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The Ryan Plan For Medicare

Paul Ryan’s plan for Medicare. We’ll look at truth and consequences, on and off the Ryan plan.

Wisconsin Rep. Paul Ryan pauses while speaking during  the Texas Republican Convention in Fort Worth, Texas,  Saturday, June 9, 2012. (AP)

Wisconsin Rep. Paul Ryan pauses while speaking during the Texas Republican Convention in Fort Worth, Texas, Saturday, June 9, 2012. (AP)

Mitt Romney was all about the economy. Add Paul Ryan to the ticket, and suddenly it’s all about the federal budget and, above all, Medicare.

Romney’s VP running mate has been going after Medicare for years. It has to change for the country to survive, he says. End the guarantees of health care for the old. Give a voucher. Let seniors pay the difference.

Romney says that competition will drive down costs. Democrats say there’s a broken commitment there. That too many of us will be old and sick and broke. This hour, On Point: the Ryan factor, and the future of Medicare.

- Tom Ashbrook

Guests

Don Berwick, former administrator of the Centers for Medicare & Medicaid Services (CMS).

Gail Wilensky, an economist and senior fellow at Project Hope, an international health education foundation. She sits on the Board of Directors of Geisinger Health System. She was Administrator of the Health Care Financing Administration, directing the Medicare and Medicaid programs under President George H.W. Bush.

From Tom’s Reading List:

L.A. Times “Mitt Romney on Wednesday unequivocally disavowed more than $700 billion in Medicare spending cuts proposed by his new running mate, Rep. Paul D. Ryan of Wisconsin. In an interview on ‘CBS This Morning,’ Romney was asked how he squared his running mate’s plan to cut spending on the popular healthcare program for the elderly with his criticism of President Obama for making the same reductions.”

Kaiser Health News “The Republican-controlled House, along party lines, twice approved [Paul Ryan's] proposals to overhaul the popular social insurance program for the elderly and disabled by giving beneficiaries a set amount of money every year to buy coverage from competing health plans. That is a fundamental shift from today’s program, where the federal government must help pay for every doctor visit and medical service that an individual uses.”

USA Today “President Obama fought back against Republican criticism over Medicare today, saying he has improved the program by eliminating wasteful spending. ‘I have strengthened Medicare,’ Obama told supporters in Dubuque, Iowa, on the third and final day of his bus tour of the state.”

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  • Yar

    In a nutshell, Paul Ryan’s medicare plan is a middle class estate tax. 
    How so?  
    Fact number one:  
    Statistically  speaking over 1/2 of lifetime medical expenditures occur in the last 2 1/2 years of life. Private insurance companies don’t want to insure seniors.  Medicare exists partly because seniors are a bad bet.  Some healthcare procedures that seniors receive don’t do them any good and may even lower their quality of life. 

    Fact number two: 
    We have socialized medicine in the USA, some people already get medical care, and other people end up paying the bill.  Much of that care is passed on through higher prices for those who pay for care.  As Chief Justice Roberts decided on Obamacare, it is a tax even though it may not be called a tax.  He was talking about the penalty for not buying health insurance, I am talking about the entire 19 percent of GDP our healthcare consumes.  Healthcare is a more regressive tax than most other taxes, maybe with the exception of the lottery. 

    Fact Number three:
    Healthcare does not participate in a free market.  Prices for services are seldom listed, consumers can’t make market based decisions, even care that is not wanted or causes harm is still charged and paid for.  All areas of healthcare, insurance, pharmaceuticals, including hospitals, participate in crony capitalism, it is the law of the land.   Elections are in part funded by this corrupt business model.  Medicare is one of the less corrupt areas of healthcare delivery.

    Fact Number four:
    People die quicker when there is nobody to pick up the bill.  When care is covered it tends to improve outcomes, when it isn’t, often people don’t get care they need.  That takes me back to my opening statement.  When a person dies, if they have any assets at all, often those assets are taken by the hospital or nursing home that provided end of life care.  Reducing medicare by making it a voucher and shifting more costs to the patient, does nothing to fix our broken healthcare funding structure, it only taxes middle class families to the point they have nothing to pass to the next generation.  Some estates get taxed at 100 percent.  I have seen it happen, the family gets nothing.  That is what I think Paul Ryan’s plan will do.

    • Wm_James_from_Missouri

      Don’t stop now, when your hot your hot ! Our family was recently told that hospice would have given our now deceased mother, ONE DOLLAR A DAY, for her use. They wanted everything ! ! You work a LIFETIME, but it is not yours in the end. Please notice the similarities to slavery. Ryan and people like him are nothing but a bunch of wana-be gangsters ! And Romney – Christian, really ? Do you think it is a coincidence that Christ came during the reign of the Roman REPUBLIC ? Even an atheist can see THAT relationship !

      • Yar

        Thanks, I think I need to turn my comment into more of a soundbite.  How is this?

        Paul Ryan’s medicare plan is nothing more than a middle class estate tax. 
        Reducing medicare by making it a voucher shifts more costs to the patient, it does nothing to fix our broken healthcare funding structure, it simply taxes middle class families to the point they have nothing left when they die.

        Think Tom will put this on air?

        • Don_B1

          What you say is spelled out in more general terms, Ryan’s whole approach to government and its roots in his Ayn Rand idolatry, here:

          http://thinkprogress.org/justice/2012/08/15/691161/why-paul-ryans-constitution-has-a-lot-more-in-common-with-ayn-rand-than-with-the-founding-fathers/

          Details on what is likely to happen under Romney/Ryan can be found here:

          http://thinkprogress.org/health/2012/08/15/693731/how-mitt-romney-would-quickly-bankrupt-medicare/

          • TinaWrites

            As we come out of young childhood, our egos start to develop.  I don’t know if that process is being speeded up thru computer/web access or not, but for someone Paul Ryan’s age, that spurt of ego development was generally about age 13-14.  That’s about the same age that many people start reading Ayn Rand.  In my opinion, anyone who is still spouting Ayn Rand-isms in later adult life really got stuck, intellectually AND in terms of ego development (the self-to-others polarity) at age 13-14.  

          • Yar

            Tina, I can only imagine the pain Paul Ryan felt finding his father dead at age 16.  I wonder if he would have a different outlook on healthcare if his father still had a pulse when he found him and died after spending two months in a hospital on a ventilator, leaving the family with devastating debt.  A definite possibility in today’s healthcare market.  The helicopter ride alone to the big city teaching hospital can top 20,000.  Then 60 days in ICU.  Tell that 16 year old that market forces allows his family to make rational decisions on healthcare.  
            We all are a product of our environment.

          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            Paul Ryan got where he is on SocSec survivor benefits. His career is largely in public sector pimping the private sector, and grabbing oodles of goverment spending for his district.

            I don’t think his father alive and suffering, and the resulting erosion of his family’s assets, would change a thing.

          • TinaWrites

            Hi, Yar.  In my own adult life — I had a young child when my brother had a catastrophic accident.  Six months later, after keeping things together enough to help re-situate my brother, my father came down with Alzheimer’s which became tragically profound very, very quickly.  My own plans to improve my employment options had to change because I was suddenly the only healthy adult left in the family and therefore the only one able to travel the 1500 miles between my family and where I lived.  I couldn’t move without separating my child from her father.  To help my family, I had to find work that would allow me the flexibility to do this travel frequently and whenever called upon to do so.  Nevertheless, I tried to find a way out of the low income jobs that allowed me this flexibility.  No sooner had I spent several years going back to school to do pre-requisites for a career level job that might allow this when I was diagnosed with cancer.  The extreme effect of the cancer medicines on my short-term memory  meant that I had to drop out of the program I had been working toward (forfeiting the scholarship money I’d achieved, as well), and go back into the world of whatever poor-paying jobs would allow me the flexibility  I needed.  During this same time period, a family member was the victim of two crimes, one of them severe enough to warrant television and newspaper coverage.  Now, Paul Ryan and other Republicans make it look like you should EASILY take personal responsibility for your own health care savings.  My personal responsibility required that I be available to help my family; that required that I forfeit the major work I’d already done in pre-requisites to try to get access to that career degree (I already had one in another field, but had never been able to get work in it because I was supposedly “over qualified” with a master’s degree, as I’ve explained in earlier posts)  How is it NOT “taking personal responsibility to help take care of your family”?!!!  Oh, I forgot!  Ayn Rand would have had me say that my brother’s accident was his problem; my dad’s Alzheimer’s was his problem; and my mom’s rheumatoid arthritis was her problem, all the while continuing in school for another 2 years, focussing on my own potential for income big enough to allow me to save for my health care and retirement.  Foolish me!  

          • Don_B1

            You capture in more oblique terms one of the comments to the first linked article, about boys finding Rand’s metaphors of “long trains” and “tall towers” exciting. But boys are supposed to grow up at least in certain ways.

            But Ryan has developed a “patois” of distraction from the details of his policies to glad-handing while he slanders his opponent. It really is a spectacle to watch.

            But the misfortune that has fallen on you is, again unfortunately, a telling example of just why Ryan’s approach is a catastrophe of huge dimensions.

            While I have no way to understand what it takes for you to share your story, we all should appreciate what that story represents.

            It has to take immense self-centeredness to actually think the way Paul Ryan does. The only “type” that fulfills that “model” in my mind is the con man, of which Paul Ryan seems a consumate representative.

          • TinaWrites

            Thank you!

          • TinaWrites

            It needs to be said:  what a great phrase: “patois of distraction”!!!

    • Shag_Wevera

      You can bet that I’ll have nothing when my time comes.  I will have long since given away all my assets.  I’m also not afraid to pull the plug on myself when I see the end coming, to save my family suffering/expense.  You are right.  It is about taking everything you have, right before you die.

      • InActionMan

         Your living in a dream world. If you give your assets away the government will simply go after your family for your nursing home care if they are the ones who got your money.

        Also odds are you are not going to have the mental capacity to make decisions for yourself at the end.

        Nursing home operators are the scum of the Earth. They pray on desperate families in a crisis offering “help” when their real goal is to drain your dieing relative’s life savings.

        • Shag_Wevera

          I work in this field.  You have to be ready to take care of things while you have the capacity.  You are dead on, nursing home owners are scum.

        • Don_B1

          Your use of “pray” for “prey” is deliciously ironic whether meant or not.

          • JGC

            There was a comment from another blog (Dwight McAfee of Toronto):

            Bishop Romney adheres to the Calvinist notion of pray on Sundays and prey the rest of the week.

      • TinaWrites

        Can we consider what happens to someone who might have made life insurance payments for decades?  I’m being theoretical, here, and not addressing you, personally.  

        IF one or more of your family members NEEDS to be the beneficiary of your life insurance policy, should you have one (let’s say your child just gave birth to a child with major birth defects), you will not be able to help them with that if you “pull the plug” on yourself and it looks too much like suicide.  

        I also wonder what will happen to people who don’t have enough health coverage or savings for pain relief in their final days, weeks.  Are they allowed to decide to end it all sooner, by either removing treatment, or by a more active method?  Should their heirs have to forfeit life insurance pay-outs just because the deceased couldn’t withstand the pain any longer?  

  • JGC

    Is Paul Ryan’s adjustment of his Medicare plan (giving current seniors a pass and a 10-year segue for near-seniors) for humanitarian reasons or just a lifeline thrown to a segment of the current population that traditionally votes for Republicans…

    • Shag_Wevera

      Old folks vote.

    • Joseph_Wisconsin

       Bingo.  It is all about retaining Republican votes among older whites (those currently receiving Medicare and SS, or who will in the next 10 years or so) by telling them that it won’t matter to them.  If Ryan and the Republicans really believe that there voucher plan for Medicare does not amount to a massive cut in benefits that will soon leave all but affluent seniors who will be impacted in the future unable to obtain health care let them sell it the aforementioned older Republican voters by applying it to them now.

      Of course those older seniors, especially that “10-year segue for near-seniors” group I would say that they should not be too confident that once Romney/Ryan ticket is elected that they will actually not get the same treatment.  With the Romney-Ryan budget absolutely certain to leave the G.W. Bush cuts in place, add massive not tax cuts for the top few percent (including virtually zeroing out taxes for people like Romney who currently receive only a tiny fraction of their income from wages), and actually increase military spending there is no way that the plan will do anything but massively increase budget deficits.  Think that this is a liberal spin?  Try noted Reagan Republican supply side economist David Stockman’s analysis of the Ryan “Fairy-Tale” budget plan for cutting deficits.  http://www.nytimes.com/2012/08/14/opinion/paul-ryans-fairy-tale-budget-plan.html?_r=3

      Of course this all assumes that the underpinning of Romney-Ryan plan is deficit reduction.  The alternate take, and I believe the real one, is that this is just a plan to move the country further towards the Ayn Rand inspired society that they both believe in and they are using promises of deficit cutting to sell that. 

      • Don_B1

        Repeal of PPACA will immediately reinstate the “Donut Hole” in Part D drug costs, just for starters. See my post above for more.

        • Don_B1

          That will affect all currently on Medicare.

    • TinaWrites

       AND the 10-year segue is not nearly enough time for people to amass the kinds of money they will need for the changes he has in mind!!!  I do not believe in his plan at all, but he would sound a lot less purely evil if he suggested the changes would start with people as young as 18 or 21.  Only they, as an aggregate group of people with a wide spread of income possibilities, have enough time to POSSIBLY amass the amounts of money needed (but, on service jobs?  It’s STILL iffy!  But decades of savings MIGHT help).  I still think they, too, like the rest of us, deserve a system based on one of the European systems that WORKS.  I get really angry when the European plans that DON’T work are given as examples.  Have you seen the post on this site from the person from Canada who just laughs at the ridiculousness of the U.S. debate on this?  It’s a great commentary!

  • Michiganjf

    As President Obama has said of the Ryan/Romney plan:

    “If health care costs rise faster than the amount of the voucher, as, by the way, they’ve been doing for decades, that’s too bad,” Obama said of the plan. “Seniors bear the risk. If the voucher isn’t enough to buy a private plan with the specific doctors and care that you need, that’s too bad.”
    He continued, “So most experts will tell you the way this voucher plan encourages savings is not through better care at cheaper cost. The way these private insurance companies save money is by designing and marketing plans to attract the youngest and healthiest seniors, cherry picking, leaving the older and sicker seniors in traditional Medicare, where they have access to a wide range of doctors and guaranteed care. But that, of course, makes the traditional Medicare program even more expensive and raise premiums even further. The net result is that our country will end up spending more on health care and the only reason the government will save any money, why it won’t be on our books, is because we shifted it to seniors. They’ll bear more of the costs themselves. It’s a bad idea and it will ultimately end Medicare as we know it.”

    AMEN!

    • TinaWrites

      The President needs to say THIS WHOLE THING over and over and over and over!  

  • Michiganjf

    The genius Ryan’s quote on his Republican-backed budget and medicare cuts:

    “We want this debate… we can win this debate…”

    Then, you’ll notice THAT’S THE END OF HIS DEBATE!!!!!!

    Not an intelligent word about a single specific of the Ryan/Romney plan!!!

    Just, “We’ll get back to you on that, we really haven’t looked at it yet.”

    Of course, Ryan knows he can’t sell his backward plan on specifics, because his “plan” is too obviously detrimental to 90% of Americans.

    Conservatives have let Republicans get away with assuming they’re stupid for far too long… they now take it for granted that the base will devour any slop they drip.

    … but they already have their base, and it’s not enough.

    Ryan/Romney are going to be surprised by how much they inspire disgust and indignance beyond their base!

    Look for more lies, doublespeak, and evasiveness from Ryan/Romney… nothing else.

    Certainly not substance.

    • William

       Where is Obama’s plan? He said he would put forth a plan to fix entitlements during his first term. Where is the plan? Or just put for a budget that will get passed. Nothing, zip, nada.

      • Mouse_2012

         Something to do with filibusters and all and 60 being the new 51.

        • Shag_Wevera

          Let’s not forget “traitor Joe” Lieberman.

          • Gregg Smith

            That’s a great example of the intolerance of Democrats.

          • Shag_Wevera

            You mean a politician who changed party affiliation just to hold onto his office.  I’d think we’d all agree that that is lousy.  

          • Gregg Smith

            He was a solid Democrat booted out for one issue. He was the Veep nominee for Pete’s sake!

          • sickofthechit

             Lieberman was no solid Democrat, he “graced” the stage at the 2008 Repugnican Convention, remember?

          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            A “solid Democrat” who wouldn’t even vote to allow a up or down vote up or down vote up or down vote?

            That’s the kind of friends one doesn’t need.

        • Gregg Smith

          51 was enough to ram through Obamacare with the gimmick of reconciliation.

          • Michiganjf

            WRONG GENIUS!!

            No “RECONCILIATION” was needed on the Affordable Care Act!!!!

            Reconciliation WAN”T NEEDED BECAUSE JUST ENOUGH REPUBLICANS JOINED DEMS TO PASS THE BILL!!!!

            Did all CAPS and the extra exclamation points finally help drill the truth into your head???!!!

            … I didn’t think so. 

          • Gregg Smith

            Not a single Republican in the House or Senate voted for ACA (Obamacare). Where do you get your info?

          • Michiganjf

            From the ACA wiki page:

            “On December 23, the Senate voted 60–39 to end debate on the bill, eliminating the possibility of a filibuster by opponents. The bill then passed by a vote of 60–39 on December 24, 2009, with all Democrats and two Independents voting for, all but one Republican voting against and one senator (Jim Bunning, R-Ky.) not voting.”

            One of the “independents” was another Republican chased out of your party by the insane.

          • Gregg Smith

            As I said, not one Republican voted for it. You said: “Reconciliation WAN”T NEEDED BECAUSE JUST ENOUGH REPUBLICANS (as independents or by abstaining) JOINED DEMS TO PASS THE BILL!!!!”. That’s not true, despite the caps. Independents are not Republicans. You are referring to the vote to end debate. Because of Scott Brown, Democrats did not have 60 votes so they used reconciliation which only required 51… as I said.

          • Michiganjf

            Wrong again! 

            NO RECONCILIATION WAS NEEDED DUE TO THE SIXTY VOTES!!!HOW THICK ARE YOU??!!!

          • Gregg Smith
          • cryptomorph

            Poor Gregggg…. he seems to be thinking of some OTHER bill than the ACA

            http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

          • Gregg Smith

            It was Ben Nelson (D) who threatened the filibuster until he was bribed with the “Cornhusker kickback” which was repealed during reconciliation. No Republicans voted for the bill. You’re looking silly.

          • Don_B1

            Senator Lieberman threatened to filibuster the PPACA over the public option and at least one other issue.

            What got through by “reconciliation,” a device that limits the intent/subject of the bill to money issues, was the ELIMINATION of the Sen. Nelson provision which was cut out in the House.

            Reconciliation is being threatened right now by Republicans to eliminate funding of PPACA. And Republicans have been  equal opportunity users of this provision, often necessary to get something accomplished without having a Christmas Tree of extraneous provisions attached.

          • Michiganjf

            Will you ever post something where you actually know what you’re talking about?

          • Gregg Smith

            Where am I wrong smarty pants?

      • Michiganjf

        Obama put forth a PLAN THAT WAS PASSED BY CONGRESS BRAINIAC, CALLED THE AFFORDABLE CARE ACT.
         
        The CBO has graded it, and give the Affordable Care Act a pretty good rating.
         
        Unfortunately for Republicans, Ryan also put out a plan which the CBO graded… not such a good grade for that, WHICH IS WHY RYAN/ROMNEY WON’T TALK ABOUT ANY DETAILS OF THE RYAN PLAN!!!!!!
         
        Are you done lying yet????

        • Gregg Smith

          The preliminary CBO report (before the vote) said it was deficit neutral and cost $940 billion. Now the CBO says it’s not deficit neutral and the cost has tripled.

          • Don_B1

            That was because Committee Chairman Ryan’s instructions were to evaluate his tax cuts and “accept that adequate spending cuts” would be achieved to meet its claimed results.

            In other words, Ryan got his “neutral” rating by TAUTOLOGY.”

            As for the CBO “change” the evaluations are for different time periods. If I select different time periods for any of Ryan’s proposals I can find where they are even more in the “red” than they are now.

          • Don_B1

            No independent evaluation of Ryan’s budget has given it a “neutral” rating. They point out his budget doesn’t achieve “balance” until maybe 2040 and the accumulated debt is more than Obama’s.

          • Gregg Smith

            I was talking about Obamacare.

          • Don_B1

            My first two paragraphs were about Ryan’s “plan,” but the last paragraph was about PPACA. But you will have to point out where it says the cost has tripled.

            Sorry about not being more specific.

    • TinaWrites

      Rachel Maddow did a great piece on this tonight (Thursday, Aug. 16).

  • LinRP

    The thing that scares me about the senior vote was brought to life in a quote by a 79-year-old Florida man, Romney-Ryan supporter, interviewed on NPR. To paraphrase he said, “MY medicare won’t change so stop trying to scare me.” In essence he was all about, “We’ve got to cut, cut, cut,,,but I’ve got mine, so the hell with you who might need this in the future.” It was a perspective at work in the current senior population I had not heard before, and I thought it was frightening.

    • InActionMan

       Ryan says to the elderly “I’m not going to screw you. I’m going to screw your kids and your grand-kids”.

      Ryan is the Jerry Sandusky of the Republican Party.

      • Mouse_2012

         Right. Ryan pretend his plan is a solution(just so happens he has to exclude seniors for 10+ years) of course the reason is  to say your stuff protected and don’t worry about what happens to your kids and grand-kids

      • http://twitter.com/MJ_Q Matthew Q.

        That is a terrible analogy. Bringing Sandusky and his criminal behavior into this discussion is disheartening.

  • Fiscally_Responsible

    The Democrats rammed through this fiscal time bomb in the 60′s when Johnson was president and the Democrats controlled both houses of Congress.  Now the Republicans get unfairly tarred because they are the only party willing to stand up to the plate and try and fix it.  The Democrats would rather allow the deficit to continue to endlessly balloon out of control ($16 trillion and counting).  Plus, Obamacare cuts $700+billion out of Medicare to pay for yet another fiscal time bomb to come.

    On another note, Biden’s race-baiting comments (“they’re going to put you back in chains”) said in his “black voice” is despicable, but nothing new.  The Democrats have no new ideas (just spend and spend money that we don’t have), and so they have to resort to lies in order to engender those ignorant enough to fall for such stupid comments into their camp.

    • Shag_Wevera

      Right about the time I start to believe that we can no longer afford to care for the old folks in this country, I see;

      1.  The QB for my football team makes nine million dollars a year, as does the leftfielder for my pro baseball team.

      2.  Bill Gates is worth about 40 billion dollars.

      3.  We continue to fight a pointless and expensive war in Afghanistan.

      4. all the Mercedes and Lexus SUV’s driven by housewives with gold trimmed sunglasses at the grocery store in the good part of town.

      5.  All the mcmansions with 3 and 4 car garages, with lawns carefully manicured by illegal aliens.

      I say you are full of beans…  A civilized society takes care of their elderly.  PERIOD.  NO EXCUSES! 

      • William

         Define “taking care of their elderly?” No expense spared? Tax everyone to death? At what point do adults step to the plate and say, “There is a limit and we can’t rob the young to pay the old”

        • Mouse_2012

           Nice, William is calling for rationing health care and death panels.

          See Republicans do support both. There was this claim going around the news and online that republicans didn’t.

          • Joseph_Wisconsin

             Republicans have no problem with “death panels.”  They just believe that those death panels should be made up of bean counters at private insurance companies.  The Republicans have no problem with rationing.  They just feel that rationing should should be done based on wealth and income.

          • Gregg Smith

            As long as I am free to choose my insurance company, how much I want to pay, what kind of plan I want and who I want to make decisions if I can’t then I’m cool. I’d rather not have a death panel imposed on my life by government.

          • nj_v2

            Ha ha! Greggg thinks he can “choose how much he wants to pay” for insurance.

            Attention KMart shoppers, clues on sale in Aisle 7.

          • Don_B1

            Then you should have NO PROBLEM with PPACA!

        • Shag_Wevera

          Do my 5 points above portray a nation that is being “taxed to death”?

      • Gregg Smith

        Why do you feel you are entitled to the fruits of other’s labor? It’s their money.

        • Shag_Wevera

          You take some of my money for silly foreign wars, I take some of yours to care for the elderly.  Let’s call it even.

          • Gregg Smith

            Call the liberation of 50 million and an ally where there was once an enemy in the heart of the Middle East silly you want to. 

          • jimino

            I’ll start to accept your view on this subject when the Wolfolwicz, Rumsfeld, Cheney, Bremer and Bush families, let alone any of our military and their families, move there and live in the general population of Iraq or Afghanistan.  Until then, I consider your view on these “wars” bordering on delusional.

          • TinaWrites

            And it’s delusional to forget that these guys “opened up a market” for their armaments manufacturing, dealing, etc.  

          • sickofthechit

             It wasn’t silly because our soldiers died.  It was stupid and egotistical.

          • Gregg Smith

            Call the liberation of 50 million and an ally where there was once an enemy in the heart of the Middle East stupid and egotistical if you want to. 

          • nj_v2

            Look at poor Greggg trying to defend the worst foreign policy debacle in the 40 years.

          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            *cough*(warcrimes)*cough*

  • jimino

    Please address the fact that before anyone over 65 gets to spend their voucher for health insurance the market will literally have to be created.  Currently there is no such market or product available for individuals.  How do proponents of the Ryan plan expect insurers to develop these products?

    • Mouse_2012

       Vouchers are just another form of big government. The government decided how much the vouchers are going to be and what private companies are able to join in and what private companies wouldn’t. Not only that but government jobs would need to be created to fight again abuse and gaming the system.

      Doesn’t sound to free market to me.

    • TinaWrites

      Do you really mean to use the word “market”???  “Product”, yes; but “market”?!!!  No!  There IS a “market”:  the “market” is all the people on Medicare and all the people who would go onto Medicare IF there were no changes as envisioned by the Republicans.  It is that very “market” that the Republicans want to COLONIZE!  Right now, basic Medicare, without the “appendages” like the Advantage plans, etc., are paid for via our taxes.  If the Republicans get to get rid of Medicare, they can add all sorts of “goodies” into the “market” like commissions, fees.  They can turn a system that does NOT have a profit motive into a system that can be wagged by the profit motive!!!  It will be horrendous!!!

  • Gregg Smith

    Ryan’s plan is irrelevant. Romney’s plan is the one that matters. Medicare will go under if nothing is done. Where’s Obama’s plan to save it. Where is a single Democrat proposal to save it?

    • Mouse_2012

       spin away little birdie, no matter how you twist and turn you wouldn’t be able to spin things.

      • Gregg Smith

        So do you think Romney’s ideas take a back seat? That my friend is spin.

        • Mouse_2012

          Glad you agree your spinning little birdie. Ryan must of been picked for his Foreign Policy experience instead of the plan that got him in the news.

           

          • Gregg Smith

            I’ll take that as a yes.

        • Don_B1

          Romney seems unable to articulate his ideas and oscillates every day between saying his plan is identical or almost identical to Ryan’s or that they have yet to identify the differences. But NEITHER plan has been verified against financial models like that of the CBO. So neither can talk specifics (probably mostly by design).

          But Ryan’s plan is out there and even with all its remaining vagaries, more specific than Ryan’s, so Ryan’s plan will be what is used to compare it with the PPACA.

    • Shag_Wevera

      You are wrong.  Ryan’s plan is relevant because it is the crowning achievement of his political career to this point.  He was chosen by Romney in part because of it.

    • Yar

      “Ryan’s plan is irrelevant” 
      Only if he isn’t a heartbeat away from the Presidency.  Both Presidential candidates have reason to fear an unhinged individual on the radical right who takes hate rhetoric as a call to arms. 
      What did Sharron Angle say?
      Angle: I feel that the Second Amendment is the right to keep and bear arms for our citizenry. This not for someone who’s in the military. This not for law enforcement. This is for us. And in fact when you read that Constitution and the founding fathers, they intended this to stop tyranny. This is for us when our government becomes tyrannical…

      Manders: If we needed it at any time in history, it might be right now.

      Angle: Well it’s to defend ourselves. And you know, I’m hoping that we’re not getting to Second Amendment remedies. I hope the vote will be the cure for the Harry Reid problems.http://www.huffingtonpost.com/2010/06/16/sharron-angle-floated-2nd_n_614003.html

      • Gregg Smith

        I have no problem with Angle’s view of the 2nd amendment but don’t understand the relevance. Romney is the top of the ticket. No one (except J_O_H_N_) expected Obama to adopt Biden’s Iraq policy.

        BTW, did you see where Huffpo had to apologize for making up stuff about Fox?

        • J__o__h__n

          I didn’t expect Obama to.  I said I agreed with Biden. 

          • Gregg Smith

            Sorry, thanks.

    • JGC

      Ryan’s plan is not irrelevant.  The focus has shifted to Ryan, and Romney (probably gratefully) is retiring into the background.  Romney has a wimp factor that will be hard to shake; Ryan is an engaging promoter of extreme conservative ideas.  

    • Don_B1

      And here is how Romney’s plan would “save” Medicare, NOT!!

      http://thinkprogress.org/health/2012/08/15/693731/how-mitt-romney-would-quickly-bankrupt-medicare/

  • Mouse_2012

    Some dems did come up with “The People’s Budget” (That got no play by the media)

    http://grijalva.house.gov/uploads/The%20CPC%20FY2012%20Budget.pdf

    • Gregg Smith

      Let them bring it to a vote. Ryan’s plan passed the House.

      • Mouse_2012

         Wow, it’s such a feat to pass a house plan when Republicans control the house. Must of been tough having a republican majority pass a republican plan.

        • Gregg Smith

          It got more Democrat votes than Obama’s budget which got zip. 

          • Joseph_Wisconsin

             You mean the budget that the Republican’s introduced that they called Obama’s budget?  LOL.  That did not get any Democratic votes.  Well imagine that.

          • Gregg Smith

            414-0 in the House and 97-0 in the Senate is hard to spin, keep trying.

          • Joseph_Wisconsin

            Spin eh?  Tell me who introduced that so called “Obama budget” in the House.  That would be Rep. Mick Mulvaney, R-SC, no?  In the Senate? Sen. Jeff Sessions, R-Miss., no? How many Republican authored amendments were attached to any resemblance to Obama’s actual budget proposals were there? Never anything but political theater.

          • Gregg Smith

            How much blame do you give Obama for not having signed a budget since he’s been President? All other Presidents managed one despite divided Congresses.

          • nj_v2

            Yet here Greggg is, spinning away.

            The loudest, most obtuse partisan hack on the forum has been extra partisan-y and extra hack-y with his new surnamed handle.

            The budgets were Republican theatrical stunts, intentionally lacking specific details, and offered without any opportunity for change or amendment.

          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            More bloviating about “Obama’s budget”.

  • Gregg Smith

    This Ryan pick has dems quaking in their boots. I love it.

    • Mouse_2012

      Delusional 

    • JGC

      Hmmm. No. But I do appreciate the clear choice from which voters can now choose.    

      • Gregg Smith

        I agree.

    • Acnestes

       More like shaking with laughter.

    • Matt Wade

      Watching fox news: because its easier than sticking your head in the sand to avoid the facts.

  • Gregg Smith

    Here’s Senator Obama in 2005 admonishing Bush for not addressing Medicare. Where’s Obama’s plan now?

    http://www.youtube.com/watch?v=klKbtYXEjRg&feature=player_embedded

    • Shag_Wevera

      I’m not as worried about president Obama’s plan as I am Romne/Ryan’s

      • Gregg Smith

        What Obama plan are you referring to? Is gutting Medicare by $717 billion a plan to save it?

        • Shag_Wevera

          Ryan’s plan takes @ 700 billion as well.  Romney’s 400 billion from what I’ve heard.

          • Gregg Smith

            Romney’s plan (the only one that matters) takes zip. Where did you get the $400 billion figure?

          • Shag_Wevera

            An interview with Paul Ryan on Fox News. (recent)

          • Gregg Smith

            I’d have to see proof because I’ve heard Romney say the opposite. If Romney’s plan takes $400 billion out of Medicare then I’ll be the first to criticize him.

          • Don_B1
          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            The intersection of you and the phrase “I heard” approaches zero percent of believability.

          • Gregg Smith

            “Ryan’s plan takes @ 700 billion as well.  Romney’s 400 billion from what I’ve heard.

            That was my point to Shag but I’m open if he can show me.

          • Don_B1
          • Gregg Smith

            That article does not mention the alleged $400 billion cut.

        • MrNutso

          He is not gutting anything.  The $700B comes from reduced payments to health care providers.  Health care providers agreed with this, since they will get more paying patients through the affordable care act.  

          The second area is waste, fraud and abuse.  I’ve never been a fan of this, since it everyone says this, and one persons WFA is another’s necessary to get the job done.  That’s not to say I’m not in favor of getting rid of real WFA.

          • Gregg Smith

            Services will be reduced. How does that help?

          • MrNutso

            Funding for payments for services is not to be reduced.

          • Gregg Smith

            “Services” will be reduced.

          • Don_B1

            Your crystal ball?

        • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

          Hahaha. Enjoy your Kool-Aid.

          (No disrespect to General Foods or that giant glass pitcher.)

        • TinaWrites

          The 700 plus in cuts from Obama was from the cutting of unnecessary subsidies and duplications that represented waste.  He took those cut savings and plowed them back into the Medicare system.  Ryan’s 700 plus takes away funding, but uses it to justify tax cuts for the very wealthy.  

    • Don_B1

      It is interesting how hypocritical Republicans can be:

      1) They say the costs of Medicare are not sustainable so Medicare must be strengthened.

      2) When Obama and the Democrats come up with ways to slow the growth of all medical care and take credit by reducing the expected costs in their planning, the Republicans charge the Democrats and Obama with “gutting Medicare.”

      3) When they see some (Democratic Party) ways costs might be reduced they claim them for themselves but do not argue to make the changes necessary to achieve the reduced costs. Thus they take the money but do not save the spending, doubling the deficits that will accrue under their approach.

      They really do have a low opinion of the intelligence of the average voter.

      • Gregg Smith

        Huh?

  • Michiganjf

    Tom,

    This is so important for ALL Americans!!!

    Please don’t let callers or guests off the hook on distortions and half-truths, lies or cherry-picking data.

    … you know, what we’ve been hearing from Ryan/Romney and the conservative obfuscation conglomerate.

    • JGC

      As in talking point, never use the word “privatize”. Replace with “preserve” and “strengthen”. 

      • Gregg Smith

        Democrats called the option to invest a teeny weeny portion of your own retirement “privatization” which is absurd. Republicans are just as bad with the word “amnesty”. 

        • Don_B1

          And the Republicans ignored the $trillions needed to finance the transition from today’s Social Security to individual accounts.

    • Prairie_W

      I’m beginning to think that the demand to quit funding NPR through Congress is something we should all support.  Tom may have his own reasons for allowing lies and distortions to go unchallenged, but public radio would indeed be more “public” now if it were wholly listener- and grant-supported at a time when “public” no longer describes our corporate-driven government. 

      Public radio has hauled in some very healthy large sums (Kroc, for example) from corporate and foundation supporters as well as from many listeners.  It deserves every penny of it *except* when its hosts pull their punches for (shhhh!) political and financial reasons.

      • TinaWrites

        “*except* when its hosts pull their punches for (shhhh!) political and financial reasons.” — which is so rare as to be negligible!!!

  • Gregg Smith

    I’ll say it again. In 2007, after 4 years of raging tax cuts and wars the deficit was $151 billion, the unemployment rate was below 5% and more revenue came in than at any time previous or since. What’s not to like?

    • sickofthechit

       That deficit was an accounting subterfuge. The Debt increased by $11 trillion under shrub.

    • JGC

      The wars?

    • Don_B1

      And the dam that was holding back all the problems [hiding them in a housing bubble used to build an even bigger financial derivatives bubble], which burst on GWB’s watch.

      The dam’s size was equivalent to China’s Three Rivers; if that broke, how many years would it take to rebuild it? Hint: it took over 10 years for the original construction.

      Nice cherry-picking on the 2007 date!

      • Gregg Smith

        The dam busting was not related to the tax cuts and wars, that’s all. You can still put it on Bush because it was his watch but the numbers speak for themselves. We can debate the causes but to say it was tax cuts is not credible.

        • Don_B1

          Sure it was; the tax cuts did not effectively generate wage growth (except for the 1%), which led people to extract equity from their homes as banks lent on the bubble-inflated home “values.”

          The Bush administration boosted the increased home ownership and supported Alan Greenspan in his refusal to enforce regulations on shadow banking (as requested by Democrats) and Bush appointee to chair the SEC did not pursue the obvious corruption in the derivatives market which was driving the housing bubble.

    • responseTwo

      “the deficit was $151 billion” – The wars were off budget. In #1 I say “two unfunded wars that weren’t even included in the deficit” If you add in about 1 trillion in cost for the wars (the Iraq war was 10 billion a month for years) the real deficit was $151 billion plus one trillion = 1.151 trillion.

      Yes, in 2007 the economy was good (what do you mean “more revenue than ever?”) but the end result was a collapsed economy that had months of 500K to 700K of jobs being lost. Last time that happened was in the depression.

      The reason the deficit increased is because we had such massive layoffs, never seen since the depression, the whole country was afraid to spend anything.

      The Bush tax cuts have been in affect for 10 years. If tax cuts work and are the cure-all for the economy we should be floating in jobs but we’re not.

  • http://www.facebook.com/bryan.vandonslear Bryan Van Donslear

    Doesn’t seem like either side is serious about really finding workable solutions to this problem.  I cringe when I hear any of them talking about ” having adult conversations” as though they are the adults in the debate.  Laughable.

    • Mike_Card

      Hear, hear!  There will be NO adult conversations involving any elected or appointed politicians–those people are incapable of behaving like adults.

      • Don_B1

        I do believe that Obama would have had an adult conversation with Republican leaders. And it might have been successful if Republicans had not figured out how to walk the tightrope between the government shutdown that Gingrich created and giving too much “success” to the president as Gingrich did.

        Thus, as McConnell said, he NEVER allowed it to appear that anything passed in a bipartisan manner; there were many times when a single Republican senator “negotiated” with Democrats at the committee level (the “Gang of Six” on the Healthcare bill was the exception) only to have the republican pull out of the negotiations after wasting weeks to months of time for nothing. That was true of the “Gang of Six” too.

        • Mike_Card

          I guess we all have our own assessments of the shameful cesspool known as our national capital, and I have no quarrel with your points.

          In my view, Obama began his term with high-minded objectives, was thwarted whenever possible by the GOP, and was likely not well-served by his inner circle.

          The lobbies have ensnared the political operatives, including the courts, and all,
          ALL of the players have been bought and paid for.

          I have no faith that any of those occupying seats in Washington are working for anyone beyond their political spheres, certainly not for me, as a mere voter who might be able to scrape together $50 to make a contribution.

  • MrNutso

    Here’s one explanation of Congressman Ryan’s Medicare plan and it’s effects:

    http://krugman.blogs.nytimes.com/2012/08/16/whats-in-the-ryan-plan/ 

  • JGC

    A prediction: If the RYAN/romney team wins the White House, Ryan will have the Resolute removed from the Oval Office and taken to a cubicle at Public Storage; he will then replace it with the Johnson desk, borrowed from the Lyndon Baines Johnson Library. 

    This will make him feel extra comfortable and extra inspired as he props his feet up on Johnson’s desk, continuing to plot how to dismantle Medicare for Generation Screwed.  (Meanwhile, president romney will be busy making peanut butter and honey sandwich snacks for Ryan and his team of advisors.)

  • http://twitter.com/TongoRad TongoRad

    Neither Ryan or Obama are talking about the best way to save Medicare: expand access to everyone. Why must we continue to pay more than any other country for our health care? 

    • MrNutso

      I agree with you.  The reason this doesn’t get discussed on the national scene is it’s a non-starter.  Looking at the reaction to a plan that is a windfall for private insurance companies makes single payer political suicide.

    • Shag_Wevera

      American Exceptionalism.

    • sickofthechit

       and we don’t cover everyone.  Insurance sales commissions and Insurance Company Overhead do not contribute one ounce to anyone’s health.

      • TinaWrites

        Shout this from the rooftops, please!!!

        • sickofthechit

           I’m trying!

  • Shag_Wevera

    Please examine the photo of Paul Ryan above.

    Is there a name for his expression?  The lips are pulled back into sort of pseudo-smile, eyes wide open, furled brow and forehead…  What does this expression say?

    • Mike_Card

      That’s the expression of someone who just got caught in a lie.

    • Prairie_W

      It says (to me, anyway), “I want people to like me as much as I like myself.”

      (Fat chance, Paul.)

    • BHA_in_Vermont

       Looks like a guy on his way to the woodshed.

    • InActionMan

       Patrick Bateman aka “American Psycho” face.

  • J__o__h__n

    I was hoping Mitt would pick Ryan.  Instead of etch-a-sketching his way to the middle, he now has to try to distance himself from Ryan’s plan which is the only reason he picked him.  That requires even more twists than explaining how Romney-care differs from Obama-care. 

  • Matt Wade

    “Harness the power of patient choice.” yes, because that has work so well to this point. It is a fact that nations with single payer has more efficient and more affordable health care for their citizens. FREE MARKET ECONOMICS DO NOT WORK IN HEALTH CARE MARKET!

    • sickofthechit

       Medicare for all under the “General Welfare Clause” of the Constitution.

  • RolloMartins

    If the “real question” as your guests state, is reducing cost (and improving care), then we would be discussing Medicare-For-All. Why aren’t we discussing that? It would save between 250-750 billion dollars…PER YEAR! (Cf Dr. John Geyman’s book Hijacked.)

    • sickofthechit

       and it covers everyone!

  • Matt Wade

    “Premium support” = VOUCHERS. Vouchers = bankrupt grandma living on the street. Can we get some people on here who will speak without spin? 

    I love the cowardice of the Ryan plan. Seniors living today on medicare don’t have to worry, because the plan won’t go into effect until 2022 (or whatever) its their children who won’t have a guaranteed health care plan. The Baby Boomers have never had to sacrifice for anything.

    The savings of the Ryan plan will go towards financing more tax cuts for the rich. Disgusting.

  • Ellen Dibble

    I heard somewhere the voucher would be $15,000 and seniors could get a cheaper plan and claim the difference in a rebate from the IRS.  Hey, I’m not needing the benefits Medicare mostly pays for, so I’d go for the rock bottom plan and pocket the difference.  Bring it on!

    • Don_B1

      The voucher will only be that high when the dollar is worth only 50 cents in today’s money; or it doesn’t happen until 2025 when that condition applies.

      Check for the “quality” of your source and the details provided.

    • Mike_Card

      It doesn’t really matter whether it’s 150 or 15,000.  The insurance companies do not want people over 65 and will price accordingly.  You might not think you need the Medicare coverage today, but what happens when those lab tests come back next week, or you trip, running to catch the bus?

      You will end up with a “rock bottom” plan and the insurance company will take your voucher, plus the vig.

      You WILL pay additional out-of-pocket; either that, or end up with no coverage.

  • BHA_in_Vermont

    Only the rich deserve good medical care and insurance. That way all the blood sucking poor and middle class will die off faster and get off the dole.

  • sickofthechit

    My fathers last years were spent in the ever denser fog of Alzheimers Disease.  How would he or other similarly afflicted Seniors be able to decide where to spend their voucher each year?  Remember, not every senior has family or loved ones they can call on.

    Has Ryan forgotten his mother or grandmother with Alzheimers? Ryan is the perfect poster child for my
    favorite saying about Repugnican Politicians.

    “Republicans:  Hypocrites? or
    Schizophrenic Hypocrites?”

    • JGC

      Remember the Hypocritical Oath:

      First, do no harm to your base.

  • MarkVII88

    The big gamble at the heart of Paul Ryan’s proposed changes to Medicare is that, if seniors are given these vouchers to purchase insurance, that the insurance companies will actually want to compete to get this business.  With the panoply of medications many seniors take and the number of providers that many seniors see to manage their pre-existing conditions, are they really good candidates to compete for from a business perspective?  I am afraid that more seniors would be excluded from coverage based on a price gap between their voucher and what the insurance companies would demand for premiums that the seniors would have to pay out of pocket.  Don’t let them bankrupt my Grandma!

    • Don_B1

      Right now, insurance companies are racing to drop Long Term Care policies. The first ones “out” found other companies to pick up the policies but that is probably ending.

  • RolloMartins

    All that increasing competition would do (per Paul Ryan) is increase the duplication–AND COST–for Medicare. It is stupid and shows the lack of knowledge of the Republicans re healthcare. They just don’t get it: healthcare is not a true market; competition will thus not work (never has, never will).

    • Don_B1

      I think at least some do “get it” but they also see the opportunity to fleece the naive and like the “I’ll be gone, you’ll be gone” rationalization of the con man.

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    So what happens if you can’t afford to use your voucher? You join the millions with no health insurance.

    ER’s will be overrun with the uninsured elderly. And instead of it being paid for by taxes, will be borne on backs of paying customers.

  • http://www.facebook.com/alnwright Alan Wright

    Tom, Ryan’s voucher plan for Medicare is intellectually dishonest.  With over 25% of spending on end-of-life care Medicare is effectively a payment plan for the costs of death and dying.  Death is not insurable as it is an expected event  not an unexpected risk. Medicare vouchers would result in an insurance spiral that no amount of competition among health insurers could prevent. What is needed for Medicare is a change in how we as a nation approach end-of-life care. This is a cultural change tasks for Baby-Boomers.

  • Dick Johnson

    Am I wrong?  Did Medicare Advantage plans survive the competition with Medicare because  some years ago Congress established a 14% (+/-) subsidy for Insurance companies who would take over an individual’s Medicare allotment and re-fashion the benefits in ways that improve upon traditional Medicare? And is that 14% the $700 billion politicians are talking about?

    • Don_B1

      It is a significant part of it. Note that those taking advantage of Medicare Advantage programs did not have better health outcomes as much as they might have thought they did.

      Those that were able to join those programs had more money than those that did not.

  • BHA_in_Vermont

    “Disruptive construction” i.e. LIAR

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    Insurers won’t insure people with existing healthcare issues – or the elderly. Why do they think that there will be cost savings through competition when insurers don’t even want these customers?

  • manganbr

    Supposedly this plan would not change medicare for people already receiving the benefit, or who are over a certain age. So I want to know why those of us in our twenties and thirties should continue to pay into medicare to cover those now receiving it, when we know we won’t be getting the same deal?  Is this the deal: we have to pay to cover current recipients now, AND, when we receive medicare, we’ll have to pay to bridge the gap between the voucher and the cost of comparable coverage? That seems inherently unfair. Why is this issue always about scaring the elderly? It’s the young that should be pissed. 

    • Matt Wade

      If the young stop paying for Medicare for the elderly, then whole system collaspes. The fact the Ryan hasn’t realized this is stunning, and proves my theory that Stupid never takes a day off.

      • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

        Oh, Ryan realizes it. But too many people who should be calling him on it are just staring into his steely blue eyes and gushing over his wonky way with numbers.

    • MrNutso

      Yes, the young should be pissed.  You should be advocating for maintaining Medicare as it was designed.  The key argument that RR make is that current seniors and those 53-55 and older will not see changes.  This is a clear ploy to get seniors to support them, because they know seniors vote, and seniors will vote to continue to support benefits they currently receive.

  • http://gregorycamp.wordpress.com/ Greg Camp

    How about a means-tested comprehensive program for anyone who wants it–elderly, uninsured, people with pre-existing conditions, healthy employed people, etc.?  Private insurance can continue; the government program would just be another competitor in the field.  The government plan could bargain with doctors and drug companies to lower costs.

    • Don_B1

      If you think the wealthy want to kill Medicare now, when a lot of them not at the very top DO benefit, wait until means testing reduces their benefit from it.

      Means-testing is just another way to kill Medicare (or Social Security).

      • http://gregorycamp.wordpress.com/ Greg Camp

         By means testing, I’m saying charge fees on a sliding scale–have one fee rate for the poor, one for the middle class, and one for the wealthy.

  • sickofthechit

    Tom, Shame on You!  Repeating the Repugnican lie that The Affordable Health Care Act cuts $700 billion from Medicare. It cuts $700 billion from provider payments, NOT FROM RETIREE BENEFITS!  It’s called cost savings.

    • Don_B1

      And it cuts that money by reducing the otherwise expected rising costs of medical care.

  • fakerbarker

    Tom, I’m concerned about the changes proposed to Medicaid. My cousin is intellectually disabled and lives in a home that relies on state and federal funding. Can your guests shed some light on what Mr. Ryan’s medicaid proposals will mean for him?

  • MadMarkTheCodeWarrior

    Ryan is a numbers guy. He’s skilled at the Devil’s arithmetic. DO THE MATH for yourself:

    Private insurers: 30% overhead and profit; Medicare: 4% overhead.

    So we’ll get over 20% LESS healthcare for our money with Ryan’s plan. He claims he’s a numbers guy.

    If we give him credit for understanding this simple equation: He knows this is not in our best interests so he’s lying to us – this is solely in the interests of his rich contributors.

    If we don’t give him credit for understanding this, he’s up there in the ranks of Sarah Palin and other reason-challenged lightweights blinded by ideology…  “Some people drink deeply from the fountain of knowledge. Others just gargle.” ~ Grant M. Bright.

    So is he a disingenuous liar, or does he just gargle?
    You have to ask yourself – do you want someone proposing to undermine the healthcare of Grammy and Grampys and today’s Mom & Pops someday for the benefit of insurance company executives?

    I can only conclude, he doesn’t care about THE PEOPLE.

  • MrNutso

    Ryan lies as good as Romney.

    • sickofthechit

       Better, he’s a px90 guy with the accompanying intensity.

  • TribalGuitars

    Gail says Obamcare is based on current prices, but neglects to mention that Ryan’s plan is based on the current rate of inflation, which is outstripped by the rates of insurance and health care costs by double. 

    Ryan thinks insurance companies will drop costs to compete, but that’s never happened, and health care costs don’t drop. Some medications may become cheaper, but procedures, doctor visits,  most devices, etc, don’t go down in price. 

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    In Republicanspeak, having people pay the same taxes for less benefits is a tax increase – which is what the Ryan plan would do to  those under 55.

  • Matt Wade

    Fortunately, privatizing Medicare is about as popular as privatizing Social Security. And we all remember how that went (democrats retook Congress after Bushy went after Social Security)
    From Quinnipiac last week: 60% said Medicare should remain as it is, while only 34% said it should be changed in the ways pushed by Rep. Ryan. In addition, the poll also found that 70% of voters opposed cuts to Medicare funding in general as a way to reduce the defciit, versus 27% who supported those cuts. Further complicating the GOP’s position, just under seven in ten voters said they supported raising taxes on annual income above $250,000 — as President Obama and Democrats have suggested. Twenty-eight percent of voters said they did not suport such a tax increase.  

  • Roger Kerr

    Instead of discussing the two approaches to Medicare, why aren’t we talking about the real problem, which is the cost of health care in the US?  We know we have one of the least effective systems of any developed nation, and at a significantly higher cost.  If we addressed this core problem, the issue with funding Medicare would be moot.

    • Wm_James_from_Missouri

      Yes,yes, yes !

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    One simple question – what happens if you can’t afford to use your voucher to buy healthcare?

    • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

      They issued you a voucher, dagnabit. That’s their end of the bargain. Whaddya want, egg in your beer?

      (I don’t have to signal /sarcasm here, do I?)

  • Ellen Dibble

    I see the skyrocketing cost of medical care as a result of capitalist profit seeking.  The incentive to seek profit from something that is not a choice, to wit health care — everybody eventually dies — is perverse.  The objective should be to deliver value, not to deliver something that extracts the maximum profit from the payer.  If the payer is the government, I think there is a bigger Billy Goat Gruff protecting value.

  • Mark Rowe

    This is what I want to know:  Mitt Romney says he’s currently unemployed.   Where does he get his healthcare?

    • Mike_Card

      He’s 65 years old; elgible for Medicare.  But he probably has a Cadillac plan through Bain as part of his separation agreement.

      • Mark Rowe

        That was my guess- part of his golden parachute from Bain.  Funny how we don’t hear anything about it. 

      • Don_B1

        Note that the PPACA taxes Cadillac plans, so that is probably the difference between Romneycare and Obamacare that does it all for Romney.

        • Mike_Card

          No doubt.  But his agreement will certainly pick up costs, as well.

  • TribalGuitars

    Romney and Ryan want to repeal Obamacare. That would mean that insurance companies would be able to cherry pick customers and throw people off rolls for pre-existing conditions, of which being old is such a condition.

    • kaybee63

      Yeah – those insurance companies are going to COMPETE to insure those old gaffers who are getting ready to die.  Yup, I’ll bet they will – and I also believe in Santa Claus.

      • TribalGuitars

         There’s nothing to stop those insurance companies from taking those vouchers while offering less and less.  Look what happened in Georgia that passed a law saying people can buy insurance wherever they wish, even over state lines – There’s no standard of care or coverage offered. The policies won’t be worth the paper they’re written on or the powder to blow them to hell.

  • MrNutso

    Just what I want to do, evaluate insurance plans to figure out which one benefits me the most.

    • Shag_Wevera

      Sweet freedom?

    • Don_B1

      And it is a psychological truth that the more options there are, the harder it is to even get to a decision.

  • BHA_in_Vermont

    The Ryan plan not affecting those currently 55 & older is pretty much an “as long as *I* get *MINE*” play for the senior citizen vote. Never mind that their kids and grand-kids are going to get shafted by Ryan’s plan.

  • J__o__h__n

    Any changes need to affect everyone.  If Medicare is cut for people under 55, do the people over 55 expect us to not cut them next?  If it won’t be there for us when we’re old, what incentive do we have to support Medicare?  And Romney claims Obama is the one dividing Americans?

    • Don_B1

      Either those under 55 today will demand the same when they reach 65 or they will demand that those over 55 today get their benefits reduced as today’s under-55 did.

      But the Republicans are hoping that the naive elderly will not think that far.

  • Matt Wade

    Hopefully the same people who yelled, “Keep your hands off my Medicare!” during the ACA debates will show up to Paul Ryan’s stump speeches.

  • TribalGuitars

    Ryan says traditional Medicare would still be there for those that want it. That’s not true, as the budget for Medicare would be slashed, and 19 MILLION people wouldn’t even qualify for Medicare.

  • BHA_in_Vermont

    If the “average” person could have opted out of Medicare 30 years ago, they wouldn’t be retired by now, they would be BROKE now. Did the caller forget that the economy tanked in 2008 and has yet to recover?

    • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

      Sounds like that caller doesn’t have a grandma wheezing (literally) through her final years in a spare room in his house. And that’s all that matters.

      Of course, back in the age of “personal responsibility” (before SocSec and Medicare), that’s where many septugenarians and octeganarians went to live their retirement.

  • Obvious Sock-Puppet

    I’m reminded of a reasonable-seeming analysis of some schools voucher scheme floated a decade or so back.  It sounded good, but the numbers worked out to an absurdly low amount per student, with the comment that the plan seemed ‘…designed to drive students into church schools,’ because those were the only ones charging that little, by a long-shot.

    This is a scheme designed to bring private charity to the fore.  If private charity had been adequate, no-one would have considered getting the government involved—the half-done Welfare State was not imposed on our nation by hook-nosed Masons from Outer Space in order to oppress decent white people, it grew as private mechanisms proved themselves inadequate to requirements (e.g., the requirement of human decency in a rich nation).

  • MrNutso

    I’m listening to the website feed.  Anyone else having problems with iTunes?

    • Roger Kerr

       No, I’m hearing it fine.

    • Don_B1

      Yes! All morning.

  • uninsured58

    How many people coming into Medicare are uninsured?  Won’t Obamacare supply preventive care to these people in their 50′s and 60′s and in that way represent a savings to Medicare?

  • jim_thompson

    Tom,

    The fact of the matter is that the far right of the GOP has always wanted to get rid of medicare.  They just have denied it since the 1970s.  Medicaid is even more up for grabs with them, with no “phase in”.  Medicaid’s most covered are seniors in nursing homes.  The GOP want to turn medicare from an social insurance program into a welfare program.  I am betting this will not happen.

    Jim in Fort Mill,SC

  • Matt Wade

    Consider this remarkable series of events:

    1. President Obama extends new benefits to seniors on Medicare and finds savings in the system to strengthen Medicare’s finances.

    2. Paul Ryan approves of Obama’s Medicare savings and incorporates them into his own budget plan.

    3. Mitt Romney endorses Ryan’s plan, which includes Obama’s Medicare savings.

    4. Romney changes his mind, and tries to argue he’s for and against the Medicare savings at the same time (for them in Ryan’s plan, against then in Obama’s law).

    And finally 5. Ryan denounces the Medicare savings he supports.

    So to review, the Romney/Ryan ticket is for and against Obama’s Medicare savings, for and against including Obama’s Medicare savings in the Republican budget, for and against extending benefits for seniors, and for and against strengthening Medicare’s finances — all at the same time.
    Complicating matters, Romney/Ryan intends to deliberately eliminate the savings — “We’re putting the $716 billion back” — which necessarily means pushing Medicare closer to insolvency and $716 billion in additional entitlement spending that Romney can’t afford.
    It’s like the Republican ticket is sinking deeper into the quicksand of policy stupidity.

    • MrNutso

      I heard that the $716B that RR would put back would come from unpaid for general revenues.

  • Michiganjf

    Tom,

    This Republican scare about providers not being able to sustain their practice without insurance middlemen…

    How do conservatives explain THE ENTIRE REST OF THE DEVELOPED WORLD, then, where providers succeed just fine???!!

    • Shag_Wevera

      American Exceptionalism.

    • Obvious Sock-Puppet

      Why do you hate America?

      You stupidly forget that Murka is the bestest greatest God’s gift to Mankind on the face of the Earth, and as such what applies to any other nation or group of human beings tells us NOTHING about what happens here. 

  • http://freeourfreemarkets.org/ Steve Banicki

    Although unsaid, and not proven, the Ryan plan
    anticipates that the cost of health care will be less under his voucher plan
    because the patient will have skin in the game and use his vouchers more
    wisely.

     

    The flaw under the voucher system is each individual will
    need to buy the best insurance he can with the voucher and then we are back in
    the same boat. http://www.freeourfreemarkets.org/2012/08/results-of-ryan-plan.html#more

  • MrNutso

    Right on Sarah.

  • Roger Kerr

    Paul Krugman has posted a good overview of the Ryan plan at http://krugman.blogs.nytimes.com/2012/08/16/whats-in-the-ryan-plan/

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    Bottom line: insurance companies can’t affordably sell insurance health insurance to the elderly. Period. That was the whole reason for Medicare in the first place.

  • BHA_in_Vermont

    People wading into the “market” with their Romney/Ryan vouchers will have ZERO purchasing “muscle”. They will get the highest rates ASSUMING they can even get insurance when they have existing medical conditions.

    One answer: Single Payer – same as every developed country in the world, except the “exceptional world leading” USA. Better health care for less money.

    • http://profile.yahoo.com/P63Y63SNNFSUBMKBJMFMUATJKE sam

      Now that’s just socialist warblegarble!!

  • TribalGuitars

    The Erie PA caller says he would have liked to opt out of Soc Security and invest it.  And what would have happened to those investments when the economy tanked?  The plan called for government approved securities and investment firms, and let’s face it – It would have been the same firms that got us into the economic debacle we’re in. There’s a reason Goldman-Sachs is called “Government-Sachs”, and that the US Govt isn’t pressing for charges against any of those firm that have been proven to have sold bad paper, cooked books for countries like Greece, foreclosed on people that weren’t in arrears, and used TARP funds to pay execs while people went bankrupt. 

  • Ellen Dibble

    The donut hole of age 65 to 67 — so you retire, you lose your insurance from your employer, and you can’t find anything affordable to buy.  Well, what about COBRA?  Isn’t that a law that requires you to be able to have the same insurance extended for a year?  That law would have to extend that to two years, at which point you get a voucher.  
         But …

    • RolloMartins

      Have you priced COBRA? Yikes.

      • DrewInGeorgia

        No one that truly needs COBRA coverage is ever able to afford it.

    • mumtothree

      Another problem with COBRA, ignoring the 18-month time limit, is that many employers, to save costs, purchase high-deductible plans and put aside funds (self-insure) to cover those costs which would ordinarily be paid by the insured.  On COBRA, your former employer is not going to pay ANY part of the premium OR that deductible.  So you’re staring down the barrel of paying a “reasonably priced” family health insurance premium of $15-20,000 a year, PLUS a deductible of a few to several thousand, before that insurance pays a penny of your health care costs.

  • jim_thompson

    Tom,

    The notion by the Ryan types-and the GOP-that medicare is going broke or on the road to disaster is just false.  If the “preiums” for medicare were raised a tiny 2.75% it will have more than enough money for the next sixty years.  I can’t remember the last time those rates were raised and if anyone checks their paystub those “premiums” are much much lower than any insurance policy would be and the benefits are very generous.  Folks, we are talking about taking care of seniors-which we all will become-get real and do the right thing for grandma and granddad.

    Jim in Fort Mill,SC

    • MrNutso

      This is one side of the equation that never gets discussed.  All solutions always look at cutting costs.  I’m all for making systems more efficient, but at some point revenue must be enhanced.

    • Mike_Card

      Do you mean 2.75% or an additional 2.75 percentage points added to the existing payroll deduction of 1.65%?  Those mean a payroll deduction of either 1.70% or 4.40%.  To you, that may be “tiny” and I could probably buy off on an increase from 1.65% to 1.70%.

      For a lot of workers, tho, their biggest payroll deduction is the FICA tax (yup, it’s a tax even if it’s euphemized as a “contribution”).

  • MrNutso

    I just heard it:  “If there is adequate payment to take care of them.”

  • http://twitter.com/bannana02 Anna K

     The fact that I don’t ever hear mentioned is that healthy people don’t cost money, they also don’t create profits. The free market has absolutely no incentive to help people be healthy, just like we are suffering from drug shortages due to the low profit margin of non-blockbuster drugs. The answer is not to create competition and just cut costs, it’s to find the most efficient way to take the best care of people. It’s going to cost money, that’s just the reality of providing social services.

  • Matt Wade

    Gail is having serious trouble doing the verbal gymnastics that are required in explaining the nonsensical Ryan plan.

    • JGC

      Just wait til Romney attempts to do the same.

      • DrewInGeorgia

        Verbal Gymnastics is much like an Olympic Sport. Participation is beneath Mr. Romney, why bother participating when you can run the game?

  • BHA_in_Vermont

    Oh, I LOVE it – disease specific plans.
    Please Ms. Wilensky, tell me which banks I should rob to get the money to pay for a plan that consists of nothing but very high cost cancer patients.

  • http://gregorycamp.wordpress.com/ Greg Camp

     The key question here to me is whether healthcare is an area that market forces can address equally for all sides.

    Personal computers used to be expensive and clunky.  Now, they’re tricky and argumentative, but much cheaper.  If there’s a market solution to healthcare that will do a good job for consumers, I’ll listen.  But so far, all I’ve seen is proposals from the right that will end up keeping a large part of the population out of the market altogether.

  • TribalGuitars

    Georgia already has passed a law saying that insurance companies can offer plans that are worth little more that the paper they’re written on, so that people can say “I have insurance so you can’t fine me.” The state assembly and senate, passing the buck (literally and figuratively) have just quantified it by saying “Buyer beware.”

  • Ellen Dibble

    If I’m shifting from one plan to another in this competitive Ryan future, do the records laws keep up, such that the doctor covered under plan M, that I have in year  1, sends my records to doctor B, under plan N, which I see as a competitive advantage, under the changing medical world, and the changing situation with my health, in year 2?  Do my records speed here and there?  And leave the teamwork intact?

    • Don_B1

      Probably not but I haven’t seen that aspect addressed by Ryan. He probably thinks the free market will do that on its own, when keeping patients incentivizes the opposite.

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    Voucher program is a government program for the rich – the poor won’t have the money to use them, the rich will be able to use them and will have the government pay for their healthcare.

  • jimino

    There is no market for health insurance for individuals over age 65.  So where does one go to spend their voucher?  Do Ryan supporters have a plan to create such a market out of thin air?  How?

    • JGC

      The evil genius of Ryan’s current plan is that it will take years ( a minimum of 13 years) for the leading edge  of voucher plan babies (ages 52 and less)  to start reaching the age 65 insurance desert. By that time, Romney will have safely completed his two terms and will be pre-occupied with building the Willard Mitt Romney Presidential Library in the Cayman Islands…

  • http://freeourfreemarkets.org/ Steve Banicki

    Although unsaid, and not
    proven, the Ryan plan anticipates that the cost of health care will be less
    under his voucher plan because the patient will have skin in the game and use
    his vouchers more wisely.

     

    The flaw under the voucher
    system is each individual will need to buy the best insurance he can with the
    voucher and then we are back in the same boat.

    What the health industry
    charges for its services and how often the services are used are back in the
    hands of the providers, with the cost covered by the insurance companies.

     

    The cost of insurance will
    then rise faster than the value of the voucher and health will decline.

     

    The Declaration of
    Independence says “… that among these are Life, Liberty and the pursuit
    of Happiness. The question is are wealthier Americans deserving of a healthier,
    longer life than the less wealthy? If we are a nation believing in basic Judeo/Christian
    values the answer is no.

  • dt03044

    Let’s not forget that Romney/Ryan want to repeal “Obamacare”, which does not allow health insurers to deny coverage to people with pre-existing conditions.  If that happens, and private insurers can go back to a policy of denial, and the future elderly are forced into private plans with a voucher, might they be refused coverage if they have previously been sick?

  • Ellen Dibble

    I thought the 20 percent that goes to the legions of secretarial sorts who manage doctor’s insurance coverage units, and the legions of people managing the insurance industry itself, that cutting back on that huge national cost was an obvious first target for cost-saving.  Extending the competition into the post-65′s would increase our secretarial costs.  Obama was talking about retraining those folks into nurse practitioners, which we surely badly need, especially if more people have actual health insurance.

  • http://gregorycamp.wordpress.com/ Greg Camp

     People who have low income or an illness will get more money?  How is that any different from the present–except that higher income people will now get a subsidy?

  • http://gregorycamp.wordpress.com/ Greg Camp

    Our current system is distorted by focusing on the sick and the elderly.  A public option that’s open to everyone makes more sense.

  • Jimprobo

    The  Romney Ryan plan will bankrupt a lot of seniors.  The inflation factors for increase vouchers does not reflect the reality of the Medical CPI increases over the past 30 years.
    The Medical CPI has increased by 200.1% over this period as opposed to the regular CPI of 33.1%.  With that in mind the real cost to seniors under the Romney plan will make insurance unaffordable for most seniors!

  • bpersoon

    It has been mentioned that the competition will drive down the insurance costs. Insurance companies are not going to compete for older people; they want young, healthy people. It is the same argument against school vouchers. The private schools take the smart, well-behaved students and the public schools would be left with what no one else wants. They would then castigate the public schools for not doing as well on standardized tests as the private and home-schooled students.

  • listener10

    A critical issue that isn’t discussed is how difficult it is to sort through the various plans available/will be available in the market.  I’m currently one of three adult children managing the care of an elderly parent (86 years old) and she, as many seniors, no longer has the mental acuity to evaluate a complicated insurance policy nor has she the ability to evaluate the variety of care options available vis a vis the cost.  Why is that issue not even part of the conversation.  Having a national marketplace will further complicate this issue.

  • http://www.facebook.com/kerryhecker Kerry Hecker

    The rising health care costs, increasing enrollment because of the baby boom generation, and the decreasing ratio of workers to enrollees will hit my generation, the citizens aged 25 and under. We will be the tax payers, the ones hit with increased taxes to offset this growing divide. I am wary because on the whole, nobody around my age is debating, discussing, or even knows much about Medicare. WE are letting decisions be made for us and yet we will be the ones who must pay for this older generation, if nothing is done about it. The older generation are the ones who are overwhelmingly voting in elections and thus are targeted directly by politicians in elections. How do we bring awareness to the younger generation and bring their ideas and views to the debate? WE as a generation need to find a voice, and to find a way to come out to the voting polls to ensure that we are not screwed over in the future.

    • commonsense197

      Remember the older generation paid for the generation before it.  We don’t want to see our children and grandchildren robbed of Medicare and Social Security by a wealthy group of legislators who don’t need these supportive programs.  These programs have been successful in keeping older folks out of poverty which existed tragically before their inception. 

      It may seem like you are paying into something for someone else but remember, your time will come and if we keep these programs strong and healthy, you will be supported by the generation that comes after you.  If we don’t, and we let wealthy legislators destroy these social support networks, than you will be truly on your own.  If you put all your money into the stock market and it crashes as it has so often, you will have no safety net. That money is gone.  Social Security and Medicare will be there for you if you fight to save it and it won’t be affected by the stock market.

    • Mike_Card

      Your point is?

  • InActionMan

     You stop calling the President a Marxist and I’ll stop.

  • Ellen Dibble

    One more issue, with people living a lot longer, those people find that they need to work, and they have to be able to be maximally functional.  The cost-cutting into catching them if they land with a stroke or heart attack but leave them on their own for teeth, so they can eat real food, or hearing aids, or — on and on.  I wish the government could focus on the fact older people have lots of experience and skills, and in many ways should be the leaders in their fields, and if only the rich can keep themselves maximally healthy, then where is our concept of never writing people off, always allowing for being able to contribute your best?

  • Mike_Card

    This whole idea of tossing health care into a free market, competitive model is just nuts and always has been.  It is like leaving fire-fighting and traffic law enforcement to the forces of competition.

    • http://www.facebook.com/drpmeade Paul S Meade

       Point well taken. Privatize the police and firefighters. Back in the late 19th-early 20th century if you did not pay your fire fees, they would let your home or business burn to the ground.

      • JGC

        There was a case of that happening just a few years ago, right?  In a red state, I think. The person had neglected to pay the annual $50 ($50?) fee to the town fire service, and they let his home burn.

        • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

          Tennessee is home to at least one of these incidents in the last few years.

        • Don_B1

          He arrived and watched as the firefighters also watched; the firefighters refused to accept his payment, which he claimed he had inadvertently failed to pay.

          But there were cases back in the 19th century where neighbor’s houses burned down because the fire in an uninsured neighboring house was too hot to prevent its spreading.

    • TinaWrites

      I didn’t get to hear much of it,but on the Take Away show today a guest was discussing the free market Versus the free market society we’ve become. Try to find the podcast!!

  • http://www.facebook.com/drpmeade Paul S Meade

    As a physician on the front line, I have investigated the impact of “Obamacare”. It certainly could have been better. Despite the opposition to single payor plans, which would disenfranchise the executive class in the insurance industry.

    The main problem is in management of medical care. Too many tests, a lack of clinical competence on the part of physicians due to lack of basic education in Medical Schools. Younger physicians rely on various tests versus basic clinical skills. The older physicians who knew how to diagnose an illness before ordering the testing are fast fading.

    Treating by the numbers and by imaging results rule now.

    Sometimes I think a well trained nurse practitioner who knows how to take a history, do a complete physical exam and enter the results into a computer program that can generate a diagnostic and treatment plan will replace all physicians soon.

    • http://freeourfreemarkets.org/ Steve Banicki

      Good Comment. 
      Although unsaid, and not proven, the Ryan plan anticipates that the cost of health care will be less under his voucher plan because the patient will have skin in the game and use his vouchers more wisely.

      The flaw under the voucher system is each individual will need to buy the best insurance he can with the voucher and then we are back in the same boat. What the health industry charges for its services and how often the services are used are back in the hands of the providers, with the cost covered by the insurance companies.

      The cost of insurance will then rise faster than the value of the voucher and health will decline.

      The Declaration of Independence says “… that among these are Life, Liberty and the pursuit of Happiness. The question is are wealthier Americans deserving of a healthier, longer life than the less wealthy? If we are a nation believing in basic Judeo/Christian values the answer is no.

    • Joseph_Wisconsin

       Paul S Meade it is always nice to hear the perspective of a physician on the “front lines” so to speak.  Countries in Western Europe that provide single payer [government funded] healthcare do provide healthcare at lower costs while actually producing superior healthcare results.  While part of the reason that those countries are able to do this is the elimination of the overhead of for profit insurance companies, there are other factors.

      The costs for prescriptions medicines are just lower there.  The ratio of income for physicians to the median income of all workers is lower.  And of course providing health care is funded through higher and more progressive taxation.  I wonder what your position is on those aspects?

      I am definitely on the side of a single payer system in the US.  Currently the system here is just failing.  The number of people below the age of Medicare eligibility unable to afford healthcare just keeps increasing.  So called Obamacare does something to address that, but the Ryan Budget proposals will just make this problem worse.  With Ryan’s voucher plan seniors who can currently count on Medicare will start joining the ranks of those without care.

  • MrNutso
  • Ellen Dibble

    Why not offer traditional medicare to all, since we never turn anyone away from the ER anyway?  And then offer gap plans for choice.  And as time goes by, we find out what works better in the program for all, which basic taxes, it seems to me, most fairly could cover.

    • TinaWrites

      Yes!

  • irwin birnbaum

    Any discussion of cuts in Medicaid, must understand the effect of proposed Medicaid cuts upon the elderly.  The vast majority of Medicaid payments are currently paid to the Elderly for the long term care that they  receive and need. 

  • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

    I don’t know how long our host was to let caller Tim go on, but all I needed to hear was “I could invest my Social Security funds better myself.”

    Every time a worker who’s been unemployed pulls up that nugget of dross, a devil gets its horns.

    Any investment house will tell you “Don’t invest anything you’re uncomfortable losing”. Tom, you can deploy that fact without being too partisan.

    • BHA_in_Vermont

       I believe you men UNcomfortable.

      • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

        Yep; now fixed. This edit thingy has its plusses.

    • http://plonque.com/waterboarding Claude Balloune

       Yep, no doubt idiot “Tim” would have put all his money in GM stock, or Lehmann Bros, or (shudder) even Enron!
      And yep. He woulda been a rich retired man today!

      • Mike_Card

        These sh1t-for-brains callers provide the entertainment quotient.  He probably owns raw land in Nevada that he’s counting on developing in his dotage.

    • TinaWrites

      Apparently that’s even more of a pipe dream with the new algorithms speeding up the trading process.

  • DrewInGeorgia

    Wrong place Disqus.

  • Jeff Perk

    The hypocrisy in the GOP’s healthcare proposals is breathtaking. If they were genuinely interest in reigning in out-of-control healthcare costs, why do they fight to prohibit Medicare/Medicaid from being able to negotiate prices with the pharmaceutical industry?

    • TinaWrites

      Thank you for this point!! And are the insurance companies that now partner with Medicare for the supplemental plans: are they required to be non-profit branches of these corps.??

  • MrNutso

    I’ve been waiting to here about fraud.

    • Don_B1

      Just since the signing of the PPACA (Obamacare) fraud investigators have convicted people of over $10 billion in fraud. And it takes a bit of time to work out these cases, so expect a lot more in the near future.

      Then maybe the case load will drop as people no longer think the area easy pickings and go try finding some other suckers. A few may even go straight; it that what Governor Scott (FL) did? Or is he still weaving his web but now from the governor’s office? Some of the things he has done, from requiring drug testing of welfare recipients has shown that that group is LESS likely to be taking illegal drugs, as their low income might suggest.

  • Michiganjf

    Yes, genius caller, we did “all plan to get old!!!!”

    That’s why we pay into SS AND medicare/medicaid…. EVERY SINGLE PAYCHECK!!!!!!

    • Mike_Card

      Among other things, he needs to get an understanding of “broke.”  We are not insolvent, illiquid, nor do our liabilities exceed our assets.  We might face a less favorable-looking future than in times past, but we are NOT “dead broke,” and allowing nincompoops like this to pollute the public airways with their uneducated drivel adds nothing.  Where are the screeners?

      • Don_B1

        Probably thinking that the public needs to know that such people exist. Otherwise they will complain in other forums that NPR is “biased.”

  • superfinehelios

    I somewhat agree with the caller. Everyone should prepare financially for future medical costs. And most of us do. Medicare is for those that were not able to and it might help a little. I hope that most working now will look at it as a nice to have but not as something to really depend on. But for those that will have to rely on it (it won’t be much anyway you look at it) it’s at least something. Improve it (gut it) don’t cut it.

    • jefe68

      Plan ahead for what?
      Cancer? A serious car accident? Getting hit by a bus?
      Where do people get this stuff from?
      Are you aware how much it cost to even set a broken leg?

      We are one of the wealthiest nations on the planet and we have one of the worst market based health systems in the world.

      By the way preparing financially for future medical cost is what the idea of health insurance is about.

    • TinaWrites

      Prudential said each couple needs $230,000 for medical expenses between ages 65 and 85. With un- and under-employment and a service economy how are people supposed to save that??!! Plus just ONE of my meds alone — just one! — will cost me my half of the 230k. Young people will still be paying off college loans for a long time, not saving. Baby boomers are experiencing or just finished the expenses of their sandwich cohort years!!! These wealthy and powerful pols have no clue and they spend money on wars!!

      • Don_B1

        Just think about these numbers:

        The Employee Benefit Research Institute regularly publishes the average retirement savings of different age groups. Recent findings look like this:Workers under age 35 barely have $6,000 in savings.Those between the ages of 35 and 44 have roughly $22,500.Workers ages 45-54 have saved just under $44,000.Baby boomers, those aged 55-64, have approximately $65,000 in savings.Those 65 and over have saved $56,000.

        What might be nice would be if the numbers for median retirement savings were available as then you could say that half of all people in those age groups had less and half had more. What is hard to know is how much those numbers are increased by a small number of people with much larger savings.

        The numbers that show the need for insurance is that the costs of medical care are distributed in such a way that 20% of the people (unfortunately you appear to have drawn an unlucky number) incur 80% of the costs. But with the obesity epidemic underway, those numbers could change such that a larger percentage of the people will have real expensive health problems.

        And for those in the unlucky 20%, even the $230,000 might not be enough. Was that $230,000 just the cost to buy insurance or for direct medical payments (on average)?

        NO ONE, except members of the 1% (maybe 2%) can afford to pay for their care when they draw an unlucky number, but too many of them seem to have lost any compassion for what the rest of the world faces.

        • TinaWrites

          I believe that the $230K was for ALL medical expenses (premiums; copays; that horrid Beast — the deductible —  and the cost of covering what wasn’t covered by insurance, etc.).  I do remember that it was for a couple, and for the years ages 65-85 for women, and ages 65-83 for men.

          (btw, with the change that OnPoint made about how we post comments, the method I chose allows me to see your comment to me, but it does NOT link me to my own comment, and I have no idea where my own comment is on all the many pages of postings.  Therefore, I may be a little repetitive here.  I wonder if the WebMaster might be able to work with Disqus on this?!)  Of course, there are additional non-medical expenses that come with medical conditions (be they the expenses of the patient or of the caring family members), like paying someone to drive you to appointments if your town has no RIDE program, or RIDE takes too long, especially if you have additional appointments to go to; like air fare to go visit or air fare to go visit while also assessing whether the patient’s living conditions are still adequate given their deteriorating situation; like the cost of prepared foods because the patient has no stamina to shop or cook; like the cost of paying someone to mow the lawn because the ill person can no longer do it themselves.  Family, friends, community?  Can they fill all these extra needs over a long, or possibly indeterminate, period of time?  What problems of their own do they have; are they already helping others? Do they even care to help?  Maybe huge amounts of money would be lost if the patient’s house were put on the market in today’s economy, but maybe the recooperation period will be both awkwardly long and awkwardly short:  eight months, say (long enough to cost a lot in services; too short to make selling the house really necessary or even wise).  Once, when I had an employment crisis AND my family had simultaneous medical crises, I had to figure out how to travel 1500 miles to visit them in two entirely different hospitals in the same city (a car city, not a public transportation city).  The stickiest part of all was hoping that my credit card had enough credit available to let me rent a car once I got there so that I COULD travel between the two hospitals!  I’m not sure if the Prudential $230K accounted for related expenses like these, but I can attest to how essential it was for me to have the ability to at least CHARGE some of these costs (interest rates were higher then, too)!  I was very fortunate that my own cancer expenses at that point had been covered by excellent health insurance; and I was filled with stamina and love for my family, so engaging with what had to be done wasn’t a chore.  But I DID have major money worries:  could I pull this off, or would the air fare and, especially, the rent-a-car expenses pull me into a ditch?!I guess if you’re always looking at financial spread sheets, you may not ever get around to reading good novels about the human condition, or listening to your neighbors’ stories, and so you may have no way of imagining what might happen, what might go wrong, or what might add to a family’s initial problem.  I fear that Paul Ryan’s ability to imagine anything other than his own success story and an Ayn Rand world is sorely taxed, to the detriment of the rest of the citizenry.    

  • http://gregorycamp.wordpress.com/ Greg Camp

    Caller, what about people with pre-existing conditions since childhood?  What about diseases that aren’t reasonably expected?  Personal responsibility is a good idea in areas where we are able to be responsible, but health has much about it that’s due to chance and fate, not choice.

  • TribalGuitars

    We, as a country, obviously need to fix the social safety net prgrams, but wouldn’t we be better off going after some low hanging fruit while working on the larger issues?

     Do people worth millions of dollars  need to be collecting it, as Ayn Rand did Darryl Isa (R-CA) says he should be off the roles as he can afford insurance, healthcare, and certainly doesn’t need Soc Sec to pay for food, heat, housing, and life’s essentials.   
     
      Even a national week out with some volunteers , perhaps from AARP, could canvas areas for health care businesses that are no more than closets in a strip mall would save billions.  Studies show that there’s a $10 return on every $1 spent on fraud investigation.  A group of citizens going from place to place on their list is free, and if they find a place that’s suspicious they check it off and it can get investigated ASAP, vs having a small one or two investigators checking addresses on a list that was kicked out as being suspicious. 

    • TinaWrites

      Speaking of fraud. I wish I could remember what I heard about the Ryan plan on ms nbc last night. It had to do with the fact that our fed senators and congressmen would continue to get fabulous health coverage while everyone else would wind up with costlier plans covering less. Can anyone remind me what I heard. It was so appalling I thought I’d never forget, but it was late at night. Thanks!

  • http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

    Here’s one thing not being discussed that would save Medicare – means tested Medicare. Let people spend down their assets paying for their own care until they hit a minimum, and then  they are covered.

    Of course, the rich want the government paying for their healthcare instead of spending their own money, so it will never happen. Even if the floor was $100K in assets – or even $500K.

  • TinaWrites

    Someone here recently quoted a television host’s question to his guest.  “Don’t you think that seniors would PREFER SECURITY OVER CHOICE?”

    I know that I prefer security over choice.  As I’ve said here before, when my medications are fed into the Medicare computer by the Medicare SHIP personnel, the difference in cost PER YEAR for my medications from one corporate “partner” to another is only $43!!!!  We would change a system for THAT???

    Also, when you are ill, you often don’t have time or energy to be making choices.  You hope your doctor will steer you in the right direction, and that, if need be, a case manager will help get you TRY to get any Pre-Authorizations that are needed for scans, medication amounts in excess of the norm, etc.  Rather than “choice” between corporate schemes, I’d prefer to make the pre-authorization process less harrowing, especially when it comes to medications.

  • Thinkin5

    President Obama was right to make health care reform a priority issue. It’s making America poorer.

    • Mike_Card

      I gather you’re saying health care is making America poorer, not that reform is/would make America poorer?

      • Thinkin5

         Yes, I didn’t make that entirely clear. The health care system the way it is, without reform, is making America poorer.

  • BHA_in_Vermont

    Yeah, Kevin has it right. It is all about personal responsibility.
    - My wife should have PLANNED ahead and KNOWN she would get Rheumatoid Arthritis at the age of 38.
    - My 19 Y/O daughter should have PLANNED ahead and KNOWN she would get a sudden onset PERMANENT 24x7x365 headache (pain level 8) for which no doctor can help and migraines every week (if not multiple times a week) that shut her down for 3 days starting at the age of 14. She can’t work and she can’t go to college. She has no life. The only reason she has insurance is BECAUSE OF THE “AFFORDABLE HEALTH CARE ACT” that allows her to stay on my employer provided plan. Yeah she should have been “personally responsible”.

    BITE ME!

    My family is really good at the “personal responsibility” thing. Sh1t happens.

    • jimino

      Maybe Kevin will see your comment and tell us how he would deal with your situation.  Are you out there Kevin? Or maybe anyone else who agrees with him will address your concerns.

      • Don_B1

        I don’t think BHA should be holding his breath waiting. Unfortunately there are a lot of people out there like Kevin who have no conception of how those things happen. They consider that they “have done things right” so they are healthy when it really is more like the luck of good genes and a good environment, etc.

        The way we are putting chemicals in the environment today (and for the last 50+ years) it is a wonder that more have not shown susceptibility to chronic health problems.

    • TinaWrites

      BHA. For your daughter: make SURE there is NO Aspartame in her diet!! It may take 10-14 days to get it out of her system if she is consuming it. Find out the synonyms and check every single food label. This happened to me for 2 3/4 years. Stay off any for the length of time I mentioned. No docs diagnosed my affliction either. Good luck!! Hope this helps!!

    • LinRP

      Man, I wish I was a Republican. Shit like that never touches them. They never have an unforeseen illness, and if they do, there’s plenty of insurance and extra cash to take of it all. What a blessed group they are. The answers are all so easy, there is never a problem with providing, and every issue is black and white. I mean, if you just believe in the Christian God blindly enough, all such ills pass you by.

      Tongue planted firmly in cheek. I am sorry for those very real troubles. The unjustness and unfairness and inanity of it all just all makes me so spitting mad.

  • Bill_Hob

    Refer to these sites to see the poor performance of America’s healthcare system in relation to other developed countries. 

    https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

    https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

    http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita

    http://www.who.int/gho/publications/world_health_statistics/2012/en/index.html

    http://www.oecd.org/statistics/

    Let us admit that America should have universal healthcare, since the rich think our system is the best in the world needs test all of us and if your gross income is above 300,000 dollars you buy your own health insurance.

  • Ellen Dibble

    Wilensky is talking about incentive to bring cost down.  I don’t look at that with my selection of insurer.  Actually, I don’t look at that in choice of hospital or doctor.  Where I live there is one hospital near, and not that many doctors near either.  They had better be offering good value.  That’s all I can say.  They’d better.

  • Matthew Tessier

    Health insurance is not like car insurance.  Anticipating future needs in a private healthcare market means you need to know what to expect.  Medicare has a more comprehensive approach to coverage whereas the private market can control costs by limiting coverage in costly areas.  A better idea would be to integrate personal responsibility into medicare.  For instance, smoking will increase long-term health costs.  Most of the taxes (above and beyond normal sales taxes) on goods like cigarettes or alcohol should directly go to funding the future costs of treatment for these individuals in Medicare.  This will have the effect of penalizing people for personal choices which cost more in long-term health-care costs while funding those costs.  It will also dis-incentivize those activities. 

  • http://profile.yahoo.com/GYOKNNUKGSRTSA4RNFMUJRO5WE Greg

    Yeah, shop for your care seniors.

     But make sure you don’t make a mistake because you only get one or two visits before your Ryan “premium” care voucher is used up.

  • Thinkin5

    I saw my parents’ savings dwindle each year as they paid for their $2,000 deductible each year. They always finished paying the deductible in Dec. and then it started all over again. This was back in the 1980′s.  We need a better system. There was never much of a price difference with private insurance. Also, very hard to compare the “apples and oranges” items against each other.

  • Roger Kerr

    You’re starting to get at the core problem itself:  the cost, and relatively low effectiveness, of our current disease management system.  It needs to be replaced with a health care system.

  • commonsense197

    The reason Paul Ryan wants to shift Medicare to seniors’ personal responsibility is because he is in the hip pocket of the insurance companies that have been lobbying against Obamacare from the start.  The want to go back to the days when they can raise rates, deny coverage at will and refuse to pay for claims after people have paid in for years. 

    My neighbor died.  After paying into insurance for 50 years, the insurance company told her husband they didn’t want to pay for the bills.  He went to the state insurance agency and they made the insurance company pay.  Bottom line: insurance companies want your money but they want to use it as they see fit: CEO salaries, investing your money for their gain, etc.

    Ryan is the insurance company’s friend.  Obamacare is the friend of the patient.  And when insurance companies don’t spend at least 80% of your premium on your health care, they have to pay you back.  Insurance companies don’t like that but it is right and just.

    Thanks to Obamacare we are on the right track.  I support Medicare as it is.  To say that going out on your own to look for insurance is better for you is absurd.  It is the huge group insurance that Medicare is that lowers the cost. That’s why you get a better deal from group insurance at work.

    • Mike_Card

      Totally agree.  Too often, people forget that insurance companies’ business is collecting and investing premiums.  Too often, people are taken in by the glossy advertising that suggests insurance companies are in the business of paying claims.

      • DrewInGeorgia

        Or actually caring about or for their insured. They care about something alright, it doesn’t stem from any sense of compassion or concern though.

  • RRHG

    Re:  Medicare/private insurance  I am a healthy 71 year old female with Medicare as my sole health insurance.  In 2002 I had major medical health insurance with Mutual of Omaha, paying $700 mo. w/high deductible.  I was also paying for a separate policy w/an even higher premium because the insured person had preexisting COPD. Mutual Of Omaha cancelled this type of insurance across the country.  My friend was devastated since he was in line for a lung transplant.  Fortunately, SC had a minor policy available for citizens who were unable to obtain private insurance; a premium of $1000/mo.was a monthly savings of $200(lower than M of Omaha). My friend lost his place in line for the transplant as a result and the medical facility began asking how the transplant would be paid/fundraising etc.

    The amount withheld from my Social Security payments is a modest amount compared to private insurance.  I would be willing to pay more for Medicare.  I have been without private health insurance since the above mentioned cancellation.  I did try a HealthSavingsPlan as Pres.Bush suggested but the bank took the majority of the money in my account as monthly fees; I had no health expenses so I cancelled that idea.  

  • Ellen Dibble

    I am thinking that a voucher would be really good for me, though this a hypothetical me since I’m 65.  I needed all my life to get a big load of heavy metals out of my system.  Modern medicine doesn’t “work” on a body constituted like mine, and the cost, over I’m not sure how many years, but several, starting with switching all my fillings from mercury amalgam to something else, has been a lot, a couple hundred dollars a week for  EDTA/DMPS chelation, which apparently is no longer profitable since the patent escaped in the 1950s.  And I am getting well, but each week, about four days I end up with unpredictable kinds of exacerbations as my body adjusts to new realities.  I had to wait for  Medicare to undertake this, because I didn’t want to forgo my private insurance as a self-employed individual.   And insurers don’t even cover the testing to diagnose heavy metals burden.  None.  Not Medicare, not others.  You bite the bullet.  In my case, you plan for a decade, financially, in terms of a few years of health procedures.  And I’m thinking that a voucher for $15,000 could cover that.  I mean, good luck finding a doctor who’d help you; but the same treatment is used for heart problems, preventing strokes, preventing Alzheimer’s.  That’s what it was used for originally, not people like me who’ve absorbed the modern environment.  It seems like a no-brainer.  But a voucher would be fine with me.  I would use it for care.  But it would have been a whole lot better to have that option when I was, say 10 years old, or 25…

    • Gregg Smith

      Your comments are always interesting. Despite the alternative nature (rightly or wrongly deemed) of your chosen treatment, you were able to take control of your body, make a plan, work within the system and get it done. It should be a lot easier. The voucher helps give the patient more options to personally craft a network and process that works for them. I’m glad you are getting better.

      • jefe68

        Where do you get this nonsense from? The voucher does none of that. Take control of your body? Make a plan? Craft a network? Tell me how is this going to be done when it can’t be done now? You left out that health insurance has list of approved physicians and hospitals and you can’t go out of the network unless you want to pay for it. 

        • Gregg Smith

          Ms. Dibble beat the odds and is doing it. I don’t want to speak for her, maybe I got it wrong. Did you read her comment?

          • Mike_Card

            You’re exposing your fairness side, and I applaud you for that.

          • jefe68

            I was speaking the bogus issue of vouchers. Which wont work and will never work. This is not school lunch, it’s health care.

  • mumtothree

    The Ryan plan will lead to the necessary RATIONING of health care much faster than the ACA.  No one wants to talk about the FACT that we live much too long, and that the bulk of our lifetime expenditures are made just prior to the end of life, sometimes only marginally delaying the inevitable.  When seniors discover that the only plan they could afford to purchase with their vouchers WON’T COVER these expensive end-of-life interventions, they will be forced to forego them.  If only the Ryan plan could kick in sooner, we could REALLY reduce our collective spending on health care.  This problem is going to get worse before it gets better.

    • http://profile.yahoo.com/P63Y63SNNFSUBMKBJMFMUATJKE sam

      DEATH PANLES!!

  • http://profile.yahoo.com/LEKRSBEFNB6WQTPRC6PPNPZJHI Al

    Medicare and SS are not welfare;you pay for them every paycheck.After paying for them for 30+ years Ryan wants to tell us there’s nothing for us.
    Do we get our Money back? 

    • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

      The dogwhistles abound. Ryan wants white non-rich folks (like me, no idea if that’s you) to be ashamed of “relying” on “welfare” like “you know who” kind of people.

    • hennorama

      Payroll taxes actually pay only about 1/3 of total Medicare expenses.  Premiums from enrollees pay about 1/7 of the costs.  The government pays the rest (about 53%)  from general revenues and borrowing.

      There are 4 parts to Medicare.  Part A covers hospitalization,  There is generally no premium for Part A as it is paid for through payroll taxes.  This is the ONLY Part paid for by payroll taxes.

      Parts B and D (doctors and prescription drugs) don’t get payroll revenues; instead, they are covered by premiums and general revenues. That distinction often gets lost in the discussion of Medicare finances.

      Part B covers necessary medical care, and has a premium, which is “means-tested,” paid by enrollees.  About 95% of Medicare Part B enrollees pay about $100/month, usually deducted from Social Security benefits.  The remaining costs are paid by Medicare.

      Part D covers prescription drugs, provide by approved private insurers.  Costs are paid partly by enrollees through premiums, deductibles and coverage gaps, with the rest paid by Medicare.  Plans and premiums vary widely.

      Part C (Medicare Advantage) plans are private insurance plans paid for by Medicare and premiums from enrollees.  They provide both Part A and Part B coverage, and some provide additional coverage for dental, hearing and vision, with most also providing Part D coverage.  Plans and premiums vary widely.

      By the way, Paul Ryan’s plan most closely resembles Part C.

  • Duras

    You know how republicans say, “Where’s Obama’s plan for Medicare?”  And then they turn around and say Obama’s plan is to cut 700B and set up a bureaucracy.  Yeah, the so-called “bureaucracy” is a screening system so a proctologist doesn’t examing a patient with two weeks to live and dying of brain cancer.

    There is massive fraud all over Medicare and that’s what the cuts target. The republicans propose to not touch any of the fraud (because it is on the supply side) and cut consumer side medicare.  Why do the republicans fight for money to be in politics and to keep fraud in place?

  • http://plonque.com/waterboarding Claude Balloune

    LOL.  I’m in Canada, where we do not have discussions like this. Probably because we do not need to.
    Any Canadian listening to this discussion, listens to it with amazement: “What is wrong with these people? WHAT is their problem?”
    Indeed if NPR could be picked up in Europe (Wait, I suppose it can, through the Internet) they also would be puzzled about all this “gnashing of teeth” over health care in the USA.
    Listen: a few weeks ago, it was announced that Canadians, now for the first time in history, had a higher standard of living than Americans.
    It was not in the Canadian Media’s interest to point out that Canada did not “jump over” the US, but actually it was the US that fell further behind, now approaching that of a third-world nation, albeit one with 14, 15 or so nuclear-powered aircraft carriers.
    Oh, the Canadian standard of living is also falling, but not as fast as that of the US.
    No doubt some short-sighted patriot will reply here “Well, once our dynamic duo of Romney and ‘Ayn’ Ryan chase that Muslim socialist out of the White House in November, and send him back to Kenya where he was born, then things will get better, the way they were under GWB (bless his soul)”.
    Sorry-  the US standard of living did not start falling 3 years ago. It’s been going on for 30+ years, ever since Reaganomics took over.  And all the Ayn Rands in the world will not put Humpty-Dumpty back together again.

    As I said, I just watch and listen to this claptrap with astonishment. To paraphrase that line about New York City, the USA is a nice place to visit, but I sure wouldn’t want to live there!

    • Mike_Card

      I’ll say it before someone beats me to it:  American exceptionalism.

      • jefe68

        I would think that exceptionally shortsighted is more like it.

        • Mike_Card

          Just a bit of sarcasm.  The right wingnuts insist that whatever they want is best–especially denigrating anything that might have European roots–because we’re “special” and we Americans have special rules.

    • Duras

      Better get Harper out before you guys have low taxes on the top and would rather destroy healthcare before raising one penny on the Creators of Jobs.

      • http://plonque.com/waterboarding Claude Balloune

         Hey, listen- Harper may be a Conservative, but by American standards, he’s a socialist, perhaps even a frothing-at-the mouth commie.
         Periodically he does make utterances about how the Canadian Medicare system “needs to be fixed” (I think it’s just pandering to the right-wing), but then usually comes to his senses and moves on to other more pressing issues.
        An aside- I live in Quebec which has (and most if not all Americans do not realize this) a SEPARATE-BUT-EQUAL (familiar with this phrase?) Medicare system, and it is supposedly better than that of the rest of Canada.
         And if you’re lucky, you might even get service in English. (grumble-grumble)

        • Duras

          I am a little suspicious of him because of the tuition hikes and new oil production.  (Not that oil production is always bad.)  Even Reagan would be stoned to death by today’s republican party, and we have proof because Obama quoted him verbatim without mentioning his name.  The speech was about taxing capital gains at the same rate as labor, and you can guess what happened. 

          Supply side economics has its moments, but you gotta make sure he’s like Andrea Merkel and Eisenhower type of conservative instead of the one that would tick off a robust brand of individualism.   

    • Joseph_Wisconsin

       Yes Claude Balloune, I can say only in America.   Of all countries of similar economic and social development—Canada, Australia, almost all of Western Europe—only in America would the Romney/Ryan plans for Medicare, and my extension  of Ryan’s budget all medical care in the US, be something that would be up for consideration.  

      If the Republicans were truly interested in lowering the costs for medical care in the US they would be clamoring for a government funded universal health care system of some sort as exists in those countries.  This would not only lead to far lower per capita costs and far lower total healthcare spending,  but better health care outcomes as well.

      The Republican aim though is not to lower the cost for a person to obtain health care, it is just to lower the total sum of money spent by the government providing health care.  It does nothing to reduce the cost for any individual to actually obtain healthcare.  It is all with the sole aim of reducing taxes, with a obscene concentration on lowering taxes on the small fraction at the top economically, to levels even lower than the already historically post WWII levels.  So the Ryan budget holds out no hope for the 50 million Americans under 65 years old, including children and adults employed at low wage jobs with no benefits,  who are  currently without health insurance. In fact will immediately increase the number of those uninsured by drastic cuts to Medicaid.  Not content with that Ryan’s voucher plan will start adding seniors currently provided healthcare through Medicare to the ranks of those without healthcare.

      This is where the Republicans are in ideology now.  It can be summed up by the response given by the audience at a Republican primary debate when the question was proposed to Paul Ryan’s fellow Ayn Rand acolyte Ron Paul as to whether a person who was without health insurance who arrived at an emergency room should be allowed to die was to a resounding “Yes.”  It is Social Darwinism with a veil less substantial than a cobweb. 

      • William

         Why is the solution always government? What does government do well? Medicare is broke. Medicaid is making most states broke. Between the two programs they lose close to 80 billion a year in fraud. What is so great about that? Close to 100 million Americans now receive some sort of check from the government and yet we still don’t have a big enough safety net? Do the riots in France and UK indicate that their safety nets are too big or too small?

        • Mike_Card

          One of the main reasons is to make ignorant people like you to shut up when you don’t know what you’re blathering about.

    • JGC

      I am a dual Canadian/American citizen (also living in Quebec).  There is an article in the July 30-August 6  Bloomberg Businessweek, called “The League of Extraordinarily Rich Gentlemen”, with a profile of Chamath Palihapitiya, a Sri Lankan immigrant to Canada who moved to the U.S. and one of Facebook’s centimillionaires:

      “While high-octane capitalism made him wealthy, he never would have gotten there without the low-octane Canadian welfare state – his family got public assistance checks, the provincial government funded the summer internship that was his first job, and his father’s considerable medical care was almost free. ‘If we were in the United States we’d have been bankrupt,’ he says. ‘Canada would never have given me the opportunity that America gave me, but America could not have given me the social safety net when I was growing up.’ “

      • William

         Is receiving welfare checks something to be proud of or shame?

        • JGC

          Sorry, William, I did not give you enough information to make your full considered opinion.  I think  Mr. Palihapitiya was not exulting in how his family gamed the system through welfare freebies; I think it was more in the line of “there but for the grace of Ganesh go I”.  His family came to Canada through a diplomatic posting to Ottawa; when it was time to go back to Sri Lanka, his father applied for refugee status due to the Tamil Tiger threat to public figures.  It is similar, I suppose, to the urgency faced by any family escaping from a murderous or repressive regime:  it takes a few days and a few dollars to get back on your feet, and before you know it, you are a contributing citizen, paying your fair share of 12.689% taxes on your earned income. 

          Read the full article (crammed with interesting libertarian and progressive ideas) at

          http://businessweek.com/articles/2012-07-26/social-plus-capital-the-league-of-extraordinarily-rich-gentlemen

          • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

            William’s on his way to asking everybody lined up at the unemployment office if they “deserve what the government is giving them”.

        • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

          When rich people get stuff from the gov’t they’re not ashamed. And nobody asks them about their fee-fees.

          Working class people just have to act like they’re rich!

  • cryptomorph

    If competition was the great panacea the Right claims, it would have reduced medical costs already. As with the pharmaceutical sector that spends more on advertising, profits, high CEO pay, than on actual R&D… we’ve allowed the private sector to suck up money that should be going to provide actual health care. The cure for this obscenely wasteful competitive overhead isn’t more competition… it’s getting the parasites out of the health care system with SINGLE PAYER.

    • WorriedfortheCountry

       Elective health care (eg, cosmetic surgery, lasic, etc.) has seen dramatic reduction in costs precisely because of profit and competition working hand in hand.

      It is harder to apply this to some areas of health care but it works in some areas.

      I can give you a specific example.  I reached the age where colonoscopy screening was recommended.  My Dr. gave me a list of a half dozen providers who he claimed where all good.  I picked one but not based on cost.  In fact, I didn’t know the cost until I received the summary from my insurance company a few months later.

      • cryptomorph

        Determining the effectiveness of competition can be difficult because we tend to be blinded by retail competition where, say with electronics, prices may be falling. Of course, there’s a place for competition in the design phase of products. But when too many companies make the same product the overall efficiency of that economic sector decreases. We are just blind to it because the market doesn’t tally those extra costs.

         
        For example, how much less expensive from design to production to maintenance would the world’s car fleet be if, say, we just had 8-10 standardized car chassis/drive trains combinations? Let companies compete on interiors and body styling. Of course such a suggestion is outside the realm of permissible thought to a market fanatic… but quasi-religious beliefs do not negate basic economic laws like economies of scale. And it’s that belief system that’s blind to the inherent inefficiencies of competitive economics… in manufacturing AND health care. Only in the latter case, the inefficiencies are inherent in administering countless pools of health care cash, different billing procedures, bureaucrats involved in approving/denying payments… plus advertising, high CEO pay, profit for shareholders etc. NONE of that money spent on the above actually goes to providing health care.

         
        Competition can only go so far in reducing costs because there is inherent waste in a competitive system that won’t go away unless we go Single Payer.    
         
         
        ulTRAX

  • http://freeourfreemarkets.org/ Steve Banicki

    “Authored by Rep. Paul Ryan, proposal combines cuts to safety net programs with sharply lower tax rates in a manifesto painting clear differences with President Obama.” GOP budget plan cuts deeply into domestic programs, reshapes Medicare, Medicaid, , Washington Post, March 20, 2012 

    Paul Ryan is naive or he thinks the American people are naive. Either way, his proposal shows everyone how disharmonious the Republican Party is with the citizens of this country. The Republicans drank too much tea. 

    Mr. Ryan is right to want to find a solution to our debt problems sooner than later. I further agree that we must find savings in entitlement programs. However, it is not reasonable or fair not to raise taxes on the wealthy and correct the problems with our economic system that is broken. Our Free Markets are not working and it is the super wealthy that have benefited the most from the free markets destruction. 

    The modern day politician, Democrats and Republicans alike, do not understand the meaning of a free market. A free market to them is simply a market that is free of all government regulation. To them it is not relevant if only a few corporations control an industry. It is ok that four major companies including ATT, Verizon, T-Mobil and Sprint control the mobile phone industry. It is ok that ESPN owns ABC and ABC owns Disney. Our politicians see nothing wrong with Comcast buying NBC. The above are examples of industries and markets controlled by a small number of companies that have the ability to set prices and control wages. 

    Our leaders ignore the fact that the creation of capitalism was to meet the needs of society. Society does not exist to meet the needs of capitalism. Government’s role in free markets is to guarantee that all companies play by the rules and do not dominate markets. 

    Wealth is concentrated when power is consolidated. Wealth then buys politicians. These large, industry-controlling oligopolies have greater power to raise prices and hold down the cost of labor. Both the consumer and worker are squeezed because they have few alternatives. The oligopoly is less concerned about the needs of the consumer and focused on consolidating power further. 

    The same elected officials see nothing wrong with the five largest banks in the country controlling over 60% of the consumer deposits in the country and it is ok that they are too big to fail. Instead, our Washington representatives are upset that the banks are choking on excessive regulations. 

    In the summer of 2011, Obama was ready to make cuts in entitlement programs; however, the Republicans refused to go along with any tax increases on the wealthy. The Republican current proposal is no different. Therefore, Obama made the decision to wait for the 2012 elections. After seeing this new proposal, who can blame him? For several months, I have been complaining about Obama not addressing the debt issue. I was wrong. Ryan’s current proposal shows the Republicans are not ready to negotiate in good faith. Their no new tax pledge to Grover Norquist is greater than their responsibility to the American people. 

  • TomK_in_Boston

    Ryan’s plan is total class warfare. It ends medicare as a comprehensive program and replaces it with Groupons that are designed to fail to cover costs. The gap between the Groupons and the costs will increase over time, shifting costs onto seniors. By this cost-shift, low taxes on the romney types will be sustained. Thus Ryan Groupons = redistribution of wealth from bottom to top.

    Ryan’s idea of “saving” medicare is cutting its costs, regardless of what services are offered. If the benefit was a bottle of aspirin/yr, it would be “saved” in righty speak. The Groupons also amount to rationing. No rationing is so powerful as being unable to pay.Compounding the negative impact of the Groupon plan, seniors will have to go to predatory WellPoint et al as individuals, lacking the clout of the millions in medicare.Since medicare costs are growing more slowly than pvt insurance costs, we should be expanding medicare, not cutting it, if we care about the total costs.The claims that Obama cut medicare too are ridiculous. We need to control costs while preserving comprehensive coverage. That’s exactly what Obama tried in the ACA. He’s not cutting benefits, he’s trying too control payments to the providers. That is essential.

    The RR plans make no sense for average American. They are designed by ideologues to keep the $ flowing to the top.

    • WorriedfortheCountry

       Class warfare?  Because he wants to means test it?

      I guess he is against the rich.

      • TomK_in_Boston

        I’d say dumping medicare costs on seniors with Groupons that won’t pay for insurance, while cutting taxes from ALREADY all-time-lows is pretty obvious class warfare.

        What ever happened to those “hard choices” and “shared sacrifices” when it comes to the elite? Do you know?

        • WorriedfortheCountry

          But he isn’t cutting taxes.  He is cutting tax rates.

          Romney has stated that the top earners will contribute the same share that they do now.  You may not know this but the top 10% pay 70% of the income tax but only have 42% of the revenue.

          If the simplification also provides economic growth (as most economists agree) then it will be a huge win.

          Were you against the Simpson-Bowles tax plan too?

          • jimino

            Ryan has not identified even one of the deductions that he says will (and must) be eliminated to allow for the lower tax rates.  Are you that unbelievably gullible to just blindly adopt a “plan” with absolutely no details?

          • TomK_in_Boston

            Yes, cut rates. Rates at the top are now close to all-time lows and the con men like Romney who can claim all their income as dividends or cap gains pay at most 15%, which I would say is an all time low. Furthermore the estate tax has been gutted. Anyone who suggests further reductions in such an environment has no credibility re the deficit.

            Everyone has their own figures, but 70% of the tax and 42% of the revenue is nothing like the level of progressivity I would like to see in the tax code.

            Don’t you realize that the bottom 90% has been so crushed by voodoo economics that they have no income? That’s why they pay less tax.

            If we got the oligarchy your side wants and ALL the income went to 100 oligarchs, would you think the fact that they paid all of the tax showed the great fairness of the system?
            You believe what Romney says? Come on! He will cut, that’s easy, but it will be impossible to to find the corresponding loopholes to close and the result will be even more redistribution to the top. That’s why he can’t give any details.IMO most non-ideological economists realize that if 30 years of tax cutting has not produced the promised trickle down, even more is unlikely to do so.Yes I am against Simpson-Bowles. We need to stop attacking the retirement programs and start collecting taxes.

          • William

            Raising taxes without a massive downsize in government spending and size of government will achieve nothing. We are service/knowledge based economy that does not need a massive government or massive government spending. Fewer jobs means less government not more.  

          • TomK_in_Boston

            Talking point. 

      • TomK_in_Boston

        Pay $1,000 in means testing, get $100,000 in tax breaks, war is hell.

    • William

      If you cut what the providers receive they won’t provide. My sister is a CRNA and they are not taking any new Medicare patients due to cuts. Their malpractice insurance keeps going up and elderly patients are high risk. So the Obama-care cuts are a disaster.

      • Mike_Card

        Let your sister speak for herself.

    • sickofthechit

       Actually they are waging “Class Genocide”(trademark Charles A. Bowsher 2010)

  • Gregg Smith

    With the most excellent selection of Paul Ryan contrasting the gaffetastic Joe Biden, it becomes increasingly possible that Joe will get the boot. Is today the day?

    http://www.weeklystandard.com/blogs/today-day_650058.html

    • WorriedfortheCountry

       Would Obama listen to Sarah Palin?

      • Duras

        She would have to stop spitting sentence fragments first anybody can understand her.

        • Gregg Smith

          Do you realize how many underdog House and Senate victories Palin has helped with her endorsements? Especially the ones she went out on a limb for. Ask Lugar about that. As I’ve said before, it’s not that Republicans have a majority in the House, it’s the majority they have. They owe Sarah big time. She is a powerful player, dismiss her at your own risk.

          • Duras

            I think America’s declilning education and the anti-intellectualism that arose around 1980 curiously enough, has more to do with people voting against economic interests.  Apparently, America would rather cut their own healthcare, social security, and raise tuition on their kids if it means that some rich guy they don’t know would have to pay a penny more.

      • Gregg Smith

        I hope not but she’d be wise to.

    • TomK_in_Boston

      If you like class warfare, you’ll love Paul Ryan.

    • JGC

      I really like the word “gaffetastic”.  I’ll put it in my political dictionary before the word “vitterish”.

      • Gregg Smith

        Touche’.

  • WorriedfortheCountry

    Tom, thank you for an excellent — if not frustrating — show today.  Your guests were very high quality on both sides.

    Mr. Berwick made some very good points but he did come across as it is “my way or the highway”.  The weakness of his position was exposed when it was pointed out that standard Medicare will still be a choice for seniors under Wyden-Ryan.  There is nothing to prevent the efficiency improvements he has proposed from being included under Wyden-Ryan. 

    • TomK_in_Boston

      Nonsense. Insurance works by having everyone in the same big pool. By letting the most healthy individuals get out of the pool, traditional medicare will be undermined, even if it available in principle. Can you really not see that? Then the right will demand “reform” and cut it – I mean “save” it – as another step toward their long term goal of eliminating it altogether.

      • WorriedfortheCountry

        I suspect you are against Charter schools too.

        • TomK_in_Boston

          Good guess.

        • Duras

          You know who also believes in corporate sponsored schools? China.

          Hey, I got an idea.  We’ll pass standardized testing knowing full well that education depends mostly upon socioeconomic background and that the real problem with education is growing poverty, but it will make our public schools look like crap, and then we will subsidize Charter Schools with corporate sponsors and regardless of how bad they do on standardize tests, we will still subsidize them, teachers won’t be able to unionize so their wages will go down and the corporate conglomerates that run the schools will make more money.  And when college educated teachers with good grades give up and take a private sector job, we’ll just hire people out of for-profit online schools (who also fill republican pockets with cash).  Now that is a real education.

        • Mike_Card

          You were home-schooled, weren’t you?

      • William

         Medicare and Medicaid have huge pools of customers and the costs for those two programs are still rising much higher than the rate of inflation. Both programs don’t put much pressure on the customer to consider costs before using the insurance. A simple means test for Medicare users and Medicaid customers should give up their EIC to fund their share of Medicaid.
         The left sold these programs as cost effective but both programs are going bankrupt.

        • TomK_in_Boston

          False comparison. What’s relevant is that medicare costs are increasing more slowly than private insurance, and it covers everyone. Medicare is the most efficient and just component of our crazy-quilt system. We’d be better off with medicare for all.

          The USA is going bankrupt paying for the most expensive system in the world, which just happens to be the only for-profit system. It’s obvious that national health care is far more efficient than out prvate sector. 

          • jefe68

            Well said. This chap wont see it this way. I don’t know why this is even an argument anymore. It’s so obvious that our market based system is broken. The real discussion should be how do we rebuild it and move away from the market based system we have. That wont happen until all the special interest are told the game is over, you don’t get to call the shots anymore.

        • Mike_Card

          “…going bankrupt.”  Got a description of what you think that means?

  • Bruce94

    A lot of discussion (B.S.) by Wilensky and some callers about the need to apply “competition” and “free-market” principles to health care simply ignores what health care economists have documented for years–the classic laws of supply & demand just do not work in the health care market, some of the reasons being:

    1) accident & illness are largely unpredictable, so health care purchases cannot be planned as with other goods & services.

    2) 3rd party payment, whether private or public, distorts consumer/household decisions about what & when to purchase because the price of care is based on the net vs. actual gross cost of that care or service.

    3) medical info. is asymmetrical, that is, too expensive & beyond the reach of most consumers.  Entry into the med. profession is limited; med. education is extremely expensive.  Hence, there are monopolistic & oligopolistic forces in the health care market that impede price competition, limit supply & access, and drive up costs.

    4) private ins. cos. are incentivized to shrink the risk pool to include only the young & healthy, thereby, dumping the elderly & sick onto public or charitable programs.  The public health model (and I would argue the only economically sustainable and morally acceptable one) is to increase the risk pool so expenses are borne by everyone and everyone has a stake. 

    5) the prevailing view in our society (and every advanced, Western country) is that health care is a human right.  In the U.S. unlike these other countries, until Obamacare was passed we lacked the political will to finance & deliver health care as a human right so that every citizen has or will have access to a health care system that assures quality & controls cost.

  • AbrahamFroman

    I howled with laughter when, at the top of the show, a sound clip was played of Ryan saying that insurance companies would compete to cover the elderly.  That theory is fundamentally flawed. 
    Insurance companies simply don’t want to cover old folks because old folks tend to get sick and are therefore a lousy bet.  The United States is the only country in the entire industrialized world that doesn’t have a national healthcare system. Until the USA has socialized medicine, the Romney/Ryan plan, the ACA and everything else is just rearranging the deck chairs on the Titanic.  Unfortunately, it is political suicide to even utter the words “Socialized Medicine.”  

    • William

       Socialized or single payer does not mean better or cheaper medical care. The costs continue to rise since the taxpayers pick up the costs and there is no incentive for the customer to be cost conscience.

      • jefe68

        It does in France, Canada, Germany, Denmark, Sweden, Great Britain, and the Netherlands.

        All the above nations pay much less than we do and have better results. So does the VA by the way.

        • Mike_Card

          I recently became eligible for Medicare.  In my life–during which I served four years’ active duty as an Army officer–the BEST medical care I ever received was while I was in the Army.

          If that is not “socialized, single-payer medicine,” I challenge anyone to provide a better example.

      • AbrahamFroman

        As it is, there is currently no incentive for the customer to be cost conscience – which is exactly as the health care industry wants it. People generally do not shop around for the most inexpensive doctor or engage in comparison pricing when they need surgery. If the pay model for doctors was similar to that for teachers (based upon number of years, experience, geographic location, specialties) rather than sheer volume (see more patients and prescribe more treatment = make more $$$), and there was one “organization” to oversee the costs and payments, that would keep in check increases in cost. In any case, if France, Greece, Canada, Spain (and the 33 other nations ranked ahead of the United States by the World Health Organization) can figure out how to give better care for less cost, then I would hope the United States could do likewise.

  • clearlycarl

    Here is the crux of the cash problem:    The covered high risk, obese, diabetic, cardiac and dialysis patients have no skin in the game.    They get Medicare and check in to the hospital and occupy the emergency rooms.   

    They get care, eventually hitting the annual limits and, as you would expect, they then put skin in the game.    They either lose house, car, accounts, etc. or quickly file for bankruptcy protection.     Many of these patients know what they need to do: exercise, regulate thaeir diets, eat leafy greens, shun starchy, fatty foods, stop drinking energy and sugary soda drinks, start drinking water, work, get off the couch and turn off the tube. 

    Since much of the treated disease is due to stupid lifestyle choices, they expect us, who don’t make stupid choices, to pay the bill.    They make no effort to make smart lifestyle choices.     We are to be their slaves, coughing up borrowed Chinese money to feed their gluttony and ameliorate the damage they self-inflict.   

    The prescription is clear:   Give each incoming Medicare patient a physical.    Prescribe the actions to be taken and the weight loss, BMI change systolic, diastolic and heart rate results.    If, in the end of the first year of eligibility, they fail to meet the objectives, their Medicare coverage is reduced.    Continual failure means further reductions.     Taking action and meeting objectives prescribed will restore the coverage to the previous year’s limits, each year of compliance, until the objectives met return the individual to full coverage.   

    • AntiBigBus

      It’s nice to blame the overweight and diabetics because of a life style that they may have chosen or has caused them harm, but many will not develop problems, however, there are many good clean living people out there that have dropped dead from heart attacks, developed diabetes, cancers, and other heart problems every day.
      It must be nice to be so perfect and healthy but your day will come, sooner or later. Enjoy!

      • JGC

        One of those people who dropped dead of a heart attack at a young age was Rep. Ryan’s father (I assume he was good and clean living). Some  irony, huh, that Ryan does not support Obamacare, which contains components for wellness checkups with doctors, specifically to flag incipient health concerns before they develop into dangerous and costly problems…  

    • Mike_Card

      You are, of course, a licensed, practicing M.D.?

  • jsmetz

    The Ryan plan protects the insurance industry.  To save the insurance industry’s financial bacon the rest of us will get our little government grants to buy health insurance, and will then have to listen to – and ultimately buy one or more – every sales pitch for cheap insurance on the planet.  I don’t want to have to spend any part of my day thinking about insurance sales pitches (they will put the credit card hustles of a few years ago to shame).  To cut costs, health coverage needs to be available everywhere, to everyone, and everybody pays their fair share.  The sooner we get to a single payer system in some form the sooner health care costs will start to drop.  I’m 70 years old, and the idea that I won’t have to worry about Medicare coverage in the Ryan plan is arrogant Republican B.S.

    • WorriedfortheCountry

       It is interesting to me that the left isn’t “PRO CHOICE” on this issue.

      I guess the Dems are the ANTI- pro choice party now.

      • jsmetz

         Oh, I am very much pro-choice.  If the health insurance companies would let me, I would choose a health care system where health care is available everywhere, to everyone, and every body pays a fair share.  (Didn’t I already say that?)  Thanks for the opportunity to extend this discussion.

      • TomK_in_Boston

        Talking point. The “choice” to “choose” my own insurer while paying $1000′s out of pocket is a garbage choice, sorta like your freedom to choose a waterfront house on MV.

      • bostonlodger

        Are you ‘pro-choice’ for being able to choose your own private police department, or your own private fire department?

      • Mike_Card

        No problem.  I choose the same plan Ryan has; write it up and send me my premium bill for $0.

    • William

       Obama-care is a sweet-heart deal for insurance companies. People that don’t need insurance are being forced to buy it. The insurance companies can soon count on some 50 million new customers thanks to Obama.

      • Duras

        Yeah, that’s the idea since Obama is forcing them to lower their rates.

      • jsmetz

         Agreed.  The fact that Obamacare – or any change of any kind by anybody in the national health care system – could not pass the congress without a buy-in by the insurance and pharmaceutical industries, and their lobbyists, is a testament to just how F___ ‘d up our governing process has become.  To me, the interesting thing about the Ryan/Romney ticket – if they win – is that they will simply turn the whole health care system over to Wall Street and the private health insurance and pharmaceutical industries, and tell them that they – Ryan/Romney – will sign off on whatever those industries propose, and it won’t cost those industries even a nickel in lobbying costs.

  • drowning_in_the_middleclass

    I agree that traditional “market forces” are very difficult to put into practical application in the world of healthcare.   Once I am with a primary care physician, I try to follow their discussion of alternatives and recommendations.  I have no other basis for judging quality and prices.  (Long ago I tried to get prices from a hospital in advance of surgery for my son — not only did they nt answer they were paranoid as to why I’d ask all those questions.)  In many cases of illness or accident, there is no shopping — you get the help you can ASAP. No market forces at work there from my perspective as a consumer.

    I am getting close to Medicare age. I work for a county in Ohio and have what most would say is good insurance.  My wife is retired after being disabled at around age 60.  I appreciate that people who have had the good fortune to be in good health want to have more control over the dollars and the insurance they buy.  However, many of us, at this age, face real uncertainties.  At this time, with insurance, the co-pays and deductibles are so high that we are going broke.  I put the max allowed in a medical savings to help offset the medical expenses but year after year our pharmacy co-pays alone exceede the amount in savings by a wide margin. 

    So this is a primarily private system that is broken and I fail to see any hope that profit driven systems can ever help.  Let’s face it: to an insurance company their profit is much better when my sick wife dies and ends their payments.  Cynical, but true! 

    Therefore, I conclude that any system that relies on the profit motive is doomed because the motive behind it is profit, not health or healthcare.

    • WorriedfortheCountry

       I appreciate your points and many of them are valid.

      However, look at the post office.  Here the government runs a very simple function and can’t seem to get it right.  They are constantly over budget.  How can we have faith that the government can get something as complex as health care on budget.

      We need massive reforms.  One thing that is missing from our system is the power of the ‘consumer’ isn’t being used effectively.  Once you have insurance, you really don’t concern yourself with cost.

      Let’s face it; most of the major innovations in our health care are driven by profit: CAT scans, MRI, robotic surgery.  Right now we subsidize the world with these developments.  My concern is once the government takes over health care and removes the profit motive then all these innovations will be curtailed.

      • bostonlodger

        The post office reform bill, which would have made the post office profitable, was defeated in part by the lobbying efforts of Ryan’s wife, Janna, who worked on behalf of UPS.

      • http://twitter.com/gbheron5 Jill Niland

        The post office delivers an envelope at what–45 cents?  The private mail providers charge at least $5.00 for that same delivery.  No wonder the Post Office is over budget if the ‘real’ cost to deliver is over 10 times that?  Medicare has worked well, with only about 10% going to administrative costs, whereas health insurance companies have skimmed well over the 15% that the ACA now allows them to do.  Where’s the evidence that the US subsidizes the world with health care innovations?  We certainly haven’t gotten our health delivery ‘perfected’, since we rate 47th on the chart of overall health outcomes.  (I know sp,e people like to say that’s due to our higher levels of ‘diversity’–well maybe wealth inequality does have something to do with that–but it’s not just that we have different minorities.)  As a ‘consumer’  I have insurance and HAVE to be concerned with costs, many of which I can never control.  I spend huge amounts of money just on dental work, which has a very stingy yearly limit.  So I put off work I really need….that’s what happens when the insurance companies ‘ration’ care, or we have to ‘self-ration’. 

      • drowning_in_the_middleclass

         I agree that our system has made many innovations possible.  However, the rest of the world has not completely neglected research and development.  Another issue is that many of the great developments are wonderful but we can not afford them!  This applies to medications and all the equipment available to health providers. 

        I do not envision the government taking over care, just the method of funding for healthcare. (Canada comes to mind.)  I don’t think many realize how much the administration of our current system costs.  Look at any healthcare office and you will see a number of workers who spend most of their time negotiating with payers, both public and private.  Those workers and their equivalent on the other end (the insurance co. or other payer) do not add any value to the care provided.  They are necessary today because the claims process is burdensome and expensive. (Rejected claims that have to be re-submitted & etc.)

      • jimino

        Don’t be ridiculous.  If UPS or FedEx were mandated to deliver your letter across country for 45 cents they would be “over budget” too. 

        Here’s a suggestion: Compare  the government programs for health care to those in private hands.  The former are vastly more cost efficient.  Given this one might well ask “How can we have faith that the private sector can get something as complex as health care on budget.”  Of course, we already know the answer:  It can’t.

      • TomK_in_Boston

        Don’t you know that the PO has been required to fund its pensions at a level that no private corporation even approaches?  That is the primary source of their deficit. The PO has “got it right” since Ben Franklin, the only thing that changed in 1980 was the rise of the far right and their attacks on all gvt functions.

        Let’s face it, the major innovations in health care start with government funded basic research, which is then commercialized in the private sector. It’s a partnership, see? If Watson and Crick don’t do their gvt funded research, no double helix, no genentech or genzyme.

        It’s absurd to talk about the gvt taking over health care. Don’t you know that in the ACA all the services are still provided by the private sector? 

      • jefe68

        The UK is a small nation that comes in second to the US in research and development in Universities.
        And they have an NH system.

        Funny how you bring up the Post Office and not the VA health care system which is a government run health care system that works pretty well.

      • sickofthechit

         The Postal Service is having financial trouble right now because the Repugnicans inserted a rider in a bill which makes the Postal Service catch up on neglected pension funding in a matter of few years rather than on an actuarial basis (that means on a reasonable basis instead of a falsely accelerated basis).  Their unspoken purpose is to bankrupt the Postal Service ASAP so they can privatize it just like they privatized parts of the military that gives us things like showers that electrocute our servicemen in Iraq or place inept Private Security personnel (earning tens of thousands of dollars per month) who are so trigger happy they shoot up groups of civilians when a car or truck backfires.  Makes the incredible job our brave service men and women are doing that much more difficult and dangerous.  So learn a little, listen to more than FAUX “News” and get back to us.  The $5 letter mentioned below is no made up. To top it off you have to carry the letter to UPS yourself.  And they sure won’t stop by your house every day but Sunday to see if you have anything for them!

  • bostonlodger

    Please explain how Ryan’s plan for covering seniors through vouchers saves taxpayers any money. We foot the bill either way, so what is the advantage to adding a layer so the middleman gets a cut, instead of financing healthcare directly as we do now with Medicare?  Medicare operates more efficiently than private insurance, with lower overhead. 

    So what’s to be gained?  Other than Janna Ryan’s former clients getting a nice big cut from the taxpayers.  The fact that Ryan’s wife was a lobbyist working for big pharma and insurance is relevant to this discussion. 

    • Joseph_Wisconsin

       You don’t understand one crucial aspect of Ryan’s voucher plan.  Seniors will get vouchers, but not of a sufficient amount to actually purchase anything like the healthcare coverage they currently receive through Medicare.  The voucher plan is really just a way discard the current Medicare obligation to actually provide healthcare for all covered seniors, and instead just give them a voucher and tell them that they are on their own as far as coming up with the difference between the voucher and what insurance coverage will actually cost them.  If they don’t have the money to make up that difference, c’est la vie.  That’s Ayn Rand (Mitt Romney-Paul Ryan) capitalism my friend.  

      It’s all about the Ayn Rand concept of a free society.  Single parents or young couples with children will be free to purchase health insurance from any private insurers that wish to provide coverage to such people at the price set by those insurers, or chose to risk having no insurance, or be forced to do without because they can’t afford it. C’est la vie, that’s capitalism my friend.  Same for young healthy adults.  Same for those in poor health or with preexisting conditions.  Same for the elderly.  That’s the what’s-in-it-for-me-right-now Republican vision for society.  

      Finally I would like to add a note to all that claim that the Ryan plan is not the same as the Romney plan. Latest from Romney: “Actually, Paul Ryan and my plan for Medicare, I think, is the same, if not identical — it’s probably close to identical.”  http://www.huffingtonpost.com/2012/08/16/mitt-romney-paul-ryan-medicare_n_1789480.html?utm_hp_ref=politics

      Also how about an analysis of Ryan’s budget and well it increase of decrease the budget deficits from Reagan supply side economist David Stockman analysis of Ryan’s “Fairy-Tale” budget:.  http://www.nytimes.com/2012/08/14/opinion/paul-ryans-fairy-tale-budget-plan.html?_r=3  That’s for all those 55 years old and older who think Romney/Ryan won’t be coming after their Medicare. 

      • TomK_in_Boston

        Exactly. The Ryan plan is a cost SHIFT. It’s so obvious I don’t know how anyone can miss it. By paying whatever they decide, regardless of whether it will pay for insurance, they simply shift the costs to the seniors. Even worse, as individuals waving a Groupon, they are at the mercy of the predatory ins companies, unlike medicare with its huge clout.

        Seniors who can afford it will pay extra, those who can’t will be rationed out of the market. The Ryan plan is rationing. The most effective rationing is not gvt control, it’s being unable to pay.

  • AntiBigBus

    Romney and Ryan will want to change Medicare by replacing it with some sort of voucher given to Medicare recipients. These will be used to find an health insurance company that will sign them up into a program. “They say the competition between providers will bring down the price of insurance, trust the market place.” I for one can’t trust them as far as I can throw them. There is an oligopoly of the insurance companies, so they will pick and choose.
      However, since the over whelming majority of Medicare  recipients are over 65 and have some sort of pre-existing medical condition they will be turned down. But, wait you say, we have the Affordable Health Care Act which guarantees coverage if you have a pre-existing condition. To bad people Romney and Ryan promised to get it cancelled; anybody on Medicare is now facing the prospect of not having health care and we know what that means.

  • http://twitter.com/timc888 Tim Heitman

    The diagnosis is simple: It’s not like the US exists on a planet by itself. Every other western democracy shows that single payer is the answer.

    Unfortunately, the prescription is not simple, as every vested interest will fight like hell to keep their piece of the dollar pie.

    • William

       A government insurance plan does not address the costs or reduce the costs unless medical care is rationed. It still boils down to who will pay for medical care and how much will they pay.

      • Mike_Card

        Once you realize how to read, come back and join the discussion.  You clearly have no cognitive abilities nor do you have anything to contribute.

      • jefe68

        What do you call the VA smart guy?

    • bostonlodger

      Which begs the real question, which is: despite the widespread support for single payer (or even Obama’s ‘public option’), why is it never even *allowed* to be discussed as a solution?

      It’s disingenuous for the Paul Ryans to haul out tpie charts illustrating doomsday Medicare/Medicaid projections without pointing out the obvious remedy: include the young/healthy in the same risk pool as the sick/aging.

      Which is what Canada and France and UK and every other industrialized nation does.

      • hypocracy1

        Because that would be what our Republican friends call ‘Socialism’.

  • http://twitter.com/gbheron5 Jill Niland

    There was a second incident of that recently, because the homeowner hadn’t paid his $75 subscription fee. 

  • Bruce94

    When I hear “Obama raided Medicare to pay for ACA,” I think the Karl Rove smear machine is in high gear and it shows the desperation of the GOP no less than when we were bombarded with propaganda like “the Individual Mandate is unconstitutional” or “Obamacare sets up death panels” or “the ACA is a government takeover.”  The extent to which Romney and now Ryan will demagogue this issue seems to have no limit. 

    The CBO estimates that this so-called “raid on Medicare” will extend the life of Medicare by nearly a decade by obtaining cost savings from reducing the rate of increase in payments to providers, increasing the premiums paid by only the highest-income beneficiaries, and cutting administrative costs. 

    Nearly a third of the cost savings will come from eliminating subsidies to insurance companies for Medicare Advantage, which studies have shown does nothing to improve patient outcomes (i.e. no difference in morbidity or mortality rates in those who use it and those who use Regular Medicare only).

    Another cost-cutting measure that ACA would bring is denying full reimbursement of hospitals when tests & procedures are repeated or patients readmitted due to preventable errors.  This reform combined with mandated coverage for wellness care & preventive services will go a long way to re-incentivizing providers to focus on health maintenance rather than depend on a revenue stream tethered to service volume (value vs. volume of services).

    Expansion of electronic records as well as adoption of evidence-based medicine under ACA will also help lower the trajectory of health care cost including Medicare.

    The Romney/Ryan Medicare Plan does nothing except shift the escalating costs of health care to seniors many of whom would be shopping in the individual private market when it’s too late or too expensive and often at the mercy of unscrupulous hucksters.

     

    • William

       So taking 710 billion dollars out of Medicare is now a savings? What a load of bunk. Medicare loses about 60 billion a year just to fraud and now it will lose another 70 billion a year to fund Obama-care? What is left?

      You don’t like the Ryan-Wyden Medicare fix then leave it just like it is but to try and pass off a 70 billion dollar a year cut as savings is just a huge lie.

      • Mike_Card

        Read the explanation, you douche bag.  It’s the same amount, regardless of how you want to spin it. 

        • sickofthechit

           Are douches covered?

      • Bruce94

        Given the history of the GOP ideological opposition to the concept of social insurance in general and Social Security, Medicare and Medicaid in particular, I’ll go with the nonpartisan Kaiser Family Foundation, Congressional Budget Office and AARP characterization of these “cuts” as cost savings that, in fact, had bipartisan support until ACA passed and the Right-wing of the GOP went into apoplexy.

        The fact is none of these “cuts” touch benefits; to the contrary, by reducing reimbursement rates to hospitals, prescription drugs under Medicaid and private insurers in Medicare Advantage, the Obama Plan enhances the solvency of Medicare.  And Obama’s reform offers the only Plan that bends the overall healthcare cost curve over time in the ways described in my previous post. 

        The truth is these so-called “cuts” only slow the growth in Medicare spending over the next 10 years. 

        An additional fact to keep in mind–the savings generated by Obama’s reforms are being and will continue to be used to strengthen the overall system as well as cover more people.  Seniors are already benefiting from the closing of the Medicare “doughnut hole” and provision of free preventive services including annual wellness visits. 

        On the other hand, the $700 billion generated under the Romney/Ryan Plan would go to fund more tax cuts for the super rich.

        As they say, everyone is entitled to their own opinion (and I can understand the mind-set of an angry, mid-western libertarian like Ryan who scoffs at the idea of social insurance or universal health care), but they’re not entitled to make up the facts.  

          

    • TomK_in_Boston

      Yep, it’s a straight righty Big Lie. The right screams at every opportunity that health care costs are “unsustainable”, and when the President tries to restrain payouts to providers while preserving medicare as comprehensive insurance, they turn on the smear machine. However, they love the Groupon plan with granny paying more out of pocket while begging WellPoint for mercy every year.

  • Debbie Bouhenguel

    Many baby boomers have lost much in recent years – reduction in 401K, loss of retirement plans, loss of jobs, and for many, no health care coverage.

    How can they be expected to wait to retire at a later age, later coverage by medicare and higher medicare costs via vouchers????

  • http://www.facebook.com/profile.php?id=1237113610 Thomas Johnson

    It not like this just happened over night, its happened over time, your guest have all these Ideas and criticism  of whats happening now. what did they do when they were in charge???

  • Mike_Card

    Better not do any calculations that assume more than $6000.

  • rd2612

    The gentleman who called in to say that it is tough luck for those who do not plan ahead, do not take “responsibility for their future” missed the major reality that most of us are just trying to get through today, pay the mortgage, the insurance, and pay for the groceries.  We don’t have the luxury of planning for the future.   And he is probably going to be pretty disappointed with his long term care that he has paid for years because it will not cover what he wants it to when he needs it.
    Competition, and capitalism,  do not always provide the best service or care,  they serve their stockholders and CEOs,  not the public

    • Mike_Card

      That “gentleman” is a complete moron who has no connection with reality.  It would be ultimately entertaining to watch him melt into a pile of sh1t when he is told by his doctor that he has inoperable cancer, and that he ought to “plan” for the millions of medical care that it is going to cost to care for him, even though his sorry ass won’t die for several more years.

  • http://www.facebook.com/profile.php?id=100003007039330 Raw Bylaw

    Ms Wilensky just stated a complete lie, the 718 billion that Ryan would have cut from Medicare (it’s hard to tell, at this moment what the Romney/Ryan plan exactly does in this regard) but, the point is, when Ryan plan stated he would cut the 718 billion that money was NOT going to trim the deficient it was goint to TAX CUT.  Please Please correct this lie your guest stated

  • http://www.facebook.com/profile.php?id=1235586628 Howard Haynes

    What happens to young people on medicare (Ex; End Stage Renal Disease) 
    Most Insurance Co.s do not offer enough coverage for Dialysis.
    My current secondary insurance costs me $1,500 per month.
    (I barely can make this *ferrari insurance payment)

  • toearley

    When Ryan says that seniors will be able to take control, evaluate, make a plan for their personal health with the insurance companies — does anyone here have parents over 70? My mother and father are not capable of these feats, hell they don’t even have an internet connection. What are they to do? Drive around meeting doctors, insurance reps, and healthcare providers? Or better yet, call them up and be scammed over the phone by two-bit hustlers, or blood thirsty, cash hungry insurance giant? It’s just nuts.

    • Duras

      Yeah, republicans like to use phrases like “We think you don’t need government to hold your hand.”  They generally say that so they can get rid of consumer protections and deregulate banks.  But I guess they are going appeal to the lowest common denominator once again and convince them they are doctors.

    • TomK_in_Boston

      In addition to what you say, how can you ” take control, evaluate, make a plan for their personal health with the insurance companies” when you are being asked to pay the growing gap between the Groupon and the cost of insurance? The right loves to go on about “choice”, but a choice you can’t afford is not a choice, it’s a talking point. The most effective rationing is not gvt control, it’s being unable to pay.

  • Frances Clymer

    It is shameful that a major industrialized country cannot take care of its people. Shame on Romney and Ryan!

    • WorriedfortheCountry

       Huh?

      Check out the us debt clock dot org.

      We have $120T of unfunded health care liabilities.  It adds up to $1M per taxpayer.

      • TomK_in_Boston

        Ooooh, the big bad debt. Better hand the USA over to the oligarchs, or the big bad debt will get you.

        • http://profile.yahoo.com/JXSANCUDPIKQSPID5KT2U4XK5Y TF

          Extra points for Worried using big numbers and no timeframe and no percentages. Hack scare talk.

          In that vein, I’m a multimillionaire, if we’re talking about every dollar I’m going to earn in the next somety-leven years. Why am I changing my own oil and mowing my own lawn if I’m so rich?

      • Duras

        Go check out the leading drivers of the deficits and look which party is talking about them and which party is talking about food stamps.

  • TomK_in_Boston

    Hey, did you see Etchasketch claims he paid “at least 13%” tax rate over the last 10 years!!! Outrage, anyone? This kind of freebie for the super rich is UNSUSTAINABLE. If we returned to pre-voodoo American tax rates at the top, maybe we wouldn’t have to listen to crazy ideas like turning medicare into a Groupon.

    • WorriedfortheCountry

       Harry Reid is a liar.

      • Duras

        He’s just trying to get Romney to show his tax returns.  Republicans once thought he should release them to, but now they have gotten quiet….

      • jefe68

        Whining again.

      • TomK_in_Boston

        Aristocrats paying 13% and all you can do is whine about Harry Reid? The free ride of the oligarchs has got to stop if we are ever going to fix the system.

        The only liar, a serial liar, in this race is Etchasketch. Reid said that a Bain investor told him Etcha paid no taxes some years. What is your evidence that is false?

        And, why are you so quick to trust the word of a serial liar and professional con man? He says he paid 13% – an obscenely low rate – and you just believe him? This is a man whose whose business is financial manipulation and confusion. I’d suggest a little skepticism.

    • http://profile.yahoo.com/ZHLEGIKYDAN5TWVCPFFUWL4RHE Greg

      Romney’s 13% is based on capital gains; that is, on investments. Those investments were made with money that was already taxed at a much higher rate, so the 13% is double taxed money. Factor in the double taxation rate along with Romney’s huge amount of charity giving and he’s paying well over 40%. Face the facts, he’s a decent, honest man who creates jobs and pays more than his fair share very much unlike the lying, divisive Obama. 

      • TomK_in_Boston

        Hahaha, you really drank a lot of Kool-Aid. You’re probably a deficit hysterical and your only reaction to the amazing undertaxing of the aristocrats is to defend them.

        Sorry, there is no evidence that Etcha is a “job creator”. He’s a greedy con man who bought companies and loaded them up with debt to pay himself and his investors, and he’s proving himself to be a serial liar.

      • http://profiles.yahoo.com/u/3EKDKPYBCUC4J4NS3B4NUIJIGM mikew

         Greg,  I invest like romney and know the “double taxed” is baloney.   The sum of the bottom line is that its easy money – 13% tax on what you rake in a year is something everyone would do if they had the capital for that game.  But thats only for the elitist club and they literally cant lose , thanks to their bought politicians having written into the tax codes a multitude of ways to write off any losses.   if it gets really bad, they just have YOU bail them out, thanks to socialism for a losing financial sector.   You WILL pay their bonuses too.

        Its hard to see honesty in a professional politician  who has flip flopped on the most principled stands possible – to a degree that nobody else before has.  
        One thing we can be grateful for is there wont be any claims to higher patriotism from the right, because of prior military service.  But what does it mean to repubs when absolutely none of the romney males spanning a few generations has served his country in the military?  Ya, they do service to their secretive religion, but is that the same thing?

      • Sy2502

        Actually, many of those investments come from the sale of stocks that rich people who don’t want to pay taxes get instead of a salary. Steve Job was famous for being paid $1 a year by Apple, but I assure you that’s not all he was getting from Apple. It’s not like Steve Jobs was getting a regular salary (appropriately taxed) and then using some of that money to buy stocks, the profit of which was then double taxed at 13%. He was given the stocks INSTEAD of a salary. So he really was paying only 13% taxes.

  • heliprincess

    The core issue needs to be addressed: Encouraging people to be healthier.  We need to shut down the corrupt FDA and stop allowing non-food items to be sold as food.  A wealthy nation should have more access to real, nutritious, whole foods that would reduce diabetes and heart disease and all the rest.  Health care costs would be greatly reduced.

    • Sy2502

      And also people need to take better responsibility about having kids. If you can’t provide them with quality health care, you may want to wait until you can before having them. Sad but true, you can’t just drop kids left and right and then expect the rest of society to pay for them.

  • Jeffrey Gregory

    Thank you for having the great guests.  It was good to hear a discussion of this between experts instead of a pundit shouting match. The experts certainly each had an ideological bias but the discussion was meaningful and respectful and I appreciate that.

  • hennorama

    These things would be hilarious if the stakes weren’t so high.

    Ryan’s plan uses the same reductions in Medicare as the Affordable Care Act, and Romney says “… if I’m President of the United States, we’re putting the $716 billion back.”

    Strike 1.  You guys MIGHT want to get your story straight.

    Then, in an interview with Brit Hume on Fox discussing the Romney budget, Ryan is asked when it will balance.  His scintillatiing reply:  “I don’t know exactly what the balance is. I don’t want to get wonky on you but we haven’t run the numbers on that specific plan.”

    Strike 2.  Rep. Ryan, you’re in the big leagues now.  You MIGHT want to get some numbers run.

    Asked about his OWN budget plan 20 seconds later, Ryan says “The House budget doesn’t balance until the 2030s under the current measurement…”

    Strike 3.  Ohhhhhhhh.  So 2 decades before balance?  So much for being a “deficit hawk.”

    Adios, Romney/Ryan.

    • Gregg Smith

      Astute but… it’s Romney’s plan. Iraq was not divided into three and the $716B is going back.

    • WorriedfortheCountry

      Romney’s budget balances between 8-10 years depending on economic conditions.

      Obama’s budget– never balances.

      Adios Obama !

  • Guy_with_Qs

    Let me offer a few provocative comments:
     
    1.  For most goods and services, more is better, adding to the gross domestic product.  More autos manufactured, great.  More burgers and lattes served, terrific.  And look at all the jobs created when there’s more demand for these goods and services.  But not health care services – more is bad.  But then, people complain that reducing the volume of health care services delivered in order to cut costs will cause a loss of jobs.  Many local governments are providing incentives to companies to create jobs (high-paying ones at that) in the health care services sector, so maybe more is OK.  All this high-priced help is partly why health care costs so much.

    2.  As usual, people want more of it, but they don’t want to pay for it.  And in health care, they want it NOWWWWWW (remember those Markie Maypo TV commercials?), though, arguably, in life-threatening situations, they NEED it now (distinguish between want and need).  But there’s a cost to all this stand-by capacity, some of which is necessary to address true need, but much more responds only to people who want in delivered in a nicely-packaged, convenient form.

    3.  Health insurance is a bad business model.  Health care is too complex and changes too rapidly to be able to define clearly what’s covered and what’s not.  Because consumers frequently demand health care services in crisis situations (they haven’t had time and resources like Consumer Reports to evaluate various new cars to purchase), they’re usually not paying much attention to what’s covered when they present in the ER.  There’s too much opportunity to deny claims for payment (by either the patient or the provider) long after the service is delivered.  Look at the list of top earning health care executives published in Modern Healthcare a week or two ago.  Health insurance company CEOs are at the top of the list, not the people leading the companies which provide the services.

    HMOs worked well in the early days when the business was dominated by Kaiser, Group Health Coop of the Puget Sound, HIP (NYC), Harvard Community Health Plan and the other non-profit pioneers.  But once investor-owned HMOs figured out that they could earn greater profits by denying claims (remember MaxiCare?) rather than keeping a population healthy, so much for that idea.

    Contrast health insurance with other types of insurance.  Life insurance is easy – if the insured dies (no gray area here), the beneficiary gets a check.  Denials of life insurance claims are rare, and limited to extraordinary circumstances.  The stakes aren’t nearly so great with property and casualty insurance – if your house burns down, you’re probably going to get a check, with relatively minor haggling over how much.  But then, it’s only money, not your life.  Because health insurance is so complex, how much advertising do you see among health insurers?  As much as auto insurers?  I, for one, am quite tired of that lizard.

    4.  My college roommate, the eminent cardiologist won’t like this, but physicians and others who are concerned about socialized medicine are probably not old enough (not even Ron Paul) to remember the pre-Medicare days when the family paid mom’s doctor bill with a bushel of apples or a few dozen eggs.  Medicare pays cash.  You may not like the amount Medicare pays, but you can do more with it than make applesauce and omelets.  But yes, having to deal with less paperwork to get that payment would be a worthwhile objective.

    Your reactions welcome.

  • E1C2B

    Take the PROFIT motive out of insurance by making HMOs OPTIONAL SECONDARY coverage. Expand Medicare Medicaid as a SINGLE PAYER national health plan. Then return the government’s ability to negotiate the lowest pharmaceutical prices before the GOP-passed Medicare Part D make that illegal.

  • TinaWrites

    That no-bargaining for drug prices needs to be broadcast over and over during this presidential campaign.  It has gotten forgotten; yet it is a major contributor to health care costs NOT going down!!!

  • E1C2B

    When will Tom have on a genuine progressive left commentator instead of someone representing center right and the “other side” some wacko far right? Bring back progressive taxation NOW! Implement government COST CONTROLS on the pharmaceutical companies NOW! Take the HMOs OUT of the picture by giving us SINGLE PAYER national health NOW! Insurance is a gambling racket, run by people who are right at home in a casino, numbers mobsters.

    • Sy2502

      “When will Tom have on a genuine progressive left commentator instead of someone representing center right and the “other side” some wacko far right? ”

      Well, at least we know you are doing your part to represent the wacko far left. :)

  • http://profile.yahoo.com/ZHLEGIKYDAN5TWVCPFFUWL4RHE Greg

    Obamacare has taken over 700 billion from providers (doctors, physical therapists, etc.) so they no longer want to see Medicare patients. Romney/Ryan’s plan will not change anything for people over 55 years of age—nothing! Those of us younger than that are the ones who will have a voucher program in order to save the program. Don’t worry Baby Boomers. You’ll be saved and pampered as usual.

    • bostonlodger

      Politifact rates the $700 billion soundbite as ‘mostly false’.  

      The figure is the amount that the CBO estimates will be saved over 20 years by making providers more efficient and accountable. A big portion of it is fraud prevention and control.  It saves taxpayers money and it strengthens Medicare.   What is actually medicare savings you smear as ‘taking’ money, just because Willard Romney told you to.

      Get informed and stop spreading lies.  Your lies do not help the country.

      • bostonlodger

        correction: the figure is a revised amount of the original 500b estimate, and the savings covers 2013 to 2022, not 20 years. Sorry for the mistake.

  • Olga Swarthout

    I’m a fairly literate person who’ll be Medicare eligible in a few months. The deluge of supplemental health care plans in my e-and snail mail on a daily basis is overwhelming. At least my additional insurance is to fill in Medicare benefits gap.  I can’t imagine how many will manage to sort out individual health plans without professional guidance when they’re handed a voucher and told to “go and shop” for health insurance.          
     

  • jakys2

    Why did Tom go directly to the caller’s point about a new French revolution and not to the very important point of defense spending cuts to pay for the health of our citizens.  If protecting our population is the goal, then it would be better accomplished through health care than through a massive military complex.

  • jefe68

    The Ryan plan: bankrupt Medicare and then blame government for it. That way the GOP can point their finger at government and say, “see government just does not work”.

  • Pingback: BHN Report: On MV, Berwick takes a break from his break to comment on Ryan Medicare plan, new film « Boston Health News

  • TinaWrites

    Even when told how Private Equity Firms work, too many Americans think that Romney’s business skills will bring them jobs!

    Even when he is backed by major corporate CEO’s, who have been outsourcing jobs for years and years, too many Americans think that Romney’s business ideas will bring them jobs!    

    • TinaWrites

      ooops….wrong show!

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