Voters face major election choice 
when it comes to fixing Medicare

By Michael J. Pramenko

The year is 2023 — what will you be doing? What will the state of the union look like? Who will be president of the United States after the election of 2020? How big will the nation’s debt be? Given the time frame involved, it’s hard to know.

However, some things we do know. The year 2023 is when the proposed Romney-Ryan plan to save Medicare would go into effect. So, if Romney wins the presidential election this fall and then is reelected in 2016, he will serve two full terms and we’ll still wait an additional three years before we start “saving” Medicare.

Hmmm — call me a bit cynical — but doesn’t that sound a bit odd? Any fair-minded individual or voter should question a plan that doesn’t even go into effect for a full decade.

Regardless of your politics, a prudent policy choice to preserve the Medicare safety net will start now and not three presidential terms down the road. Are we or are we not in a fiscal crisis? Do we not need to change the popular Medicare program now in order to protect it for future seniors? Of course, the answer is a resounding “absolutely!”

We are in desperate need to mend this country’s fiscal health. In fact, the fiscal problems with future Medicare “promises” are nearly seven times bigger than that of Social Security. We need bold policy changes and bold decisions that will reshape how we pay and deliver health care in the United States. This includes some of the structural changes included in Obamacare and then some. Moreover, we must ask Americans of every age to accept more changes to Medicare.

Regardless of your politics, should not every American join this cause? Given the importance of saving the health care safety net for seniors, why does the Romney-Ryan plan ask nothing from individuals older than 55? Indeed, a plan that doesn’t start for 10 years, and asks nothing from the aging population that votes the most smells of political posturing.

Where is the Mitt Romney who helped write a bold and reasonable health reform plan in Massachusetts? Where is the sense of urgency Gov. Romney illustrated in Massachusetts? Where is the sense of civic teamwork witnessed as Gov. Romney supported the individual mandate in state health reform?

Fixing Medicare will never be politically popular. It requires tough choices. Even if you don’t like President Obama’s policies, there is no question he was willing to look past politics to pass legislation that most health policy experts agree begins to address Medicare’s problems.

Certainly, it is difficult to compare Obamacare to a future Romney-Ryan health policy that doesn’t start for 10 full years. Nevertheless, if you look closely at the Romney-Ryan plan, it ironically includes some of the cost-saving measures that are included in Obamacare.  One major difference is that Obamacare implementation began two years ago and the other plan waits until 2023.

In addition, the Romney-Ryan plan will rely on private insurers to help bend the cost curve. Starting in 2023 and sometime after my kindergartner starts high school, insurance companies will be given the task of holding down health costs so that the Medicare voucher you will receive maintains its relative value over time. That’s right, for-profit insurance companies and executives will be responsible for devising ways to contain the rapidly increasing cost of health care.

So, here in present day 2012, we have a choice. It’s a real choice on saving Medicare. This particular choice does not ask you to trust Obama or his challenger Mitt Romney. However, it does ask: “Who do you trust in the difficult task of controlling the inflation rate of health costs for the senior population.” Here is your choice:

1) Under Obamacare: Medical experts appointed to a Medicare board (some would call them bureaucrats) will recommend cost saving measures that can be approved by Congress.

2) Under the Romney-Ryan plan: Private and mostly for-profit insurance companies (some would call them greedy) will recommend and implement cost-saving measures that do not have to be approved by Congress.

Choices like this are why elections are so important. When and how do we reshape the Medicare system? Indeed, elections do matter.

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is the immediate past president of the Colorado Medical Society.


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Four items in Sunday’s Sentinel – AP’s reports that “Ryan misstated claim of running 3 hour marathon” and “Matthews plays over-the-top hardball with Republicans”,  Kathleen Parker’s “Romney offered a clearer picture of who he is in Thursday speech”, and Michael Pramenko’s “Voters face major election choice when it comes to fixing Medicare” – offer “food for thought”.

Ryan lied about his marathon time (by over an hour) in a nationally televised interview.

The “clearer picture” offered by Romney omitted any reference to “RomneyCare” – nor corrected the record regarding Romney-Ryan’s falsehoods about the Affordable Care Act, the Simpson-Bowles Commission, and/or the bogus $700 billion “cut” to Medicare.

No wonder Chris Matthews is incensed by Republicans’ persistent resort to overt racism to evade the “garbage” being peddled as “policy” by Romney-Ryan and Reince Priebus.

Fortunately, our own Dr. Pramenko offers a clinically “clear picture”.  Who should you trust?, he asks—those who would “fix” Medicare ten years from now by converting it from a defined benefit guarantee to an uncertain “voucher” program, or those who have already extended Medicare’s (as we know it now) viability by eight years?; those who falsely accuse President Obama of “cutting” future Medicare benefits by $716 billion while using that same “savings” to fund more tax cuts for the wealthy, or those who are already redeploying those savings to expand preventive care for the elderly and women?

“In addition, the Romney-Ryan plan will rely on private insurers to bend the cost curve”, but these are the same “private insurers” responsible for rising premiums, “pre-existing conditions”, benefit caps, arbitrary coverage cancellations, and profit-driven medical “death panels” in the first place!

Meanwhile, both President Obama and Club 20 endorse our local approach as an example of how competition from not-for-profit insurers in a statewide “insurance cooperative” can foster vital competition.

              Bill Hugenberg                   543 Rim Drive, GJ 81507
              .(JavaScript must be enabled to view this email address)

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