The almost-definitive guide to the Medicare debate
by Joan McCarter
http://www.dailykos.com/story/2012/08/25/1123784/-The-almost-definitive-guide-to-the-Medicare-debate
The New Republic's Jonathon Cohn has an exhaustive guide to the Medicare debate playing out in this election. Or, nearly exhaustive, because of course neither Romney or Ryan has produced sufficient details to answer all of the questions Cohn poses.
But here are his key questions: 1) How do the plans control Medicare spending; 2) How quickly do the plans cut spending; 3) On whom do the plans place the most risk; and 4) What else would the plans (and the men behind them) do to the health care system? And here's a quick chart of Cohn's analysis.
More details are below the fold, but if you want the full analysis, Cohn's article is well worth the time.
http://www.tnr.com/blog/plank/106298/guide-to-medicare-debate-romney-ryan-obama-voucher-premium-support
1. How do the plans control Medicare spending?
In the case of the Affordable Care Act, through "reductions in what Medicare paid providers—that is, doctors, hospitals, and suppliers of medical goods," using information about where Medicare is overpaying and introducing incentives for increasing quality of care. In the case of Romney/Ryan, market competition—moving Medicare to a privatized, voucher system.
2. How quickly do the plans cut spending?
This is a harder one to nail down, for both plans, since there are so many factors at play. But, in essence, the Affordable Care Act cuts $716 billion (that number is subject to change) in the next 10 years, extending the program's solvency to 2024. The Romney/Ryan current voucher plan doesn't really supply enough specifics to know how quickly spending cuts will unfold, but those cuts will likely be harsher if Romney/Ryan followed through on their promise to restore the ACA cuts, the same cuts Ryan included in his budget. They'd also be harsher because Romney has a budget cap, a hard target for spending. Keeping Medicare spending to a hard target will mean "a more severe spending cut than Ryan’s or Obama’s."
3. On whom do the plans place the most risk?
That's an easy one, and also the most important question of the whole debate. With the Affordable Care Act: "It does not undermine the basic guarantee to seniors—that, upon retirement, every American will get a comprehensive set of insurance benefits." There is the very real possibility that access with be more of a problem, if providers start dropping Medicare patients because of reduced payments, but seniors will still have comprehensive insurance. The Romney/Ryan plan would force seniors to pay more, and does put the future of the program as it exists today at risk.
4. What else would the plans (and the men behind them) do to the health care system?
Obviously, the Affordable Care Act expands access to affordable health insurance and to a key program for providing health care to lower-income people: Medicaid. Romney/Ryan's plans for Medicaid would drastically cut the program, shrinking access to health care for millions, including many seniors. It would force states to have to prioritize who got health care, forcing states to become de facto death panels.