We the People: Is Medicare on life support at Trump Memorial?

In 2013, Republicans and Democrats met behind closed doors to find common ground on a proposed budget. Democrats proposed a $1 trillion increase in spending funded by increased revenue through elimination of income tax loopholes and $1.5 trillion in spending cuts. Republicans, led by House Speaker Paul Ryan, proposed a $4.6 trillion spending cut spread over 10 years but no increased revenue.

If President Obama had compromised on spending cuts, the two sides could have met in the middle which would have resulted in a timely budget and a better spending plan instead of government shutdown gamesmanship.

Republicans must realize that draconian cuts in spending for older Americans, working class Americans and American children are shortsighted and bad for America. However, Democrats must accept that unchecked government spending is wasteful and is bad for America. We can preserve services for the people and still reduce spending.

Many Americans fear that Mr. Trump may change his mind about promises made or just adopt GOP plans he previously rejected. On the campaign trail, Mr. Trump said, “Every Republican wants to do a big number on Social Security … they want to do it on Medicare … we can’t do that [because] … it’s not fair to the people who have been paying in for years.” He distanced himself from his rivals on cutting Medicare.

Ryan has revived his plan to “reform” Medicare and replace coverage with a fixed-dollar subsidy used to buy private health insurance. The breakneck rush to repeal the Affordable Care Act (ACA) or Obamacare will also have bad consequences for Medicare.

Obamacare helped Medicare; it eliminated some benefits, raised revenue to pay for coverage and clamped down on waste while it also allowed tens of millions of Medicare beneficiaries to get free preventive services (flu shots, and cancer and diabetes screenings) to avoid bigger costs for critical care down the road.

More than 57 million Americans rely on Medicare and 77 percent of Americans polled call the program “very important.” It has provided affordable access to health care for millions of American families and allowed senior citizens to grow old with dignity, secure in the knowledge they can provide for their health needs.

Ryan’s proposed “reform” of Medicare has representatives taking stands along party lines. Democrats have pledged their opposition to the end of Medicare. Mr. Trump’s choice of Representative Tom Price (R-Ga.) to run the Department of Health and Human Services has people wondering, since he is an advocate of Ryan’s Medicare replacement plan. Critics have described it as nothing more than a “voucher system.”

Mr. Trump could not abolish or change Medicare with an executive order; he would require legislative action but the Republicans control both Houses of Congress.

Medicare is a “defined benefit” program which assures a certain level of health coverage for beneficiaries. It currently pays about 80 percent of costs associated with doctor and hospital visits while the beneficiaries pay monthly premiums, co-payments and contribute an annual deductible.

Ryan’s “reform” would convert Medicare from “defined benefit” to “defined contribution” and instead of a guaranteed level of coverage, the beneficiaries would be allotted a dollar amount that they would use to buy insurance from private companies.

Ryan is correct that changes must be made; increased premiums, restricted eligibility and raising the eligibility age from 65 to 67 would all help control costs.

Ryan promises that the annual subsidy would be sufficient for people to have health insurance coverage but it is unlikely his defined contribution plan would keep pace with the rising cost of insurance coverage. Then, the beneficiaries would just pay more or do without needed medical care. It is unlikely that “premium support” or defined contribution or voucher system would give the same number of people covered today the same coverage.

If both parties worked together, they could consider “out of the box” solutions. Let some of the ballyhooed infrastructure investments be made to build large medical schools with teaching hospitals where the graduates provide services at reduced remuneration in exchange for free tuition. Congress could pass tort law reform that caps ridiculously high jury verdicts and malpractice insurance rates could be lowered.

A combination of moves could save Medicare for the next generation if our leaders can work together. No matter what, anyone who expects to get old or sick should be involved in the debate.

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