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Paul Ryan Will “End Medicare As We Know It


Stanley Feld M.D.,FACP,MACE


The battle cry of the Democratic Party in its opposition to Paul Ryan’s Medicare plan is “It Will End Medicare As We Know It.” 

If you are told a lie enough times it becomes the truth.

Paul Ryan’s plan will not end Medicare, as we know it for people over 55 years old. I do not know how many times Mr. Ryan Has to repeat his point.

Paul Ryan’s plan is not going to push grandma off the cliff.

President Obama’s Healthcare Reform Act and the Democratic Party have already “Ended Medicare As We Know It” in 2011. The changes in Medicare will only get greater when fully implemented in 2014.

How has “Medicare Ended As We Know It” under President Obama?

1.    President Obama’s Healthcare Reform Act cut $145 billion over 10 years from Medicare Advantage. The cuts start in 2012, at first slow and then build up yearly. Insurers are going to shift the burden of payment from government to beneficiaries in the form of fewer services and higher out-of-pocket costs. Insurers will then stop offering Medicare Advantage coverage.

In April, President Obama used another trick political move to appease seniors who have Medicare Advantage coverage. He is going to give a  $6.7 billion dollar bonus to above average Medicare Advantage plans. The bonus is only 4.6% of the total Medicare Advantage cut and will only be good until 2015. I wonder when he is going to realize that seniors are not stupid and another trick will not work to gain political favor. 

2.    Medicare deductibles have increased as has the cost of base premiums and means tested premiums for Medicare Part B. Medigap premiums have also increased. Nevertheless, the most recent Medicare trustees’ report declared the system is going be bankrupt in thirteen years, five years earlier than predicted last year. They have used the term unsustainable.         

3.     Tim Geithner explained  the reason the alarming update was the result of "technical changes in the economic assumptions underlying the projections."  "We were counting on our economic policies actually working”.                                                                                              

Richard Foster the Medicare actuary said this would happen before we saw the failure of President Obama’s economic policies.

Paul Krugman wrote an article entitled “ Medicare Is Sustainable In Its Current Form”. He then goes on to describe sustainable in its current form.

4.     “Medicare American-style is very open-ended, reluctant to say no to paying for medically dubious procedures, and also fails to make use of its pricing power over drugs and other items.”  Paul Krugman is saying government should say no to paying for government defined dubious procedure. The Democrats made that mistake in paying for “dubious procedures” with the Medicare entitlement program at the onset. Patients should decide on “dubious procedures” with government input and not government.

5.  "So Medicare will have to start saying no; it will have to provide incentives to move away from fee for service, and so on and so forth." My interpretation of this statement is government will have to start restricting access to care, interpret the value of care and pay providers a lump sum rather than fee for service for their services to patients.

6.     "But such changes would not mean a fundamental change in the way Medicare works". I do not get it. Paul Krugman’s statement means it changes Medicare as we know it, doesn’t it? Doesn’t Accountable Care Organizations mean it changes Medicare as we know it?

President Obama, America’s seniors are not stupid.

7.     "So this business about Medicare in its present form being unsustainable sounds wise but is actually a stupid slogan. The solution to the future of Medicare is Medicare should be smarter, less open-ended, but recognizably the same program.”  Republican politicians did not introduce the term unsustainable. The Congressional Budget Office and Medicare Actuaries and the Medicare Trustees introduced the term before Paul Ryan’s plan existed. Paul Krugman is incorrect.

The difference in philosophy between Republicans and Democrats is clear. Both sides are proposing to "end Medicare as we know it."  President Obama has done it already.

Paul Ryan and the Republicans are offering solutions to give individuals more control over their healthcare decisions. Paul Krugman and the Democrats are suggesting and implementing changes to give the government more control over individuals and their healthcare decisions.

Americans must understand the problems Medicare faces. They must see through the Democrats’ demagoguery.    

I believe my position is a libertarian position if labels are needed.  Only the consumer will solve our healthcare systems problems. Government must empower consumers to make choices about their health and healthcare. The government must give consumers control of there healthcare dollars. If the government did this it would generate competition for among stakeholders for consumers healthcare dollars. These actions would cleanse the dysfunction of the healthcare system rapidly.


The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.




  • Senior Planning NJ

    Interesting article, it really makes someone think. I always like to read thought provoking articles about things like this. Keep the great posts coming. Thanks again for sharing it with us.

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