The Republican campaign committee tried to make a Comcast TV station quit airing an ad about Republicans "ending" Medicare.
Wait. Don't feel all relieved! Republicans still do want to end Medicare. They just don't want to, well, phrase it that way. "The plan would simply install a 'new, sustainable version of Medicare'" is the Republicans' preferred phrasing. Something like: "We're not going to kill grannie; we just want to help her, um, go."
Paul Krugman points out:
Comcast, the station’s owner, rejected the demand — and rightly so. For Republicans are indeed seeking to dismantle Medicare as we know it, replacing it with a much worse program.
I’m seeing many attempts to shout down anyone making this obvious point, and not just from Republican politicians. For some reason, many commentators seem to believe that accurately describing what the G.O.P. is actually proposing amounts to demagoguery. But there’s nothing demagogic about telling the truth.
Start with the claim that the G.O.P. plan simply reforms Medicare rather than ending it. I’ll just quote the blogger Duncan Black, who summarizes this as saying that “when we replace the Marines with a pizza, we’ll call the pizza the Marines.”
It may be difficult to explain the difference to Republicans. For years they have relied on a belief that words are fungible, interchangeable. Whichever works better at the moment. So when you listen to them talking about a "new" Medicare they mean ending Medicare and replace it with what Krugman accurately calls "vouchercare." Vouchers are not, nor could they be, a part of genuine Medicare. There is a key difference.
Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead.
In other words, Medicare is run for the benefit of the patient, aka the citizen, the voter. A voucher system favors the insurance providers and allows them to set their prices. The money winds up in the pockets of corporations rather than in the health care system. "Most seniors," in this voucher system,"wouldn’t be able to afford adequate coverage."
What about the quality of care?
Well, American health care these days isn't very high quality. We like to think it is, particularly those of us who haven't experienced health care in other developed countries. We have a lot of doctors. But the outcomes here aren't very good compared to, say Germany or France or Canada. We're down the list. We're a lot fatter, have fewer hospital beds, and die younger.
Many like to dismiss comparisons with Canada, but Canada's system works. They're generally healthier and live longer.
Canada ... has a national health insurance program, actually called Medicare, that is similar to the program we have for the elderly, but less open-ended and more cost-conscious. In 1970, Canada and the United States both spent about 7 percent of their G.D.P. on health care. Since then, as United States health spending has soared to 16 percent of G.D.P., Canadian spending has risen much more modestly, to only 10.5 percent of G.D.P. And while Canadian health care isn’t perfect, it’s not bad.
Canadian Medicare, then, looks sustainable; why can’t we do the same thing here? Well, you know the answer in the case of the Republicans: They don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it.
So in voting for the House budget plan, Republicans voted to end Medicare. Saying that isn’t demagoguery, it’s just pointing out the truth.
There are plenty of Americans who seem to believe that health care is a privilege. The idea of sharing a common burden is anathema. Maybe a lot of us are prospective plutocrats trying to break away from the "faceless masses, waiting for handouts," as Ronald Reagan so gracelessly put it. That was before Republicans got in the habit of twisting the truth into "a new, sustainable version of Medicare."
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Uwe Reinhardt, the Princeton economist who probably knows more about the economics of health care than anyone, will be interviewed about the future of Medicare this morning here (10ET).
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Paul Samuelson writes a shamelessly partisan and wrongheaded editorial in WaPo in which he conflates overspending and corruption within America's health care system with Medicare. As we know, Medicare is the most efficient health care deliverer, but it has to deal with a pre-existing for-profit system in which private insurers compete with health care providers for the honors of bilking the system. If you have an illness serious enough to put you in the hospital for a week or so and you're a younger patient with private insurance, in the three months following your hospital stay, you'll still have bills coming in from private service providers (radiology, lab tests, etc.) If you spend any time looking at those bills and checking them against other records, you'll find the overcharging.
The first thing we have to do before throwing Medicare to the sharks is to be very clear about whether we want a private and inevitably corrupt system setting the prices or a system with government oversight. The more oversight there is on the part of all of us, the better. And we won't get that with a privatized system.
I'm willing to bet that up to 40% of our "vouchers" would pay the usual "greed taxes" imposed by many private health care providers. As with every part of our economy, oversight, review, and regulation are essential in health care.
