In the Arena

Fixing Medicare, For Real

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I’m a big fan of Matt Miller’s columns and books about domestic public policy. Today, he has a very good column about the real problem with Medicare. Here’s the most important point:

Rightly understood, health-care entitlement reform is not, as conservatives suggest, a matter of lessening the dependency of big chunks of the population on government largesse. It’s about weaning the members of our medical-industrial complex from their entitlement to far higher payments, despite shabby results, than their counterparts abroad get. This license for inefficiency, issued by both parties to doctors, hospitals, health plans, drugmakers and device firms, is diverting precious resources in an aging America from urgent non-health care, non-elderly needs.

Matt promises future columns about how to get that done–and I won’t be surprised if this involves replacing fee-for-service medicine with salaries for doctors and a heavy reliance on electronic record-keeping and best practices that I described in my piece about the death of my parents. Atul Gawande, who has done some of the very best writing about our medical system, makes a similar point in his recent New Yorker piece comparing the way the Cheesecake Factory works to the current chaos of our medical system.

The real frustration for me here, as with so many other issues we face today, is that there are good answers out there–but they are unattainable because of political gridlock and the entrenched powers that special interests have in a mature democracy. In his Time magazine interview this week, Mitt Romney talked about the inability of government to react to change as well as private enterprise does. True enough. There’s no creative destruction in government–but there’s also tremendous amounts of money staked on the status quo. We need to address both, but I’m not very optimistic that we will.

78 comments
ScottEngageAmerica
ScottEngageAmerica

We can argue about who's weening who off the entitlements, the main point is the current situation is not working and it needs to be reformed. 

Medicare is running out of money. The 2012 Trustee's Report reports the exhaustion of Medicare's trust fund in 2024 (http://1.usa.gov/Kg5KuF).

RobertSF
RobertSF

The problem is that no matter how you frame the issue, it means "less care." It may mean less unnecessary care, but who's to say what's unnecessary? Who are the senior citizens who are going to volunteer for "less care?" Given a choice between less medical care and more medical care, people almost always want the latter.

Part of it is how Americans are. I read an account by a British doctor who had cancer, so for a time, he was both an employee and a patient in the British NHS. He knew the protocol as well as his doctor did, and when the last drug on the flowchart didn't work, the two just stared at each other. From now on, there would be no more treatment, only palliative care. The thing was, the doctor still didn't even feel that ill. This was when he wrote the article, and he eventually died of course. I wish I still had the link but I lost it.

Can anyone imagine Americans accepting that? Getting to a point where it's, well, we'll just have to let Nature take its course? No way. To the very end, it's always, "But there must be something you can try, doctor!"

PawPawSlim
PawPawSlim

Miller is right on target.  

Fee-for-service results in 89-year-olds like my dad being driven to the doctor's "office" -- more like the waiting room, actually -- sitting for an hour, having a "nurse" take their blood pressure, and then sitting in another, private little room with a paper-covered examining couch.  Then the doctor comes in, re-takes the blood pressure, asks a question or two, and tells [me] to schedule another appointment in six months.  Most questions from [me] result in a quick look of interruption, then brief consideration, and then a suggestion for some test or medication.

The aged are like cows to be milked of their Medicare dollars. 

Treat?  Analyze? Cure?  Seldom.

dennissinclair
dennissinclair

I thought for progressives, the one-size-fits-all and the government having all the answers is the only solution.

casey4
casey4

Do you understand the proposal?  The amount of the voucher will be keyed to the cost of a variety of insurance plans (specifically, the second cheapest) that must meet a minimum coverage level.  If you want more you can choose a different plan and pay more, which keeps the rest of us from paying for something we don't need/want but may be important to someone else.   And that would be my decision. It bothers me that many think we're too stupid to determine our own needs and need to rely on someone else to decide for us.

superlogi
superlogi

Why not just fix the business cycle by installing a command control economy as the present administration is promoting?  However, there are a few problems with that, some but not limited to the lack of high quality medical staff, pharmaceuticals, prosthesis, equipment and hospitals.  Other than that, it's a great idea.

Curious_Quiche
Curious_Quiche

I once worked for a giant filing conglomerate that specialized in medical records. They had four warehouses filled with banker's boxes (think the ending of Raiders of the Lost Ark). Hojillions of files. Literally. Hojillions.

Once, one of the untrained minimum wage goobers drove a forklift (OSHA who?) into one of the myriad shelves of files, causing a hilarious domino effect made only more laughable by the fact that I was immediately promoted to forklift operator.

The less hilarious part was when they just wrote that aisle off as totaled, leaving thousands and thousands of medical records to form low income housing for rats and cockroaches. A year later, it was a mountain of filth and pestilence. Also, bad feng shui. Also, the plague.

Someone telling me that cutting the mammoth excess involved in paying a whole company's worth of expenses on shuffling all this superfluous paper could be achieved by going electronic would probably garner less of a raised eyebrow from me than usual.

Besides, think of the fortune to be made by all those entry level data entry people! They'll be compensated fairly, right? u_u

Scotty_A
Scotty_A

Neither Romney nor Obama have any real plans based on what they have said on the campaign trail. Neither of the two are willing to move doctors to a salaried system. And the system does need to be setup such that the government only pays up to a point if you are over 65 years old. It is not free service. Where the marketplace should come in is to potentially offer supplementary insurance beyond the government supported baseline that people who have saved up for retirement can pay for out of their own pocket.

cin
cin

Find a way to lower costs overall, and Medicare costs will also fall.

I'm curious to see how universal coverage will affect prices. I'm curious to see the long-term effect of Obamacare's medical loss ratio requirements. I'm curious to see how much savings can be brought about from updating practices, computerized medical records, that kind of thing. (Though we won't get a true picture of any of this, because of Republican intransigence.)

Hughes Hunt
Hughes Hunt

Be vigilant and wake up America before it is too late! Praise be to Gawker.com, Wikileaks and the power of the internet. Doubtlessly with the revelations, it is confirmed that Romney is a cheat, liar, fraud and a criminal unfit to be President. He can never be trusted at his word. Since the wheels of justice turn ever so slowly, Romney has yet remained untouchable due to money, power, influence and the perverse double standard of justice for the rich and for the poor. It is interesting to note the overzealousness of Romney, Ryan and the entire Republican Tea Potties in buying the presidency at all costs with the backing of 33 billionaire donors to his campaign of mass deception, in their hunger for absolute power, total control and unbridled monopoly in the USA and in a new world order. Is it any wonder then that in the history of the USA, President Barack Obama is the first black United States President after 235 years of white monopoly of the White House?

rokinsteve
rokinsteve

The elephant in the room says everything they don't like is liberal, communist, or socialist.  Cloudy day?-liberal.  Traffic jam?-communist.  Affordable care?-socialist. 

allthingsinaname
allthingsinaname

 1.Universal Coverage.

2. Non-profit hospitals that can keep their doors open by competing for customers.

3. Salaried Doctors.

4. Let the wealthy spend their money on those doctors who will take them for everything they have.

georgiamd
georgiamd

The Medicare Trustees declared last month that Medicare

Part A (Hospital Insurance Trust Fund) will be insolvent by 2024, a

mere 13 years from now. Others estimate it will be only nine years. The

entitlement program has racked up almost 25 trillion in unfunded

liabilities. Others say it’s actually 38 trillion. It turns out free

health care is pretty expensive. Meanwhile, the Democrats keep kicking the can down the road.

Health care decisions that are based on political considerations are meant to benefit politicians, NOT patients. President Obama’s

solution is to force even more people into government health care.

Obamacare will increase the Medicaid rolls by 16 million people, further taxing an already overburdened system.

In the few remaining years Medicare

has left, dispirited doctors are already fleeing the program in droves  - leaving millions of patients behind. The Democrats’

only plan is to maintain the crumbling status quo: Plunder Medicare,

chase more doctors away with  additional  cuts  in

reimbursement  and then watch from the bleachers as Americans

are turned into medical refugees desperate for any salvation.

Paul Ryan, has put forward the only serious proposal to date that can save Medicare

by reforming it into a system that is in line with America’s values. It

wrestles control away from Washington and instead, entrusts states and

empowers American citizens. And this is precisely why Barack Obama and the Democrats oppose it.

 

f_galton
f_galton

"I’m a big fan of Matt Miller’s columns and books about domestic public policy"

I'm sure you are.

ERenger
ERenger

"The real frustration for me here, as with so many other issues we face today, is that there are good answers out there–but they are unattainable because of political gridlock and the entrenched powers that special interests have in a mature democracy."

and 

"there’s also tremendous amounts of money staked on the status quo."

--------------------------

This is exactly correct and affects so many areas of policy, not just health care. This is why it is so hard to make any changes to energy policy, industrial policy, fiscal policy... etc... etc... 

Entrenched powers and so much money on the line.

HudsonValleyTim
HudsonValleyTim

How about this....In exchange for participating in a salaried practice, which admisters primarily to publicly-funded insurance, the practicioner is shielded from malpractice claims in all-but gross negligence cases. Plus, in exchange for this work, the government underrites med school loans and forgives the debt at a rate of 10% per year of this service (with an annual cap - the govt cannot afford Harvard Med). That way, someone who really WANTS TO PRACTICE MEDICINE doesn't have to worry about marketing or lawyers (and gets a fair wage).

This is a problem that can be solved...Congress just lacks the creativity to do so.

Joe - Any thoughts?

shepherdwong
shepherdwong

"...the inability of government to react to change as well as private enterprise does. True enough. There’s no creative destruction in government–but there’s also tremendous amounts of money staked on the status quo."

Good lord. Our "counterparts abroad" are able to control costs because "private enterprise" doesn't (completely) control their governments. When are you going to get over your simple-minded, anti-liberal infatuation with so-called "market forces"? In this case, as in many others, they're the problem and the reason behind "the inability of government to react to change."

Trajan Saldana
Trajan Saldana

well, the "market approach to healthcare" doesn't seem to work either so.....

superlogi
superlogi

I hope you're not suggesting doctors work for the government?  If you are, you're living in the wrong country.  

Ivy_B
Ivy_B

Medicare now only pays up to a point. Most people I know pay out of their own pocket for insurance that supplements Medicare and pays most of the costs Medicare doesn't. What is called Medicare D is a separate plan you need to sign up for (and pay for) that covers some drug coverage.

Taxes for Medicare were taken from my paycheck when I worked. Now that I'm on Medicare, payments for Medicare is taken from my Social Security check.

There are a lot of changes in the ACA that will work to put Medicare on a better footing, so Obama doesn't need to propose any more. Big changes that have already taken effect are to slowly close the donut hole in Part D (if you don't know what that is, you can Google it) and require coverage with no deductable for certain preventive services like mammograms.

georgiamd
georgiamd

 Medicare’s own financial projections show that under current tax and

spending rules, the program will be insolvent by 2024. 

The reason is burgeoning health care costs. In the coming years,

the government will be forced to devote a growing share of the federal

budget to providing medical coverage for the millions of seniors who

have been promised Medicare benefits. The strain on both the nation’s

health care resources and the budget has become especially severe now

that baby boomers are retiring.  Maintaining Medicare’s current financing structure and benefit rules

will mean imposing back-breaking payroll taxes on younger and future

generations.

Just when do you propose fixing the system, cin? Democrats are being patently dishonest with the American public by continuing to ignore this impending crisis.

Sue_N.
Sue_N.

Yeah, it's pretty hard to have a reasonable conversation with people who say this: Just pray that this time we do not round up all progressives / communist and put you all in concentration camps. (libbylies to me in the "Exile" thread)

Sue_N.
Sue_N.

All these poor, dispirited doctors of yours who are "leaving in droves" because they're not making the Benz payments off their Medicare patients – what are they gonna do when the GOP guts Medicare entirely and seniors are left with no way to pay medical bills, and thus aren't going to doctors? When ObamaCare is repealed and, once again, vast swaths of our population don't have insurance because they can't afford it, and thus aren't going to doctors? How are your poor, dispirited doctors going to pay their country club fees when they have no patients in their waiting rooms because no one can afford their services?

You say you're a doctor, fine. How much health care can a senior buy for $6,700 (the amount of the Ryan voucher)? My mother's a diabetic who's had one knee replaced and had back surgery (thanks to Medicare), and my father has blood pressure and circulation problems out the wahzoo. Their lineup of daily medications is staggering. Medicare is keeping them alive.

But what about when Medicare is gone, and folks of my generation start needing all that care? Will $6,700 cover a knee replacement? Back surgery? All the tests and scans for vascular problems? A cardiologist? Please.

And you keep saying "the states" will somehow magically fix things. Really? Even states like mine that are actively seeking ways to kick people off Medicaid roles because we don't want to pay for their care? Where public hospitals (UTMB Galveston) is turning people away because they don't have insurance?

Your "American values" may include doctors in BMWs giving people the finger and telling them to crawl off and die. Mine don't.

anon76returns
anon76returns

"The Medicare Trustees declared last month that Medicare

Part A (Hospital Insurance Trust Fund) will be insolvent by 2024, a 

mere 13 years from now. Others estimate it will be only nine years. The 

entitlement program has racked up almost 25 trillion in unfunded 

liabilities. Others say it’s actually 38 trillion. It turns out free 

health care is pretty expensive."

May I presume that you are either 

A) thrilled that Obama's cuts to Medicare reduce the inefficient payout to overpriced services represented by Medicare Advantage

or 

B) full of sh!t and just looking for another excuse to rag on Obama's health insurance policy, which is probably going to take some money out of the wallet of folks like you down the road.

cin
cin

 The Ryan plan--the Republican plan--is to pass the costs onto seniors.

Think about that. Please.

People past working age, past getting insurance through their providers. People living on fixed incomes. Those who can't get promotions, can't get raises, can't work their way ahead. They've worked all their lives, and now they're past all that. They're retired.

Do you think it's OK to pass those costs to them?

filmnoia
filmnoia

Your American "values" are warped and are responsible for why we are in this mess. Let those doctors leave if they want. They are in the practice for the wrong reason - good riddance.  Ryan's voucher plan is a joke that would toss the elderly back into the bandits in the for profit insurance system, which is the whole GOP plan.  We aren't going back to the "good" old days.Then they can decimate SS to make sure that people invest their savings, and  then get scammed by Wall Street. Your "values" suck, and the public won't buy it.

fhmadvocat
fhmadvocat

HudsonValleyTim,

As an attorney, I can tell you that it is not the malpractice claims which are the problem.  In truth, the number of malpractice claims has been going down, while the malpractice insurance rates have been skyrocketing.  The rates the insurance companies are charging doctors has nothing to do with malpractice payouts.  A number of states have caps on malpractice awards and those doctors are still seeing their rates go up.

The University of Michigan has instituted a program where doctors admit their mistakes and work to solve the problem.  It is a great program because it takes the lawyers out of the system.  Often it is enough for a patient to hear from a doctor, "I'm sorry", and doctors should be able to admit mistakes without it being used against them in court.  The University of Michigan was able to lower its medical malpractice reserves by nearly 70%.  That would be much more effective than malpractice caps on non-economic damages.

As far as loan forgiveness, there are already options which are available in a few places.  One of our problems is we do not have enough family practice doctors in small communities.  The University of Minnesota-Duluth has a program for debt forgiveness for students who go to be doctors in small towns.  This should be a program which can be instituted throughout the whole country.

filmnoia
filmnoia

I've had somewhat the same thought posted below.

Subsidizing med school will separate those that truly want to help their fellow citizens from the money grubbers. As it is,  many doctors are somewhat like Willard and the boys at Bain. The  prime motive is to make money, and if some jobs are saved from a Bain deal, well, OK, but it's ancillary to the core goal. Likewise, if doctors can make the sick well again, fine and dandy, but it's secondary to "I want mine." This problem is so big that many of us won't see a dramatic change in our lifetime.

manapp99
manapp99

Actually they are not controlling costs well. Every country is struggling with this issue. 

superlogi
superlogi

How can you take $716 billion out of Medicare and put it on a better footing?  It must be progressive math?

PS  Payroll taxes cover about 50% of the expenditures they were targeted for.  The rest we borrow and/or steal from other tax revenue, primarily the income tax.  In short, neither Medicare or SS cash flows and the joke is, the government won't admit they're broke until that worthless treasury paper backing the programs runs out.  Oh, and how can a program which CBO says will run well in excess of a $trillion deficit over ten years make another program solvent?

georgiamd
georgiamd

 "changes in the ACA that will work to put Medicare on a better footing, so Obama doesn't need to propose any more."    said, Ivy as she buries her head even deeper in the sand.Medicare faces an unfunded liability of 38.6t or 328,404 per household.

(CNSNews.com) – Medicare faces an unfunded liability of 38.6 trillion, according to the Medicare Trustees report released Monday.

Are you prepared to write that check for 328k, Ivy?

The commentator George Will put it in a nutshell: Arithmetic will eventually and inevitably end Medicare “as we know it.” End of story.

Arithmetic will also end the Affordable Care Act as written. What

emerges in a few years after necessary amendments to make it affordable

will little resemble the present law.

The only real question, and one on which reasonable people can differ,

is what changes are necessary. At the least Representative Paul D. Ryan

does offer a plausible solution. His opponents offer no solution,

plausible or otherwise, except for, as they say, kicking the can down

the road.

georgiamd
georgiamd

 "so Obama doesn't need to propose any more". She states, as Ivy buries her head even deeper in the sand.

Medicare Faces Unfunded Liability of 38.6T, or 328,404 for each U.S. household...

(CNSNews.com) – Medicare faces an unfunded liability of $38.6 trillion, according to the Medicare Trustees report issued last month.Are you ready to write that check for 328k, Ivy?

The commentator George Will put it in a nutshell: Arithmetic will

eventually and inevitably end Medicare “as we know it.” End of story.

Arithmetic will also end the Affordable Care Act as written. What emerges in a few years after necessary amendments to make it affordable

will little resemble the present law.

The only real question, and one on which reasonable people can differ,

is what changes are necessary. At the least Representative Paul D. Ryan

does offer a plausible solution. His opponents offer no solution,

plausible or otherwise, except for, as they say, kicking the can down

the road.

omgamike
omgamike

Democrats would be more than willing to work with Republicans, or anyone else, to fix the problem.  That is, to take reasonable, measured steps, over a period of years, to rationally reform the health care system.  But neither side is willing to do what is right for the people of this country.  All they care about is their own re-election, their campaign contributions and their own perks and benefits.  We need to keep throwing them out of office until they get the point that legalized bribery is not acceptable.  That they are there to do a job, for everyone, not just their campaign donors, or the corporations or other special interest groups.

Amend the constitution to do away with Citizens United and it's harmful effects on the system, make public financing mandatory.  Put in term limits and take away the perks and benefits.  Then maybe, just maybe, our politicians will get to work fixing the health care system the right way -- then the financial markets.

The fox has been in the hen house for far too long.

NC doc
NC doc

Wow i hope you see reality when your daughter graduates from her residency with over$100,000 in student loan debt, has to pay malpractice, run an office, pay nurses, billers and a secretary AND buy an EMR system as mandated by Mr. Bush. Ain't no time to play golf. Change your stereotyped bigotry about surgeons and wake up to 2012. Medicare doesn't come close to paying the bills.

georgiamd
georgiamd

 Your bitter commentary castigating doctors is misplaced, Sue_N. Your anger should be directed at the politicians who have ravaged Medicare and keep selling you a bill of goods. What part of insolvent do you NOT understand? These numbers are provided BY Medicare. Cuts will have to be made sooner, than later. The Ryan plan is at least honest and attempts to solve the problem.....much better than the Democrats refusal to even address the issue.

FactCheck.org : No End to ‘End Medicare’ Claim

The newest Republican budget, proposed by Rep. Paul Ryan of Wisconsin, keeps traditional Medicare — unlike his plan from 2011 — and the increased cost claim is no ...

factcheck.org/2012/07/no-end-t... - Cached

casey4
casey4

Um, the $6700 is to buy the insurance policy . . . not pay for the medical care.  So please stop ranting long enough to think rationally:

 If you think that anyone can keep "Medicare as we know it", you're dreaming.  What we need is a debate on how best to continue care and it's pretty apparent it's going to mean individuals spending more money.  The question is how to get the most out of that money.

All the name-calling and venom (envy, fear, ignorance, entrenched partisanship) from both sides is what is really keeping us from making progress. 

Regarding all this "free" care.  C'mon, you all know it's not free.  Someone is paying for it and right now we're just jockeying to be sure it's not us.

superlogi
superlogi

The Ryan/Wyden plan, passed in the House budget bill, is to provide the choice of guaranteed benefits to the level of the 2nd lowest cost insurance plan, meaning there will be no out of pocket costs for seniors and, in fact, if they accept the lowest cost plan, will save them money.  However, if seniors want to stay in the traditional Medicare plan, that is their option.  So, cut the BS.  Conversely, Obama's plan is ? or simply to do nothing.

georgiamd
georgiamd

 cin,

Ryan’s plan would shift future beneficiaries to private insurance

plans,but it doesn’t call for seniors to find their own plans “on the

open market.” Instead, it sets up a Medicare exchange. Obama ignores

certain provisions of the proposal.

Here are the main bullet points on the House Republican plan:

Medicare won’t change until 2022. New enrollees that year

(65-year-olds) would get a subsidy to help them buy a private insurance

plan through a new Medicare exchange.The exchange would offer plans only to seniors, and those plans

would be required to provide a certain level of standard benefits.

Insurance companies would also be required to cover anyone who wanted a

plan and to charge the same premium for those of the same age.The average subsidy, or “premium-support payment,” as Ryan calls it,

would be 8,000 in 2022. Those with higher incomes would pay more out

of their own pocket, and the payments also would be different, depending

on health status.Low-income seniors would get government-financed medical savings accounts, with 7,800 deposited into the account in 2022.FactCheck.org : Obama Misrepresents Ryan PlanThe president implies that seniors could be rejected by ... The president attempted to explain the Ryan plan at an ... and the insurance company said it’s going to cost ...factcheck.org/2011/04/obama-misrepresents-ryan-plan - Cached

georgiamd
georgiamd

"Let those doctors leave if they want."   And leave, they will, filmnoia, so good luck on getting an appointment in a timely fashion. Welcome to Obama's socialized medicine, take your number and wait...remember now, we don't want to hear any complaints.

The Six Main Reasons Physicians Are Dropping Medicare ..

Physicians continue to drop Medicare patients and it will continue unless something is done to reinvigorate enthusiasm on the part of providers.

www.physicianspractice.com/blo...... - Cached

Hundreds of Scots die waiting for NHS heart treatment

Hundreds of Scots die waiting for NHS heart treatment The Sunday Times (UK) ^ | May 12 ... have died after being forced to wait up to a year for heart surgery. A Sunday Times ...

www.freerepublic.com/focus/new... -

HudsonValleyTim
HudsonValleyTim

I agree that the lawyers aren't the problem...mostly. However, having seen the abuse of the legal system as an employee of Wyeth during the phen fen debacle...somethings gotta change. Awards are so outta whack with actual damages that it's no wonder that the cost of care is insane. Then the insurers take their big chance to boost prices. If there were a system in place that could restore some sense to the insure/treat/litigate cycle, and use the reforms as a carrot, along with debtrelief, to reform Billing practices, then maybe we'd be getting somewhere. Thanks for the info.

peacock2828
peacock2828

But, if they're good doctors (which is another question entirely), does it matter why they're doing it?  Would you rather be treated by a well-meaning idiot or someone who's in it for the money, but knows what he's doing?  Whether the incentive is money or a tingly feeling inside, doctors usually want to do the best they can.

NC doc
NC doc

Wow. Lawyers are the good guys and doctors are the bad guys? Money grubbers? Wow. I wish you could live a day in my shoes. If you saw what I have to shell out to be in compliance, pay my office staff, buy electronic medical records systems and pay more malpractice insurance than any other developed country in the world, all while helping people and making far less than an ambulance chaser... I think you'd change your mind. You just have no idea. I can barely cover the cost of taking care of a Medicare patient much less get rich off of one. Wow. You guys need to come back to reality.

georgiamd
georgiamd

 Unfortunately, this is not the case, omgamike.

At some point, Democrats will need to decide whether to introduce

their own plan, and confront all the potential pitfalls that come along

with it.

In short, Medicare may not simply be a Republican problem for much longer.

Will Democrats have a Medicare plan? - The Washington PostBut what about Democrats? The White House has said major Medicare cuts need to be on the table, and as we ... Afternoon Fix; Ezra Klein's Wonkbook; Federal Insiderwww.washingtonpost.com/...... - CachedMore results from washingtonpost.com »

casey4
casey4

I don't really see how your response is helpful to the discussion.  Our problem is the entrenchment of everyone into their name-calling, insult-throwing, won't-look-past-their-own-interests positions. 

Nothing will change from either side.  You and your outlook is part of the problem.  You offer no solutions you just want a platform to spread your anger.

 I have no problem with my taxes helping to take care of people, either.  Just what do you think Medicare is, anyway?

This is my last comment.  It's too frustrating to try to have a discussion and just get the same response over and over.  Definition of insanity, right? 

Sue_N.
Sue_N.

I know what the $6,700 is for. I also know that throwing seniors onto the tender mercies of a for-profit insurance industry is no mercy at all. Seniors on fixed incomes will not only have to pay more for insurance, they'll also be paying more to pick up the costs the insurance doesn't cover.

And where did I say anything about "free" care? I know it's not free. But I have no problem with my taxes being used to help ensure the health of the people of this nation. I would much rather pay for that than another stupid, needless war or to help keep the oil industry at the top of the food chain.

The point is, we're not serious about "cutting costs" in this nation. We have one political party that is all for gutting the entire social safety net in the name of "fiscal responsibility," yet gets the vapors when anyone suggests looking into defense spending. And until that changes, I reserve the right to heap every kind of insult upon them.

ERenger
ERenger

$6,700 is not enough. My medical coverage costs me more than that already, and I'm not a senior. In 20 years the $6,700 will be worth even less, and the coverage will cost even more. It's likely seniors will have to pay significantly more than they do now, and most won't have the money to do it. What good is the voucher if it won't buy coverage? 

georgiamd
georgiamd

 Physicians are reimbursed .4o cents on the dollar under Medicare, cin and it is virtually impossible to pay staff, buy equipment and maintain a profitable practice at that low rate. Obama is threatening further cuts in the immediate future,so the only alternative is withdrawal from the system. We will be treating fewer patients, sure, but at least we can keep our heads above water. Those physicians who have dropped Medicare, are doing MUCH better, financially.

cin
cin

 Where are they going to go?

Somalia?

Really?

Where are they going to go?

NC doc
NC doc

And I am a registered Democrat. So just ratchet the stereotypes down a few notches people.