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(photo: Leo Reynolds)
To make his Republican budget more politically palatable, Paul Ryan decided to go with an age-based “divide and conquer” strategy. He promised to keep Medicare intact for those currently on it and those above 55, and will only turn it into a privatized voucher program for those under 55.
The Third Way, with whom I rarely agree, does makes the interesting point that, in reality, Ryan’s plan doesn’t actually protect current seniors Medicare. With no new people joining traditional Medicare, its pool would steadily shrink, making doctors less willing to accept it.
The traditional Medicare plan, which covers three-fourths of today’s beneficiaries, relies on its huge size to keep costs down. Doctors and hospitals are not required to participate in it, but they have little choice if they wish to treat any seniors, who are the nation’s biggest health care consumers.
Fewer doctors would participate in the traditional Medicare plan if there were an alternative. The traditional plan pays physicians about 20% less than private health insurance plans. Today, that is essentially a discount for the large volume of Medicare patients. Under the Ryan budget, it would become a reason for doctors to leave the traditional plan.
Despite the promise that people on Medicare will have their current insurance protected under Ryan’s plan, as they got older, the quality of Medicare’s coverage would actually get much worse.
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I personally believe doctors and hospitals should be forced into accepting medicare as a “pay or don’t play” policy, if they want to be certified then they need to pay their dues which means caring for the elderly
Um, how would it(theoretically) affect those who are at 55?
I would be in real trouble if they cut my Medicare because I’m 77 and have a number of health care issues. Maybe I could get a job. s/
This is a great point, one that should be used against the voucher plan.
But, but, but, Obama was mean and not bipartisany with him!
Way to keep your powder dry there Nancy you Scyphozoan.
Nothing like embracing a deal cut to get Republicans on board without trying for a better deal.
But Jon, you’re not looking at this as Ryan does.
This would result in them dying faster, creating more savings for the US Government and more wealth for the doctors.
Glad that Obama called out that punk. I have been very critical of Obama and will continue to be but his speech yesterday was right on. Ryan is an unserious, math challenged, cruel, fraudulent, and irresponsible punk. And I think even the Republicans are going to get this very soon. Boehner is going to begin to see Ryan as a nuisance.
Putting the above aside, however, there is too much talk about how we pay and too little talk about what we pay and way. Health care, whether insured or not, is still too expensive. Let’s start by flooding the system with free medical school for doctors.
Dya think.
This is why Obama threw him a shout out. They’re like peas in a pod.
PARTS of his speech were right on but he’s still ceding the framing to the deficit peacocks and he’s still starting out “negotiating” so far to the right that we’re sure to wind up with some version of Ryan’s plan. And judging by his history, it will be something to the right of Ryan’s plan. One thing I’ve learned about Obama is that the disconnect between his words and his actions is profound and apparently irreconcilable.
I’ve long advocated a system for educating doctors along the lines of the military academies. The taxpayers foot the bill for medical school if the person agrees to spend x amount of years in areas underserved by MDs. The military academies get a 6 year obligation, why not the same or more for MDs? It prolly means a lower income from rural communities, etc, but they don’t have school loans to pay off and it lowers the number of MDs going into specialties, giving us more general practitioners.
Agree. The bigger the single buyers pool, the more pricing power it has. And if you chip away at that pool, it can lose pricing power until you get in a death spiral. Of course, that’s part of the argument for a mandate, no?
I can see Pelosi’s logic. If it’s true that they just got the Tea-GOP to let the 2011 budget through, but it only cost a half billion or so, take it rather than risk worse, she might argue, especially if you don’t trust the WH to protect your interests in a rematch. But the net numbers include billions more for wars at the expense of billions less for people who need it. And EPA took a real hit, as did health programs for women, children. It looks like a deal unless youre one of the victims.
Hope i die before i get old……OH…….CRAP.
I’m not sure what military trained doctors’ obligation to the armed forces is but I know a lot of military and ex military docs who have gone into very successful private practice. Seems like the system is already in place. It just needs to be expanded to include people who object to military service but still want to be physicians. The Pentagon, Republicans and Neolibs will hate the idea though. Anything that makes sense but might cut into their power base/profit….
Exactly my point. Pelosi’s “logic” in my opinion amounts to more surrender. After all, Pelosi and her relatives aren’t going to feel a thing.
So Obama’s solution to the health care crisis is the existing Independent Payment Advisory Board (IPAB), changing the rule that the existing board steps in at medical inflation greater than GDP plus 1% to GDP plus 0.5%. Got to like the IPAB – it can’t make recommendations that would ration health-care procedures, increase taxes, change Medicare benefits, or make the program more expensive for beneficiaries, but whatever it recommends becomes law if Congress approves and the presidents signs the bill, and if Congress does not act they become law, and in a new twist of separation of powers, they become law if Congress votes the recommendations down, but the president vetoes what Congress did, and Congress cannot override the veto.
So given what the IPAB can not recommend, what the heck can they recommend – well they can change the things Medicare pays for, what it pays to providers, and the program’s structure, and whatever else their creative minds can come up with. Somehow these are not rationing care! They are just not paying health service providers what was billed – so doctors, hospitals, and other providers – the medical establishment – want to toss the existing IPAB.
Should be interesting.
Meanwhile seasonally adjusted “initial” unemployment claims last week increased by 27,000 to 412,000 claims – whatever happen to jobs, jobs. jobs?
I get a kick out of Obama saying he could help bring down costs by negotiating drug prices with pharma. I guess he thinks we’ve already forgotten the sweet deal he gave them last year.
I think it’s 6 years but don’t quote me on it. I was thinking of something totally separate from the military. Get ‘em signed up in pre-med, just like the military, and go from there. A lot of MDs who go into the military do so to get through their internship and residency requirements, do the rest of their 6 years and bail.
LMAO! Frothy mixture FAIL!
I think it’s at least eight but definitely more than six post residency.
Sort of like how it works for airline pilots.
Could be. Most of my exposure to medical personnel was with Corpsmen. They can plug a bullet hole as well as anybody.
My last boss was an AF Urologist.
Jobs are off the political agenda.
Haven’t you heard, unemployment is “structural,” which is code for: it’s off the political agenda.
I answered your link of yesterday. If you didn’t catch it, I’ll search it out for you.
I had a pilonidal cyst removed at the Balboa Naval Hosp in San Diego by a Navy CAPT, the world’s leading proctologist at the time.
The military has some top notch doctors but also some ones that wouldn’t be qualified to work on animals. Had one give me a 24 hour “light duty” chit when I had pneumonia. I was supervising the airframes shop at the time. Shortly after seeing her, I passed out at my desk, Chief Casey called an ambulance and I spent the next couple of weeks in the hospital.
DeeCee is caught between a rock and a hard place when it comes to jobs. Nobody wants to create govt jobs for the unemployed while at the same time they don’t want to admit to the world that American corporations are unwilling to create jobs here.
It’s worse than that.
They don’t care about jobs.
Corp campaign contributions will get O elected regardless of the jobs situation.
With or without a proposal like Ryan’s, doctors already are leaving Medicare, and they’ll only leave it faster the more we impose price caps on them. — Unless, as some of you suggest, we attempt to “force” all doctors to accept Medicare patients at cut rates. Then we’ll just get fewer doctors.
Always the same fantasy about being able to control prices by fiat instead of by supply and demand.
I don’t think it’s that they don’t care about jobs. They take great care in not creating them. Creating jobs would lower their quarterly earnings statements and now that we’re seeing their profits rise 50-60% every year they’re not about to consider it. Most are now nothing more than importers but they’re not going to put up with tariffs or quotas or any such nonsense.
It’s even worse than that. They want unemployment to remain high for the same reason the Republicans did before 2010. The Dems are betting that the people will blame Congress and give Obama a pass as the sanest one in the race.
SD & Margaret,
Ding on both.
And take a gander at the USG’s real financial priority.
You can’t force doctors to accept patients, so the Ryan/Obama plan just means “let them eat cake.”
There are two bottlenecks that, if cleared, could greatly increase the number of US doctors without building a single new medical school. 1. Immigration code requires foreign doctors who train here to leave the US for at least two years before they apply for a work or immigration visa (which has motivated more than one marriage, an American spouse always gets you a green card). 2. Medical residents are actually paid by a little known government program called…Medicare. Congress put a cap on the number of resident slots in 1997 and hasn’t increased them since. Let’s see, IIRC, there are 16,000 US med school grads annually and 24,000 residency slots. Congress could get thousands of new doctors forthwith by giving automatic work visas to any foreign doc who finishes a US residency and could add tens of thousands to the pipeline by dramatically increasing residency slots that Medicare funds. Longer term, since residencies last so now, might as well save time on the front end by moving from 8 years total of college and med school to combined 6 year program like they have at UMKC. Of course the only organization with the leverage to make every med school move to a 6 year program is… oh you know the answer to that. :o)
Until 1973, it was an automatic rite of passage for male doctors to be drafted for a two year stint in the military. My uncle went to Korea to serve as a battalion medical officer (so few Army docs today, that billet is covered by Physician Assistants), his med school roommate was sent to the South Pole for a year by the Navy.
As I mentioned upthread, Medicare pays for all US medical residency programs, without which you can’t practice medicine or get hospital privileges. So Uncle Sam could bring back the functional equivalent of a doctor draft by use of its Spending power (and no, Congress doesn’t have to do anything).
Medicare could require as a condition for any US citizen to begin residency program the new doctor accept an Army Reserve direct commission (the disabled, veterans and, perhaps, females excepted). There’s nothing coercive about it. If you don’t like the military, you can always go teach high school biology. :o)
Military obligation are always for 8 years, but there’s no reason to make the newly minted captains actually go through the “knife and fork” direct commission school unless and until the Army calls them up to active duty.
I’m just so proud to see affirmative action holding up in the Republican
Party, when Ryan gets done what the Koch Brothers want. Does he get to play
Golf at their Country Club with Conni Rice, and John Bonner?
SouthernDragon, I would do this instantly were the opportunity offered to me. However, if it’s structured along the lines of the military, it’s likely to be age-limited, and some of my best physicians are physicians as a second career; my GP, for example, was a research chemist first. I know a lot of prospective physicians would jump on this, but question whether I’d be permitted to at my current age of 51, to say nothing of when I get older, despite the fact that I actively seek to be a GP and not a specialist.
I don’t think age limitation here is necessarily reasonable as current GPs retire and there are few coming out of the medical schools now to replace them. Let those who can and choose to do, do, regardless of age.
Paul Ryan is Ayn Rand’s revenge
Why draw the line with doctors?
Maybe we could do the same things with, say, teachers. If you want to get government funding for your teacher’s education (i.e. federally backed loans or other subsidies), then all you have to do is get drafted.
Or engineers? Many work on government-funded research or at schools that get federal funds for one purpose or another.
Seems a bit rash to me.
Don’t you understand? The theme here is that the government mandates that some careers are hereby in the national interest and thus, to have the “privelege” to serve in that capacity, one must make the sacrifice of low wages, or conscription, or both.
“Allowing” people to earn what the market dictates is heresy.