The idea of privatizing Medicare is not winning popularity contests with voters. A Pew Research Center poll released Tuesday found that the public is aware of the proposal by GOP vice presidential candidate Paul Ryan to transform Medicare from social insurance into a voucher plan. And among Americans who have heard of the Ryan plan, 49 percent opposed it; only 34 percent were in favor. Pew found particularly high disapproval rates among older Americans, and independent voters weren’t keen on it either: 49 percent oppose and 34 percent support it. Thursday The New York Times reported that the GOP plan “is widely disliked,” and also that it has become the third most crucial issue to likely voters in the key swing states of Florida, Ohio, and Wisconsin, ranking behind the economy and healthcare.
This is another in CJR’s ongoing series of CJR Town Halls—conversations with citizens about the issues they are following in the press, and it will be the first of several Town Halls focused on Medicare. Part of the idea is to encourage journalists to do similar pieces, talking to ordinary people about dollars and cents issues and their needs and perceptions. Last week I was in Missouri, a swing state leaning red. My unscientific sample in St. Louis—made up of white women, some of whom just turned 65—pretty much lined up with what the scientific polls are showing.
Marie Cunningham and Janie Mueller
Cunningham, 65, and Mueller, 60, were on their lunch break, sitting outside the Bank of America Tower in downtown St. Louis, where they manage accounts for a property/casualty insurance broker. Cunningham, who recently signed up for Medicare, hadn’t heard much about Paul Ryan’s plan—“Are they trying to do away with it?” she wanted to know—and then let Mueller do the talking.
And Mueller had a lot to say. She had read about Ryan’s ideas in the newspapers, and watched coverage of it on CNN and MSNBC, and has an idea of how Medicare could change: “He wants to do away with what we know Medicare to be,” she said. “I’m not in favor of it at all. I’m extremely concerned.” Her main worry: preexisting conditions. She believes that under Ryan’s plan, older people who have medical conditions may not get insurance. It is an issue worth worrying about, since no one knows what final legislation might look like, though pre-existing conditions would seem to be something such legislation would address.
“Realistically when people into their 60s, their bodies start to fail,” she said. “Where are they going to get insurance? If Obamacare falls apart, we don’t have the force to make insurance companies take them.” Mueller is a Democrat and will vote for Obama, but she made clear that she views the issues independently, and also believes that “focusing on tort reform would be beneficial” in solving the healthcare cost dilemma. Tort reform is a solution pushed by the GOP.
Frances Flecke
Flecke, 55, was on her lunch break too, smoking outside the Federal Reserve Bank of St. Louis where she is the assistant manager for the Federal Reserve credit union. She told me she knew firsthand how the Great Recession has affected working families. “I saw many families suffering. They were living off courtesy pay,” she said, referring to a form of check overdraft protection that some banks and credit unions offer, which can be costly, but which allows consumers to pay their bills. “I saw more people living off that than I care to mention,” Flecke said. “A lot of our middle class is now lower class. What they had has been taken away from them.”
I asked Flecke how she gets her news. “The media doesn’t always tell you what’s true, “ she said. “What TV stations you watch are what you believe. You have to open your eyes or you’ll never have a clue.” She said she sometimes voted as an independent, and I asked her what she knew about Paul Ryan’s plan. “I would say it’s not a good one,” she said, and proceeded to accurately described what the plan would do.
Trudy, it's important or you and others in the media to emphasize that the Medicare privatization and voucher proposal is Romney's proposal as well as Ryan's. Romney put out his own Medicare voucher plan which is quite similar to Ryan's.
#1 Posted by Harris Meyer, CJR on Sat 25 Aug 2012 at 12:11 PM
The problem with any debate about changes to Medicare is the lack of discussion about the huge cost of not making changes. It is not like we can simply tax discretionary income of the rich and solve the future cost problem. To keep the system as it is, we need to increase medicare taxes from 2.9% to over 6% 20 years from now. That would work it would not affect any choices people are currently making, but it will. Prices will go up because employer costs will go up or there will be more unemployment if employers cannot pass the cost on to consumers. Workers will have a little less to spend so their will less consumption, less saving and that would result in more problems.
#2 Posted by Roger Jones, CJR on Sat 25 Aug 2012 at 01:54 PM
It is important to remember that rationing will occur under Obamacare. People that are old and need expense treatment will be sent home with pain killers. Obama said this very thing when asked.
#3 Posted by Roger Jones, CJR on Sat 25 Aug 2012 at 02:05 PM
" Obama said this very thing when asked."
Argh!! Dude! Context!
http://m.whitehouse.gov/the_press_office/Remarks-By-The-President-In-ABC-Prescription-For-America-Town-Hall-On-Health-Care-6-24-09
"THE PRESIDENT: Well, first of all, Doctor, I think it's a terrific question, and it's something that touches us all personally, especially when you start talking about end-of-life care. Some of you know my grandmother recently passed away, which was a very painful thing for me. She's somebody who helped raise me. But she's somebody who contracted what was diagnosed as terminal cancer; there was unanimity about that. They expected that she'd have six to nine months to life. She fell and broke her hip. And then the question was, does she get hip replacement surgery, even though she was fragile enough that they weren't sure how long she would last, whether she could get through the surgery...
THE PRESIDENT: Well, let's take an example. And they may be represented here, I wasn't sure. But the Mayo Clinic -- everybody has heard of it -- it's got some of the best quality care in the world, people fly from all over the world to Rochester, Minnesota, in order to get outstanding care. It turns out that Mayo Clinic oftentimes provides care that is as much as one-third less expensive than the average that's provided or some other health care systems that aren't doing as good of a job.
Now, why is that? Well, part of it is that they have set up teams that work together so that if you go first to your primary care physician and they order a test, you don't then have to duplicate having two more tests with other specialists because they were in the room when you first met with that primary care physician. They know how to manage chronic diseases in an effective way, so that we have people who are getting regular checkups, if they're trying to manage diabetes, as opposed to us paying for a $30,000 foot amputation because we didn't manage the disease properly.
So they are doing all kinds of smart things that we could easily duplicate across the system, but we don't. And our job in this summer and this fall -- and which I think everybody understands we've got to move in a different direction -- is to identify the best ways to achieve the best possible care in a way that controls costs and is affordable for the American economy long term...
THE PRESIDENT:.. [E]nd-of-life care is one of the most difficult, sensitive decisions we're going to have to make. I don't want bureaucracies making those decisions. But understand that those decisions are already being made in one way or another. If they're not being made under Medicare and Medicaid, they're being made by private insurers. We don't always make those decisions explicitly. We often make those decisions by just letting people run out of money or making the deductibles too high or the out-of-pocket expenses so onerous that they just can't afford the care...
But what we can do is make sure that at least some of the waste that exists in the system that's not making anybody's mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care... maybe this isn't going to help, maybe you're better off not having the surgery, but taking the painkiller."
This was not about "expense treatment old people need". Read the mayo article above.
#4 Posted by Thimbles, CJR on Sat 25 Aug 2012 at 05:10 PM
And read this:
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande
when you're done with the Mayo link.
This here:
http://m.motherjones.com/kevin-drum/2012/08/american-doctors-hospitals-and-pharmaceutical-companies-are-overpaid
is also something good. The American system over prescribes medicine because the system has treatment to manage near every condition, but those treatments often carry a quality of life cost to the patient. This system doesn't take that into account. What's billable is what's pushed and that isn't usually in the best interest of the patient nor the nation.
And we see that in the nations who pay multiples less for better results within a system they use more.
Expensive does not equal quality in a captive market.
#5 Posted by Thimbles, CJR on Sat 25 Aug 2012 at 05:30 PM