Democrats ready to commit suicide? Senate health bill will slash $491 billion from Medicare

Seniors back Medicare overwhelmingly, as do non-seniors!

The official analysis of the Senate health care "reform" bill on which Majority Leader Harry Reid wants the first vote tomorrow is out from the non-partisan Congressional Budget Office. The most important number in this "scoring" of the bill is this: it will cut Medicare by a whopping $491 billion.

As was the case with the House bill, most of the public debate and media attention to the Senate version concerns the "public option," the total cost and new taxes proposed, and whether or not federal money will somehow wind up paying for abortions.

The huge Medicare cuts are still largely hidden from view, because Democrats don't want to talk about them and most Republicans talk about the cuts only by way of accusing Democrats of using budgetary flim-flim to make the bills appear "deficit neutral."

But these cuts are a very big deal. They will affect some 46 million current Medicare beneficiaries and millions more who are past 55 and beginning to worry about health care coverage in retirement. As the full impact of these cuts becomes clear to this reliably voting segment of the population, the backlash against any member of Congress foolish enough to vote for the bills will be fierce and merciless.

It's as if Democrats in Congress are prepared to commit political suicide. They have backed themselves into a corner where the failure to pass a bill -- any bill -- is viewed as a blow to President Obama and an affront to labor unions and other powerful constituencies that back the changes. In my view, the backlash will not only strike House "Blue Dogs" and Senate moderates who vote for the bills. It will hit liberal Democrats running in Democrat-friendly states and districts, as long as the GOP is smart and nimble enough to put up strong, appealing candidates. For example, New York's appointed junior Senator, Kirsten Gillibrand, may face Rudy Giuliani next year. If so, Rudy will not be shy about positioning himself as pro-senior and pro-Medicare, as Gillibrand tries to explain away her vote for some $500 billion in Medicare cuts.

That won't be easy, since the cuts will have a real and demonstrable negative impact, as the federal agency that administers Medicare reported a few days ago.

According to the CBO, these are the big blows to Medicare as we know it in the Senate bill:

• Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector to "save" $192 billion over 10 years.

• Cutting $118 billion from Medicare Advantage programs that now enroll more than 13 million seniors over the 2010–2019 period.

• Reducing Medicaid and Medicare payments to hospitals that serve a large number of low-income patients by $43 billion -- about $22 billion from Medicaid and $21 billion from Medicare.

In addition, the bill would create a new agency -- the Independent Medicare Advisory Board -- that would be required to "recommend changes to the Medicare program to [further] limit the rate of growth in that program’s spending. Those recommendations would go into effect automatically unless blocked by subsequent legislative action." In other words, a panel of bureacrats, not accountable to anyone, would propose further cutbacks in Medicare that Congress would not have to vote on and the President would not have to sign into law, thus insulating the politicians from blame for the cuts.

All in all, if the Democrats pass either the Senate or the House bill with cuts of this kind into law, they have to be crazy if they think they will avoid the wrath of the senior voters.

What do you think? Post a comment.

Senate to seniors: Screw you!

Harry Reid claims cutting $400 billion from Medicare makes it "stronger"

Senate Majority Leader Harry Reid finally rolled out his health care "floor" bill late Wednesday, and to no one's surprise, roughly half the claimed $838 billion cost over 10 years will be paid for by slashing more than $400 billion from Medicare.

Like the bill already approved by the House of Representatives, Reid's bill would gouge $118 billion from Medicare Advantage programs, which will virtually eliminate this popular managed care option chosen by some 13 million senior citizens. (How's that for keeping Obama's promise, "If you like your current insurance and your current doctor, you won't have to change"?)

Also like the House bill, the proposed cuts are presented as reductions in future cost increases. But commenting on the House version, a report issued a few days ago from the non-partisan Centers for Medicare and Medicaid Services (CMS), the agency that administers Medicare and Medicaid, confirmed that the cuts will reduce Medicare benefits and run a real risk of limiting seniors' access to care by reducing Medicare reimbursements to hospitals and doctors, driving up the numbers of providers who decline to accept Medicare patients. Now, Reid proposes that the Senate follow suit and screw seniors.

Of course, millions of seniors already have trouble finding primary care physicians in the midst of an acute shortage that will only get worse as the rolls of insured are expanded by the millions. And all too many top-notch specialists shun Medicare patients as it is. That's a big attraction of the Medicare Advantage programs that Congress wants to eliminate. They ensure access to a managed care network.

There is a lot of merit to the reform that Democrats are trying to push through. But there is nothing "progressive" about robbing Peter to pay Paul -- i.e., slashing Medicare in order to pay for fully half the cost of expanding coverage to others. Republicans are charging that the Medicare cuts will never be made, that it's all a sham to parade the bill as "deficit neutral," and that the Democratic Congress will keep deferring the cutbacks after the bill passes. Maybe, but for seniors, that would be betting their future care on the odd proposition that Reid, Nancy Pelosi and scores of other Democrats in Congress are all blatant liars. And what if the GOP retakes control of Congress by 2012? Republicans have been talking about curbing "entitlements" like Medicare and Medicaid for decades. Won't today's Democratic majorities have done their work for them?

What's your take on the Medicare cuts? Post a comment.

Fed report: House bill's $500 billion in Medicare cuts will reduce benefits and endanger access to care for seniors

Seniors: One super-voting bloc politicians mess with at their peril

For months now, it's been clear that the road to "deficit neutral" health care reform is a bumpy, maybe even dangerous, one for seniors. Ironically, in their zeal to extend health insurance to the roughly 40 million people who don't have any, President Obama and many Democrats in Congress appear ready to make deep cuts in Medicare, a program that is on the short list of the signal domestic accomplishments of the Democratic Party over the past 80 years, alongside Social Security, labor rights, and civil rights. What the 45 million seniors and people with disabilities who depend on Medicare are going to think about this remains unclear, although it's hard to see why they would embrace it with resignation.

A new report from the non-partisan Centers for Medicare and Medicaid Services (CMS), the agency that administers Medicare and Medicaid, has now confirmed the $500 billion in cuts in the House health care bill that passed a week ago will reduce Medicare benefits and run a real risk of limiting seniors' access to care. From the Washington Post:

A plan to slash more than $500 billion from future Medicare spending -- one of the biggest sources of funding for President Obama's proposed overhaul of the nation's health-care system -- would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.

The report, requested by House Republicans, found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.

Congress could intervene to avoid such an outcome, but "so doing would likely result in significantly smaller actual savings" than is currently projected, according to the analysis by the chief actuary for the agency that administers Medicare and Medicaid. That would wipe out a big chunk of the financing for the health-care reform package, which is projected to cost $1.05 trillion over the next decade.

More generally, the report questions whether the country's network of doctors and hospitals would be able to cope with the effects of a reform package expected to add more than 30 million people to the ranks of the insured, many of them through Medicaid, the public health program for the poor.

In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, "exacerbating existing access problems" in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services.

[snip]

In its most recent analysis of the House bill, the CBO noted that Medicare spending per beneficiary would have to grow at roughly half the rate it has over the past two decades to meet the measure's savings targets, a dramatic reduction that many budget and health policy experts consider unrealistic. [Emphasis added.]

Whatever bill Senate Majority Leader Harry Reid takes to the Senate floor this week will also have to rely on hundreds of billions of dollars in Medicare cuts to pay for it.

Most of the public debate about health care reform has focused on the issue of a public option and the overall cost, with the Medicare cuts usually mentioned only in passing. It wasn't long ago that more liberal Democrats were the fiercest defenders of of Medicare and Medicaid, as in 2007 when President Bush proposed cuts that were a fraction of those now approved by House Democrats. No more. Democrats want to pass a bill, so they are largely mum on this topic and talk only about generating "efficiencies" and tackling "abuses" in Medicare.

And the Republicans? Some Republicans may take it up as a talking point now and then, but the GOP's deep-seated objection to "entitlements" like Medicare and Medicaid eliminate them from serious contention as a defender of seniors in this case.

What about the supposed "seniors' lobby," AARP? It has thrown its support behind the House bill in a deal that will bring more customers to its lucrative insurance business.

So seniors are on their own. But here's the thing about that. Seniors -- and near-seniors -- are handily the most reliable group of voters. They may have to hobble on their canes to get to the polling place, but they do vote.

As early as last July, it was already noteworthy in many polls that opposition to health care reform was higher among seniors. That's still true -- but you ain't seen nothing yet. Assuming a bill that cuts $400-500 billion from Medicare is signed into law, the issue will no longer be hypothetical, or muddled by a constantly changing and confusing array of proposals, or hidden behind high-minded rhetoric and clever spin. When it becomes clear to seniors that their health insurance benefits actually have been reduced and that it's going to even harder to find a doctor who accepts Medicare patients (a growing number of physicians have already opted out of Medicare), anyone who voted for it is going to have a hard time convincing constituents over 60 that it's a good deal.

Anyway, it's not just about politics. What's so "progressive" about slashing health care benefits for tens of millions of older Americans -- a large majority of whom have low to moderate incomes -- to subsidize benefits for younger Americans, many of whom don't want insurance now and will resent being obligated to take on premium payments? Beats me.

What's your opinion? Post a comment.

Pelosi and House Democrats stick it to seniors with health care "reform" bill that will slash Medicare by $400 billion

Nancy Pelosi announces a bill to strip millions of seniors of their quality care

The House health care plan unveiled yesterday by Speaker Nancy Pelosi has a lot that is commendable in its 2000 pages. But it's not at all commendable that the bill, which will cost $894 billion over 10 years, is "deficit neutral" only because it slashes more than $400 billion from Medicare in that period. Senior citizens are to see a significant decrease in the accessibility and quality of their health care, in order to pay for nearly half the cost of extending coverage to others.

The Congressional Budget Office's scoring of H.R. 3962, the Affordable Health Care for America Act -- which might as well be named the Medicare Reduction Act -- cites these "savings" to be achieved in the Medicare program:

Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services), yielding budgetary savings of $229 billion over 10 years...

Setting payment rates in the Medicare Advantage program on the basis of Medicare spending per beneficiary in the fee-for-service sector and changing the way that payments to Medicare Advantage plans reflect differences in the health status of enrolees, yielding savings of an estimated $170 billion...over the 2010–2019 period.

The massive $229-billion reduction would drive hoards of doctors to refuse to participate in Medicare -- and there are already far too many who don't, due to reimbursement rates far below those of private health plans.

Oh, but Democrats are saying in stage whispers that no one should worry about the reduced fee-for-service payments, because they'll "fix" that in a separate bill. Of course, that makes the claim of deficit neutrality for H.R. 3962 duplicitous. But seniors also need to worry that the Democrats may not be able to keep their promise of a sly "fix." If the bill passes, as is, it becomes the law of the land, period. By the time that happens, who knows what the political environment will be like. How many people predicted early last summer that we'd be into November with no health care bill passed by either the House or the Senate? Seniors would be foolhardy in the extreme not to worry that H.R. 3962 will set the terms of their health care for a long time to come.

The Medicare Advantage plans from which $170 billion would be cut currently enroll 11 or 12 million seniors. These plans have been cast by Democrats as too generous to the insurance companies that offer them, because the companies get as much as 14% more from the feds than providers under the regular Medicare program. There are two things wrong with that argument: first, as indicated above, the regular Medicare reimbursement rates are lower than they should be to ensure that providers accept Medicare patients; and second, the whole point of the Advantage programs was to pay insurers more to induce them to offer managed-care (HMO) plans that would provide better overall quality of care for patients with multiple health problems, emphasize wellness and prevention, and eliminate the need for seniors to navigate through mountains of Part A, Part B and Part D insurance paper work. That's why a quarter of all Medicare enrolees prefer Advantage plans.

Anyway, didn't President Obama and other Democrats say over and over about health care reform that if you like your current plan and your current doctors, you won't have to change? Well, if this bill passes, Medicare Advantage plans will disappear and millions of seniors will be thrown into regular Medicare. Not incidentally, these millions will be chasing many of the same doctors and other providers who might opt out of Medicare anyway.

Medicare arguably is one of the signal achievements of the Democratic Party of the last 50 years. Why would Democrats want to eviscerate one of their great successes? Republicans may exploit the huge negative impact on Medicare of the House bill as a talking point -- but Republicans are not going to stand up for Medicare in the long run.

Democrats who support the House bill may think they can bob and weave around the issue of Medicare cuts and hope that seniors remain in the dark or confused about the impact of the bill (or distracted by minor additional benefits for Medicare recipients in the bill, such as an increase in drug coverage). If so, they would be wise to think again. Seniors are already well aware of the fact that they will get the short end of the stick under health care "reform." That's why only 36% of people over 65 support the proposal in a recent poll. Seniors are by far the most reliable voters. It will be tough to conceal the impact of the cuts when they actually happen, and seniors will be really, really pissed when they go to the polls.

What do you think? Post a comment.

Final act in health care reform drama: the seniors will decide

The health care "deciders" -- America's old folks

In a post four months ago, I wrote this:

Here is my prediction: seniors are not paying much attention to this whole issue now, because they have health insurance. In all likelihood, they also don't think Obama and a Democratic Congress will monkey with their coverage. When they start to pay attention, watch out on Capitol Hill, because these folks vote. I mean, they ALL vote.

Then, in a post one month ago, I added this:

Sure enough, polls show that seniors are the major group that is least supportive of the various health care reform schemes, and the steady erosion of Obama's public approval ratings is being driven in significant part by seniors.

And that was when seniors were just skeptical but -- what with all the smoke and mirrors surrounding multiple health care bills and Obama's serial speeches -- not yet really sure that Medicare benefits were going to be cut. Now the cat is out of the bag:

Congress' chief budget officer is contradicting President Barack Obama's oft-stated claim that seniors wouldn't see their Medicare benefits cut under a health care overhaul.

The head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, told senators Tuesday that seniors in Medicare's managed care plans would see reduced benefits under a bill in the Finance Committee.

The bill would cut payments to the Medicare Advantage plans by more than $100 billion over 10 years.

That's what the CBO chief had to say about just the $100 billion in cuts proposed for the popular Medicare Advantage plans. There is as much as another $400 billion in Medicate and Medicaid cuts being proposed (depending on which of the bills, which keep changing).

Folks, there is no way in hell that this Congress is going to pass a bill that relies on such huge cuts in Medicare. Only the safest Democrats could risk voting for something that will, as surely as the sun rises in the morning, rouse seniors to vote against them. The only thing worse for your reelection prospects is to cut Social Security benefits.

Mark my words: any final bill will have to be radically changed -- somehow -- to eliminate the Medicare cuts or it won't pass.

What are your thoughts? Post a comment.