Medicare repair will require an end to fantasy

By Michael J. Pramenko

Our national deficit is getting more and more attention. It should. Unfortunately, the continued partisan atmosphere fails to lend itself to any realistic solutions as politicians generally tell “their” voters what they want to hear, as opposed to what they need to hear.

Serious problems deserve serious solutions, not ideological grandstanding.

Other than interest on the growing debt, Medicare represents the biggest problem with our budget. Thus, it offers the most effective avenue for addressing the deficit. Yet, it is often seen as untouchable.

We will not solve this nation’s deficit without changing Medicare. And we will not solve the states’ fiscal crises without changing Medicaid.

The long-term liability of Medicare is approximately five times larger than that of Social Security. In fact, Medicare Part D alone, a relatively recent addition to Medicare, has a price tag that equals Social Security over the coming decades.

Let’s be adults, here. It’s the peoples’ responses, our responses, to legitimate solutions that have driven this conversation into a stalemate. We are partially to blame. Witness the response to the work of the Deficit Commission last December. The ink on the commission’s proposals had not dried before partisans on both sides of the aisle rendered the advice worthless.

If you don’t want Medicare cuts, we will need to raise taxes. I repeat: If you don’t want Medicare cuts, taxes will have to be raised. The fantasy world of cutting taxes and leaving the structure of Medicare in place must end.

In fact, our fantasy world has boldly included more Medicare benefits and lower taxes. Remember, while we added Medicare Part D to the equation just eight years ago, we were busy cutting taxes. In essence, as citizens, we have come to expect more for less. It’s fiscally impossible. It’s fiscally insane.

The solutions are difficult, yet relatively simple in concept. Tax reductions will require huge cuts to Medicare. A relatively small tax increase will still require big Medicare cuts. The larger the tax increase, the less we will have to cut Medicare.

This is not oversimplified. The predicament relates to the size and growth of Medicare relative to other federal programs, before and after the recent health reform legislation was passed.

Here’s the good news. We can reform the Medicare system without harming quality. Grand Junction’s health system is one example. U.S. taxpayers spend much less money on the average Medicare patient here in Grand Junction than in most other places in the country. Savings are achievable.

The recent health care legislation provided some needed changes. The legislation incentivizes Grand Junction-like efficiencies in other areas of the country. And, yes, there are some cuts to Medicare. Nevertheless, even more changes will be needed. Specifically, we simply must address the over-utilization of expensive technology and pharmaceuticals.

Undoubtedly, it’s time to embrace the science of comparative effectiveness. If the science and literature suggests an expensive treatment is roughly equal to its less-expensive alternative, should the U.S. taxpayer be responsible for paying for the more expensive treatment? Indeed, the utilization of medical innovation and technological science must be carefully scrutinized against the limits of our willingness to tax ourselves.

To achieve fiscal solvency, we must be honest with ourselves and with our representatives. Stop asking for the impossible. The political right should avoid asking for less government and lower taxes while simultaneously demanding no Medicare cuts. Similarly, the political left should avoid asking for more benefits and more access without asking for increased taxes.

We are in this mess together. We might as well be honest about it. If we are honest, we might just stimulate some real problem solving in the capitol domes of Denver and Washington, D.C.

Michael J. Pramenko is a Family Physician at Primary Care Partners. He is currently President of the Colorado Medical Society and serves on the Club 20 Healthcare Committee. His opinions don’t necessarily reflect the views of those organizations.


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