<<America will join the rest of the civilized world
Then we'd be joining them in an over-capacity lifeboat. How stupid do we have to be to do that willingly? What provokes such mindlessness? Best I can tell from my participation here, it's the need to be just like the cool kids, those civilized countries. We could lose our democracy because some of us haven't gotten over high school? How ignoble is that! >>>
There are two very separate questions that are mixed up here that makes this difficult situation more difficult to understand and to resolve.
1. Do we want to join the rest of the civilized world in their desire to provide better health care access for every one of their citizen's through a universal health care system (even though they all do so through various means and implemented over different time lines) or not?
2. How do we find a way to pay for it is an entirely separate question?
We can all agree that it is not something that is easy to implement. It has been made more difficult in this country because of poor policy decisions made by past administrations, especially after the actions of the Bush administration.
Constraining the Medicare Debate
Published: February 25, 2008
The Bush administration has just made several proposals — some sensible, some not — to reform Medicare financing and spending. Unfortunately, the exercise is seriously hobbled by an ill-advised 2003 law that prevents consideration of some of the best and fairest ways to begin fixing Medicare.
The 2003 Medicare prescription drug law requires that no more than 45 percent of total Medicare expenditures be paid for by general revenues, drawn mostly from the progressive income tax. (The other main funding sources are payroll taxes and beneficiary payments.)That restriction means that Congress can’t bolster Medicare with money generated by closing corporate tax loopholes or letting the president’s tax cuts for the wealthy expire. Those sensible steps would increase the amount of income tax supporting the program — pushing it over the arbitrary 45 percent cap. Instead, as health care costs rise and the population ages, the program will have to reduce services and reimbursements or find additional revenues elsewhere.
Now that two reports from the Medicare trustees have projected that the cap will be reached in the next several years, the administration has submitted its proposals for keeping general revenue support below 45 percent of Medicare costs. Its main proposal is to reduce the subsidy, and thereby increase the premiums, for wealthier beneficiaries in the drug program — individuals who earn more than $82,000 a year, and couples above $164,000. That alone would keep the support from general revenues below the cap, according to officials.
Such increases have already been imposed on the part of Medicare that covers doctors’ bills, and it seems reasonable to apply them to drug coverage. The major defect is that the income limits would not be indexed for inflation, so more and more beneficiaries would face increased premiums over time. That flaw should be repaired if this proposal is accepted by Congress.
Other potentially useful proposals would speed the adoption of electronic health records, pay health care providers based partly on the quality of their work, and disclose pricing and quality information to help consumers pick their doctors and hospitals.
The worst proposals, a slew of provisions to restrain medical malpractice awards, look mostly like a jab at the trial lawyers who support the Democratic Party. They are not apt to save the program much money.
The administration has made no effort to reduce the lavish and unjustified subsidies granted to the private health plans that participate in Medicare. Eliminating them could save Medicare far more general revenue money than reducing drug-program subsidies would.
Medicare needs to be reformed, but that debate should not be artificially constrained. Congress needs to focus on ways to restrain the relentless rise in health care costs that is bedeviling all health insurers, including Medicare. Congress and the administration need to be able to consider all possible sources of revenue for Medicare — on their own sound and equitable merits.
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