvency, perhaps in 2016.

DEFICIT REDUCTION Mr. Romney and Mr. Ryan said last week that they would restore the entire $716 billion in cuts by repealing the law. The Congressional Budget Office concluded that repealing the law would raise the deficit by $109 billion over 10 years.

The Republicans gave no clue about how they would pay for restoring the Medicare cuts without increasing the deficit. It is hard to believe that, if faced with the necessity of fashioning a realistic budget, keeping Medicare spending high would be a top priority with a Romney-Ryan administration that also wants to spend very large sums on the military and on tax cuts for wealthy Americans.

Regardless of who wins the election, Medicare spending has to be reined in lest it squeeze out other priorities, like education. It is utterly irresponsible for the Republicans to promise not to trim Medicare spending in their desperate bid for votes.

THE DANGER IN MEDICARE VOUCHERS The reform law would help working-age people on modest incomes buy private policies with government subsidies on new insurance exchanges, starting in 2014. Federal oversight will ensure a reasonably comprehensive benefit package, and competition among the insurers could help keep costs down.

But it is one thing to provide these “premium support” subsidies for uninsured people who cannot get affordable coverage in the costly, dysfunctional markets that serve individuals and their families. It is quite another thing to use a similar strategy for older Americans who have generous coverage through Medicare and who might well end up worse off if their vouchers failed to keep pace with the cost of decent coverage.

Mr. Romney and Mr. Ryan would allow beneficiaries to use vouchers to buy a version of traditional Medicare instead of a private plan, but it seems likely that the Medicare plan would attract the sickest patients, driving up Medicare premiums so that they would be unaffordable for many who wanted traditional coverage. Before disrupting the current Medicare program, it would be wise to see how well premium support worked in the new exchanges.

THE CHOICE This will be an election about big problems, and it will provide a clear choice between contrasting approaches to solve them. In the Medicare arena, the choice is between a Democratic approach that wants to retain Medicare as a guaranteed set of benefits with the government paying its share of the costs even if costs rise, and a Republican approach that wants to limit the government’s spending to a defined level, relying on untested market forces to drive down insurance costs.

The reform law is starting pilot programs to test ways to reduce Medicare costs without cutting benefits. Many health care experts have identified additional ways to shave hundreds of billions of dollars from projected spending over the next decade without harming beneficiaries.

It is much less likely that the Republicans, who have long wanted to privatize Medicare, can achieve these goals.

**Chuckiechan** · August 18th, 2012, 06:07 PM

I hate to burden you, but you need to read this:

Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare - Forbes

Of the $716 billion in cuts, $415 billion come in the form of “updates to fee-for-service payment rates,” a euphemism for reducing Medicare’s payments to doctors and hospitals. But what happens when you reduce payments to doctors? Doctors stop being willing to see Medicare patients. And if you can’t actually get a doctor’s appointment, what does it really matter what your insurance plan covers on paper.

Snip

Of the $716 billion in Medicare cuts, the next biggest chunk, $156 billion, is taken out of the market-oriented Medicare Advantage program, known to wonks as Medicare Part C. Nationwide, 24 percent of all seniors are enrolled in Medicare Advantage, though that percentage is meaningfully higher in important swing states like Florida (32 percent) and Ohio (34 percent).

The rationale for cutting Medicare Advantage’s rates is that, prior to Obamacare, the government paid $1.14 per retiree in an MA plan, vs. $1.00 per retiree in a traditional plan. President Obama has called these differences “unwarranted subsidies [that] pad [private insurers’] profits but don’t improve the care of seniors.”

But the comparison between MA and government-run plans can’t be made on price alone. Due to the constraints placed on MA plans, those plans are incentivized by Congress to offer more benefits at the expense of lower prices. Imagine if you were searching airfares from New York to London, but couldn’t shop on price, only on what the planes served for food, and what movies were on board.

However, on an apples-to-apples basis, if you take out the extra benefits, Medicare Advantage plans are 9 percent cheaper than government-run plans. That was the finding of three Harvard economists, published in the Journal of the American Medical Association this month.

Read it and understand it, because the NY Times is just preaching the party line.

The 415 billion is not going to happen. Doctors will not stand for a cut in reimbursement rates for Medicare patients, and congress usually backs down.

BTW Pickel, do you have Medicare Advantage? That's the most direct impact on seniors who aren't considered poor. It is subsidized by the government @ ~ 13% ($ 1.00 premium = $ 1.14 in care) but it's managed by private insurance.

You have to understand that you are going to have to dig the truth out yourself, 'cause the MSM isn't going to give it too you. It's very complicated, and you have to be diligent.

Also, you union folks mostly have "Cadillac plans", and even though you probably have a temporary waiver, you will eventually either pay a penalty or have your benefits reduced to equal the rest of the "unwashed masses". As a matter of fact, with Obama, you can't be sure if you will have a waiver!

**brandon184** · August 18th, 2012, 07:43 PM

PolitiFact | Mitt Romney said Barack Obama robs Medicare of more than $700 billion to pay for Obamacare

PolitiFact Assessment: Mostly False

First things first: Neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.

Rather, the health care law instituted a number of changes to try to bring down future health care costs in the program. [..]

What kind of spending reductions are we talking about? They were mainly aimed at insurance companies and hospitals, not beneficiaries. The law makes significant reductions to Medicare Advantage, a subset of Medicare plans run by private insurers. Medicare Advantage was started under President George W. Bush, and the idea was that competition among the private insurers would reduce costs. But in recent years the plans have actually cost more than traditional Medicare. So the health care law scales back the payments to private insurers.

Hospitals, too, will be paid less if they have too many re-admissions, or if they fail to meet other new benchmarks for patient care.

Obama and fellow Democrats say the intention is to protect beneficiaries' coverage while forcing health care providers to become more efficient.

[..]

Now, to address the word "robbed." We know the civility is at a low ebb these days, but we think it’s worth pointing out that the money was not robbed in any literal sense of the word.

Congress passed the law through its normal process, and the proposal was debated out in the open during the many weeks that the final law was being negotiated.

At the time the health care law was being finalized and passed, Democrats said it was important to them that the new law not add to the deficit. So the reductions in Medicare spending were counted against the health care law’s new spending. That spending is primarily to cover the uninsured, by giving them tax credits to buy private insurance. But some new spending increases Medicare coverage for prescription drugs for seniors.

Finally, Romney said Obama is the "only one president that I know of in history that robbed Medicare." In reality, several presidents have reduced Medicare spending.

We reviewed this history in detail in a fact-check of Romney’s statement from December, "Only one president has ever cut Medicare for seniors in this country . . . Barack Obama." We rated that False. Many presidents have sought to rein in Medicare spending.

Here are a few highlights from that fact-check:

• President Ronald Reagan cut Medicare by reducing payments to hospitals, and he cut benefits by raising deductibles.

• President George H.W. Bush cut benefits by repealing a law that would have expanded coverage for drugs and catastrophic illness.

• President Bill Clinton cut Medicare by changing payments to doctors and other providers, which could be considered to have an indirect effect on beneficiaries.

(Edited for brevity)

The discussion over whether or not they are "cuts" or "savings" is a detour from the real issue; managing healthcare costs and ensuring that everyone has access. I find the claims from the right that Obama is "robbing" Medicare to be amusing, considering that Romney's plan to repeal Obamacare would mean that healthcare access altogether would be "robbed" from tens of millions of Americans.

Pick your poison!