Lies, Damn Lies and Medicare

The general election is just a month away. Like most of my friends and colleagues, I’m part of the 97% of likely voters who’ve already decided who they are going to choose in the ballot box. That leaves the various candidates, parties and political action committees but a small proportion of the electorate to sway if they wish to maintain or regain control of our various political institutions. Unfortunately, that means that for the next 33 days we will be inundated with political ads on television, on the radio, on the Internet and in print.

One key issue that has been used in ads by both parties is Medicare, the federally funded program that provides health insurance for elderly or disabled Americans. The Republicans and their allies claim that the Obama Administration has slashed Medicare by over $700 billion dollars, and has empowered a panel of “15 unelected bureaucrats” to make further cuts. This will, they claim, restrict seniors’ access to doctors or deny them life-sustaining care.

On the other side of the aisle, Democrats and their supporters charge that a Romney Administration would do away with Medicare altogether and replace it with a system of vouchers.  That, it is alleged, will “throw seniors off a cliff” by reneging on the promise of secure health coverage after a lifetime of paying into the Medicare lock box. They also claim that the Romney-Ryan voucher plan would cost seniors nearly $6,400 a year.

The fact of the matter is that both parties are lying, or at least misleading the public on Medicare.  Let’s consider each set of claims.

The Romney campaign’s claim that the current administration has slashed Medicare by nearly a trillion dollars is nothing more than a cheap accounting trick.  That oft-cited figure actually comes from a Congressional Budget Office report that says that a repeal of the Affordable Care Act — known colloquially and somewhat pejoratively as “Obamacare” — would result in a $716 billion increase in Medicare costs. But that is a cost savings, not a budget cut. Moreover, many of the same proposals to cut costs were included in Vice Presidential nominee Paul Ryan’s 2012 budget plan.

As for the claim that 15 unelected bureaucrats will be making healthcare decisions for all of America’s seniors, that refers to the Independent Payment Advisory Board created in 2010 by the Affordable Care Act.  Starting next year, the Board will replace the ineffectual Medicare Payment Advisory Commission (MedPAC), which advises Congress on how to improve the Medicare program while controlling costs.

Over the past decade, MedPAC has recommended changes that would save hundreds of billions of dollars, without adversely affecting care. Sadly, Congress has largely ignored these recommendations and MedPAC lacks any regulatory power to make these changes itself.

The Independent Payment Advisory Board would have some regulatory power. The Department of Health and Human Services would be expected to implement any recommendations the Board makes to reign in Medicare costs, unless Congress adopts similarly effective measures. What the Board cannot do, however, is make any recommendations on rationing access to care, restricting benefits, changing eligibility criteria, or raising Medicare premiums and copayments. Furthermore, while the President appoints the members of the Board, he does so in consultation with Congress. The US Senate must also confirm the appointments. This is a process that is not unlike the appointment of Supreme Court justices, and few want to abolish this panel of nine unelected bureaucrats who rule on the Constitutionality of federal laws (except when they disagree with the Courts decision).

What about the Obama campaign’s claims? What the Republican plan would actually do is allow seniors to choose a private health plan with the federal government contributing towards the cost based on age and health status. This may or may not improve quality and access to care, but it probably won’t result in seniors paying as much as $6,400 more per year for coverage. That figure comes from an analysis of an older Medicare reform plan proposed by Rep. Ryan in 2011, and relies on a number of unproven and untested assumptions about rising insurance premiums. The new proposal supported by the Romney-Ryan team would cap any rise in Medicare premiums based on economic growth and inflation using the same formula used by the Affordable Care Act.

Both the Democratic and Republican plans for reform have flaws, but these flaws are not as fatal as the current spate of political ads and campaign trail speeches would lead one to believe. Rather than working on a bipartisan solution to the problem of rising health care costs, our leaders and those who aspire to public office would rather rely on lies and fear mongering to sway voters into their political camp. Shame on them … and shame on us for falling for it.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on October 4, 2012. It is also available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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