Tuesday, April 05, 2011

EDITORIAL >> Overhauling medical care

The Republican leadership of the U.S. House of Representatives unveiled its budget blueprint for the future Tuesday and it explains with very little detail how the party plans to reduce the deficit over the next decade. You can’t address the deficit without addressing health-care costs.

Are you ready? They are going to turn Medicare into what they have been calling “Obamacare,” except without the protections for patients.

The central tenet of the Patient Protection and Affordable Care Act of 2009, the part that Republicans are trying to stop in the courts, is a requirement that most people who are not insured buy a policy from an insurance company, with the government’s assistance if their family incomes fall between 133 and 400 percent of the federal poverty line. They will select a plan that suits them from an exchange—a market set up by the federal government or by the state where competing insurance companies will offer a variety of plans for businesses and individuals to choose from. Arkansans will have to shop in the national exchange because Republican lawmakers in Arkansas last week blocked the creation of a state exchange.

So here is how the new Republican plan, outlined by Rep. Paul Ryan, chairman of the House Budget Committee, would reform Medicare and bring down the deficit: When people reach 65 or become disabled, they will have to buy a medical and hospitalization policy from an insurance company, with generous help from the government, particularly if you are poor.

Medicare will not be there for you. You will select your plan from a national exchange and your dealings will be with the insurance company. It turns medical care for the elderly over to, not the government but the insurance industry. The federal subsidy, which Ryan calls a voucher, will go directly to the insurance company, which will determine what kinds and levels of care are reimbursable. If medical costs keep rising, the brave new Republican government will not be a party. The elderly patient will have to find a way to deal with them.

In other words, “Obamacare” without its regulation of the insurance companies to prevent profiteering and abuse of consumers and without the government guarantee that you will be cared for.

It will never be described that way, of course. They have invested too much in the campaign to convince people that the new health-insurance law will turn health care over to the government and shift Medicare costs to patients to tell them now that they are going to do to them what they had said Obama was doing to them.

But Ryan and the House leadership are too clever to arouse the alarms of the great army of the elderly that they frightened into opposition to the health law in 2009. So the new, improved Medicare will not apply to people who are on Medicare now or those who are approaching Medicare eligibility. Only people who are now 54 or younger will go into the new privatized Medicare starting in 2021 when they land on the Medicare rolls.

If the new Medicare is beneficial and economical, why shouldn’t it apply to everyone and right away, not just those who face it far into the future?

The logic is obvious. People who are at the point in their lives that they are concerned about the looming costs of medical treatment in their golden years need not be concerned. The Medicare they love will be there for them.

Younger people? They don’t worry about such things now or when they vote. When it comes time for them to worry about such things, they probably will be more than happy to shoulder the burden of balancing the budget.

Also, the insurance industry likes it a lot: tens of millions of new customers, all hand-delivered to them and generously subsidized to assure good profits.

The House Republicans also have a plan for stopping the growing cost of Medicaid, which pays for nursing-home care for the aged and disabled, institutional care for disabled children and adults, medical care for poor children and, starting in 2014, insurance for very poor adults in states like Arkansas. They are going to turn Medicaid over to the states, give them a fixed block grant and let the governors and state legislatures decide who to boot out of nursing homes and children’s colonies and how many children will lose medical insurance or else which state taxes to raise.

Our new congressman, Tim Griffin—actually all four Arkansas congressmen—condemned “Obamacare” last year. We assume that all of them except Mike Ross, the nominal Democrat from South Arkansas, are obliged to vote for the Budget Committee reforms.

We eagerly anticipate their explaining it.