The Medicare Non-Debate

Every dollar in four of health care spending is consumed by the beneficiaries of health care in the last 12 months of their lives. Medicare costs are a huge part of the US budget deficit and according to President Obama, ‘a key driver of the budget deficit’. Both candidates for president and their respective parties are promising to cut the deficit as a priority. Neither party is really spelling out what this may mean for ordinary Americans who are sick and in their final year on this Earth.

The Democrat plans for ‘Obamacare’ (the federal government’s plan for health insurance for older Americans as well as disabled ones) are based on some untested assumptions, and so are the Republican projections around savings on the healthcare budget. The democrat proposals for cutting medicare costs are based on, as yet, untried measures. While the Republican figures just don’t add up. Can it all be just another case of ‘campaigning in poetry and governing in prose’?

The final year drain on healthcare costs is not an issue either candidate seems keen to spell out specifics on. A former director of a Medicare trust and political insider, as a one-time director of the Congressional Budget Office, is concerned:

“There’s a whole lot of uncertainty about this stuff. Would I be surprised if things turn out to be 10, 15 percent better than projected? No I wouldn’t be. I wouldn’t be either if things turn out to be 10, 15 percent worse than expected.”

The Administration’s plan B is for an independent board who can mandate savings from medicare payments if the projected savings are not forthcoming. But this board has to get past Congress and a filibustering Senate.

It can sometimes seem that republican politicians say one thing while doing the opposite. Their commonest refrain is that they are against ‘big government’ telling the individual what to do. Yet when President Obama proposed the funding of counseling for those all-important end of life medical decisions, in draft legislation of the health care bill, it had to be dropped because of republican opposition to what Sarah Palin branded ‘death panels’. It seems that you cannot have a say in how you are treated as you approach ‘the clearing at the end of the path’ (Stephen King, ‘The Dark Tower’).

It is clear that health insurance and end of life care costs are all about the money and not the dignity of human life, or freedom to choose how you die. As an Obama campaign spokesman puts it “The president has been very clear that controlling the growth of health-care costs is essential to our long-term economic security.” Medicare was instigated in ‘65 by Lyndon Johnson’s ‘Great Society’ administration. It gave health insurance to over 49,000,000 Americans last year at a cost of $483 BILLION to the US taxpayers. It is important to remember that the receivers and the givers are not mutually exclusive groups.

In between the bickering politicians and long-suffering taxpayers are the health insurance providers. They make profits and take dividends from the cash that passes through their hands. They are the house that control the odds on your life and health wager. Would we all be better off just saving a little, tax-free every month to pay for our own health care?