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August 14, 2012


I just sent Senator Wyden an email. I hope he takes my advice.
"In a little over a year I'll be eligible for Medicare. I have zero desire to see Medicare converted into a voucher system to buy private insurance, like Paul Ryan and Mitt Romney want to have happen, and as House Republicans have voted for in their budget plan.

I'm disturbed that you are being used by Romney-Ryan to bolster their election chances. Tonight I wrote a blog post where I argue that you need to strongly come out in opposition to the voucher plan for Medicare -- not just issue press releases and tell reporters that you're angry at being used to tout Ryan's bipartisanship. See:


Get tough. Make ads for the Obama campaign. If you don't, you'll never forgive yourself if Romney wins the presidency, in part because he and Ryan were able to use you as a tool to plug their Medicare voucher plan.

Sincerely, Brian Hines"

Blogger Brian said:

"...Romney-Ryan being this country's next President and Vice-President, the scariest words I've written for a long time."

I would say:

"Obama-Biden continuing as this country's President and Vice-President, the scariest words I've written for a long time."

It is interesting, this chasm of perception..really weird if you think about it. It is like we are standing on an African plain looking at a creature ambling along. You are certain it is a cape buffalo. I am certain it is a zebra.

I say, "You need to have your eyes checked. Can't you see the stripes? They're plain as day and there are no horns."

You reply, "You need to have your eyes checked. There are no stripes and the horns are plain as day."

Then someone else comes along and says, "You're both blind as bats. That thing is a lion and it's coming this way to kill you. Run!"

I just cannot see any forthcoming difference in the general quality of life based upon the results of the upcoming presidential election. The tribulations we will experience, if any, are a lock regardless of who is in the Oval Office. The suspense will eventually kill me, I trust.

Brian, your central complaint (and Senator Wyden’s defense) against Romney’s bipartisanship linkage between Ryan and Wyden is that both the Ryan budget plan and the Romney-Ryan plan convert Medicare to a 100% voucher system. This is not true. It’s why you won’t see Wyden doing campaign ads for Obama.

Ryan’s 2012 budget plan (voted on in 2011) did call for converting Medicare to a 100% voucher system. This was the plan that Democrats said “ends Medicare as we know it.” To eliminate that key critique Ryan joined with Wyden to develop their Dec. 2011 Medicare plan that offered both the “voucher” option as well as the traditional fee for service option that exists today.

That dual option is how Ryan’s Medicare plan has been structured ever since. It was in the 2013 budget plan passed by the House on 3/29/12. It was in that same budget when rejected by Wyden and the Senate on 5/16/12 (along with four other budgets including Obama’s which was rejected 0-99 for the second year in a row). And the same Medicare dual option is built into the Romney plan. http://www.mittromney.com/issues/medicare

So while it’s true that Wyden didn’t co-sponsor the 2013 Ryan budget, he did co-develop with Ryan the Medicare aspects it contains. The reason he voted against Ryan’s 2013 budget was due in part to political pressure and in part to his opposition to its Medicaid provisions; in his words: “By block-granting Medicaid, they put at risk the most vulnerable seniors, the seniors who need nursing home care that is paid for by Medicaid, and since Medicaid is a Federal-State program, by block-granting it, we put at risk the most vulnerable seniors.” http://nbcpolitics.nbcnews.com/_news/2012/08/14/13279164-wydens-medicare-collaboration-with-ryan-puts-him-center-stage-for-2012?lite

In its attempt to scare seniors, Think Progress also tells untruths: TP claims that traditional Medicare will be negatively impacted when the 2023 “voucher” plan kicks in. They claim insurers will cherry pick the healthy applicants and dump less healthy applicants on traditional Medicare. http://thinkprogress.org/health/2012/08/14/690361/how-the-romneyryan-medicare-plan-would-affect-todays-seniors/

Not so, TP, the Ryan-Wyden plan prevents it: “Insurers would be able to sell coverage if they meet federal requirements designed to protect consumers. They would have to meet actuarial requirements, sell a program at least as comprehensive as traditional Medicare and agree to offer insurance to all seniors, regardless of age or health status — to prevent insurers from cherry picking the healthy and cheaper clients.” http://www.gumm.org/index.php?q=aHR0cDovL3d3dy5wb2xpdGljby5jb20vbmV3cy9zdG9yaWVzLzEyMTEvNzA0NTkuaHRtbA%3D%3D

Big Oil

DJ, you're probably right. This would explain the confusion in various news articles. Sometimes they say the Ryan plan would require Medicare recipients to buy a private insurance plan with a voucher; other time they say that seniors could choose between traditional Medicare and a voucher plan.

Like I said, I don't have much of a problem with the second approach. Choice is a good thing. And I suspect that the private plans wouldn't be able to successfully compete with the single-payer traditional Medicare plan, due to their higher administrative costs (assuming all plans offer the same benefits).

There's a lot of misinformation floating around. Like, the current Republican claim that Obama cut $700 billion from Medicare to fund Obamacare. Actually, Ryan's plan has the same "cuts." Which aren't really cuts, just projected reductions in the baseline rate of growth in Medicare spending.


Brian, confusion/misinformation regarding the $700B appears to be intentional.

The Republican claim that Obama cut $700B from Medicare to fund Obamacare is true. Those cuts, largely from Medicare Advantage, reduce services by and payments to insurance companies, hospitals, and home health care workers. The misinformation floating around is coming from Cutter and company… it’s her role to confuse the issue and she’s doing a bang up job of it. Thanks to Cutter reporters keep asking, “doesn’t the Ryan budget cut $700B as well?”

Yes – in fact it does – Obamacare forces it! Since Obamacare was signed into law on 3/23/2010 – any subsequent budget including Ryan’s must reflect that same $700B cut. Stephanie Cutter knows that wasn’t a Ryan choice – but she’s cynically trying to distract from the real debate – namely, what should be done with that money. Obama takes it from Medicare to spend on Obamacare, while the Ryan budget sets it aside to extend Medicare’s solvency.

The reason that’s important is because only by robbing Medicare (along with a number of other tricks including double counting and hiding the “Doc fix”) was the President able to put a healthcare bill in front of the CBO that they would score as revenue neutral or better. As Ryan said directly to the President about the CBO, “Their job is to score what is placed in front of them. And what has been placed in front of them is a bill that has been filled with gimmicks and smoke and mirrors.” Without the gimmicks Obamacare would have been scored with a $460B deficit the first 10 years and a $1.4T deficit the second 10 years.

Ryan knows the budget issues inside out and speaks to them better than Romney. And better than anyone in the room at the President’s Feb 2010 Bipartisan Meeting on Health Reform. You really have to see Ryan’s six minutes speaking there to understand the $700B matter (at the time it was $500B) as clearly as he explains it. He starts at the 08:30 mark and doesn’t mince words. (Favorite line: “Hiding spending does not reduce spending.”)


Big Oil

DJ, good try, but not quite... true.

The Affordable Care Act cuts $700 billion from payments to hospitals, insurance companies, and other providers. Benefits to Medicare enrollees aren't affected at all.

But here's the important part: the Affordable Care Act adds tens of millions of people to the insurance system. A trillion dollars in payments will be made to the same providers who are affected by the $700 billion in Medicare cuts.

So the providers will come out hundreds of billions ahead, as will the people who now have health insurance -- instead of being part of the "uncompensated care" pool who drive up costs for everybody else.

Also, it's bizarre that Romney/Ryan would criticize Obama for doing exactly what they say needs to be done: find savings in Medicare to keep the Medicare funding solvent. I can't believe Romney/Ryan want the government to keep spending as much as we are now on Medicare.

Obama and the Affordable Care Act are doing just what they should: producing savings in Medicare without cutting necessary health care benefits, while expanding insurance coverage to tens of millions of Americans.

Brian: “Benefits to Medicare enrollees aren't affected at all.”

The above statement is true on paper but not in practice. Why? Because more than half of the $700B in “payment cuts” come from reduced fee-for-service rates paid to doctors and hospitals. The result will have the same effect on Medicare as reduced fees already have had on Medicaid – fewer doctors willing to see patients. According to Obama’s Medicare actuary, Richard Foster, Medicare reimbursement rates fall below Medicaid reimbursement rates by the end of this decade under Obamacare. Good luck, seniors, getting an appointment with a quality physician to access those unaffected benefits.

And the above statement is not at all true for Medicare Advantage. More than 30% of Oregon seniors are enrolled in this plan for its extra benefits – benefits that will no longer be available to them thanks to Obamacare.

Brian: “…the providers will come out hundreds of billions ahead…”

If that’s an adequate margin, why would Obama’s actuary, Foster, say, “It is doubtful that many [hospitals and other health care providers] will be able to improve their own productivity to the degree” necessary to accommodate the cuts. Foster projects that Obamacare’s Medicare cuts could make 15 percent of hospitals serving Medicare patients unprofitable.

Embedded at the bottom of the link below is a video of Foster’s testimony in front of Ryan’s budget committee. The subject is the impact of patient choice and competition on cost and quality. (This will be of special interest to you, Brian, since you believe traditional single-payer Medicare to be more cost-effective). Foster indicates that Medicare Part D (prescription benefit) beneficiaries have migrated EVERY YEAR toward more efficient plans with lower premiums and higher quality benefits. He also said trial data shows competitive bidding can bring down the cost of fee for service durable medical equipment by 40%. Foster believes choice and competition can create savings across all of Medicare under a fee for service (voucher) plan. http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/

Brian: “Also, it's bizarre that Romney/Ryan would criticize Obama for doing exactly what they say needs to be done: find savings in Medicare to keep the Medicare funding solvent.”

Brian, where are you getting this misinformation? Stephanie Cutter? You clearly didn’t watch Ryan speak at the Feb 2010 Obamacare meeting – and you didn’t watch Obama’s response to Ryan where he defends the cuts and talks about how he’d like to SPEND them. He doesn’t mention dedicating the cuts to extend Medicare solvency like the Ryan-Wyden plan does.

Don’t let the Stephanie Cutters confuse you with lies and distortion. You’re on the doorstep of becoming a Medicare beneficiary and you’re going to spend the rest of your life regretting you let her hoodwink you into promoting a Medicare program you’ll grow to hate. I can just see your blog posts already.

Watch the video! starting at 08:30 http://www.youtube.com/watch?v=teEpm9_TJdQ&feature=relmfu

BTW, here’s what Obama’s Fiscal Commission Democratic co-chair, Erskine Bowles, thinks of Paul Ryan’s character and how his budget compares to Obama’s: http://www.youtube.com/watch?v=dbzpuqWo6yU

Bowles is 67. Wanna bet who he’ll be voting for in November?

Big Oil

DJ, you didn't read, or understand, my comment, did you? Please read it again before spewing Romney talking points that you heard on Fox News.

To repeat: doctors, hospitals, insurance companies and the rest of the health care industry are getting a trillion dollar infusion of money through the Affordable Care Act.

Finally, almost everybody in the country will have health insurance. Uncompensated care/bad debts medical providers now have to deal with will be hugely reduced. Plus, Medicare reforms are being put in place to improve efficiency and quality of care by reducing unnecessary procedures, coordinating care better (Oregon is a leader in this) and other means.

So health care providers are coming out way ahead: $700 billion in Medicare cuts vs. a trillion in new spending. That's a good deal for providers. No change in benefits.

By contrast, Romney and Ryan want to put all the burden of reducing costs on Medicare enrollees, who will get a voucher that won't cover the full cost of the health care they need. It's a fact that Medicare enrollees will pay thousands of dollars a year more under the Romney-Ryan plan.

Which is why they're going to lose this election. Good luck winning Florida by campaigning on a "We're going to end Medicare as you know it and let you buy insurance from private companies."

Brian, do you really think Richard Foster – Medicare’s chief actuary since the Clinton days – didn’t have the sense to take into account the impact of millions of newly insured under ACA/Obamacare? Do you really think his Board of Trustees dropped that ball as well? They didn’t; the Foster team’s analysis includes the newly insured. He still concludes that the trillion dollar infusion you cite (offset by the $700B cut resulting in a $300B infusion over 10 years) is inadequate and will bankrupt hospitals that will be forced to shed Medicare patients and physicians. There’s more on the market dynamics behind that rationale at the end of this comment below.

So not only did I understand your comment, my rebuttal addressed each point with the words of the president and his advisors.

My sources?

1) Whitehouse.gov, source of the Ryan-Obama video.

2) Richard Foster, the Medicare chief actuary.

3) Erskine Bowles, entrusted by the president as Democratic co-lead of his debt commission.

Care to provide your sources?

This week in Iowa Obama repeated numerous Medicare lies in order to scare seniors. See the Iowa video… do these sound familiar Brian? http://www.youtube.com/watch?v=z2jMY1T-zFc

Obama: “They want to turn Medicare into a voucher system. That means seniors would no longer have the guarantee of Medicare, they’d get a voucher to buy private insurance, and if it doesn’t keep up with costs, well, that’s the seniors’ problem.” Pants on Fire, pure scare and completely wrong. As I keep repeating, both the Ryan-Wyden and Romney-Ryan plans guarantee today’s seniors and those under 55 can continue with traditional Medicare.

Obama: “It was estimated that Governor Romney’s running mate, his original plan, would force seniors to pay an extra $6400 year.” Ask yourself, why is Obama still talking about Ryan’s original plan as if Ryan-Wyden never happened? Wyden should be offended with Obama. Both the Ryan-Wyden plan and the Romney-Ryan plan offer seniors the option to choose today’s traditional fee for service Medicare plan, guaranteeing that no Senior is forced to choose a voucher plan if that option is of higher cost and/or lower in quality. In fact, if a senior chooses a plan cheaper than traditional Medicare – the senior pockets the difference! Remember, Foster tells us seniors are good at making this type of choice, and have done so effectively every year for 10 years with Medicare Part D.

Obama: “My plans extended Medicare by nearly a decade.” Obama is not lying here, he’s referring to the 2010 Medicare Trustees Report. But he is intentionally ignoring a warning in that report from Foster and his Board of Trustees: “The actual future costs for Medicare are likely to exceed those shown by the current-law projections.” The problem here is – like the CBO – Foster and the other Trustees are only allowed to score ‘what is placed in front of them’ when creating the Trustees Report.

But that didn’t stop the Trustees from publishing a companion analysis that provides a more realistic scenario. In that analysis, Foster and the Trustees show that under a fee-for-service model the Medicare cuts Obamacare counts on will likely never happen and that savings from price controls are “extremely unlikely to occur.” That means no bending of the cost curve under Obamacare. So, while Romney comes right out and tells voters he will reverse the $700B Medicare cut, the Trustees analysis says Obama will be forced to reverse the cut as well – after he’s already begun to spend it! For political reasons Obama can’t admit what he knows this report says to be true. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/2010TRAlternativeScenario.pdf

And I couldn’t help but notice one more example of Obama double talk. In that same Iowa video, Obama promotes spending some ($300B) of the $700B cut to close the donut hole on the Medicare Part D prescription plan. But here’s what Obama says at the 21:00 minute mark in the Feb 2010 Obamacare video that Brian refuses to view: “I agree with you (in response to Coburn) about the fact that the prescription drug plan added to our deficits because we didn’t pay for it. And I just have to point out it didn’t happen under my watch, it happened under the previous Congress.” Translation: he’s perfectly happy today to cut $300B from Medicare – not to set aside for Medicare’s solvency – but to SPEND on a program that itself was never paid for. http://www.youtube.com/watch?v=teEpm9_TJdQ&feature=relmfu

Truth makes the Medicare topic a clear winner for Romney-Ryan. I hope it stays front and center for another 80 days. The longer it gets debated the more time voters will have to pull back the curtain and hear Obama’s lies for themselves.

Finally, back to answering Brian’s assumption that millions of newly insured will translate into the health care industry coming out way ahead because the trillion dollar infusion that extra business represents (coupled with reduced “uninsured/free rider bad debt”) more than offsets the $700B cut the industry will see on the Medicare side of its business.

On the face of it, that statement looks legit, until you think about the realities of market dynamics. The healthcare system is about to be flooded with millions of newly insured patients for which providers will be reimbursed “full price” by the insurance company for services rendered (cha-ching). At the same time, Medicare reimbursement rates are being cut (anti cha-ching) as beneficiaries look to access the system at ever increasing rates. A doctor can only see so many patients. With so many profitable new patients to replace those they may lose over time, why would an increasingly stressed, stretched, and overworked physician workforce choose to accept discount Medicare patients over patients clamoring to find a doctor and pay full price? Ditto for hospitals, they all have a bottom line. And if you think physicians are altruists, ask yourself why there’s a general practitioner shortage already.

Here’s how this topic is addressed in the Foster/Trustees analysis previously posted above: “…it is equally hard to imagine cutting only Medicare spending while spending by the commercially insured under age sixty-five continues to grow at historic rates, which would lead to a marked divergence between what providers are paid for treating the commercially insured relative to what they are paid for Medicare beneficiaries. This gap could jeopardize Medicare beneficiaries’ access to mainstream medical care.”

And that’s what you get when bureaucrats cobble together a plan without taking into account market dynamics. Brian’s assumption addressed and answered.

Anyone reading this who votes Obama anyway – you’ll get the healthcare you deserve.

Big Oil

Thanks to DJ/Big Oil for the research and commentary. I will forward it to someone also interested in this debate.

Current seniors receiving medicare payments are not going to suddenly lose their benefits with Romney/Ryan and find themselves and wheelchairs being shoved off cliffs.

Once this is made clear to Florida residents I think Romney/Ryan have a good chance of winning the election because Florida is THE crucial must win swing state, imo. I just hope the thing doesn't come down to a few hanging chads.

I feel sorry for Floridians who are, and will be, continually bombarded with political ads until this thing is over. It will be relentless.

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