Medicare

Who do we blame for soaring health insurance premiums?

You can blame AARP, health insurers, doctors and hospitals and the politicians that they paid with campaign contributions to distort the health insurance and health care markets.

And you can blame uninformed, unorganized and powerless voters for letting the Henry Waxmans of Congress and every president since JFK for making it all go wrong.

Health care is big money and big government.

Big government spends big money.

Big money in the hands of Big Government corrupts. 

Big government corrupts politicians, campaign contributors, drug companies, hospital administrators, physicians and regulators who have anything to do with distorting our health insurance and health care markets.

That's why America's huge government is and looks so corrupt. We're a third world country now.

Democrats and Republicans are deeply divided within each party as well as between parties on how to avert putting the country over the "fiscal cliff," which really is a slope, not a cliff. As a Small Government Republican Medicare beneficiary who's benefited from the free gift of Part D, cheap Medicare premiums, tax credits on home mortgages and coverage of primary care services that I should be paying for out of pocket, here's the deal I would like to see:

1. Make Medicare and Medicaid catastrophic programs only. Drop all the wellness and primary care nonsense that enriches providers and often hurts patients with false positives and harmful procedures.

2. Take all Congressionally imposed mandated benefits out of M/M.

3. Take all payments for teaching and medical research out of M/M. Fund them in separate bills and programs.

4. Breakup regional and metro hospital systems, medical groups and national health insurers.

5. Free seniors to buy non Medicare health insurance plans that cover primary care, wellness care and alternative care services without any Medicare subsidies for those premiums.

6. Raise premiums on all parts of Medicare. They're ridiculously low. 

7. Raise co-pays for all primary/preventive care and lower co/pays on catastrophically expensive cases.

8. Make Medicare Advantage enrollees pay the full premiums for the expanded coverage. 

9. Use money saved by eliminating coverage of provider-enriching preventive and wellness services to cover long-term care expenses that become catastrophically expensive as a percentage of the beneficiary's wealth, including the value of a a home or other investments. If someone is worth, say, $5 million, and long-term care costs, say, $80,000 to $100,000 a year, let that person pay for that care. If the person is worth $500,000 or less, Medicare could pay. That's the Moocher Nation way, of course.

10. Eliminate the death tax. Keep taxes on capital gains and dividends at 15%. No tax increases on the rich unless everyone gets income tax increases. Shrink the number of people who don't pay income taxes, get food stamps and are fraudulently filing disability claims.

11. Keep SS/Medicare enrollments at current ages. Change CPI calculations to reflect real inflation, which is a lot higher than the CPI shows today.

Congress and the Obama administration are fighting over how to fix entitlements, especially Medicare and Medicaid. Even Democrats disagree among themselves, according to today's Wall Street Journal. Some Democrats want no cuts, others want cosmetic cuts. Republicans want real reforms, but good luck with that.

Here are some ideas for fixing Medicare and Medicaid that I've made over the years and are even more relevant today: 

1. Take free physician office visits out of ObamCare. They waste physicians' time and create tremendous wait times for sick Medicare/Medicaid beneficiaries, which increases costs.

2. Require patients with minor symptoms to see nurse practitioners and other allied providers before wasting the time of the shrinking number of primary care physicians.

3. Eliminate coverage of the most wasteful primary care and allied providers.

Over the last 35 years, there have been a lot of attempts to slow the growth in Medicare expenditures, which have continued to soar unabated because of poor policy making by both parties. 

Although the Budget Control Act of 2011 (S. 365) says the Joint Budget Committee that will try to agree on the next round of budget cuts won't be allowed to change Medicare's benefits, I think it should.

Here are some ideas for changing Medicare that would give consumers and providers strong financial incentives to increase access to care and higher quality care at lower costs per patient and per enrollee:

The Budget Control Act signed by President Obama today creates a Joint Committee of a dozen members of Congress. It's job is to cut the budget by Thanksgiving.

Everyone expects that the committee, which will be comprised of six members of the Senate and six members of the House with six from each party, will target Medicare, Medicaid and other health services for savings.

This is a slightly revised piece I'm posting on comments sections and on Facebook:

What I want GOP candidates to promise:

On Thursday, Mitt Romney, a yet-to-be-announced presidential candidate, will try to get the RomneyCare Massachusetts health insurance disaster off his back. 

Romney experimented with health insurance markets in Massachusetts, and his stab at increasing access to health services while containing costs has failed big time. Health insurance is more expensive and health care is harder to get in Massachusetts under Romney care. And 100,000 still are uninsured.

Mike Fallon, M.D., Wednesday gave the one best talks on health care economics and policy that I've heard since 1976 when I started covering health care deform. He certainly showed that he knows more about health economics and policy than any Republican who's in the U.S. House of Representatives today. More with links after the jump:

When you get two Ivy League Easterners debating Colorado issues, you never can be sure which one will talk specifics and which one will talk generalities.

Appointed Obama Democrat Sen. Michael Bennet has voted against seniors, workers, home buyers and Colorado since he began representing his home town of Washington, DC and President Obama about 18 months ago. This National Republican Senatorial Committee ad makes the point: 

Are Colorado’s Sen. Michael Bennet and Conneticut’s Joe Lieberman both winners as a result of the reported decision by Senate Democrat leaders to dump the government-run public option health plan from the health spend and tax bill (HR 3950)?

Bennet has strongly backed the public option that won’t happen. He has endeared himself to 

House Democrats have found they don’t have the votes to pass a health insurance deform bill with a “robust” public option HMO/PPO, and now they’re talking about expanding the number of people who would be eligible for Medicaid benefits.

Unless Sen. Michael Bennet (D-CO) and Rep. Ed Perlmutter (D-CO CD 7) defend Colorado’s budget the way Senate Majority Leader Harry Reid (D-NV) and Sen. Chuck Schumer (D-NY) are defending their states with special favors, Colorado’s taxpayers will pay big time for an expansion of Medicaid benefits by Congress. Colorado and the federal government share the cost of Medicaid, which has been bloating states’ budgets for years.

Martin Vaughan at wsj.com’s impact graphs:

President Obama, Speaker Pelosi and Senate Majority Leader Reid are doing all they can to force working Americans and their families into a Medicare for all HMO/PPO that would sharply cut payments to providers and limit patients’ access to advanced medical technology and quality care. The Wall Street Journal is the only news organization covering this scandal in depth, and it explains in an editorial what the hard left Democrats are plotting. Other media are willingly being sucked in by clever White House distractions designed to hide what’s going on in Congress.

Link

The Public Option Comeback The secret to its budget ‘savings’? Medicare price controls. [Read comments after the editorial.]

Colorado’s two Democrat Senators, Michael Bennet and Mark Udall, today voted for a slight of hand accounting measure that would have taken $247 billion in Medicare physician payments out of the Senate Finance Committee’s health bill (S 1796) and added them to the Federal government’s budget deficit. more

Senators Harry Reid (D-NV) and Chuck Schumer (D-NY) are showing Americans how they would mismanage a public option health insurance plan that would compete with private insurers.

They are trying