Ryan’s meat-cleaver approach not best way to solve Medicare issue

By Michael J. Pramenko

In Friday’s Daily Sentinel, Josh Penry extolled the virtues of Congressman Paul Ryan’s plan to address the federal budget deficit by changing Medicare and Medicaid into voucher programs. Certainly, Ryan’s plan deserves credit for directing our attention to the part of the federal budget that deserves the most scrutiny, Medicare and Medicaid. Indeed, it does direct our attention — using a meat cleaver.

As I have recently stated in previous columns, the United States cannot solve our long- term debt issues without addressing the fundamental problems with the costs associated with Medicare. It must be changed. We must lay our hands on Medicare costs. Nevertheless, saving Medicare and solving the federal deficit do not have to be mutually exclusive propositions.

Not too long ago, many individuals in Penry’s corner were actually criticizing last year’s health reform legislation for cutting Medicare, and they erroneously referred to “death panels” in the bill. So let’s examine how a voucher system would rate using those same arguments.

Starting in 2022, under Paul Ryan’s plan, future Medicare beneficiaries must start shopping around for an affordable health insurance plan. Oh, and while they’re at it, they should start looking around for an affordable nursing home for their elderly mother, using the limited Medicaid voucher.

The Medicare voucher for traditional senior health care will increase in value, indexed to inflation, rather than indexed to increased rates in medical costs. Remember, health care costs are rising much faster than the overall inflation rate. A parent’s Medicaid voucher for nursing home care will vary depending on which state you reside in and the state’s economic status.

So, someone might decide that she can afford her premium, but there is no way to finance the $5,000-per-month nursing home for her 88-year-old mother — even with a state voucher.

With frustration, our future health care recipient decides to care for her mother at home and purchase a bare-bones Medicare insurance premium for her mother.

To reduce premium costs while maintaining a profit for the insurance company, this health plan only covers catastrophic care for her elderly mother. There is no cancer therapy, no chronic-care management and no prescription medication coverage. She is forced to take her mother off her expensive heart and diabetes medications. The mother’s condition worsens, she is forced into the hospital prematurely and the daughter has no means of paying for the hospitalization. Subsequently, with the current cost shift in full force, everyone’s health insurance premiums go up another notch.

Congressman Ryan, via his proposed policy, will have successfully addressed the deficit. He would preserve current tax policy and open the door for further tax cuts in a nation where currently one half the wealth is possessed by 2 percent of the population. Congratulations.

And, by staying one step away from actual health care policy decisions, he can blame the rationing, the so-called “death panels” and the poor health status of patients on insurance companies, state government and on financial decisions that families will be forced to make. Genius.

This so-called “Path to Prosperity,” fondly described by Josh Penry and others, will strip more care, limit more doctors and reduce more access to care than anything written in the Affordable Care Act, commonly referred to as “Obamacare.”

Another option is to continue the Medicare and Medicaid programs as we know them. This will not be easy, as we must bend the cost curve.

Despite the rhetoric, there are elements of the current health reform legislation that actually transfer power away from Washington, D.C., and help control costs. Three examples of this include the provisions on state insurance exchanges, accountable care organization incentives and a program to start private non-profit insurance companies.

Regardless, we will still need more cost containment. As I have previously written, I believe we must utilize comparative effectiveness research to obtain the twin goals of deficit reduction while preserving the health care safety net. In effect, let’s use a scalpel versus a meat cleaver to balance the Medicare program with fiscal prudence.

Again, credit Ryan for focusing our attention where it belongs. However, we can still avoid the Paul Ryan Medicare meat cleaver and his misguided version of prosperity.

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


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