Stanley Feld M.D.,FACP, MACE
“ Nine Republicans who had voted against cloture last week pivoted to produce a potentially veto-proof 69-30 vote in favor of linking another temporary physician-pay fix to Medicare Advantage (MA) modifications already passed in the House by a 355-59 margin.”
The answer is President Bush is committed to the transfer of Medicare to the healthcare insurance industry (privatization of Medicare). He is subsidizing the healthcare insurance industry through the Medicare Advantage program at the expense of physicians’ reimbursement and to the disadvantage of seniors. The reimbursement reductions are below cost. Seniors are one of the primary stakeholders in the healthcare system.
President Bush’s advisers have convinced him that he has to get rid of the Medicare entitlement program. Medicare was invented by the Democratic Party and initiated in 1965 by President Johnson. It has been pretty clear for a while that Medicare’s business model was faulty. It is predicted to result in a 100 trillion dollar deficit by the time today’s young children become eligible for Medicare at the present level of spending.Source: Social Security/Medicare Trustees Reports 2008. The Medicare payment structure is seriously flawed. The two biggest flaws are the DRG system and the payments to the healthcare insurance industry.
Rather than being innovative and repairing the healthcare system by, eliminating waste, inefficiencies, and adverse incentives in order to protect future seniors with guaranteed, effective healthcare coverage, President Bush and his administration have opted to subsidize the healthcare insurance industry, a very powerful secondary stakeholder in the healthcare system.
Unfortunately, Senator McCain is thinking like President Bush. He has pledged to eliminate entitlements. Senator Obama is focused on universal healthcare and a single party payer.Obama’s plan will simply expand the Medicare deficit and yield more profit for the healthcare industry. I have discussed constructive policies that are needed to change the paradigm of the healthcare system. Neither candidate has uttered a word about innovative solutions that provide hope for the healthcare system and the citizens using it.
President Bush is handing our healthcare system over the healthcare insurance industry. He is providing subsidies equal to at least three times the present cost of Medicare to the healthcare insurance industry to take the healthcare system off his hands.
“With the White House ideologically committed to protecting MA, the outcome of a veto struggle remains uncertain. Republican senators who changed their votes will be under heavy pressure from the administration to support a veto.”
President Bush’s veto was overridden on July 12, 2008 simply by constituent outcry once they understood the consequences of his actions. Much of the healthcare insurance companys’ profits come from Medicare Advantage (≈10 billion dollars per year).
“As the juggernaut for Medicare privatization, the PFFS plans have been staunchly supported by the Bush administration despite per beneficiary costs that are an estimated 17 percent higher than those of traditional Medicare.
Does anyone think this helps anyone except the healthcare insurance industry? The budgeted money is shifted from physicians’ reimbursement to a healthcare insurance industry subsidy. When President Bush’s veto is rejected he will be decreasing the healthcare insurance industrys’ profit from the Medicare Advantage program. I think he is afraid the healthcare insurance industry will be upset and not want to take over Medicare.
Before Medicare bankrupts the country, it must be reformed. However, this is not the way to do it. By putting the healthcare insurance companies in charge will lead to disaster. The way to do it is to provide incentives to the primary stakeholders, not punish them to the advantage of the secondary stakeholders.
President Bush has not even mentioned medical care outcomes and impacts (i.e., is the nation getting what you pay for?). This is the point when it comes to evaluating whether a program that transfers money from the public sector to the private sector will accomplish a public mission.
“All of the research says “NO.” Both types of MA plans provide no more care nor any better care than traditional Medicare does, in terms of health outcomes of seniors. There is no justification to continue this Medicare Advantage program, by any definition of “efficiency” or “effectiveness” that the “market-based” conservatives may use. The Congressional Budget Office points out; the current IME adjustment represents a double payment to MA plans, because Medicare’s fee-for-service hospital rates, on which MA benchmarks are partially based, already include an IME add-on.
President Bush has called himself a “compassionate conservative”. I think he is being an unthinking conservative bent on protecting the vested interests of secondary stakeholders and ignoring the perverse consequences to primary stakeholders…