Perhaps no other health issue is as important to so many Americans now and in the future as Medicare. In this new series, “Covering Medicare,” we will follow the reportage and offer Medicare beat memos from time to time.
Medicare was big news on the political circuit yesterday, with Florida congressman Allen B. West getting, shall we say, pushback from local town hall attendees who are not keen on the Medicare cuts his party has proposed. The ruckus made page one of The New York Times. People in other parts of the country aren’t too pleased, either, as Republican members of Congress are finding in their chats with constituents. In New Hampshire last week, Republican congressman Charles Bass heard loud and clear that some folks in his district don’t like what the GOP is up to. The Los Angeles Times reported that a group of gray-haired constituents, mostly Democrats, “quickly pushed him (Bass) back on his heels. He struggled to defend the GOP plan vigorously, once mischaracterizing a key element.” In our own CJR Town Hall in Philadelphia, we found no support for Congressman Paul Ryan’s proposal, which would privatize Medicare and turn it into a voucher program.
To review, Ryan’s plan will transform Medicare from a social insurance program into a privatized system, making it more like private insurance coverage for people under age 65. If the amount of the voucher is insufficient to buy policies in the private market, Medicare beneficiaries will have to dig into their pockets to come up with the rest of the money to pay the premiums. For some, that will mean digging very deep, if the voucher does not keep pace with increases in the cost of health care. Seniors currently on Medicare are already paying large out-of-pocket amounts for health care, a point older people know well but perhaps not recognized by the pols and others.
And here’s where the New York Times story went astray, omitting a crucial point made by no less a neutral arbiter than the Congressional Budget Office. The CBO estimates that twenty years from now a typical sixty-five year-old would have to pay 68 percent of the total cost of his or her health coverage (premiums, deductibles, and other out-of-pocket costs), compared to about 39 percent today. The CBO said that those out-of-pocket costs—on average now $6150 a year—would more than double in 2022, to $12,513. The Times is not alone in leaving out the CBO numbers. A few weeks ago, Campaign Desk reported that a NewsHour segment did, too.
The Times story was as “garden variety, political, he said/she said” as you can get. Here’s a taste:
Under the Republican proposal, Medicare would be converted into a program that would subsidize health coverage for retirees rather than provide coverage directly, a change that many Democrats say would risk leaving the elderly with inadequate health care as costs rise over the long run.
Why are people angry? We don’t know if the reporters asked that question. But certainly their story didn’t provide much of an answer. People currently on Medicare, and those who will be there someday in the near future, know in their guts that the program is super important to their survival, and fear any changes—especially if Social Security benefits are reduced. They know that will mean less money to pay for the increased costs of health care.
Republican pols—and the Times, by virtue of the framing it chose—seemed to dismiss those fears. The Times ends with a quote from Republican congressman Lou Barletta of Pennsylvania who said his “town halls are being disrupted by Democrats. When I explain that people over 55 are not affected, there is almost a sigh of relief.” But many under fifty-five do worry, and that brings up The New York Times again. When Lyndon Johnson signed Medicare into law in 1965, Max Frankel, who was a then a Times Washington correspondent, approached LBJ and told the president: “My mother thanks you.”
“No,” Johnson replied. “It’s you who should be thanking me.” LBJ knew what Medicare would mean to future generations. That is the missing link.
For more from Trudy Lieberman on Social Security and entitlement reform, click here.
Medicare was big news on the political circuit yesterday, with Florida congressman Allen B. West getting, shall we say, pushback from local town hall attendees who are not keen on the Medicare cuts his party has proposed.
Three people out of 500, one of whom was a former AirAmerica host, boy … that’s some “pushback” Trudy.
If the amount of the voucher is insufficient to buy policies in the private market, Medicare beneficiaries will have to dig into their pockets to come up with the rest of the money to pay the premiums.
You mean like I have to … sucks for them.
The CBO estimates that twenty years from now a typical sixty-five year-old would have to pay 68 percent of the total cost of his or her health coverage (premiums, deductibles, and other out-of-pocket costs), compared to about 39 percent today.
The CBO, or rather its precursor, estimated that Medicare would only cost $9 billion by 1990. Its actual costs was $110 billion in 1990. That’s some fine forecasting.
“No,” Johnson replied. “It’s you who should be thanking me.” LBJ knew what Medicare would mean to future generations. That is the missing link.
He sure did know what it would mean: an large and reliable voting block from the governments new wards.
#1 Posted by Mike H, CJR on Wed 27 Apr 2011 at 12:31 PM
In our own CJR Town Hall in Philadelphia, we found no support for Congressman Paul Ryan’s proposal, which would privatize Medicare and turn it into a voucher program.
As scientific as your Town Hall was you should look into the latest polling from Gallup:
Ryan's plan includes a complete restructuring of Medicare for people younger than 55. Pluralities of middle-aged Americans as well as those 65 and older prefer Ryan's plan to Obama's, while adults 18 to 29 show more support for Obama's, 53% to 30%. These findings are in line with approval of Obama by age, more generally.
http://www.gallup.com/poll/147287/Americans-Divided-Ryan-Obama-Deficit-Plans.aspx
#2 Posted by Mike H, CJR on Wed 27 Apr 2011 at 12:41 PM
Your Max Frankel anecdote is perfect, Trudy. If Americans 55 and older fall for the line that the Ryan Medicare plan is OK because it won't affect THEIR Medicare, what does that say about this country? I've got mine and that's all I care about. I sure hope Americans have more social consciousness than that. But we'll see.
#3 Posted by Harris Meyer, CJR on Wed 27 Apr 2011 at 01:01 PM
It is ok to debate whether a premium support system or the current Medicare plan is the right way to provide medical care security for seniors. Then people could decide for themselves, based upon their own moral priorities, whether Medicare as we now know it is more important to them than tax cuts for millionaires largely funded by shifting much of the costs of health care for seniors to seniors. But that is not the basis of the debate. Instead, the supporters of the Ryan plan are ramping up a disinformation campaign that would make Orwell feel naive. If they are proud of the plan then they should state the details of the plan clearly and factually instead of burying us in disinformation.
#4 Posted by Gary B, CJR on Thu 28 Apr 2011 at 12:18 AM
This post illustrates nicely the inability or unwillingness of reporters to evaluate what politicians say rather than amplify whatever they say. The issue at stake in the Medicare dispute is fundamental, as Trudy suggests.
#5 Posted by Ted Marmor, CJR on Thu 28 Apr 2011 at 08:39 AM
Mike H: As a defender of Ryan's plan, you should know that the very poll you cite shows that Americans think that Ryan's plan goes TOO FAR with Medicare cuts by a factor of 2 to 1. The same poll shows that the public thinks the Ryan plan "protects the rights of the rich at the expense of everyone else" by a similar margin. You have to admit, there is no great popular support for Ryan's approach to Medicare.
On a separate subject, I have a question about the Ryan plan that nobody has yet been able to answer. Medicare was created in large part because the private insurance industry was not serving the elderly population. If you think about it, why should a private insurer sell health insurance to a sick elderly person? From a business standpoint, it makes little sense. Since the Ryan plan restores private insurance for the elderly, what is in the plan that will motivate private insurers to sell health insurance to an 82 year old sick person? Are there mandates of some sort? Are there regulations that prevent insurers from considering pre-existing conditions? If not, then why would we expect the private market to cover elderly people adequately?
#6 Posted by Rick Sullivan, CJR on Thu 28 Apr 2011 at 09:55 AM
Rick, I would expect the Ryan plan to mandate Medicare voucher insurers to take all comers, even though Republicans abhor mandates. But, remember, the Ryan plan would delay Medicare eligibility to age 67. If the Republicans repeal last year's health reform law, a big question is how people who are 65 and 66 would fare, because there would be no requirement for private insurers to sell them coverage. Secondly, insurers have sophisticated ways of selecting healthier risks even if they are required to take everyone, and they undoubtedly would do that.
#7 Posted by Harris Meyer, CJR on Thu 28 Apr 2011 at 06:33 PM
Harris, thanks. I suspect you're right about the requirement that Medicare voucher insurers will be required to take all comers. In addition, for this to truly make business sense, there would probably ALSO have to be a mandate that all those over 65 (or 67) buy health insurance. Otherwise, healthy people will wait until they need insurance before buying it. This is the reason that the Affordable Health Care Act has the mandates. The risk pool has to be spread out over the whole population.
I don't know if this is spelled out in Ryan's plan. But if it were, I imagine even Republican support would thin out - especially after the recent resistance to mandates.
#8 Posted by Rick Sullivan, CJR on Fri 29 Apr 2011 at 10:49 AM
Rick, you've raised a really interesting point. With the voucher worth so much less than the cost of Medicare private coverage in 2030, there is great potential for millions of seniors to try to go without coverage because they can't afford to pay 70% of the cost out of pocket. The Republicans would have to impose a dreaded mandate on seniors to force them to buy, otherwise we could have lots of sick, costly patients seeking uncompensated care from doctors and hospitals. I hadn't thought of that. Yes, GOP voter support would thin out if all the ramifications of this were spelled out.
#9 Posted by Harris Meyer, CJR on Sat 30 Apr 2011 at 12:25 AM
Harris - Yes, there's an irony here that isn't be covered by the media. I'd love to see this spelled out somewhere.
#10 Posted by Rick Sullivan, CJR on Mon 2 May 2011 at 11:57 AM