Just The Facts, “Ma’am:” Medicare, The Ryan Plan, and Cost Control

Recently, an entire panel on “Meet the Press” chastised Democrats for truthfully describing the Ryan plan. Steve Benen, a contributing writer to the Washington Monthly, observed:

I’m at a loss to understand what, exactly, Ruth Marcus, David Brooks, and their cohorts would have Dems do. (1) Congressional Republicans have a plan to end Medicare and replace it with a privatized voucher scheme. The proposal would not only help rewrite the social contract, (2) it would also shift crushing costs onto the backs of seniors, freeing up money for tax breaks for the wealthy. The plan is needlessly cruel, and (3) any serious evaluation of the GOP’s arithmetic shows that the policy is a fraud.

Which part of this description is false?

None of it.

But apparently, Democrats just aren’t supposed to mention any of this.

Frankly, it’s a bit amazing that there’s any push back when the immense fallacies in the Ryan plan are revealed. After political points with niche-element, die-hard Tea Partiers were scored — and then especially after the loss of a traditionally Republican congressional seat in New York State to Dems in a special election last week — one would have expected the political leaders to move on and find a new GOP policy icon to worship.

Instead, Republican leaders have mostly dug in, like a tick… with lime disease… condemning anyone who points out that the plan is rubbish as unreasonably out of bounds.

Medicare Rethought

Moreover, reforms in Medicare payments under the Affordable Care Act — designed to achieve more cost-effective care — are drawing opposition from hospital groups. Robert Pair with the New York Times observes:

For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive.

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

The proposal seems like what needs to be done — after all, it’s the same basic formulary prescription conservatives have administered to school teachers… pay-for-performance, folks. Teachers can’t directly control what happens after a student leaves school and is guided by parents, family, and friends… neither can hospitals, as they’ve stated.

But so what? Teachers are still held accountable.

And for that matter, any business manager with a bonus program is also held accountable and bonused based upon variables over which they have little or no direct control.

I would expect hostility from hospitals directly impacted by such significant change. What’s amusing is that so many editorialists and commentators read about this resistance, pontificate about the difficulties in proper measurement of the metrics, and then wax poetically that President Obama and Democrats do nothing to limit the growth of health care costs.

Well folks, this is what cost control looks like.

  • Ryan’s plan to privatize Medicare with vouchers is just cost shifting (moving unrestrained excessive cost of care onto seniors).

  • Obamacare is the real deal… actual attempts to reform and reduce costs.

Time to give credit to Obama and Dems for actual effort at reform and cost containment.


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