The latest from the Romney campaign is that the President is “robbing” $716 billion from Medicare. Kate Pickert has put the lie to that here. And I must say, I’m outraged by the bald baloney-slicing Romney is attempting. It goes back to the cover story I wrote about the deaths of my parents. Romney and Ryan want to take the country in the precise opposite direction from sanity when it comes to end of life issues.
As Kate has written in the past, the bottom line on the cost reductions in the Romney-Ryan and Obama Medicare packages is pretty much the same. The question is, how do you get there? Romney-Ryan relies on mythology, the notion that a “free” market in Medicare will reduce the costs (and will reduce government spending by $6400 per senior citizen on average in anticipation of these efficiencies). But we’ve had an experiment in private Medicare delivery the past few years. It’s called Medicare Advantage and, as Kate has reported, it costs, on average, 14% more than standard fee-for-service Medicare.
Obama gets his many of his reductions by eliminating the bonuses to private insurers that participate in Medicare Advantage. He would also reduce some payments to hospitals. But the most important reforms in the Affordable Care Act have to do with the wasteful fee-for-service nature of Medicare as it now stands. Obama promotes electronic record keeping and reviews best medical procedures to see what really works and what’s really wasteful. He also encourages medical group practices to see how much money they would save–and allows them to keep some of those savings–if they try a “team” approach where doctors are paid salaries instead of paid for each test and procedure they perform.
It is impossible to know how much these reforms will save. “The Congressional Budget Office didn’t give us very much on the scoring here, since it’s something new,” an Administration Official told me. But the savings could be significant, if the results from the Geisinger Medical group in Pennsylvania are any gauge–a 10% reduction in cost, perhaps. (Of course, Romney would mischaracterize this as a cut).
But the more important consideration here is that the President’s plan is a far more humane way of going about the business of end-of-life medicine, as I found when Geisinger took over, and coordinated, the care of both my parents. As I wrote in June, I was made to feel part of a team, apprised of each new development as my parents declined, without having to chase down and organize the various specialists who’d been treating them. This is the model toward which Obamacare is pointing.
The Republicans hate it. Their answer, which–like supply-side economics–has proven to be an utter failure (see Medicare Advantage above) is to inject market discipline into the process. Let the elderly choose their health plans, let the plans compete for customers. I’m all for market disciplines and choice. It might not be a bad idea to extend the choices that will be part of Obamacare to people up to the age of 75. But there has been zero evidence that markets make much of a difference when it comes to elderly care. And I would have hated to watch my proud, but addled, father trying to make a wise choice in a market that is extremely complicated. (And believe me, he would have insisted on making that choice, even though he couldn’t hold a thought from one moment to the next.)
Maybe it’s because I’ve just been through a very painful experience, but the Republican flummery on this issue hits me harder than any position taken by either party on any other issue. This is a case of common decency. We really need to respect, and care for, our elders–and also our children who will be elderly when many of these reforms are enacted.