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The Definitive Guide to the Medicare Debate
August 23, 2012 10:38 AM   Subscribe

Jonathan Cohn compares the effects on Medicare from the Affordable Care Act with the proposals being promoted by Mitt Romney and Paul Ryan.
posted by reenum (27 comments total) 8 users marked this as a favorite

 
Matthew Yglesias's take on the issue: "Obama and Romney Agree on Medicare".
posted by Perplexity at 10:42 AM on August 23, 2012 [1 favorite]


There's a handy-dandy chart on the bottom, by the way.
posted by Sticherbeast at 10:46 AM on August 23, 2012 [1 favorite]


I only skimmed so I may have missed it but I don't see where he points out that one option is an actual on-the-books law that has made it through the political sausage making and the other is a plan that has yet to be subjected to congress's meat grinder.

Kind of reminds me of that Family Guy joke where they're offered a boat or a mystery box. Well yeah, the boat is a boat, but the mystery box could be anything! Even a boat!

(I know the boat in this analogy isn't the Queen Mary, but I'm at least pretty sure it's a boat.)
posted by ghharr at 10:50 AM on August 23, 2012 [1 favorite]


Matthew Yglesias's take on the issue: "Obama and Romney Agree on Medicare".

Cohn does a pretty good job of showing why Yglesias is wrong. Although I guess Yglesias can always claim that he means only that from a sufficient distance the two proposals are pretty much the same. But then, from a sufficient distance there's really not that much difference between, say, a 40% top marginal tax bracket and a 30% top marginal tax bracket--but there can, nonetheless be a vast political gulf between those two targets and very significant real world consequences for certain individuals depending on which one is adopted.
posted by yoink at 10:54 AM on August 23, 2012 [1 favorite]


A Giant Hospital Chain Is Blazing a Profit Trail
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.

The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.

HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.

The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.

HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
posted by rtha at 10:55 AM on August 23, 2012 [4 favorites]


We don't need any more articles telling us these things that we're already being said two years ago. We need something that convinces the majority of the public that the program the GOP tried to hang like an albatross around Obama's neck is more like a gold-freaking-medal the man cannot show off enough.

It also wouldn't hurt to really get it into people's heads that the HMO model is far too cruel for a 'civilized' country to harbor.
posted by Slackermagee at 11:02 AM on August 23, 2012 [2 favorites]


The idea that seniors would be able to effectively negotiate with insurers, thereby initiating some magical Adam Smith nonsense, needs to be taken behind the barn and shot
posted by angrycat at 11:17 AM on August 23, 2012 [26 favorites]


What I want from Social Security and Medicare, now disabled at 52 years of age, is the same level of coverage I would have received had I plunged all those years of paycheck deductions into an actual insurance portfolio instead of this two-bit bullshit with which I must deal now. Luckily I foresaw the need for a gap plan, however even with that, my overall coverage is nowhere near what it could have been had I been able to choose how to initially distribute those funds myself.

Right now, I figure the Federal Government is behind in my benefits paid to date by about US$1.3 million. I would gladly take that sum right now to invest and never receive another penny from SocSec or Medicare.
posted by Ardiril at 11:21 AM on August 23, 2012 [3 favorites]


It also wouldn't hurt to really get it into people's heads that the HMO model is far too cruel for a 'civilized' country to harbor.

How do you think "civilized" countries run their medical systems? Back in Australia a GP was a gatekeeper to specialists just as much as they are in HMOs. My "coverage" is not accepted "out of network" (outside of Australia without a reciprocal agreement or in private hospitals) and experimental treatments and elective plastic surgery wasn't covered either.
posted by Talez at 11:28 AM on August 23, 2012


I'll shorten the debate on Medicare policies even further:

In an analysis of Ryan's plan from last year, the CBO has said that by 2030 a typical 65-year-old would be responsible for about two-thirds of his or her own health care costs... much more than if current policies remained in place.

So, basically, his vision is that of turning Medicare into the insurance equivalent of a single sheet of single ply toilet paper.

Sure, his grandma doesn't have much to worry about. Her generation is preferentially treated yet again. But chances are that you do...

Unless, of course, you think that having people on a fixed income paying for 65% of their medical costs is in any way acceptable, either morally, or, quite possibly, from a personal standpoint, as a future recipient.

The debate should, quite rightly, be whether we are going to let tomorrow's elderly die from neglect or not, forced to choose each month which of the basics of existence they won't pay for, because that is literally what is at stake in the future.
posted by markkraft at 11:34 AM on August 23, 2012 [13 favorites]


The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.

It seems that the US system really does prioritize the needs of corporations over individuals - it's a structural issue that is unlikely to be easily changed. Holy cow.
posted by KokuRyu at 11:35 AM on August 23, 2012


“Medicare was there for my family, for my grandma, when we needed it," Ryan told the crowd. “And Medicare is there for my mom when she needs it now, and we have to keep that guarantee.”

Liberals take note: this is the same guy who in the fine print wants to dismantle Medicare. But under the spotlight, he's the biggest defender of socialist medicare that there is.

To me this says that there really is broad support across both parties for the big government socialism and even a guy like Ryan - who in his black little heart would like to tear it all down - he knows, and basically accepts, that there is no public support for that position.

The irony of a Tea Party hero defending one of the hallmarks of LBJ's Great Society is too sweet to ignore. Liberals have clearly won on this.

But you know what have you done for me lately....
posted by three blind mice at 11:40 AM on August 23, 2012 [1 favorite]


"even a guy like Ryan - who in his black little heart would like to tear it all down - he knows, and basically accepts, that there is no public support for that position"

... and yet, that won't stop him from lying about what he believes in, in order to give the servants of the very, very rich in Congress the opportunity to push through exactly what they want.
posted by markkraft at 11:45 AM on August 23, 2012 [2 favorites]


It may say that to you, but what it says to me, someone in the referenced age bracket, is that Ryan wants the Federal Government to pay us back what we are owed for what we already paid, and to correct the system for what is needed to serve future generations.
posted by Ardiril at 11:45 AM on August 23, 2012


If by "correct" you mean "fuck up", you're right on the money.
posted by schoolgirl report at 11:50 AM on August 23, 2012 [3 favorites]


To me this says that there really is broad support across both parties for the big government socialism

Yep.

Among the findings of the August Health tracking poll:

* 85% of Dems, 73% of Independents, and 69% of Republicans oppose reducing Medicare benefits to help reduce the deficit.

* 68% of Dems, 53% of Ind., and 55% of Repubs say "Medicare should continue as it is today, with the government guaranteeing all seniors the same set of health insurance benefits"

* 29% of Dems, 42% of Ind., and 39% of Repubs say that "Medicare should be changed to a system in which the government guarantees each senior a fixed amount of money to help them purchase coverage either from traditional Medicare or from a list of private health plans

Usual disclaimer: I work at KFF; I don't work on the policy side, I don't write or research or poll. I proof and post.
posted by rtha at 11:52 AM on August 23, 2012


You don't "correct" Medicare by making it massively dysfunctional for those on a fixed income in the future... while giving others -- possibly you, btw -- much more in benefits than they've actually paid in.
posted by markkraft at 11:55 AM on August 23, 2012 [2 favorites]


Right now, I figure the Federal Government is behind in my benefits paid to date by about US$1.3 million.

I'd be curious how you came up with that figure. By my numbers, even if you had paid the maximum possible medicare and socsec taxes every year since you were 18, and only became disabled this year, your payment stream would only have a value of $880K if invested at 6%.
posted by ROU_Xenophobe at 12:06 PM on August 23, 2012 [2 favorites]


(sorry -- forgot that medicare taxes aren't capped and figured them at the oasdi cap)
posted by ROU_Xenophobe at 12:33 PM on August 23, 2012


"What I want from Social Security and Medicare, now disabled at 52 years of age, is the same level of coverage I would have received had I plunged all those years of paycheck deductions into an actual insurance portfolio"

...and if you were disabled twenty years earlier in your career, before you had the ability to pay so much in taxes, you would want something else.

Oh, and BTW, did either of your parents collect Social Security or Medicare?

"Ryan wants the Federal Government to pay us back what we are owed for what we already paid.."

Paul Ryan wants to cut you a check for $1.3M? Or does he want to give you no more than what you are currently getting from the government... and likely give you considerably less in the future?

Because I'm sorry, but I have seen nothing in the news about Paul Ryan cutting checks for $1.3M. The closest thing he has said is that he wants people to pay into their own government-run account, and then get that money out later... but in order to be one of those people in the future, you would have to not be on disability anyway, right?!

So no... you're probably going to pay much more in the future. But hey, you can afford it, right?!
posted by markkraft at 12:33 PM on August 23, 2012 [3 favorites]


According to this thing (pdf) most currently older people will get a lot more lifetime SS and Medicare benefits than they paid in.
posted by ghharr at 12:42 PM on August 23, 2012


Not everyone gets to be a net beneficiary. That's the whole point.
posted by fleacircus at 1:02 PM on August 23, 2012


...what it says to me, someone in the referenced age bracket, is that Ryan wants the Federal Government to pay us back what we are owed for what we already paid, and to correct the system for what is needed to serve future generations.

Very, very distant future generations who are always going to turn out to be a little bit further out in the future than they were last time.

It seriously blows my mind that the Ryan budget which is supposed to be so hardcore and deficit-hawkish doesn't try to balance the budget until 2040 but was still taken seriously. Why do people fall for this from the Republicans again and again and again?

Guess what they were promising thirty years ago - that they were the party of small government because "government is living too well" and the number 1 priority would be to reign in the apocalyptic insanity of our national debt, which we all need to be terrified of, and balance the budget if the American people would just turn over power to them. (Well, technically as far as priorities Reagan said that "true peace is our dream", but that's even more laughable.)

And now, and continuously over the last three decades, they say "Well shucks, guys, we could swing getting Mitt Romney's taxes down to 13% and deregulating the banking system so that our financial apparatus could play the economy like a pinball machine, but we just weren't quite able to manage the whole balancing the budget thing or reducing the national debt, much less the deficit, this time around. But we are totally the party of fiscal responsibility and small government and all that. You betcha."

And the conservative base just laps it up and signs up for more and seems to unskeptically believe that it's not that they're being used and the Republican establishment doesn't actually give a crap at all about reducing the budget or any of the other "little people" concerns that are used to stoke the base up and get them to vote as needed, it's just all those nasty Democrats' fault. And you can have things like this, the guy who promises to balance the budget thirty years in the future and cross my heart this time we are totally going to do it for realz and not at all putting it so far in the future so that we can just blame it on any handy thing the Democrats do in the intervening three decades when it doesn't actually come to fruition. And they still cheer for him.

Not that I think either party in a two-party system is going to be fundamentally different and less manipulative than that in the end, it's just so ridiculous that the Republicans can pull the exact same trick again and again and again and it's like their voters are all infants with no object permanence or something.
posted by XMLicious at 1:57 PM on August 23, 2012 [5 favorites]


"What I want from Social Security and Medicare, now disabled at 52 years of age, is the same level of coverage I would have received had I plunged all those years of paycheck deductions into an actual insurance portfolio instead of this two-bit bullshit with which I must deal now."

An insurance portfolio that somehow magically didn't decline massively in value during the Great Recession, no doubt.

(Part of the deal is that you get less because you know it will be there. It's also the same idea behind why we give great pensions to public employees instead of great salaries — another promise that conservatives would love to renege upon.)
posted by klangklangston at 2:06 PM on August 23, 2012 [4 favorites]


Right now, I figure the Federal Government is behind in my benefits paid to date by about US$1.3 million.

Extraordinary claims require extraordinary proof.
posted by samofidelis at 3:01 PM on August 23, 2012 [1 favorite]


Healthcare in the USA: A strange game... The only winning move is not to play. How about a nice game of chess?
posted by j03 at 7:03 AM on August 24, 2012


Romney and Ryan Are Peddling Fear to Seniors by Grossly Distorting the Facts on Medicare
posted by homunculus at 2:58 PM on August 26, 2012


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