LYING ABOUT MEDICARE

FRUM, DAVID

LYING ABOUT MEDICARE by David Frum AT THE REPUBLICAN CONVENTION, Bob Dole pledged to cut income taxes by 15 percent, balance the budget, and leave Social Security and Medicare untouched....

...People who worry about Medicare like to contemplate with a kind of sick horror the fate of the program after 2008, when the baby boomers begin to turn 62...
...In order to do that, the president is proposing to rely more on managed care, to encourage more intense competition among private providers, and to impose even greater top-down price controls on doctors and hospitals treating Medicare patients...
...Anybody see a pattern here...
...a few minutes with government documents proves it...
...Let’s look a mere four years into the future, to the year 2000 and the last year of a reelected Clinton’s mandate...
...In 1990, there were 31 million Americans older than 65, and they cost $98 billion...
...When they accuse Republicans of “cutting” Medicare, they don’t mean that the program’s costs will actually fall, or even that they will fall after you discount for infl ation...
...We all suspect it...
...Bob Dole will cut Medicare and Bill Clinton will cut Medicare for the very simple reason that Medicare in its present form cannot be sustained, not even to the end of a second Clinton administration, much less into the baby boomers’ retirement years...
...Just digits on a page...
...Two weeks later, the Democrats met in convention and, to put it simply, lied through their teeth about their plans for Medicare...
...And the blurrier those digits are, the better they serve President Clinton’s interests...
...The truth is there to be had by anyone who wants it...
...What they mean by a “cut” is any change that will deny its constantly expanding number of benefi ciaries the same generous level of service that benefi ciaries have enjoyed in the past...
...What Democrats mean by the word “cut,” as we all have learned by now, is not what ordinary budgetmakers mean...
...Managed-care operators may be able to demonstrate that their customers are just as healthy and live just as long as people who enjoy traditional medical practice...
...For reasons we could debate, the Medicare price controls that the federal government has been imposing since 1983 have not touched off the innovative search for effi ciency that they were supposed to...
...otherwise it would have to admit that it, too, is “cutting” Medicare...
...Some of the Clinton administration’s other plans go further and will “cut” the actual quality of medicine...
...Evidently, the networks and the print press don’t...
...President Clinton’s last pre-election budget promises to hold the growth in Medicare to a bargain-basement $248 billion by the last fi scal year of his second term...
...One hundred billion dollars is an extra $500 out of the wallet of every adult American worker in the last year of a Clinton second term...
...That’s why they want to replace Bill Clinton...
...What’s $100 billion...
...But let’s not race that far ahead...
...These are not all bad ideas...
...But by that defi nition, Medicare is heading for huge cuts no matter who is elected in 1996...
...Without these “cuts”—if Medicare costs were allowed to rise as fast over the next fi ve years as they have over the past fi ve—the cost of Medicare in Bill Clinton’s last year in offi ce would be, not $248 billion, but $302 billion...
...And if you want to avoid “cutting” other federal health programs, as the president does, you’d better be ready to spend a total of some $100 billion more on health services by 2001 than the president says he plans to...
...And yet they have real impact on the pocketbooks of American taxpayers...
...Back in 1970, the 20 million Americans over age 65 cost the country $6 billion dollars for Medicare...
...The Clinton administration describes these “cuts” as byproducts of its zeal to strengthen Medicare...
...In 1980, the 25 million Americans over 65 cost the country $32 billion...
...Tough-minded reporters be lieved none of it and shared their skepticism with a national television audience...
...Those remarks are blatantly untrue, both about the Republican plans and about Clinton’s own...
...It must do so...
...Since discussions about Medicare rapidly degenerate into hideous explosions of statistical megatonnage, I’ll keep it simple...
...And the media said-.-.-.-nothing...
...But for Medicare patients, many of the consequences of these ideas will feel very much like a “cut”: Medicare patients, like the rest of us, very understandably prefer fee-for-service medicine to managed care...
...Instead, doctors and hospitals have coped with the artifi cial ceiling on their fees either by fi ddling with their bills, by cheapening the medicine they offer (by, for instance, substituting generic pacemakers for the latest and safest models), and in some cases by simply ceasing to treat Medicare patients at all...
...By now, we’re entering a hyper-infl ationary stratosphere, in which numbers can lose all meaning...
...They accused Republicans, in Al Gore’s words, of wanting to “give health-insurance rip-off artists a license to change Medicare, to let this program for our seniors wither on the vine...
...Transferring Medicare patients to managed care may only “cut” the amenities of medicine...
...but it’s also true that managed-care medicine is less convenient, reassuring, and courteous (no small thing when you’re sitting on a table naked except for a smock) than the sort of medicine that Medicare patients are used to...
...That’s on top of the $8,800 per adult that Clinton is already planning to take in 2001—and the $7,100 per adult he took in 1996...
...But we won’t let them...

Vol. 1 • September 1996 • No. 50


 
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