As soon as she filed for benefits, she looked for another job and found the one at the gift shop. “They don’t pay much, but it’s a job,” she said. And she had just gone on Medicare. She said she is a registered Democrat but voted for the elder George Bush. Could Paul Ryan’s Medicare plan affect her vote for the president? “Absolutely,” she said. She has been watching the coverage of Ryan, and continues to weigh the candidates. “You have Obamacare on one side, and on the other Ryan and Romney wanting to mess with Medicare. And here in Missouri we have Akin who wants to abolish Social Security.” McClanahan seemed frustrated by the politics of it all.
This is part of a series of CJR Town Halls, conversations with voters about the issues and how people learn about them through the press. And Trudy Lieberman’s “primer” on Medicare is here.
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