Medi­care, front and cen­ter

Ryan re-en­er­gized the de­bate; now it’s time for ev­ery­one to show their plans

Modern Healthcare - - OPINIONS EDITORIALS - DAVID MAY

The end of Medi­care as we know it.” In the dwin­dling weeks be­tween now and the Nov. 6 elec­tion, ex­pect those words to be re­peated on the cam­paign trail and in the news me­dia just as of­ten, if not more so, than the all-too-fa­mil­iar call to “re­peal and re­place” the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

The se­lec­tion this month of Rep. Paul Ryan (R-Wis.), chair­man of the pow­er­ful House Bud­get Com­mit­tee, as Mitt Rom­ney’s run­ning mate im­me­di­ately rein­tro­duced the phrase back into the na­tional po­lit­i­cal echo cham­ber. The choice of Ryan also guar­an­tees that health­care will re­main cen­ter-stage in the pol­icy de­bate, in­volv­ing not only the pres­i­den­tial/vice pres­i­den­tial con­test but races all the way down the bal­lot in the bat­tle for con­trol of Congress.

The “end of Medi­care” ref­er­ence, of course, is one of the charges against Ryan’s most ag­gres­sive plan to over­haul the pro­gram from stan­dard fee-for-ser­vice to a “pre­mium sup­port,” or voucher, model. Such a change would mean se­niors would be paid a fixed amount of Medi­care dol­lars that they would then use to com­par­i­son-shop for a pri­vate in­sur­ance pol­icy.

There can be no ar­gu­ment that such a plan would spell the end of Medi­care as we’ve al­ways known it. Even an­other idea floated by Ryan and Sen. Ron Wy­den (D-Ore.) last year of­fer­ing se­niors added choices would re­quire re­struc­tur­ing of the pro­gram. The real ques­tion is whether Medi­care as we know it is a healthy pro­gram that we know will be there for the next gen­er­a­tion and be­yond.

Ev­ery­one agrees the cur­rent sys­tem is un­sus­tain­able. Anal­y­sis shows a “so­lu­tion” such as Ryan’s might make Medi­care more af­ford­able for the trea­sury, but at the same time equally less af­ford­able for se­niors. One of raps against the plan is that the vouch­ers can’t pos­si­bly keep up with health­care in­fla­tion if the pro­posed bud­get is to be hon­ored, re­sult­ing in an out-of-pocket in­crease of $6,500 per ben­e­fi­ciary, ac­cord­ing to the Con­gres­sional Bud­get Of­fice. And that cost would continue to grow.

So, for many se­niors, that could mean the end of a se­cure re­tire­ment as they might have known it.

Rom­ney, set to of­fi­cially ac­cept the Repub­li­can pres­i­den­tial nom­i­na­tion next week at the GOP soiree in Tampa, Fla., was quick in his at­tempt to de­flect the ini­tial tsunami of criticism for his run­ning mate’s ideas, say­ing that he would have his own plan for Medi­care, and that Ryan’s plans aren’t nec­es­sar­ily his plans. But we have yet to see the nuts and bolts of such a plan. Last week, he of­fered some ideas that might pass as a frame­work, but for de­tail, the only sub­stan­tive pro­pos­als we have are cour­tesy of Con­gress­man Ryan.

To be fair, when it comes to Medi­care, we’ve yet to see a com­pre­hen­sive plan from the Obama ad­min­is­tra­tion ei­ther. The White House can take some credit for ex­tend­ing the life ex­pectancy of the pro­gram through pro­vi­sions of the ACA, but it’s no long-term fix. By con­trast, Ryan’s vi­sion is there for all to take in. Based on opin­ion polls, the pub­lic doesn’t like what they see, es­pe­cially those sure-to-turn-out-at-the­p­olls se­niors. Rom­ney, mean­while, con­tin­ues to vow that part of the so­lu­tion to Medi­care’s ills is the re­peal of Oba­macare. Again, we say, if un­plug­ging the re­form law is part of the an­swer, we’d love to hear more. Where’s the plan?

The na­tion needs to have a civil, bal­anced dis­cus­sion about our fis­cal fu­ture. The di­rec­tion of Medi­care, Med­i­caid and So­cial Se­cu­rity are core is­sues, along with bi­par­ti­san so­lu­tions for their sol­vency. The ques­tion: Can we ex­pect to see such changes en­acted any­time soon?

If so, that would mean the end of pol­i­tics as we know it. As­sis­tant Manag­ing

Ed­i­tor/Fea­tures

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