Romney-Ryan Medicare: Privatized System Would Raise Premiums For Recipients: Study
Rep. Paul Ryan, R-Wis., speaks during a campaign event at Youngstown State University, Saturday, Oct. 13, 2012, in Youngstown, Ohio. A Kaiser study says premiums for traditional Medicare would jump more than $200 a month if a plan similar to Ryan's proposed overhaul were in place.
By RICARDO ALONSO-ZALDIVAR 10/15/12 03:42 PM ET
WASHINGTON — Nearly six in 10 Medicare recipients would pay higher premiums under a hypothetical privatized system along the lines of what Republican presidential candidate Mitt Romney has proposed, according to a study released Monday.
The report by the nonpartisan Kaiser Family Foundation also found striking regional differences that could lead to big premium hikes in some states and counties. That finding instantly made it ammunition in the presidential campaign.
In the senior-rich political swing state of Florida, the hypothetical plan modeled by Kaiser would boost premiums for traditional Medicare by more than $200 a month on average. In Nevada, another competitive state, 50 percent of seniors would face additional monthly premiums of $100 or more for their coverage. A new pattern of regional disparities would emerge from overhauling Medicare's payment system, the report said.
Romney and his running mate, Wisconsin Rep. Paul Ryan, have proposed changing Medicare to a "premium support" system dominated by private plans that are paid a fixed amount by the government. President Barack Obama says replacing the current open-ended Medicare benefit would shift costs to seniors.
Romney's approach would mirror the difference between traditional workplace pensions and modern-day 401(k) plans, in which the employer contribution is limited. While Medicare financing wouldn't be as heavy a lift for taxpayers, the risk is that retirees could end up paying more if medical costs rise.
The study carried a prominent disclaimer: It should not be taken as a specific analysis of the Romney-Ryan proposal, partly because their plan lacks details. However, Kaiser says it is modeled on what Romney and Ryan propose.
"This approach is similar to the premium support proposal included in (House Budget) Chairman Paul Ryan's ... budget proposal for (fiscal year) 2013 that was embraced by presidential nominee Mitt Romney," the report said.
Like the Romney-Ryan plan, government health insurance payments for individual seniors would be tied to the cost of the second-lowest private insurance plan in their geographical area, or traditional Medicare, whichever is less expensive. Seniors could pick a private plan or a new public program modeled on traditional Medicare. But if their pick costs more than the government payment, they would have to pay the difference themselves.
One of the biggest differences, however, is that the report assumes the privatization plan is already in place. Under Romney-Ryan, current beneficiaries and those 10 years from retirement could stay in the traditional system. But the Kaiser study assumed the change has already happened, and all Medicare recipients are already in the new system.
The study also did not model the effects of additional financial help that Romney has promised for low-income seniors and those in frail health, because such details have not been filled in.
The Obama campaign pounced on the findings, while the Romney camp pointed to the disclaimer, saying the report does not reflect the candidate's own plan.
"As the authors stress, this is not a study of the Romney-Ryan plan," said Romney spokeswoman Andrea Saul. "Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare."
The Obama campaign posted a link to the study on its website.
"Under Romney's plan, millions of people _especially those with complicated health needs who see a lot of different doctors_ would have to give up their doctors or pay extra to maintain access to their choices," said Obama spokesman Adam Fetcher.
Kaiser's top Medicare expert, Tricia Neuman, said the organization has been working on the report since the early part of the year, well before Romney picked Ryan as his running mate and cemented his support for the congressman's Medicare overhaul.
Kaiser serves as an information clearinghouse about the health care system. Neuman, a vice president of the group, said the goal is to help inform next year's budget debates, regardless of who is elected president.
Currently about 75 percent of Medicare's nearly 50 million beneficiaries are in the traditional government program, while the remaining 25 percent have opted for private Medicare Advantage plans. The standard Part B premium most beneficiaries pay is now $99.90 a month.
The study's main finding is that changing Medicare from an open-ended program that covers the same benefits across the country will have profound local implications.
Since Medicare spending per person varies dramatically around the country, privatizing the program would create big regional disparities. In high-cost areas, the difference between the second-least expensive private insurance plan and traditional Medicare can be substantial, said Neuman.
Because the government's contribution would be limited under the new system, seniors in areas with high medical costs would see an increase in their premiums for traditional Medicare unless they switch to a low-cost private plan.
In low-cost areas, the reverse would be true: seniors in private plans would pay higher premiums unless they switched to traditional Medicare.
Overall, the study found that 59 percent of all Medicare recipients would face higher premiums if they stick with their current coverage, including about half of those in the traditional program.
In five states – California, Connecticut, Florida, New Jersey and Nevada – more than 45 percent of beneficiaries would pay at least $100 a month more in premiums.
Premiums could also vary within states. In San Francisco and Sacramento counties in the northern part of California, premiums for traditional Medicare would remain unchanged. But to the south, in Los Angeles and Orange counties, premiums would go up more than $200 a month.
"If coupled with caps on the growth in Medicare spending, a premium support approach could make federal (spending) for the Medicare program more predictable but also increase costs and financial risks for beneficiaries over time," the report said.
Romney's Talking Points on the Uninsured Are Like the Ones I Wrote When I Was an Insurance Industry Flack
By Wendell Potter Posted: 10/15/2012 10:30 am
I understand where Mitt Romney was coming from when he said last week that Americans without health insurance don't have to worry about dying at home.
"We don't have people that become ill, who die in their apartment because they don't have insurance," the GOP presidential nominee told members of the Columbus Dispatch [ http://www.dispatch.com/content/stories/local/2012/10/11/health-care-called-choice.html ] editorial board. "We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack.' No, you go to the hospital, you get treated, and it's paid for, either by charity, the government or by the hospital."
I have no reason to believe that Romney saw anything wrong with what he said. In fact, I probably would have said the same thing back when I was still a health insurance PR guy and trying to convince folks that the problem of the uninsured wasn't really such a big deal.
And Romney is absolutely right, people who are uninsured don't have to die in their apartments. They can indeed be rushed to a hospital, and the hospital is obligated to treat them. It's what he didn't say, and likely doesn't understand because he simply can't relate to 47 percent of us, that is actually more important: many of the uninsured die in the hospital, in the emergency room, because they could not afford to get care earlier when it might have saved their lives. Instead of going back home to their apartments, many of them, unfortunately, go to the morgue.
In 2007, when the Democratic candidates for president were beginning to talk about health care reform, I was asked to write a policy paper that the insurance industry would use to "educate" people about the uninsured. I found that if you sliced and diced the data in just such a way, you could make people believe that many of the uninsured were simply shirking their responsibility by not buying coverage.
It is true, for example, that young adults comprise almost a third of the uninsured. We in the insurance industry perpetuated the belief that those young people consider themselves so bullet-proof that they didn't see the need for insurance. Hence the term "young invincibles" that insurers use to describe them.
It is also true that some relatively high-income people are uninsured. A lot of politicians have pointed this out over the years, including former House Speaker Newt Gingrich, who said this last year on Meet the Press:
A large number of the uninsured earn $75,000 or more a year (and) don't buy any health insurance because they want to buy a second house or a better car or go on vacation.
It is true, as I pointed out in that paper, that about 20 percent of the uninsured live in households with median household incomes of $75,000 or more.
But there are some crucial facts I left out of that policy paper -- and of course, I left them out on purpose.
Many of those "young invincibles" were (and still are) unemployed. Consequently, they are not eligible for employer-subsidized coverage and don't have the extra cash lying around to buy health insurance. And many who are employed work for small employers that don't offer coverage, and they make so little that they must live paycheck-to-paycheck.
And many of those folks in households that bring in $75,000 or more a year would love to have health insurance but simply can't buy it -- at any price -- because of pre-existing conditions. A Silicon Valley millionaire told me his wife went back to work for no reason other than for him to qualify for coverage as her spouse. He had been deemed uninsurable because he had been treated in the past for -- get this -- gout.
The reality is that most people who are uninsured are not that way by choice; they have no insurance because they can't afford coverage or can't even find a company willing to sell it to them. That will change in 2014 under Obamacare. Insurers will no longer be able to deny coverage to anyone because of a pre-existing condition -- unless Romney is elected and persuades Congress to repeal the law.
A 2009 study published in the American Journal of Public Health estimated that almost 45,000 annual deaths in this country are associated with a lack of health insurance.
The researchers found that uninsured Americans have a 40 percent higher risk of death than their privately insured counterparts. One main reason: the quality of care for those with insurance is considerably higher than for those without it.
Those unfortunate folks might not have to die in their apartments. But many of them are dying prematurely, nonetheless, because they are not fortunate enough to have insurance.
Obamacare gets my vote: Romney and Ryan's alternative nearly killed me
Mitt Romney has pledged to repeal Obamacare; Paul Ryan wants to replace Medicare with a voucher system. Photograph: Reuters/Shannon Stapleton
I'm critical of Obama's presidency, but my medical emergency convinced me that for Obamacare alone we must re-elect him
Clancy Sigal guardian.co.uk, Saturday 13 October 2012 08.00 EDT
Under the influence of the painkiller Dilaudid, and dog-tired after another day of fighting for my life with my private health insurance company, I glimpsed Mitt Romney and his running-mate, Paul Ryan, entering my Los Angeles hospital room dressed in surgical gowns with scalpels in their hands ready to fatally operate on me.
It was a drug-induced hallucination, of course. But the mirage made me sit bolt upright in bed and, fully awake, start to rethink my previous, bitterly dissenting view of Barack Obama.
For the past year, I've been in a death spiral without knowing it. The occasional fainting spell, sprawls on the street and a dramatic weight loss were shrugged off as merely a cost of doing a writer's business. Denial is a most powerful analgesic. Even when paramedics first rushed me to the hospital, I angrily argued with the doctors.
But when a lightning-bolt sciatica pain, triggered by a car accident, brought me down like a bull under the matador's sword, more or less paralyzing the left side of my body, the health gods decided it was time to shut down my hubris. Like something out of the TV's "House" or "General Hospital", suddenly there were midnight ambulances, emergency room traumas, drip feeds, oxygen tubes up my nose, renal failure, suspected meningitis, pneumonia and a minor heart attack.
Thankfully, working as a team at my local Cedars-Sinai hospital, whole platoons of neurosurgeons, cardiologists, nurses, infectious disease experts, radiologists, physical therapists, pulmonologists and hospitalists (whatever they are) dragged me back from the edge. Emergency surgery in a special spinal unit was successful, and today I'm back on my feet – I'm a product of American medicine at its best.
Ah, if only the doctors were free to do their jobs!
My private insurance company, a subsidiary of Wellpoint Inc – America's largest "managed healthcare", for-profit company – interfered at almost every stage of my treatment. They were aggressive and shameless. At my most vulnerable, with tubes sticking out of me, they phoned my hospital room – kicking my anxiety level sky-high – to let me know that Wellpoint's profit-seeking radar had targeted me. The anonymous voice warned, with a kind of smiling threat, that they were on my case: meaning, some bureaucrat – was he or she even medically competent, or just an IT geek – in a far-off, distant corporate office believed that my treatment was violating a mysterious insurance algorithm.
Here in California, Wellpoint and its member plans are notorious, as Reuters reported, for "using a computer algorithm that automatically targeted [women] and every other policyholder recently diagnosed with breast cancer … the insurer then [allegedly] canceled their policies based on either erroneous or flimsy information."
The practice is called rescission. To put it bluntly, the company collects your money when you're healthy, but cancels if you get sick. In the case of another insurance company, Health Net Inc, employees were actually paid bonuses based on how many cancellations were carried out; at other insurers, like Wellpoint, staff were praised in performance reviews. Wellpoint's California subsidiary, Anthem Blue Cross, has raised premiums capriciously by as much as 39%. Politically, Wellpoint is, in effect, a rightwing "political action group" that lobbies hard against healthcare reform – even calling upon employees to do their share. In other words, it's the ogre in the medicine cabinet.
Perversely, none of the bad stuff would have come down if my primary insurance had been traditional, government-paid Medicare, the closest America has to a single payer. But a quirk in my union benefits put me in the sweaty hands of Wellpoint. I wasn't threatened with recission, but almost daily, and sometimes several times daily, my doctors were interrogated about practically every measure they took to keep me alive. Again and again, I saw caregivers, even the most skilled and courageous, retreat with an embarrassed, impotent shrug of resignation that said, "what can I do; it's 'the system'?"
So I – and my courageous tiger wife – fought, wangled, yelled, protested until I ultimately squeezed past the algorithm. The surgeon of my choice skillfully removed the whatsit that was pressing on an inflamed nerve that had been beating up my spine, and I even won a little rehab time before the insurance computer forced my early discharge. Along the way, anguish over near-daily arguments with the faceless insurance hanging judges almost gave me another heart attack.
Need it be this way?
Obamacare – also known as the Affordable Health Care Act – isn't medical heaven, or single payer, or anything like the "socialized" NHS that kept me well for the 30 years I lived in the UK. The new law, an obvious compromise with the corporate sickness industry, still keeps us in the hands of private insurance companies. But when the law fully kicks in for the first time, all Americans – regardless of income and "preexisting medical conditions" – must have health coverage. Individuals up to the age of 26 are covered by their parents' plan. Low-income Americans will get subsidies to help them buy insurance, and doctors and hospitals will be paid for outcomes not "procedures". Starting in 2014, insurers are forbidden to deny coverage to anyone who has no workplace – the jobless and freelancers will be able to get a government-mandated, insurance plan; indeed, they must or pay a "fine". And under the new law, "federal parity" means mental healthcare will be more accessible to more people.
Granted, that all depends on this upcoming election day. If Romney and Ryan win – the latest polls tell us this is a real possibility – they, a vengeful Republican Congress and their insurance lobby allies have sworn to sabotage healthcare-for-all. As for repeal and replace, Mitt's prescription for uninsured folks is that emergency room care is a good enough substitute:
"We do provide care for people who don't have insurance … If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care."
Here and elsewhere, I have written bitterly attacking Obama's serial betrayals. He's no street-scrapper, our Barack. Prior to falling sick, I pined for a third-party candidate, and seriously thought about not voting. But a drug-induced vision of a Romney/Ryan medical hell changed my mind. On 6 November, I'm pulling the lever for Obama: my arrogant, self-sabotaging, drone-happy, compromise-addicted war president.
I never want to see Dr Romney in my hospital room again. Damn it, I want to live.
The National Debt and Our Children: How Dumb Does Washington Think We Are?
By Dean Baker Posted: 10/15/2012 9:44 pm
While much of the country is focused on the presidential race, the Wall Street gang is waging a different battle; they are preparing an assault on Social Security and Medicare. This attack is not exactly secret. There have been a number of pieces [ http://www.washingtonpost.com/business/ceos-and-simpson-bowles-30/2012/07/20/gJQAMLfp0W_story.html ] on this corporate-backed campaign in the media over the last few months, but the drive is nonetheless taking place behind closed doors.
The corporate honchos are not expecting to convince the public that we should support cuts to Social Security and Medicare. They know this is a hopeless task. Huge majorities of people across the political spectrum strongly support these programs.
Instead they hope that they can use their power of persuasion, coupled with the power of campaign contributions and the power of high-paying jobs for defeated members of Congress, to get Congress to approve large cuts in Social Security, Medicare, Medicaid and other key programs. This is the plan for a grand bargain that the corporate chieftains hope can be struck in the lame duck Congress.
Most of the media have been happy to cooperate with the corporate chieftains in this plan. There are two main ways in which they have abandoned objectivity to support the plan for cutting Social Security and Medicare.
First they continually run stories about how the deficit and debt are the biggest problems facing the country. They routinely use phrases like "crisis" and other hyperboles to scare their audience about the risks that the debt poses to the country.
The whole notion of a "fiscal cliff" is an invention that implies an urgency that does not exist. There is almost no consequence to not having a deal in place by the end of 2012. The dire projections of recession and rising unemployment assume that we don't ever get a deal on the budget.
The fixation on the debt certainly cannot be justified by any objective standard. Clearly the most pressing economic problem facing the country is the tens of millions of people who are unemployed or underemployed as result of the collapse of the housing bubble. These people and their families are seeing their lives ruined due to a monumental failure by policymakers.
Furthermore, it is easy to show that the large budget deficits of recent years are entirely the result of the economic collapse. If the economy were back near full employment, the deficits would be relatively small as was the case before the collapse. Yet it is the deficits and debt that dominate news reporting and debate questions, not the overall state of the economy.
The other way in which the media have been pushing the agenda of the corporate honchos is by refusing to press candidates on their support for the cuts to Social Security that are a likely part of a grand bargain. Does President Obama support reducing Social Security benefits by 3 percent by cutting the annual cost-of-living adjustment? Does he support raising the age of Medicare eligibility to 67? How about your candidates for the Senate or the House?
It's unlikely that many people know the answers to these questions because the reporters have not been asking them. Yet these policies and other cuts that would likely be part of a grand bargain would have a much more direct impact on most people's lives that the tax proposals being touting by President Obama and Governor Romney.
To be specific, the reduction in Social Security benefits from the cut in the in the cost-of-living adjustment that is being pushed as part of a grand bargain would have more impact on most future retirees living standards than ending the Bush tax cuts on the richest 2 percent would have on their living standards. While the media have done endless pieces on the impact of this possible tax increase on the wealthy, they have done almost nothing on the impact of cutting the cost-of-living adjustment on the living standards of retirees.
This, of course, fits the needs of the corporate honchos who are pushing the agenda for cutting Social Security and Medicare. They don't want these cuts to become an issue before the election because it will make it harder for members of Congress to vote for them.
This is why the reporters covering this election deserve nothing but contempt from the public. It is their job to highlight the issues that will matter to people's lives, not to help push the agenda of corporate America. But clearly they have decided to do the latter.
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