The participant's in last night's GOP presidential debate once again took the opportunity to pretend that the Affordable Care Act ("Obamacare") put a massive dent in Medicare by cutting $500 billion from the program.
Michele Bachmann told us that "We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare." Mitt Romney intoned "He cut Medicare by $500 billion. This is a Democratic president the liberal, so to speak, cut Medicare."
Yeah…except that nobody stole anything and Medicare was not cut by $500 billion.
Here are the facts:
For starters, nobody cut anything from the Medicare budget in the health care reform bill. The actions taken in the legislation are designed to slow the growth of Medicare spending without cutting benefits. Further, not one cent that would have gone to Medicare is somehow being shifted over to a program created by Obamacare (for first time readers, I readily use the term Obamacare because I believe that this name will ultimately stand as an honor to the President who made it happen.)
With respect to the infamous $500 billion, the non-partisan Congressional Budget Office has made it clear that the bulk of the projected savings will come from two primary sources—ending the subsidies to health insurance companies who offer Medicare Advantage programs and reining in the growth of payments to physicians. The remainder will, hopefully, come from cutting back on the waste and fraud that have long been rampant in the Medicare system.
Let's begin with the Medicare Advantage program. Established via the Medicare Modernization Act of 2003. the program—a Bush/GOP creation—was ostensibly invented to encourage Medicare beneficiaries to gravitate towards privately operated insurance programs pursuant to the theory that the private sector could do a better job of delivering care to our seniors than the government.
I say 'ostensibly' because the true purpose was to create a windfall for the private insurance companies who have done so much for so long for so many Republican elected officials.
The way the script played out, the private insurance companies said that they would only be able to paricipate in the program if, and only if, the government gave them a head start by agreeing to subsidize their "start up costs" until the year 2010.
As a result of the deal, Medicare found itself paying, on average, an 11% surcharge on medical services and procedures provided by Medicare Advantage plans. This was enough to guarantee the insurance providers a tidy profit fully comprised of the government subsidies, creating one of the greatest examples of corporate welfare in the history of the nation.
Not surprisingly, the health insurers took advantage of the windfall to attract customers by offering very low premium charges, not to mention free gym memberships, one pair of eyeglasses per year, spa treatments, zero co-pays and assorted other benefits not available to those who opted to take their Medicare directly from the government. And why not? The insurers don't need to make a penny from those who were insured as each customer guarantees them an 11 percent return on any medical benefit receieved courtesy of the Medicare program. Thus, they are more than happy to offer a free toaster to anyone who agrees to sign up.
What Obamacare did was put an end to the subsidies, thereby reducing future costs to the program by billions while continuing to provide Medicare beneficiaries with the benefits promised.
By any standards, this was a no-brainer in terms of reining in the growing costs of Medicare and creating a system that is fair to all beneficiaries.
Now, the doctors.
This gets a bit tricky and, to be honest, I don't really believe that these savings will ever materialize.
At the heart of the discussion is a formula that was designed during the Clinton Administration called the Medicare Sustainable Growth Rate, or SGR. The approach was created in an attempt to control Medicare spending for physician services with the idea being that the yearly increase in the expense per Medicare beneficiary should be tied to the growth in GDP. Thus, when actual Medicare spending exceeds the annual target in a given year, the SGR requires that physicians, and other system providers, must take a cut in order to bring the spending back in line with the annual spending targets.
The docs, understandably, do not like the idea of taking less in their Medicare payments. As a result, Congress has been delaying the cuts for years, constantly rolling them over into the next year at which time they roll them over again and again. Were Congress to ever stop delaying the SGR cuts, the physicians would find themselves feeling the cumulative pain of the delays with a one time Medicare rate reduction in excess of 20 percent.
These cuts are factored into the Medicare savings projections, along with hoped for savings to come by encouraging physicians to try some different approaches to practicing medicine.
Will this ever happen? Probably not.
So, while a skeptic can argue that these projected savings may never materialize, one cannot argue that this is, somehow, a cut to the Medicare program.
The bottom line is that there is nothing in the ACA that takes anything away from Medicare beneficiaries, now or in the future. Yet, the GOP continues to do its best to scare the hell out of seniors, the most reliable voter block in the nation.
We need to take this very seriously.
If the 2010 elections taught us anything, it is that a frightened voter population will do some crazy things. So, it's on us to make sure that our grandparents and parents understand that the Repubican fear peddlers are selling nothing but lies and that falling for the lies could result in the end of Medicare as we know it if the Republicans are permitted to gain full control of the government.
If you would like more information on this to share with family and friends, just let me know. The effort to mislead our senior citizens worked well in 2010. We simply cannot permit it to work again in 2012.