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It’s More Than Just Nickels and Dimes

So you probably saw the headline this morning... “Medicare Premiums Up 3.1%” ...and thought ‘hey that’s not so bad’. At least that what CMS hopes you think.

But Medicare premiums are just one part of the picture. Seniors are also facing higher co-payments, out of pocket costs, rising prescription drug fees and doughnut holes. In 2000, the Medicare Part B premium was $45.50. Next year it will be $96.40. This 112% increase is certainly not good news for seniors living on a fixed income. Social Security cost of living increases just can’t keep up with rising healthcare costs, which continue to grow unchecked. These programs aren’t flawed, healthcare costs are running amok.

The Center for Retirement Research at Boston College has issued a new report describing the real challenges facing seniors...
The long-run solution is to control the costs not just of Medicare, but of the entire health care system. The United States spends a much higher share of GDP on health care services than other countries, yet in many instances produces less favorable outcomes.

Here is coverage of yesterday’s Medicare premium announcement. We also shouldn’t forget that this 2008 premium is artificially low. It assumes that Congress will cut payments to doctors, which is unlikely, meaning there's a possibility those costs will be passed on to beneficiaries in later years.

Seniors or Insurers?

The Senate is currently searching for money from the Medicare program to prevent next year’s cut in doctors’ reimbursements. If you needed to cut billions of dollars from Medicare which of these options would you choose? Eliminate all or part of the $54 billion in government subsidies going to private insurers in the Medicare Advantage program (as proposed by the independent Medicare Payment Advisory Commission-MedPAC ) or cut healthcare benefits going to seniors making higher than average incomes?

Seniors or Insurers? A seemingly easy choice.

For the Bush Administration and their allies in Congress the choice, of course, is to cut benefits for seniors. According to Jonathan Weisman and Christopher Lee writing in the Washington Post today, Nevada Senator John Ensign is once again pushing his plan to expand Medicare means testing.

This is a perpetual favorite for those who believe the way to erode public support for Medicare is to turn it into a welfare program serving only the poor by driving wealthier seniors into private insurance. As we’ve seen with the SCHIP debate, the concept of providing healthcare for all drives some in Washington crazy.

The Post says:

Already, the section of Medicare that pays for outpatient care, including doctors' fees, imposes some means testing. Single seniors with incomes exceeding $82,000 and couples with incomes about $164,000 pay higher premiums on a sliding scale as their wealth rises. Those thresholds rise each year with inflation. The original Bush proposal would have frozen those thresholds at $82,000 and $164,000, so more seniors would have been affected by means testing over time. The same thresholds would have applied to the new prescription drug benefit. According to the White House budget office, the proposal would have saved more than $10 billion over five years.

But wait. Cutting government overpayments to private insurers in Medicare would save more than 5 times that amount! Even if you trimmed just half of these outrageous overpayments to insurers you would still save more than this means testing proposal.

Seniors who aren’t living paycheck to paycheck are an easy target. But means testing Medicare will not improve its long-term solvency. Driving healthier, younger and higher-income seniors away from Medicare will change the program from one providing universal coverage to all beneficiaries to a welfare program with increasingly unsustainable costs.

Maybe that’s their ultimate goal after all.

What Part of “No” Don’t they Understand?

Make no mistake about it...the Bush administration clearly understands the value of a well structured and financed public relations campaign. Yesterday’s release of the first in a series of Treasury department “issue briefs”, signals the start of another run at defining Social Security reform in a way that best suits this administration’s ultimate goals...the creation of private accounts and massive benefit cuts. What the White House doesn’t seem to get is that sometimes even the best PR and Marketing strategy can’t sell misguided policy goals.

Here’s our analysis of this first Treasury brief entitled "Social Security Reform: The Nature of the Problem".

The Brief overstates the problem repeatedly by using the discredited “infinite horizon” calculation. The American Academy of Actuaries, the leading professional organization of actuaries, has warned that infinite-horizon projections “provide little if any useful information about the program's long-term finances and indeed are likely to mislead anyone lacking technical expertise in the demographic, economic, and actuarial aspects of the program's finances into believing that the program is in far worse financial shape than is actually indicated”.

Focuses on Benefit Cuts. Treasury Secretary Paulson says that Social Security can only be fixed by raising taxes or cutting benefits, yet he is focusing on benefit cuts.

Issue Brief Introduction: “Social Security can be made permanently solvent only by reducing the present value of scheduled benefits and/or increasing the present value of scheduled tax revenues.”

Secretary Paulson’s Statement : “While differences over personal accounts and taxes dominate the public debate over this issue, in my conversations I found that there are many other things on which people agree.”

Statement from the White House: The Associated Press reports, “But White House officials stressed that President Bush remains opposed to raising taxes."

So, while the Administration says tax increases and/or benefit cuts are the only solutions, they again propose only benefit cuts as the solution. To suggest that there are only “differences over personal accounts and taxes” (implying people agree on the need for benefit cuts) does not reflect the political reality.

Resurrects Privatization. The report makes it clear the Administration is interested in resurrecting privatization. However, rather than addressing it directly, the report uses “prefunding” as the code-word for privatization.

Issue Brief Statement: “Fairness to Future Generations Requires True Pre-Funding” and “Only if pre-funding is ‘real’ can this goal of fairness be achieved.

This is the setup to Social Security privatization. Remember when the White House renamed private accounts as “personal” accounts? The American people still understood this was the privatization of Social Security and they rejected it. The new buzz-word (for the same thing) appears to be “pre-funding”. Changing the terminology doesn’t change the fact that the political goals remain the same.

The Administration is merely resurrecting its arguments for privatization and laying the groundwork for President Bush’s plan for so-called progressive price-indexing of Social Security benefits, a plan which would cut benefits drastically affecting 70 percent of future retirees.

Bet He Won’t Be Invited Back...

CBO Director Peter Orszag offered insurers some advice yesterday they probably didn’t want to hear. He told attendees at the American Health Insurance Plans conference on Medicare that insurers should present data showing what is working in Medicare’s overpaid and highly subsidized private Advantage plans.

Private insurers have been promising for decades they could provide cheaper and more efficient coverage for seniors than Medicare. But they’re currently charging Medicare $1,000 more a year to cover a beneficiary in a private plan than it would cost to provide care to that same beneficiary under traditional Medicare. So far, private insurers can’t (or won’t) show us what we’re actually getting for that subsidy. Here’s Congress Daily’s coverage:

CBO has determined through a review that disease management programs mightreduce some healthcare costs, but the savings are offset by the costs of preventative measures, such as screening. "I know a lot of private practitioners have a different view, and I would say, show us the data," Orszag said at an American Health Insurance Plans conference on Medicare...Because the
interventions are not backed up by evidence,they drive up cost without improving health or outcomes," Orszag said.

MedPac’s estimates, that in the case of Private Fee-For-Service plans, only about half of these excess payments are used to deliver extra benefits for enrollees. The rest finances administrative costs, marketing, and profits. This is the elephant in the AHIP conference room Orszag had the courage to acknowledge.

Don’t forget that CBO has also said we could save $54 billion over the next five years and $149 billion over the next ten years if we just paid private plans the same rate as Medicare. Not only would eliminating these large overpayments save billions of dollars, it would also add two years of solvency to Medicare’s trust fund.

A "Must-Watch" Debate for Seniors & Their Families

For 90 minutes last night 5 Democratic Presidential candidates focused on the issues nearest and dearest to our hearts...financial and retirement security and healthcare.

If you missed this debate last night (and we understand some may already be suffering from presidential campaign fatigue...just 15 months out no less) this is one worth watching even after the fact.

Kaiser has a very good coverage roundup here and Iowa Public Television has the video.

Bookmark it and make this one a must-watch. These issues will affect all of our lives for decades to come.



   

Questions?

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