Election places Medicare at greater risk

“Don’t Touch My Medicare!”

By Trudy Lieberman
Harper’s Magazine, November 2016

Given the monumental sums Medicare has been paying out, it’s hardly surprising that for years the annual report issued by the program’s trustees has argued that it needs more revenue. This year’s report, released in June, warns that although Medicare’s costs are low by historical standards, there is substantial uncertainty regarding the adequacy of future Medicare payment rates under current law.

Medicare is placing its bet for cost control on new ways to pay doctors, penalties for bad care, rewards for good care, and more coordinated care. Whether these practices will work and how much they will slow down the growth in costs is unknown, and most Medicare experts on both the left and the right believe that new revenue will be needed. Along with her colleagues at the American Institutes for Research, former Medicare trustee Marilyn Moon (who remains skeptical of privatization) believes that critics often overstate the program’s financial challenges.

The big question is who should bear the burden of necessary revenue increases — taxpayers or Medicare beneficiaries. So far the answer from the government, many economists, and conservative advocacy groups is, unequivocally, the beneficiaries. Moon and her colleagues note that the “potential depletion of the trust fund in the future is taken as ‘proof’ that benefits must be reduced.” But in a subsequent interview, she warns that as more of the cost burden is shifted to the beneficiaries, “the likely reaction will be that benefits become so small Medicare won’t remain viable. It would destroy the program.”

It’s ironic that when it comes to one of the government’s most popular public programs, there’s no talk of raising taxes — an option polls show much of the public is willing to support. The failure of policymakers to consider revenue increases reflects the success of the right’s thirty-year crusade to change the conversation. “Those of us at the Heritage Foundation and allied public-policy institutions like the American Enterprise Institute have effectively defined the terms of the debate on Medicare reform,” says Robert Moffit, a senior fellow at Heritage. The Democrats, he adds, “are debating our proposals. We’re not debating theirs.” Former Iowa senator Tom Harkin tells me that his fellow Democrats were poor strategists, always finding themselves in rearguard actions trying to block provisions they didn’t like. “The Democrats were talking a good game for the immediacy, not the long term. It’s like checkers,” he says. “They knew how to block the next move, but were not seeing the row lined up at the back of the board.”



By Don McCanne, M.D.

House Speaker Paul Ryan indicated today that, as a result of the election, they will now have a president who will sign their proposed legislation making major changes in our health care financing system. This important article by Trudy Lieberman explains the ongoing attack on Medicare and the threat to further privatize the program while shifting more of the burden of paying for health care onto the backs of the Medicare beneficiaries.

Trudy Lieberman warns us that conservative organizations “have effectively defined the terms of the debate on Medicare reform,” according to Heritage’s Robert Moffit. The Democrats have been complicit with the partial privatization of Medicare and likely will continue to be so as further erosion of Medicare accelerates under a conservative government (all three branches).

Harper’s allows access to one free article per month. Considering the danger Medicare faces, this should be the article for you. It is a fairly long article, so you may want to wait until you have a little more time, but do it this week for sure.