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  • The President’s Medicare Plan: A Trojan Horse to Ration Health Care?

    Medicare, the federal health care program for America’s seniors, represents $30.8 trillion in long-term unfunded obligations. If Medicare’s runaway costs are not reined in, the program could cease to exist for future generations.

    The issue is not whether Medicare costs should be controlled but how. Congress can pursue one of two routes: (1) It can change the structure and culture of Medicare to empower patients to make health care decisions in order to achieve the best value, forcing plans and providers to compete for their dollars, or (2) it can further empower bureaucracy to impose top-down controls on the costs of services. This can indeed reduce spending, but it guarantees a simultaneous reduction in the quality of health care Americans enjoy today.

    The first is the path taken by Budget Committee Chairman Paul Ryan (R–WI) in his fiscal year 2012 budget proposal. Heritage’s Robert Moffit and James Capretta write that a premium support system like the one proposed by Ryan would:

    …give Medicare patients control over the flow of dollars and freedom to make decisions about how they access medical services. This will stimulate intense market competition among plans and providers, control costs, and promote rapid innovation and higher productivity through the efficient delivery of quality care, thus guaranteeing value in return for retiree premiums and taxpayer dollars.

    Last week, President Obama embraced the alternative: toughen up the bureaucracy and ratchet down Medicare payment to doctors and hospitals. The President described strengthening the Independent Payment Advisory Board (IPAB), a 15-member board of unelected officials created under Obamacare to rein in the cost of Medicare.

    Under Obamacare, the board can tweak Medicare to hold growth in spending beneath its target, mainly by making cuts to provider reimbursement rates. Reducing provider payments means reduced senior access to physicians, another form of rationing of health care that already occurs to some extent in Medicare today.

    Strengthening IPAB could have even more alarming consequences. The President suggested further reducing the growth rate target IPAB would act to achieve. The White House would “give IPAB additional tools to improve the quality of care while reducing costs, including allowing it to promote value-based benefit designs that promote proven services like prevention without shifting costs to seniors.” In addition, it would “give IPAB additional enforcement mechanisms such as an automatic sequester as a backstop for IPAB, Congress, and the Secretary of Health and Human Services.”

    The consequences of a strengthened IPAB would be far-reaching. In today’s Wall Street Journal, British physician Anthony Daniels outlines why focus on prevention will be unsuccessful at addressing Medicare’s fiscal problem based on his experience with Britain’s National Health Service. Furthermore, while cutting physician salaries would enable the board to contain costs by restricting access to care, allowing it to make benefit and coverage determinations in the name of “value” would require the use of comparative effectiveness research and cost-effectiveness information in ways that Americans would find objectionable. Obamacare already provides important tools for rationing through its creation of the Patient-Centered Outcomes Research Institute. The President’s proposal would give IPAB the power to put the hammer to the nail.

    The track record of top-down cost containment in Medicare isn’t politically attractive, evidenced by Congress’s continued delay of the formula-driven cuts to physician payments. These are already prescribed in law by the Medicare “sustainable growth rate” (SGR) formula. Not only would empowering IPAB hurt the quality of health care in the United States and the autonomy of doctors and patients, but, if the standard political response is the same as the SGR, it would also be unsuccessful at reversing Medicare’s looming insolvency.

    The President’s answer to Ryan’s proposal to reduce the deficit hardly represents a credible strategy. It falls far short of what is needed to rein in health care costs and restore sustainability in Medicare. Meanwhile, the consequences of such a policy for patients would likely be reduced access to care, thus introducing the kind of health care rationing that Americans fear. The way to avoid such an outcome is to repeal the IPAB and the rest of Obamacare and then to pursue consumer-driven reforms that put patients, not bureaucrats, in charge.

    Read more about why the IPAB falls short of real Medicare reform here.

    Posted in Obamacare [slideshow_deploy]

    36 Responses to The President’s Medicare Plan: A Trojan Horse to Ration Health Care?

    1. Richard says:

      You show your cards–"Obamacare". As the wolf smiles through grandma's bonnet. Come here, I have some candy for you,,,,,not!!!

      Raise the cap's. Big deal. Pay for a civilized society. Roads, armies, civil order, etc.. Civilization has a price. Isn't that the real issue? Or should we move backwards to benefit those who have already? Let's be humane here.

      To many people getting paid to vote. Bottom line. That's the bigger issue.

    2. kevin, foresthill CA says:

      to be honest…..anyone that has ever recieved care through medicare or medicaid knows that it is a very limited form of insurance (I know i have recieved it in the past). Many doctors won't give you the time of day once they find out your on medicare (or medicaid), and the quality of care from the doctors that will see you is greatly deminished. Many times it is the "not so great" doctors that see people with medicare because the good doctors are too full with patients and do not want to take a partial payment for the same procedure that they can get a full payment for…….and you cannot blame the doctors. At what point would the average person want to work for half pay or for free? If you could save a life then you probably would…..but what if everyday, multiple times a day it was life threating? would you spend the rest of your life making half of what you worked to earn? Who pays for the huge college loan if you only make half of the money you anticipated to make? Medicare and Medicaid have been broken for a long time and paul Ryans plan to put people onto a private insurance at least gives them the chance to have health care that is equal to the health care the average person has.

    3. kevin, foresthill CA says:

      I also was wondering when Barak Obama was on Medicare…..Why isn't someone that spent a long time with children or medical problems, that has had medicare for a long period of time (say atleast 5 years), been asked how well Medicare (or medicaid) has worked for them. I have had private insurance for most of my adult life and the little time i spent with medicare was horrible. What about those who have dealt with it for a long time…. that have private insurance now? Ask anyone of them if they had the choice of whether they want medicare (or medicaid) or would they like a private insurance policy……..I know what their answer would be. Why hasn't our president even acknowledged that …..? I think he has picked a battle that he thinks he is going to win, but ironically since he knows little to nothing about the subject……..it has only made him look like a bumbling fool. Maybe if he actually spoke to the public (instead of giving lectures and speeches) he would know a little more about the average american and the needs of the american citizens.

    4. bill hammett says:

      Absolutely fantastic article. This clearly lays out why the IPAB is very dangerous and why we must radically change how we view Medicare. A total shift in our approach to HC reform is critical if we want to continue to lead the world in medical innovation.

    5. George Colgrove VA says:

      Medicare and Medicaid (MC/MC)- as with nearly all domestic spending is based on ideals implemented by a single mindset – that being the federal workforce.

      Private sector relies on PROFIT as the motivator of innovation, efficiency and effectiveness within services provided. The federal workforce would be negatively hit if they were met eye to eye with innovation, efficiency and effectiveness. Due to most federal workers being education only on how to make policies and write budgets (i.e. MPA's) they have no clue about the effect of their over burdensome regulations and requirements their programs have on the country. They choose to "work" for the federal government for the high pay and out of this world benefits first, but then they lay out the excuse that they want to make a change and have decision making capabilities.

      Yet with the thousands of new feds who show up in the massively growing federal workforce, nothing ever changes. It just seems to get more expensive and less efficient. MC/MC were supposed to be a safety net for the poor – so that they would get medical care even if they had no money. The problem was and is, through government obfuscations, we were and are being led to think the poor could never get healthcare. Hospitals have always allowed the poor to enter their doors and get the needed assistance. There have always been private organizations, churches and others who have provided very cost effective healthcare to the poor through donations and trust funds and volunteership. MC/MC now has become the single largest line item on a national budget ($756 – or roughly the entire DoD Budget – core & war) that is covered by 46% debt.

      This country is broke – we have passed the point where there is no more money. The federal workforce and their acultic belief in Keynesian economics have done all that can be done to utilize that theory to grow the economy – only to fail generations. Federal spending has only awarded federal workers with excessively high compensation packages and the nation – a massive national debt.

      I agree with Ryan’s ideal with Medicare – it has to be privatized. It takes at least 2 federal workers to do a job that in the private sector would take one. Federal workers get compensated twice the amount of their counterparts in the private sector on average. By moving ALL customer driven occupations from the federal government to the private sector will provide a savings of 75% of the current administrative costs. With competing companies, savings will come from innovation. By eliminating government altogether and allowing the health care industry to self-regulate, cost savings will become more evident.

      I also contend that all employers should get out of the benefits business. Right now due to the federalization of all that is America, we have hundreds of thousands of redundant HR departments throughout corporate America as well as in government. The feds alone have over 100 redundant HR departments in every agency, and department and in programs where they employ large number of feds. Private sector employees and public workers should be able to go to a Main Street benefits broker to package their own set of targeted benefits – for which the employer would pay a portion of – depending on the employment negotiations. This would greatly enhance competition for health care insurance which would dramatically lower the prices. By eliminating government regulations and price controls, the health care providers would start charging lower prices. Knowing they will no longer have targeted audiences for corporate and government group plans, they will need to compete for customers which will also drive down prices.

      The point is, the more we put healthcare in the private sector with no government intervention, access to healthcare will only increase for all – poor and rich. Where a federal worker will say they want to make a difference, they really just want the big paycheck they put only 8 hours in for. For all the 2.7 million federal workers with hundreds of thousands entering the federal government in recent years, we are still running these inefficient systems as if we were in the 50’s. There has been no positive change provided by feds. Their regulations are killing the healthcare industry day by day. Doctors, nurses, hospital administrators and so on truly want to make a difference and are. They work ungodly hours for very low pay. Yes some doctors do make large sums of cash, but they tirelessly work nearly 24/7 saving actual lives – give them a break. They are not bureaucrats preventing American from living rich lives. If I had to put my dollars somewhere, I would rather have them go to a Doctor – who adds to life – and allow them to own a mansion rather than have a federal bureaucrat – who takes from life – own one.

      The only way to solve the healthcare crisis (which started when government took it over) is to get the federal government far away from it. No regulations, no cost controls – no involvement – zip-zero-nada! Send the feds home and close down and sell off the buildings. The feds have been the root of the healthcare costs skyrocketing.

      Other nice factors we could also add to make healthcare more affordable is to allow health insurance to cross state borders; put serious controls over lawsuits and require American citizenship for all healthcare provided with any public funds, be it taxed, volunteered or donated.

      The private sector will continue to make healthcare available for the poor through the many ways it currently does. With less money being taxes, more people will donate time and money for the poor. NO NOT EVERYONE – not the point. Not everyone has to be generous – we just want more people to have the resources to be.

    6. Jeremy, MI says:

      Another great analysis of the Medicare aspect of "The Path to Prosperity!" This is real analysis and, dare I say, journalism that we simply do not get in the mainstream media. As far as the media is concerned, Rep. Ryan's plan is to let seniors and the poor die. When you peel back the fold, one would conclude that having insurance companies compete for taxpayer dollars will benefit the patient, and, reducing the deficit will keep our economy on a sustainable path. My question is, who wouldn't want that?

    7. Kevin H, college par says:

      What is Chairman Ryan's plan for Medicare? It's to push costs onto the backs of seniors, causing seniors to pay 2 to 3 times more in out of pockets and premium costs. The vouchers will continue to provide less and less value and seniors will pay more and more. Ryan's plan contains nothing to slow the growth of health care costs, it just shifts the costs on the backs of Americans. At least the Democrats are looking to slow the growth of health care, which is the real problem that needs to be addresses.

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    9. Gwendolyn, North Car says:

      Obama is simply implementing one more step in his plan to bankrupt America. The object is to strip us of our freedoms entirely in the end, allowing for a Dictatorship to take over. Scrub away the cobwebs, and see the truth.

      • Sandy says:

        You, Gwendolyn, are right on the mark! I am happy to see that someone else understands what this Obama characor is doing. Most people have forgotten Obama's mentor "rev. White" who said "not god bless America but God damn America" ..does anyone understand what he means? I do and evidently you do too! Thank you for being an alert citizizen and for thinking!!

    10. Dave Miller - Chelse says:

      Where in your American upbringing were you taught that American Citizens should be addicted to the public-dole? When were you taught that public dependencies are to be sought?

      Ryan's plan seems to begin the transition back to when Americans were self-sufficient and responsible for their own actions and outcomes. America is a meritocracy, not a social democracy – although if you prefer that form of Government and economic outcomes, there are plenty of Nations in the EU that might welcome you to their plight of unsustainable social programs bankrupting their nations.

      How about we defend the need for people to work and save for their own futures and to be free of Government interventions into every aspect of our lives. You know, hold the Federal Government to providing that which is required under the Constitution versus an on-going attempt to take over larger pieces of our economy and freedoms – THAT would be a good outcome.

    11. Brad, Detroit, MI says:

      Kevin H – Stop reading Ezra Klein's propoganda.

      Ask Woodrow Wilson how price controls worked out for him. That is all we are talking about here. As soon as you limit the supply of something – in this case – medical care dollars – you only have 2 choices. 1 – Lower the cost of the product ; 2 – Limit supply (Restrict access to the product). Any thinking human being knows that choice #1 is not going to happen. When has the cost of health care gone down in the last 50 years ? So, you are left with limiting access – also known as rationing. Ask Great Britain and Canada how that's been working out for them . . .

      If you let medical procedures compete on a true open market, costs WILL go down. One example – Lasik eye surgery. Why do liberals insist that more government is the answer ? Do you really trust politicians ? Seriously ?

    12. Nickolas L. MN says:

      Chairman Ryan's plan for medicare is to offer essentially the same plan that congress receives to seniors. Shoving RESPONSIBILITY back to where it belongs, the backs of Americans.

      How does the Democrat plan of increasing the tax/debt burden of the country help to not shift the costs on to the backs of Americans? The real problem that needs to be addressed are the people that think that there is no real cost to government sponsored programs. The Democrat plan does nothing to actually fix the source of the illness, just keeps treating the symptoms by throwing money at them.

      Money that I work for. Money that I need to support my family. Call it greed if you want, my kids come first, and anyone who says differently is a liar.

    13. garettc, Louisville, says:

      Congressman Ryan's proposal gives $15,000 in todays dollars to purchase healthcare insurance. That is wuite a high quality insurance. IF you want gold plated care, then start early and pay into a supplemental policy. Seniors, those 55 and above, will not be affected ata ll. They get medicare or Medicaid as they do now, unaffected. Let's be blunt, Medicare is not great care, it is the bare minimum. Under the Democrat plan, there will be no new effciencies, just more and more rationing. Check out what happens in the UK. that is your future. So go ahead and resist; it makes the problem worse for you in the long run.

    14. Corky, Howey in the says:

      I am in the VA and I am here to tell you it is Government run Healthcare and it sucks! It took me 9 months to get in to get my eyes cheched. I have cataracts and it's an 8 month waiting period for surgery. I will not be able to see by then and the doctor says they can't get surgeons…go figure, This my friends is what obama care is like………………….

    15. Carol,AZ says:

      Thank you H.F , for the forensic in this article.

      To pay for every American dollar (we, the Gov.) spends, we now borrow, 40 cents against every dollar.

      Added to that, interest on 14. trillion dollars of debt.

      Once again no one, really addresses the deep pockets of the fraud that already exist in all Medicare/Medicaid programs under the reality of costs, that our Gov. admits exist.

      Think , think, about adding all the illegal population living here, legally added, by a stroke of a Gov. pen with full inpunity, by our own government called "universal health care."

      This atomomatic legal action will force all of us, to pay for, under this blanket of care, all costs, adding billions more, we now, already pay for, over this issue.

      Employers who hire any work force that are here illegally are responsible for these costs. But we all know that these company's , refuse to pay for health care under these conditons and the Gov. has given them a blank check passed on to all of US.

      All of us must be brain dead to allow our own Government to force all us to pay-for these added costs.

      I feel like , My fellow Americans come first, on all issue of health care. Our Gov. does not.

      Naturally health care will be rationed.

      It already is.

      This has been pointed out by most comments above.

      Most Doctors will not take Medicare clients where I live.

      The stellar example of health run amusk already in place, is the State, of MA.

      Few people speak about this openingly.

      It's a fiscal mess and the cost of doing Buss in over- runs cost, is breaking the bank in MA. passed on to the citizens of MA.

      Project that on a National scale, added to a 14 trillion debt we carry in America.

      We can certainly look forward to becoming a third world country as we head down this fisal road toward perdition.

      The Trajon Horse is the largest segment of our population needing (Medicare), the baby boomers.

      That's the Trajon Horse, few people realize will be taking the biggest hit.

      Obama keeps repeating that; "seniors that are now 55 years and older will see No change in care."

      Oh really?

      If you believe that America, I have some water front property to sell here in AZ. and "our borders have never been more secured."

    16. Norm CT says:

      In reply to Kevin H, who thinks Obama's plan is better for seniors. As a new retiree, I went from insurance I paid for to Medicare. My doctor used to write an annual prescription for a intestinal maintenance medication. Now, (I'm sure because they get paid much less under Medicate) I receive a 6 month Rx and have to go in for 2nd office visit where an assistant just checks my weight and temp so I can get a renewal Rx for the rest of the year. Does less pay per visit require a 2nd visit to balance the Dr’s budget?

    17. Leon Lundquist, Dura says:

      Kathryn Nix, thanks. Might I add a Third Way to reduce the Cost of Medicare and Medicaide? How about we just Deregulate Medicine? Seems to me the costs of Healthcare 'necessarily skyrocketed' when the American Medical Association was 'taken over' by the card carrying Communists after McCarthy's efforts failed. I know, it is awfully hateful for me to say it, but the AMA actually was overrun by Communists! The AMA got so bad that the Doctors abandoned it! Too bad the Government still uses their ideas (nobody else will.) Medical History says that the true reason for out of control Health Care Costs is that the Patients now pay more in Administrative Costs than we do for actual Medicine!

      Deregulate Medicine! Stop the waste at its source, the insistance by the Government that Doctors become scarce! The insistance by Government that Medical Schools become scarce! The point is, Obama wants American Medicine to fail, but it just won't go down like it is supposed to! They didn't pay the Doctors! (The Doc Fix!) They cut Medicare! They forced Urban Violence costs to be borne by the Emergency Rooms! They forced Hospitals to pay for millions of Illegal Emmigrants! It still would not go down! So, they wrecked the Medical Insurance Industry with Obamacare!

      I'm serious! We have enough Lawyers to keep the Doctors in line! Just Deregulate Medicine, let the Doctors have their heads! Let our Doctors have Free Enterprise! And, like you say, repeal IPAB and Obamacare! I think it should be known that the Health Care 'take over' had the Government duplicating all the Research in "Standards and Practices" and passing that expense onto the Medical Consumer! Now wait a cotton pickin' minute there, 'Precedent' Obama! Medicine has already 'necessarily skyrocketed!' What? You are going to make Medical Costs skyrocket again? This brings new meaning to the CNA talking point, "It is all about the poo!" To all Certified Nursing Assistants, you were right! It IS all about the Poo!

    18. Lloyd Scallan (New O says:

      Sara Palin said it more than a year ago, "death panels". Like so many other facts that conservatives knew, this is just one more that Obama and his lackeys

      in the main stream media crucified her and anyone else that exposed their hidden aganda. Don't you get it yet? This is Obama!

      • P Woolfork says:

        Sarah Palin wass right, Obama care is a death panel. I am faced with this situation right now. No care
        for elderly over 70, even though I pay for a policy additional beyond medicare over 300.00 a month.

        watch out American. It is a purging of the sick and the old to finance their own agendas.

    19. Anne C says:

      There is no question that cuts need to be made. The only question is where. I don't know of safeguarding against fraud and other health care waste is enough to bring down health care costs and sustain the system enough to provide comprehensive medical services. Either way, through Obamacare or Ryan plan, the old and the sick will have easier access to health care but the problem will be with the services they can get.

      Anne C

      NY Health Insurer

    20. Kevin H, college par says:

      Brad, though i don't ready Ezra Klein, i can only presume he has far less propoganda on his posts than this blog, but i will try to check it out more often.

      The fact is simple, and Ryan himself does not deny it, his voucher will lose value over time and seniors will have to pay 2 to 3 times more – and that is not decades down the road, that is 10 years. There is no denying the fact that Ryan's plan shifts costs to seniors. Look at the CBO reports. Read them. 65 and 66 year olds will be paying nearly triple for out of pocket and premium. His plan does absolutely zero to slow the growth of health care costs. Nothing. That is not leadership. At least the health reform bill put in mechanisms to test different provisions to see what does, if anything, bend the cost of health care downward.

      In essence, Ryan's plan now has a death tax, where seniors will haev to pay far more for end of life coverage. But when it comes down to it, it does not matter, Ryan's proposal will go nowhere, as everything else the far right has gotten passed in the House. They are just wasting time when they should be working on jobs, and loading up Dems and Obama with ammo due to the horrible policies they are passing.

      Liberals do not insist that government is the answer, but my liberal self wants to see the government compete with private insurers. I'm not sure why you are so trusting of corporate CEOs – do they have a record of always standing with the consumers? With politicians, you can throw them out of there. With CEOs, as long as they keep producing profits, they stay in.

      I suggest you stop reading blogs with opinions and read the more factual CBO responses to Ryan.

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    22. Linda, Somerset, TX says:

      "Where in your American upbringing were you taught that American Citizens should be addicted to the public-dole? When were you taught that public dependencies are to be sought?"

      1. Medicare and Social Security are NOT the public dole. They were paid for by the working people. It is not our fault that the politicians robbed both funds, the most recent being Nancy Pelosi's and and the liberals in congress taking 500,000,000,000 and placing it aside for Obamacare!

      2. While this was going on, the seniors had MORE money deducted from their social security checks for medicare (yes, medicare is deducted, all except part A which is hospitalization and has a HUGE deductible).

      3. If a couple makes a gross, not net, but $35,000 combined a year or more (this concerns retirement funds, one of the couple being on social security and the other still working) they must pay Federal Income Tax on the social security payment.

      4. Oh, and also let us not forget what has happened since the dems took over both houses of representatives while President Bush was in office:

      Cost of living increases for Social Security

      2007: 2.7% (averaged about $20 a month increase)

      2008 5.4% (it was an election year)

      2009 none

      2010 none

      Now, given the increases in gas, food, etc. these politicians bailed out hanks and corporations (and don't blame TARP on president Bush, as he consulted BOTH candidates and BOTH of which approved the bails out), you can see above that the seniors and disabled were left out in the cold!

      Check the voting record on the bail outs while you at it. You'll be surprised who voted FOR them, Congressman Paul Ryan being one of them. Oh, and you want to hear an even greater irony? Congressmen Ryan's college attendance was paid for by the Social Security survivors fund.

      Ain't politics just grand? Now, I will say this one last time. Social Security and Medicare are not a 'dole' or an 'entitlement.' but were paid for by working people and which the funds were stolen by our elected officials. The deduction from your check is not called FICA (Federal Insurance Contributions Act) for nothing. If you paid YOUR insurance and when it came time for you to file a claim and you were told, "So sorry, we spent that money on something else," how would YOU feel if you complained and were told you were looking for a handout or 'on the dole." That clear things up a bit?

    23. Joan, New Mexico says:

      According to the Health Care Economist only 13% of medicare expenditure is used for physician fees and yet further fee cutting is the thrust of all CMS bureaucratic activity.Hospitals, Administrative fees and "other" mostly non medical care expenses count for most of Medicare expenditure. The current administration aims to wade further into the quick sand by expanding the bureaucracy in order to further "control" physician fees. the NEJM reports that the data from the five year trial for ACOs shows that they are a failure and financial quagmire for participants.Yet, in the face of this data, ACOs will be in full force in January 2012. If the doctors were paid nothing, the bloated monster which is Medicare and its well paid administrators and unforeseen economic complications(due to their faulty decsion making) would continue to bankrupt the economy. If you want to control the economic fallout, seriiously support the Ryan plan and end the bureaucratic madness.

    24. George Colgrove VA says:

      Keven,

      The CBO is fact-challenged. It is populated by federal workers who for the most part are also fact-challenged. They report to the O-man. They lied to us about O-Care and then graciously provided corrections after the election.

      I strongly believe in enterpises that employ MBA's that can provide management that makes money, unlike the federal workforce that plunges the bation into annual deficits over a trillion – anually.

      Competition wit the federal workforce when they have the power to shut down the competition is not a fair playing ground. Also, Rush Limbaugh brought up the point, the federal workforce is not taxed like Blu Cross Blue Sheild is. Timeto end federal programs. Either send these programs back to the states or back to the private sector where they belong.

      Te feds duties are as follows in order of importance:

      1) Restore the dollar

      2) reduce the natioanl debt

      3) a lean and mean defense dedicated on protecting America

      4) International affairs

      5) A fully transparent treasury

    25. Betty D, East Moline says:

      Some doctors in my area have started refusing to take new Medicare patients because of the threat of reducing their fees. I encountered this personally when I needed to see a specialist who refuses to accept new Medicare patients. My family doctor said this is happening more and more frequently, especially with specialists. Medicare pays a little over 50% of the fees healthcare providers charge in my area. A friend who owns a small medical facility says she could not stay in business if all of her patients were on Medicare.

      Under Obama's plan the number of health providers who refuse to see new Medicare patients will increase significantly. That will leave seniors fewer healthcare providers to choose from, longer waits, and reduce the quality of healthcare. Let's start by targeting Medicare fraud. Then let "the marketplace pursue consumer-driven reforms that put patients, not bureaucrats, in charge."

      We voters understand that our country is on the brink of financial ruin unless there are dramatic cuts in spending. The old, retread scare tactics no longer work.

    26. Linda, Somerset, TX says:

      Dave Miller – Chelsea, MI on April 19th, 2011 at 11:42am said:

      "Where in your American upbringing were you taught that American Citizens should be addicted to the public-dole? When were you taught that public dependencies are to be sought?"

      Oh my gosh, Dave, you are so very well…..UNINFORMED!!!!

      Social Security and Medicare are not 'entitlements' or, as many put it, 'on the dole.' Those words nauseate me to no end, and I've read those terms at the Heritage Foundation and at the 912 network (which I have now permanently left due to the ignorance of people like you.)

      .

      I happen to be a conservative American and am disabled after working 2 and sometimes even 3 jobs to support myself and my 4 children. I did this because it was my job, not the governments, to do so. 7 years after remarried to my now husband of 20 years, I began to have severe migraines 3 or more times a week (in my case, a genetic disorder; 2 of my grandkids started having them at age 4) and was forced to quit my job (I've worked since I was 16 years old) due to my severe ill health. It took my husband 3 months to talk me into even applying for SS Disability, and based on my long medical record, I was approved 1st time. It has since been determined I have multiple disabilities, some caused by overworking myself earlier in my life.

      Let me tell you something, Dave, I HATE not being able to work! HATE it!!! Now, to add salt into the wound, I am reading the above comments from people like you who are CLUELESS as to what Social Security paycheck taxes are for. You all know that Social Security and Medicare are all but bankrupt, due to politicians robbing both the SS and Medicare funds (try 500 billion by congress under Nancy Pelosi to fund ObamaCare). What you do NOT realize is that;

      #1. Seniors and the disabled have Medicare taken out of their SS payment (with the exception of Part A) just like working citizens have deductions taken from their pay and;

      #2, for the past 2 years, those on SS and SSD have received no cost of living increase and yet MORE is being deducted for Medicare and it covers LESS. Oh, yes, and since my husband works, I pay Federal Income Tax on my SSD payments; any couple receiving a combined GROSS yearly income of $35,000 a year MUST pay taxes on the SS or SSD. You can fact check this at http://www.ssa.gov.

      I am NOT on Medicare because my husband has me covered by his job (he pays out the wazoo and his workplace pays a small amount) and I have refused to go on Medicare because since my husband's insurance covers me, it would feel like I'm stealing from the government.

      Let me put this in terms everyone can understand. When you see the initials FICA and next to it a deduction on your paycheck, that is the deduction for Social Security. The initials FICA stand for "Federal Insurance Contributions Act", emphasis on "Insurance".

      Now let's say you've been paying regular insurance payments on your car or house, and something happens and you need to make a claim, but when you call, you are told, "Oh, gee, sorry, we know you paid your premiums, but we had to use that money for something else, so too bad, we're not going to be paying you anything (which is what would have happened to AIG customers if they hadn't been bailed out)." Then some well meaning person said, "Well, gee, I have that insurance too and you're looking for a handout because you'd be taking my money if they paid you."

      I'm so sick of hearing over and over that I am doing the one thing I fought all my adulthood NOT to do, when it is not my fault that the politicians STOLE THE MONEY!!! Let them replace the money they stole instead of bailing out the banks, the insurance companies and GMC!!! Better yet, but the Medicare money BACK where it was stolen to fund ObamaCare, and the money that has not been spent be put BACK into the Social Security fund!

    27. Kevin H, college par says:

      George, It's odd that you would state that the CBO is fact-challenged, then cite Ruch Limbaugh. That pretty much sums up your comments. As much as you may not believe it, the CBO is the official score keeper of Congress. Go back through the last 12 months of Heritage papers and blogs and check out how many times they cite the CBO. You cannot only cite CBO when it backs up your argument.

      Really, those are your top 5 priorities for the federal government? Do you see that list in the Constitution?

    28. Bobbie says:

      Really Kevin, there you go again. Not considering all. We pray.

      With the dems deception, scare tactics and death threats falsely regarding the context of Paul Ryan’s plan (unfairly dumped on him due to the dereliction of government’s administration,) thoroughly put together and thoroughly thought through, is what obamacare is all about. Guess what? Obamacare is not forthright. Danger lurks in the 2000+, very inhumane. If Obama didn’t involve his “unconstitutional care” we wouldn’t be needlessly SACRIFICING NOW!

      The Ryan plan is the appropriate plan with true intellect and people will come to see it once they rise above the lies, exaggerations put on them from their elected officials and accept the truth and facts.

      What the heck do you expect, Kevin? Paul Ryan worked endlessly to fix the inept, corrupt mess of others outside his control. He earns his pay. Then he faces the derelict who doesn’t earn theirs/

      You and the like minded always predetermine the worst and most improbable scenarios if everyone is working together to make it work. As the democrats promote crisis who’s to say they wouldn’t go out of their way to carry out their threats they insist? Obama’s actions show his favor to see people sacrifice as Ryan’s plan avoids as much as possible. No thanks to the derelict. Again, we pray.

    29. George Colgrove VA says:

      Kevin H, college park, md

      I would never promote Obama's federal workforce that works in the CBO as being a source for anything. They have yet to be accurate and have yet to put out numbers that are not significantly "corrected" after the political event passes.

      Incidently the massive cuts that were made ($38 billion) to your sides massive complaints was corrected to be only $320 Million. How do you score them? If they are accurate then it looks like the very powerful federal workforce won out with virtually no cuts. That is the way I read those CBO numbers.

      In the end it is always the voters and taxpayers who lose out on every debate. Government always wins. In the end the entire country (government et.al.) will lose.

    30. Pingback: Political Rationing of Care for the Elderly—A Good Idea? « American Elephants

    31. Pingback: Pay-for-Performance in Medicare Could Do More Harm Than Good | The Foundry

    32. Donna, Georgia says:

      I don't understand why insurers would "compete" for seniors' premium dollars. The premium would have to be mighty high to make it profitable to insure the elderly. What would stop the private sector from jacking up premiums to the point that seniors couldn't afford it, even with the government subsidy?

    33. Donna D., Gainesvill says:

      I've always believed in the private sector over govt control. However, providing healthcare to seniors for a set premium is not a profitable venture. Why would the private sector compete for those premium dollars when the costs will outweigh the premiums?

      I'd really like to understand this. Please answer.

    34. Pingback: VIDEO: Ryan Goes on Offense, from the White House to the U.S. House | The Foundry

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