Killing current Medicare system not way to solve debt crisis

By Michael J. Pramenko

Contrary to recent proposed legislation, we do not need to end Medicare to address the nation’s debt. Instead, it’s time for grown-up conversation and debate on the federal budget and Medicare.

It’s time for honest and fact-based dialogue, time to put ideas ahead of ideology.  We must appropriately address our national debt and effectively addres the medical needs of our fellow citizens.

The U.S. government will be forced to raise our debt ceiling in the coming weeks. If not, our economy will be threatened with another recession or worse.  This is not a rare scenario. The debt ceiling was raised seven times during the previous administration. Yes, seven times.

Now, as opposed to then, many conservative politicians are demanding a drastic change to a widely popular entitlement program in exchange for their vote to raise the debt ceiling. In reality, the proposed change will effectively end Medicare for those younger than 55.

These same legislators are excluding any tax increase as part of the solution to our debt crisis. In effect, Medicare is being held hostage in exchange for a vote for financial solvency.

As previously outlined in this column, our nation’s budget woes cannot be effectively addressed without changing the Medicare program. At the same time, it is obvious that a large majority of Americans want to keep the security and guaranteed coverage of the Medicare system. Witness the strong and negative response to Rep. Paul Ryan’s plan to effectively end Medicare as we know it and transition it to a voucher program run by private insurance.

A Washington Post/ABC News poll last month revealed that 78 percent opposed cuts to Medicare. Ryan’s plan, which cleared the U.S. House of Representatives in early April, would drastically cut Medicare. Indeed, even some Republicans, like Newt Gingrich, appear to be opposed to this plan.

Make no mistake, Americans want to save Medicare while we work to address the nation’s debt. The majority of Americans don’t want to end Medicare and replace it with a voucher system. Ryan wants the American people to think this is an all-or-nothing proposition. Ryan wants people to believe that we must end Medicare as we know it in order to avoid fiscal ruin.

So, after overspending for a decade while simultaneously cutting taxes, some politicians want to use the resulting large deficits as an excuse to end Medicare.

However, the “purple” middle ground does exist. While talk-radio pundits and political ideologues say it can’t be done, we can simultaneously address the national debt and save Medicare. It can be done. But, it will take honesty, sacrifice, and political compromise.

How? First, we will need more vigorous, and yes, more controversial cost-containing measures than those already included in the federal health reform bill passed last year. These include the utilization of comparative-effectiveness research to limit where Medicare dollars are spent and value-based benefit design that asks the consumer to pay more out of pocket for care that has been determined to be of less value.

Second, we will need more revenue to limit the number of those controversial cost-containing measures and to reduce the existing debt. The American people should be encouraged to engage in a meaningful and well-informed conversation on health-system and benefit design. This is a moment of truth.

We could continue to cut taxes, but we will have to end Medicare and the guaranteed access to health care that comes with it. Alternatively, and vastly more in tune with the majority of Americans, we can decide to compromise on revenue and benefits to save Medicare while we address the nation’s looming debt crisis.

What is not possible is to have our proverbial tax-cut cake and eat it too. Saving Medicare will require tough and non-partisan choices on taxes and benefits. Don’t let a politician tell you otherwise. However, as responsible citizens, we must realize that a status-quo approach to Medicare and tax policy is a recipe for fiscal insolvency.

Michael J. Pramenko is a family physician at Primary Care Partners. He is president of the Colorado Medical Society and serves on the Club 20 Healthcare Committee.


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