Ev­ery in­dus­try for it­self

Groups fight­ing to stave off cuts go­ing af­ter Medi­care el­i­gi­bil­ity age

Modern Healthcare - - OPINIONS EDITORIALS -

In ad­di­tion to Steve Jobs, the new iPhone and Amanda Knox, the cul­tural events of last week in­cluded the pub­lic TV air­ing of the new Ken Burns doc­u­men­tary “Pro­hi­bi­tion.”

As many ob­servers on the pro­gram noted, the 18th Amend­ment was one of the worst ideas in Amer­i­can his­tory. It took an enor­mous toll on so­ci­ety and its in­sti­tu­tions. Un­for­tu­nately, we still are play­ing with dan­ger­ous propo­si­tions—not so grandly dele­te­ri­ous, but still bad news.

A cur­rent ex­am­ple is the no­tion of rais­ing the Medi­care el­i­gi­bil­ity age. Pre­vi­ously, this idea was en­dorsed by po­lit­i­cal philoso­phers such as Rep. Paul Ryan (R-Ayn Rand) and Sen. Joseph Lieber­man (I-Cranky). Even Pres­i­dent Barack Obama briefly toyed with the idea while in­eptly seek­ing a nonex­is­tent mid­dle ground with Congress over deficit re­duc­tion. The Medi­care age hike was at least tem­po­rar­ily set aside, in part be­cause many politi­cians re­al­ized their con­stituents would em­brace it with the en­thu­si­asm they show for root canals and home fore­clo­sures.

So it’s a lit­tle dis­qui­et­ing to see health­care ex­ec­u­tives take up a cause that even the most un­pop­u­lar Congress in re­cent his­tory finds un­palat­able. For ex­am­ple, the Amer­i­can Hos­pi­tal As­so­ci­a­tion in­serted the idea in talk­ing points the group’s mem­bers could waft pass law­mak­ers dur­ing its ad­vo­cacy meet­ings last week. The Health­care Lead­er­ship Coun­cil also floated it in that or­ga­ni­za­tion’s leg­isla­tive agenda. The AHA and the HLC want mem­bers of Congress to avoid cuts to the in­dus­try as leg­is­la­tors, es­pe­cially the so-called su­per­com­mit­tee, de­bate deficit re­duc­tion. And the Amer­i­can Med­i­cal As­so­ci­a­tion and 42 other med­i­cal groups of­fered it as an op­tion. The AMA coali­tion wants Medi­care to scrap the sus­tain­able growth rate for­mula—but to do so with­out cut­ting other physi­cian pay­ments.

The in­dus­try is say­ing cut any­body but us. The AHA main­tains it merely wants of­fi­cials to “con­sider” rais­ing the Medi­care el­i­gi­bil­ity age, but is not nec­es­sar­ily en­dors­ing the idea. That’s akin to coun­sel­ing a fi­nan­cially strapped fam­ily to con­sider con­sign­ing granny to an ice floe—not that any­one is en­dors­ing that, of course.

Stud­ies by the Kaiser Fam­ily Foun­da­tion and oth­ers have con­cluded that while rais­ing the el­i­gi­bil­ity age might save the fed­eral govern­ment money, it would ac­tu­ally in­crease state and pri­vate sec­tor costs. Kaiser es­ti­mated the price tag would reach $11.4 bil­lion, more than off­set­ting fed­eral sav­ings of $5.7 bil­lion. Se­niors would have to find cov­er­age through in­sur­ance ex­changes or em­ploy­ers, in­cur­ring bil­lions more in out-of-pocket costs.

More im­por­tantly, the move would counter a cen­tury of ef­forts to ex­pand health cov­er­age in this coun­try, a goal that many peo­ple in the in­dus­try claimed they sup­ported. In­sur­ers have never stam­peded to write poli­cies for older Amer­i­cans (that’s why we have Medi­care). Even if the Supreme Court up­holds the tepid re­form law—don’t bet on it—se­niors would have a hard time ob­tain­ing af­ford­able cov­er­age. All this would oc­cur dur­ing the worst eco­nomic down­turn since the Great De­pres­sion, with com­pa­nies re­lent­lessly cut­ting jobs. To sug­gest that vul­ner­a­ble peo­ple should be put at risk so the world’s most ex­pen­sive health­care sys­tem with the high­est prices and in­fe­rior pub­lic health (Sept. 26, p. 17) should go un­touched is hardly flat­ter­ing to the in­dus­try. Ron Pol­lack, ex­ec­u­tive di­rec­tor of the ad­vo­cacy group Fam­i­lies USA, said the AHA “is try­ing to shift the fo­cus on pro­gram ben­e­fi­cia­ries rather than hos­pi­tal op­er­a­tions.”

We are now in an eco­nomic cri­sis with a po­lit­i­cally/ide­o­log­i­cally driven bud­get-cut­ting frenzy that is pit­ting in­ter­est groups against one an­other and the com­mon good. It’s a mis­er­able time, but in a few decades it may at least make for a great doc­u­men­tary.

NEIL MCLAUGH­LIN Man­ag­ing Editor

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