Mitt Romney’s choice of Wisconsin Rep. Paul Ryan as his vice presidential nominee elevates Medicare and Medicaid (along with Social Security) to Level A campaign issues. Ryan has emerged as a leading Congressional thinker and idea shaper for the GOP on fiscal matters, and his path cuts right through Medicare and Medicaid.
Consider the scale: Last year the Congressional Budget Office examined the “Path to Prosperity,” his budget proposal for 2013, and found, among many other things, that it would cut federal health spending as a percentage of GDP from about 12 percent projected under current law to about 6 percent in 2030. That’s huge. No wonder his proposals are controversial.
Until recently, coverage of the discussions about entitlements—programs that eventually touch almost everyone—has been has been largely unhelpful, or cloaked in political spin. But covering Medicare (and Medicaid too) is hard. How do journalists cover and clarify the debates about reform without getting too deep in the weeds?
As with most legislation, the devil will be in the details, and a lot is not known about what will finally emerge from the legislative sausage grinder. What follows might help reporters cover the discussion—a rough guide to how these programs could change under Ryan’s influence, whether he remains as chairman of the House Budget Committee or moves to the vice president’s chair. Either way he will exert his pull over the future of entitlements. This guide offers a way to identify and categorize the kinds of changes that are on the table.
THE PROBLEM
Last year, Medicare cost the federal government some $551 billion dollars and the federal government and the states together spent $389 billion in fiscal 2010 for Medicaid. Both are projected to grow, which worries budget experts. Medicare could be fixed by raising payroll taxes that fund Medicare Part A, which pays for hospital benefits, but in the in the current climate, raising taxes even to support a popular program like Medicare is politically out of the question. It’s the same story for Medicaid, which is funded jointly by the states and the federal government. Since tax increases are not likely, that leaves cutting the programs as the solution of choice. But how?
Some changes are already here. For Medicare, both the prescription drug law passed in 2003 and the health reform law enacted two years ago under President Obama, already include some changes to beef up the program’s finances. Other possibilities for trimming both Medicare and Medicaid in the future are “in the wind,” supported by pols from both parties, who sometimes still talk of a “grand bargain” on entitlements. And then there is Paul Ryan.
Here’s how to think about what may be coming down the pike:
SHIFTING SOME GOVERNMENT COSTS TO BENEFICIARIES
What’s already happened? The health reform law, also called the Affordable Care Act (ACA), already calls for seniors to pay more for their healthcare by requiring their Medigap insurance policies to pay out less. Seniors typically buy Medigap policies to cover the gaps in Medicare benefits. But the ACA bars insurers who sell Medigap policies plans F and C from covering all of a seniors’ expenses that remain after Medicare pays the bills. Those two plans are the most popular Medigap policies precisely because they do cover almost all remaining expenses. Seniors tend to be risk averse and want no financial surprises at the end of an illness.
Politicians on both sides supported this provision in the ACA, so there’s been little talk about it and therefore little press coverage. Millions of seniors will be surprised come 2015, when they learn their Medigap policies won’t cover as much. The rationale: Some health policy analysts believe consumers use too many medical services, and paying more out of pocket—having “more skin in the game”—will cause them to seek less healthcare.
Seniors, Do we want to live in the world where even tho we produced these younger generation who don't care if we live some golden years free of where we will get our next meal or a much needed bottle of meds? What kind of America will we leave to our children without our GOD and SAVIOR? wON'T IT BE INTERESTING IF WE HAVE TO LOOK UP TO THE HEAVENS AND HUNT FOR STARS AND FIND THAT OUR GOOD GOD JUST TURNED OFF THE LIGHTS. tHEN WILL WE PRAISE mOHAMMAD OR WILL WE GET DOWN ON OUR KNEES AND ASK OUR GOD FORGIVENESS FOR DENYING HIM AS OUR CREATOR AND REDEEMER?
#1 Posted by Ruth M. Meyer, CJR on Thu 16 Aug 2012 at 06:23 PM
" Lieberman’s proposal would instead cap all out of pocket spending at $7,500 for low and moderate-income families—meaning such families would pay the first $7,500 of medical expenses".
This is a catastrophe for healthy seniors, in effect having them pay bills for those who require advanced medical care, very expensive prescriptions, and inpatient hospitalization. One senior would pay, maybe, $2307.00 for an entire year of medical expenses, receiving no benefits at all. Another might pay $7300. for a year, which would be crushing to many seniors. Then, the really sick ones would pay $7500. for health care possibly running into six figures. The divided deductible is way more equitable.
One subject no one wants to talk about is removing the FICA cap on Medicare deductions for employees. It seems very unfair that the richer one is, the less they pay for Medicare as a percentage of their income.
Finally, whatever happened to that good ol' single payer, that public option? We desperately need governance by people who are not cowed by corporations and who actually consider it important to care for the citizens of this country.
#2 Posted by BarbL, CJR on Thu 16 Aug 2012 at 06:43 PM
Smooching a Voucher, state travelers beware of failures of Vouchers since military and organized martial law would turn that key towards their own protection seniors are likely to find having paid into something that ends them in a coliseum, auditorium, gymnasium, or other large building perhaps a aircraft hanger. Now why has Paul Ryan not got a keen eye for what makes America tick? I am referring to Stocks & Bonds. Should Congress be so kind to make it legal to allow seniors to own stocks & bonds we can iron out the problem Medicare has with a New Proposal which says, "Be kind to yourself, buy your Doc Shares which he is allowed to establish as your doctor, if he finds nothing wrong with you maybe he won't buy a lot of shares, but every other doctor he refers you to can add to this simple share plan and to make it fun you could sell, sell, sell (rather allow a insurer to buy your shares from the doctor too but you really do not want to sell what you bought seeing that yours cost you more at $5 a share while the primary doctor and the insurer pays $1 for your share but the kickback is grand at 35% per quarter and that is more money than Social Security could ever mass at one time per individual. I'm not rich like some people are but their are possibilities which do exist for even the poorest of the poor to participate in this eloquent future plan to save themselves the trouble of accounting quarterly. I call it a Mutual Virtual Family, if they have no family this is where they want to hangout their hat and take it easy, a chosen administrator could handle the virtual family plan just as easily as any insurer and because of the other opportunity available in a sharecrop concept you could give permission for a friend to be your sponsor allowing buys and sells for your Doc Shares which builds income for them at 35% of the total if you were to die but a grand total in Mutual Funds that pays off the debt your healthcare experienced.
Since this network grid encompasses all States there's no need of a provider and this eliminates the so called Insurance Policy for Healthcare since a Insurer can buy shares and/or manage your Share Assets for you on a quarterly basis you have no administrative monetary details in clinics and hospitals which slowed down patient access to a medical doctor. Being In The Grid allows any and all medical practitioners in America to offer advice and a opinion on a medical matter, pharmaceutical matter, nursing home matter, Alzheimer and Dementia matter, DNA matter. It is a Library for the future which Medicare did not offer anyone and Medicaid is really trying hard to deal with not having what they create in every state, this extends Medicaid's activity. What I am saying initially is that if a State has already got a healthcare program such as Medicaid for its employees that does not change and they do not have to consider Doc Shares for their employees but like a medigap plan it could fill in monetary holes where Medicare didn't fund entirely like nursing homes and 24/7 nursing job opportunity. These medigap popups cover everything which is not covered but the catch is Doc Shares.
#3 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 08:19 PM
DOC SHARES IS THE ANSWER FROM ME, START THE POLICY NOW, I'M OPPOSED TO A VOUCHER...
A Doctor is allowed to start the process and given his quota allowed as 500 Shares per patient, the more patients the more he can earn, it is up to him on what he wants to earn from saving your life or saving you from a illness, or simply making your life better and its not your money he is using to do it with and it only costs him $1 per Share but he earns 35% off each one he buys per quarter and he can sell Shares to you which is not losing hm any Shares of You but doubling the Shares that are out and the same is true for other Doctors he can offer for you and a Insurer if You give permission to a Insurer each earns 35% per quarter. Sound like to much earnings, do not forget that every penny is nothing to a fund which is sloshed and Waked for it is not a Slush Fund that you can dip into nor anyone which handles its purpose is specific and if any money were to come out of it its allowed to loan between Doctors or between Virtual Families, and Insurers do not need it cause they have opportunity already. If Medicare Grows it is not Seniors that are going to make it grow and topple the fund over before paying its bills or going bankrupt its younger people that could cause Medicare to fail initially they create new families and add to the grid more people, but they can't change Doc Sharing any whatever they accomplish their future don''t have to dive into Doc Shares yet.
The Affordable Care Act does not impress me at all.
You need to get the PDF entitled: "Affordable Care Act Provisions_03-13-Coverage Estimates" and another entitled "Medicaid Program; Eligibility Changes Under the Affordable Care Act of 2010 - 2011-20756". Specifically you need to read this one at The Federal Register...
Eligibility Changes Under the Affordable Care Act of 2010; Proposed Rules
Part II Vol 76 No 159 Wednesday August 17, 2011
Department of Health and Human Services
Centers for Medicare and Medicaid Services
Medicaid Program [42 CFR Parts 431, 433, 435, and 457]
URL: http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20756.pdf
The Affordable Care Act is something which Ryan worked on and failed to see how it could occur that Obama could access $721 Billion of the $750 Billion available out of the taxpayers for enactment and overhead cost of making it a law. What is taking the proceeds coming from taxpayers that have their property stolen by Medicare & Medicaid which includes their SSA Checks, homes, vehicles, furniture, land, businesses, and assets including stocks/bonds, investments, and bank accounts plus savings and it all adds up to a eventual NATIONAL DEBT because there's no feedback to repay what is being spent so if OBAMA gets re-elected and Affordable Care Act Stands as-is OBAMA will have the money and the bill will go to the NATIONAL DEBT owed by taxpayers. In general you do not want OBAMA-BIDEN ever to have that capability, Ryan has been told about the Affordable Care Act Medicare Fraud issue and is looking to make changes as soon as is possible.
#4 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 08:43 PM
DOC SHARES CAN BRING AMERICA TOGETHER...
One certain change is not to cut-off everyone at the age of 65yo, and yet that don't solve the entire issue it simply adds to the maze of complexity at which its purpose is reserved. Currently anyone above 65yo is not insured and doctors cut-off patients (throwing them under the bus) at age 80. That is a large gap of support of insurance non-coverage and currently the state only benefits from the death of those whom have no will, The Affordable Care Act does not consider the end result properly, between 65yo and 80yo or beyond without coverage is a bad scenario for those people whom lost a lot of money during the years they were employed or simply paid into a healthcare provider like Medicare or Medicaid, and interest which government earned from its investments. Now you know why Obama wanted to bailout the Auto Industry so fast when they got short changed, they have health insurance payments through the Unions they belong to just like Coal Miners have insurance through their Coal Company Unions. Next OBAMA focused on ENERGY Co's becauyse they also have large payrolls and pay lots to insurers. Obama changed nothing except misleading statements, both the Auto Industry Coal Companies and Energy Companies are doing the same thing they always have been for their workers. OBAMA's gesture was aiming to make them see that he was including them while many state began to reject the concept that everyone must pay for government insurance Obama's next idea was to crush Medicare and Medicaid. I can't see that eliminating it would help anyone anymore but the insurance companies would have a field day starting new insurance providers they could depend on without government policy. Obama approached Ryan hoping for some magic to happen over the Affordable Care Act, instead Ryan angered at what the people were saying voiced to Obama their desires not his agenda.
What I found in The Affordable Care Act; I am shocked that no one seems to want to take credit for Fraud. The age limitation in Affordable care is 65yo, anyone already in a nursing home had 150-days paid by Medicare but after that these people might as well seek shelter somewhere else because Medicare fails to provide, mystically Medicaid is shown as a option, what states don't have Medicaid, this is Fraud. Not to mention that some people in nursing homes are already older than 65yo it is saying they cannot SWITCH OVER TO MEDICAID because of their age. Whatever my Grandmother was SWITCHED OFF at 80 years of age by her Doctor because he did not want to treat her after she turned 80yo. She had one valve operation in her pancreas which then leaked when she turned 80 and he refused to repair that leak but he sent her home wishing she could live longer than the six months he gave her laying there in a medical bed with oxygen tank and oxygen purifier awaiting her weekly opium shot to eliminate her pain because the cancer cells were suppose to drain out the valve into her stomach and she excrete them but instead the valve leaked into her body cavity and you know what happens when cancer cells go astray like that, there is no cure to stop the cancer growth afterwards since it invades the entire bodily organs and eventually kills it subject.
#5 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 08:52 PM
DOC SHARES CAN MANAGE ITSELF, NO NEED FOR DOWN THE ROAD GROWTH FEARDOM...
So what I propose is a simple plan which does not distract like some blank voucher ideology because it is handling your one the way you want your money to be handled. My Grandmother did not need to be thrown under the bus, she did not have either Medicaid or Medicare because her husband was not only a open pit coal miner but heavy equipment operator and member of a Union that also insured the wife and she was insured by the Union. The big question yet answered is how did she get cancer of the pancreas to begin with, she was not a diabetic, she lived a normal life without TV, radio, automobiles and music as she told me before she died her father owned a covered wagon and if she went anywhere with him she road in it and otherwise she would walk but didn't walk much and there was no running water nor toilet like you people know about because an outhouse was all that was available and if you want to wash your hands you had to draw the water from the well yourself or use rain water that came off the roof. Some crazed lunatics from California that were OCCULT caused her old home to burn down they bought from my Grandfather before she moved to the big city life of less than 10,000 people and a high school and a million dollar water work facility and one railroad train that moved coal primarily through the city every afternoon and some cars. Even though there was a water works facility this small community, I should call it a single traffic light town cause that is what it is today, had to buy water from a larger city 20 miles North of it and the water was pre-purified before it came through the 20" pipeline. One day th lunatic employees who were boys felt deeply they should have a drunk party at the water work facility and by crook and cranny they decided to dump more chemical into the water, this happened three times and I believe my Grandmother died because her city water was contaminated by a chemical that causes cancer called trihalomethanes which are limited to 0.080 mg/l (MCL - Maximum Contaminated Level) allowed contamination level, its a byproduct of chlorine disinfecting drinking water, can clog pipes break away and cause more damage to home piping and hot water heaters esp.. THIS UNDER ANY MEDICAL PLAN SHOULD NEVER HAPPEN IN A CITY.
I wanted to clarify who was making statements about Grannies being thrown off cliffs and under buses, I had a Grannie and she never knew about DOC SHARES, but if I can I will eventually tell her I thought it up one day when I was online thinking about her in the wake that she died without a kind word from William Clinton whom I asked to contact her amongst other people.
Obama-Biden is sunk in this arena entirely, they have nothing to do except BLUFF VOTERS for now until election day hoping that will get them re-elected so expect more garbage from where the garbage always came from for four years or I should say eight since Obama did hang with Bush as a US Senator accomplishing nothing. I don't like firebombing ideas like Democrats fell in love with through supporting Mister Barack Obama.
#6 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 09:09 PM
DOC SHARES ONLY AVAILABLE TO YOU WHEN YOU WANT YOUR DOCTOR TO HELP YOU WITH THE BILL (BE HAPPY YOU ARE WELL)...
I do not need another OBAMA-BIDEN, I do not need another failing medical program, Medicare Advantage Plus covered my mother in a nursing home up to 150-days now she has to rely on Medicaid but she is 78yo and that is above 65yo, tell Romney - Ryan that is the problem and there appears to be no answer even by taking the Obamacare money back into Medicare, Fraud is there in that Affordable Care Act so you now know the truth which pissed me off on Twitter and Facebook so I can't say why I should care so much, the house my Grandmother last lived in must be sold because we now have a debt above $15 thousand dollars on a Discover card which even when we pay $357 each month only $65 is going to that principal and it will never be paid in my lifetime unless I were to become a gambler or someone like the thief named Barack Obama that continues to commit Fraud since he started changing his name hiding from what his mother wanted him to be NOT HAWAIIAN, NOT AMERICAN perhaps 1st a Kenyan then that didn't work and later a Indonesian and even that attempt failed through help of Communist whom Obama employed for FOUR YEARS at the WHITE HOUSE. I WANT CATHOLICS TO CEASE IT AND HAVE IT SANCTIFIED TO ELIMINATE THE DEMONS WITHIN IT THE LAST FOUR YEARS, but there has been demons in it longer than that. Obama and his family are possessed plus getting obese. My mother may not live to her 80th Birthday and that nursing home cannot help change her Dementia and Alzheimer's which they billed to Medicare beyond the 1st 100-days she was made to remain there under the premise she would be accepted into Medicaid and that would pay the nursing home their money they demand $5,400 each month, and I did not like that plan then and I still don't like that plan, Frauds write garbage and don't know how to employ someone. I am TheJonalist at Facebook and I am Jonalist at Twitter, if you read me you will learn I am the author of "The Electric Vehicle Free Conversion Foundation" (EVFCF). If you know how to read between the political lines on all newsmedia sites and Cable TV. IT IS NOT FUNNY!
More to follow one day if you want me to continue, please contact America's Come Back Team and allow them to add to this situation because we need an immediate response. Closing my Republican Stance, Democrats lost out when they chose OBAMA as their Leader, but Mister Harry Reid of Nevada is the bigger loser with his lies, while Biden coughed one out about chains which wasn't really a intended joke someone in his audience distracted him saying NO. The Bluff was not understood by the media which sought after it like a needle in a horses foot trying to paraphrase the content to mean other than Biden's Bluff, I know Federal And U.S. Treasury control Dollars not Wall Street and Wall Street don't control DOC SHARES either nor ever can ITS A PATIENT/DOCTOR THINGY AND WHY WOULD YOU WANT TO HAVE IT ANYOTHER WAY, DOCTORS PAY THEIR WAY AROUND HOSPITALS WITH YOUR MONEY.
IM OUT OF WORDS ANY QUESTIONS FROM ANYONE TALK TO ME ON TWITTER OR FACEBOOK CAUSE ITS LONELY HERE IN FROM OF THIS COLD MACHINE ... VOTE AGAINST THE OBAMA-BIDEN TICKET.
#7 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 09:23 PM
The problem is not Medicare. The problem is that US health care costs are the highest among the developed nations, and the way our system is structured, Medicare must pay those costs. The free market has utterly failed in the health care industry, witness the total lack of productivity gains over the past 100 years and the fact that though we have lots of choices and plenty of competition, prices continue to increase at more than twice inflation. This will bankrupt the country in a few short years.
A single payer system (Medicare for all) will only partially solve the problem. We must abolish fee-for-service, put all MDs on salaries and price controls on prescription drugs, medical devices, and hospital services.
#8 Posted by Wally Roberts, CJR on Thu 16 Aug 2012 at 09:45 PM
DOC SHARE MAN AT TWITTER & FACEBOOK....
Infamous spoken words, NO, were the outspoken crowd pleaser's Biden was going to put back into chains once he realized banks and his Wall Street would again be in control of his money, why would he need a primer, he seems to have control out in the audience quite well enough to laugh at his own joke. Obama-Biden Teleprompter-primer that's all they got going for themselves or a new chain speech (one hits it the other carries it further or rejects opposition because of it), same garbage to us lionhearted. Join me on Twitter and Facebook, its a great time to "Over Yonder Ya'll". Finished the disc brake job all four wheels and emergency shoes too. It was a pleasure to explain DOC SHARES to you.
#9 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 09:47 PM
Responding to #8 Posted by Wally Roberts on Thu 16 Aug 2012 at 09:45 PM
(1) All that is left of Medicare right now is MINUS $721 BILLION
(2) The Affordable Care Act (with errors and falsehoods which are Frauds.
Fix it the way you think best but less people paying into Medicare will shut it down eventually, Ryan has told you that much, eventually employers are going to squabble over their totals the employees are being asked to pay and they could simply walk off the job and pay zero to h8im and they had a high paying job they could get anywhere even OVERSEAS. That could bankrupt employers eventually having to rely upon State Employees or worse yet have to pay for labor from a employment agency till they can find replacements. Yes Obamacare is going to cost taxpayers more money isn't much or anything else going to be cost effective like you want it, I mean The national Debt Growth cannot grow larger if you have nothing Obamacare can steal from you and use the way they want it in their washing machine so their laundry smells clean, looks, clean, but rots every four years or up to the time to read out the BUDGET or pay the government Interest Debt owed to other nations like China. It has already happened, Vouchers are not transparent in other nations, walk it out to Brazil, or Johannesburg, South Africa ask them what a Affordable Care Act does for their patients without money in the Medicare pot to pay them off when it is due? WAR IS ON ITS BRINK. STOP WHAT YOUR THINKING JUST THE SAME.
Wally Roberts, electric vehicle overhead costs start out at manufacturers above $100,000 each prototype they produce. You keeping up with their entire model selection that changes each year? GM - nothing earned due to machinery upgrades, downsizing after each prototype produced, more of the same wax from the bees!
#10 Posted by Charles Jones, CJR on Thu 16 Aug 2012 at 10:04 PM
DOC SHARES ESTABLISH GRANTS & SCHOLARSHIPS...
When you contribute to DOC SHARES for your own healthcare future you are establishing the capability for a Mutual Trust to be established for colleges and hospitals especially for research, testing, and cataloging data (non-personal). Normal proceedure allows hospitals to issue Grants and Scholarships for those that are integrated into the system they depend on for data. In turn some employee funds are collected to be added into the Mutual Doc Share Fund just like Walmart employees can contribute for their own charity options. It serves to repay money which is used by colleges and hospitals without being specific in details, no tracking necessary. Loans are possible but carry a high interest rate which serves to profit, provided to DOC SHARES. There should be at least two individuals employed per county regional medical services that are knowledgeable in DOC SHARES and can function as go-betweens for anyone which receives the DOC SHARE opportunity. One function is to serve the person whom has designated automatic provisions established without intervention by themselves to keep their DOC SHARES working at a high efficiency providing the most monetary value for their medical expenses. Long term patients of nursing homes would have this provision available to them which auto attaches withdrawals from their account to buy/sell DOC SHARES. Anyone can get the provision if they so designate where withdrawals should be made from to buy specific amounts of DOC SHARES or auto direct deposits to DOC SHARES available from a personal doctor. Once the Mutual Fund is established for a Virtual Family Mutual Fund (10 people conglomerate) DOC SHARING is automatic, these features are Tax Exempt Donations and filing tax returns should show that there are donations being made throughout the year to a specified number of Virtual Family Mutual Fund without specifics and a tax form showing that the donation has actually taken place annually likened to a tax withholding form per employer which is attached to the tax return. Auto funding is made possible through a SSA recipient account before the individual fund is dispersed.
Foreign Intervention
All International matters really deal with having a situation of individual(s) being under the category of having to leave America thus changing their legal residential address. Their DOC SHARES if they had established any prior to leaving America would continue to stay active within the Mutual Fund Network until such time that they die. If death is the issue the fund is removed from the individual status & placed into the grid no matter where they have a residence with no further recognition made available on the grid alleviating a clogged network of individuals served. International Tax reporting is not necessary.
Establishing DOC SHARES
DOC SHARES are a addition to the provider services without the overhead that is experienced by providers and is a personal medical application per Doctor acceptance. As has been the policy of the IRS nothing that has been paid into Medicare or Medicaid at a hospital regarding co-pays have no recognition per tax return and DOC SHARES on the otherhand will contain earning statements regarding the total shares owned per doctor tax id number. Initial funding for the DOC SHARES Program is established via a Congressional Act, since each individual earns money per share the government also will earn from the overall operation and the money will be repaid at a low interest rate allowed bylaw.
#11 Posted by Charles Jones, CJR on Fri 17 Aug 2012 at 10:12 AM
Early periods of the cancer tumor may be treatable effectively simply by surgical procedure. Yet, the extremely developed whipple procedure anatomy cannot be solely cured by way of surgery. Along with those, radiation and / or chemo will also help. In general, the aggressiveness regarding treatment is based on the particular level of pancreatic cancer, over-all power as well as health of individual and the opinion of your doctor.
#12 Posted by Johnson Paula , CJR on Fri 21 Sep 2012 at 10:45 PM