Repealing Obamacare spells problems for Medicare, Medicaid

By Dr. Michael J. Pramenko

Some recent rhetoric by a certain Fox News commentator and rabble rouser got me thinking. Like him, I started pondering the civil rights movement and what “social justice” actually means.

Along those lines of thought, let us assume that Medicare did not exist. And, to be true to the scenario, let us assume Medicare’s state-level partner, Medicaid, did not exist either. Ah yes, your taxes would plummet. Hallelujah!

OK, but what else would this mean to Americans? Have you price- checked a private insurance premium recently for a 64-year-old with a few medical problems or no medical problems at all? Not cheap. In fact, it might just run you about a thousand bucks more per month than you would save on taxes in the Medicare-and-Medicaid-free world. Whoops.

Imagine every citizen above age 65 suddenly having to buy private insurance. By the way, private insurance still reigns supreme under Obama- care. Imagine thousands of families in America suddenly trying to figure out how to pay for nursing home care for their elderly family members.

Indeed, rhetoric and rabble rousing is easy. On the other hand, policy development and management relies on a few more functional brain cells.

So, how do we save Medicare and Medicaid from themselves? In a nation where the constant drumbeat calls for lower taxes while the phrase “don’t touch my Medicare” echoes from the older anti-health-reform crowd, this endeavor is akin to climbing Mount Everest.

OK, so maybe as we keep the Medicare and Medicaid programs, we actually make changes to the programs that will make them more financially sustainable over the long haul.

This will require sacrifice over satire and reason over rhetoric. More specifically, it will require open discussions among family members about end of life care and living wills. It will require more patient involvement in their health care. It will require utilization of evidence-based medicine — an idea that some erroneously refer to as rationed care. It will require a reformed health care workforce and a new way to reimburse those professionals. It will incentivize communities to build local health care systems that work for their communities and that prioritize quality over quantity. It will require better communication utilizing electronic health records. This list goes on.

Wait a second, didn’t Congress just pass some legislation that includes many of these elements and begins the process on others?

Indeed, we have three options:

✔ We can keep Medicare and Medicaid with significant reforms to make them financially solvent.

✔ We can significantly raise taxes to continue these programs under the model set in place over the last 45 years.

✔ We can repeal Medicare and Medicaid and let citizens of all ages fend for themselves.

Naaaah. These decisions are just too hard.

Let’s just shout and repeat the phrase, “Repeal Obamacare.” Ahh yes, a simple phrase that works so well at a libertarian or conservative rally but means so little in terms of problem solving. There should be a requirement for any candidate who uses the term “repeal Obamacare” to follow that simple thought up with some real substance. What would they do to cut back on Medicare spending in order to save the program?

Maybe that’s just it. Maybe they don’t want to save the socialized systems of Medicare and Medicaid. Apparently for some candidates and commentators, that is social justice.

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


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