When Medicare and the Internet are "Free," Can You Put Them Back into The Bottle?

I shall argue that Medicare and Internet share one thing in common - the public perceives them to be “free.” Once that perception takes hold, it is hard to put the Medicare and Internet genies back into the bottle.

If you doubt my premise, I invite you to look at two things:

• One. The current raging town hall debates over Obama’s perceived health care proposals, as set forth in H.R. 3200, “America’s Affordable Health Choice Act of 2009.” Most passionately engaged in these debates are America’s seniors, who feel they may be deprived of life and death benefits they now regard as essentially “free,” in that America’s other taxpayers foot the bill and in that Medicare rarely currently interferes with the doctors’ and the seniors’ choice of services. Seniors fear bureaucrats, not doctors, will direct their care. They are also fearful that services will arbitrarily be cut off on the basis of age.

• Two. The Internet which is turning the world of print and publishing upside down by offering “free” access to print material, thereby threatening the very existence of newspapers, print encyclopedias, textbooks, and books themselves, which you can now read on Kindle. Why go to paper when you can Kindle, Google, Twitter, and YouTube? The Internet, in the hands of the goverment, may also turn upside down health care by creating the illusion that information technologies can replace patient and doctor judgements.

Medicare - Wildly Popular and Free

Medicare, as everybody knows, is a wildly popular program among seniors. And why not? Compared to private health plans, which must make a profit to stay in existence and to satisfy stockholders, Medicare rarely interferes with the provision of services. Patients like it for that very reason, and many doctors who serve the elderly like it too, even though its fees are, on average, 20% less than those offered by private plans.

But, alas, this lack of interference in an entitlement program is the source of Medicare’s main problem – runaway costs. These costs far outstrip private costs by 30% or more, no matter what you read to the contrary. To contain costs and offer basic services to 50 million of the uninsured in addition to the 42 million Medicare recipients, the government would have to make deep cuts, about $500 billion, in future Medicare services.

These cuts will entail rationing of services in the name comparative effectiveness. This rationing will most likely focus on high ticket items (cataracts, joint replacements, heart procedures, MRIs and CT scans), and of course physicians and hospital fees, which will be reduced and which will reduce access to care.

The public thinks of Medicare as “free,” in the sense that people don’t have to worry or even think about costs, and someone else, other anonyomous taxpayers, especially the “rich,” are paying the bill.

Following the Debate

In any case, if you are following the passionate and hostile exchanges now taking place in August during contentious and disruptive townhall meetings between politicians and their constitutents, you might want to have a scorecard to follow what is being said. You could, of course, read the entire 1018 page House proposal and you could read the 52 page summary now being offered by the Medical Association of Georgia, but that would take a long attention span and too much time. Besides, it is much more fun to have a scorecard, a primer, to follow the soundbites. charges, and counter-charges.

Here is the New York Times summary of the issues being batted back and forth.

KEEP IT OR LOSE IT?

President Obama’s promises that citizens may keep their private plans and their doctors may not be literally true because changes in health plans may change and cause an automatic switch to a choice of a federal plan , and people may lose their doctor who will not be acceptable to a public option. Another factor, seldom mentioned, is more and more doctors no longer accept new Medicare patients.


SOCIALIZED MEDICINE : Or Uniquely American?

Republicans bash Democratic proposals to create a government-run insurance plan, or public option, to compete with private insurers. Republicans say this would drive insurers out of business and lead to “socialized medicine.” Democrats say they want a “uniquely American” system with public and private elements. One thing is sure. An additional 10 million people, most of them now uninsured, would enroll in Medicaid, extending the federal reach into health care. Various government programs account for 35 percent of $2.5 trillion in health spending this year. According to others, the federal share may be closer to 50%.

BLAMING INSURERS , Or Ensuring Blame?

Democrats attack private health insurers as they try to convince Americans who already have coverage that the current system is tilted in favor of corporate profits, not patients, and that insurers are a main obstacle to passing legislation. The insurance industry opposes a government-run insurance plan . Insurers are of an obstacle in that public apprehension is growing over such sweeping reform. It is easier for Democrats to paint insurers as greedy than to explain the complex math showing current health care spending is unsustainable.

DEFICIT-NEUTRAL . Or Budget-Buster?

Mr. Obama has insisted that the bill not add to the federal debt, leading Democrats to say that the overhaul will be “deficit neutral,” with the roughly $1 trillion, 10-year cost to be offset by reduced spending or new taxes. The Congressional Budget Office has warned that the legislation “would probably generate substantial increases in federal budget deficits” beyond 2019, in part because health costs are rising faster than the rate of inflation and proposed new taxes would not keep up. Republicans use those warnings to cast doubt on the claim by Mr. Obama that the legislation will “bend the cost curve” by slowing the growth of health spending in the long term. Democrats say the overhaul will lead to theoretical savings.

EUTHANASIA , And Abortion

Conservative critics say the legislation could limit end-of-life care and even encourage euthanasia. Critics asser it would require people to draw up plans saying how they want to die. The House bill would provide Medicare coverage for optional consultations with doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care. The legislation instructs Medicare officials to propose ways to measure the quality of end-of-life care. Doctors would have financial incentives to report data on such care to the government. Of abortion, like the National Right to Life Committee, say the legislation would use tax dollars to subsidize insurance that could cover abortion.

CUTTING MEDICARE. Or Preserving It?

To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare. These savings would pay nearly 40 percent of the bills’ cost. The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. The providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries’ access to some types of care. Mr. Obama told AARP last month, “Nobody is talking about reducing Medicare benefits.” All the savings, he said, would come from measures to “eliminate waste and inefficiency in Medicare.” As an example, he cited duplicative tests ordered by different doctors for the same patient.

And so the debate rages on. Where it stops no one knows, but everyone one cares, for everyone will receive health care sometime in the future. Medicare-for-all is the not-so-secret dream of American liberals. Unfortunately paying for it all will require cutting benefits for an essential voting blog - the elderly.