Medicare COSTS Too Much

The world's most war-ish country is not a kind or gentle place. How could it be? When the mantra of dog-eat-dog is the underlying anthem of capitalism, kind and gentle just doesn't cut it. When millions languish in prisons and America uses capital punishment, the resemblance to Switzerland is mistaken. And there's nothing wrong with that, especially in a democracy where the citizens want to play that kind of in-you-face life game. Sadly, though, America's capitalistic roots have gotten fouled, softened and federalized over the years. Federalism and a strong central government are inimical to expressions of self determination, states rights and individualism.

Perhaps federalism has crept in by popular vote. If so, the people have spoken. Nice. Democracy at work, indeed. Perhaps a strong central government is required, considering the behavior and the mis-steps of the fractious fifty states. United? Without federalism, there would be no "United States ". Consequently, the rise of federal power is the necessary result of having so many states of so many sizes and varying populations with disparate views.

As an aside, isn't it time to change this fifty state construct around? Transportation and communication have changed since the 1700's. Why does Rhode Island or Delaware or Wyoming have the same relevancy as California or Texas or Florida or New York? C'mon...

An example of run-crazy federalism is Medicare. Created in 1965 under the Great Society of Lyndon Baines Johnson, it changed everything. Many cannot remember when health care was a pay as you go system. Private health insurance was the only game in town before Medicare and Medicaid and if a person worked, a health policy came along as a benefit. Retired folk either paid for services out of pocket* or if they had the $$, bought insurance. Inasmuch as most of the health care expenses occur later in life, many oldsters were out of luck when they took ill and they either received little or no services. A shame, but in the dog-eat-dog arena of capitalism, oh well.

LBJ changed all of that. Through his federal-centered application of Medicare, he opened the health care floodgates for the oldsters. Despite the fact that Medicare is socialized medicine, Americans sucked it up. Almost no one then and no one now rejects Medicare as soon as they are eligible (65 years of age). And it has been wonderful in its own way. People live longer and in better overall condition than ever before in the history of the nation. Access to quality health services for those eligible is assured. But Medicare has become so expensive that the country cannot afford it. Choices...

• Eliminate Medicare, go dog-eat-dog, like the old days 
• Raise the eligibility age, say to 67 or to 70 or to 75, 90 would work well, tee-hee
• Raise the $$ contributions of citizens via increased deductibles and more dear copays
• Means testing to eliminate the well-to-do, the well pensioned (cops, firemen, teachers, civil servants, etc.)
• Eliminate payments for the last 2 weeks of life, absent comfort measures
• Raise taxes or add new taxes to pay for the current program, eg, increased pay deductions, value added tax, federal sales tax, etc.
• Decrease reimbursement to providers, all of them
• And more...

Eliminating Medicare entirely would be cool. A definite, exciting throw-back to responsibility and the true American spirit. This move would also encourage family unity, since the old, uninsured infirm would become the charge of their blood relatives and not the government. Dog-eat-dog. Capitalism without socialism!

President Obama, today, has offered to raise the Medicare eligibility age. http://www.huffingtonpost.com/2011/07/11/obama-medicare-eligibility-age_n_894833.html Now this is a smacked idea for a Democrat, elected in part to insure broader and more wide health care. The Republicans have him reeling and truth be told, he is a bit unglued at the moment. Nonetheless, it is an idea with merit. Sure, there would be a lot of new people pounding sand, while waiting for their socialized medical care. But wouldn't they really be like the out-of-work, out-of-insurance present day 62-65 crowd, who are Medicare ineligible? And who gives a fig about them?

Raising money to fund Medicare is always a winner. Whether that would be by taxation, increased copays and deductibles would not matter. Any measure that increases $$ to pay for the application of Medicare would be useful in making it a go. Another gambit would be means testing. That is, if folks are rich enough or well pensioned enough, they would be forced to forego Medicare entirely and in effect, outlays would be reduced and money saved.

Considering that it is estimated that somewhere between 10-20% of the entire health care expenditures for Medicare occur within the last two weeks of life AND that the outcome of that treatment is DEATH, Medicare should simply stop paying for it! Think about that! Who pays for bad outcomes? Why waste money on futile, useless care. Contentious on its face, remember patients and families can step in and pony up the $$ for this useless care. Providers may have to swallow some of that cost as well. It's not that patients would be denied care, just that they, not Medicare, would have to pay for it. Consequently, there would be a windfall savings pop, rendering Medicare more solvent. Comfort care should be funded.

Of course, provider reimbursement should be reduced. To what point? Well, to the color change of economic litmus testing. Once red to blue or blue to red (if preferred, hehe) or yellow to blue happens, stop the cuts and add 10% back to the compensation schedule. The litmus test =

• when medical school applications fall off
• when ancillary programs for PA's and NP's go unsubscribed
• when hospitals begin to shut down
• when nursing homes start to shutter up
• when pharmaceutical and medical device companies are not wildly profitable
• others...

At any of these when points, the market will signal it's time to stop the cutbacks and to sweeten the pot by 10% (for that pay group). For now, though, cut reimbursements for ALL providers; 10% per annum every, January 1 until the litmus colors indicate it's time to change course. There is, by the way, a lot of reducible fat in the medical marketplace... and the supply side of service may be more elastic than anticipated. Query how the pharmaceutical manufacturers make a buck in Canada, where the government pays less for drugs than the American consumer? Just saying...

Medicare costs too much. Be clear, there's more at stake than the obvious economic erosion of the country's balance sheet. The Medicare system encroaches on pure Americanism. Socialized medical care  is incongruent with Capitalism. Now, that the country is in a crossroads of fiscal irresponsibility, Medicare has come under scrutiny. Deservedly. It is possible that the tsunami of red ink flooding America may represent an opportunity to right Medicare. Whatever right means?? Indeed!

E cosi va...

*unless they had work retirement benefits and or pension plans which provided health care