Sorry, ThinkProgress: Paul Ryan is Right to Say 'Obamacare Ends Medicare As We Know It'
3:00 PM, Jun 1, 2011 • By MARK HEMINGWAY
The folks over at the Center for American Progress are up in arms over this statement by Rep. Paul Ryan, D-Wis.:
Setting aside ThinkProgress' red herrings about what medical reforms Ryan may or may not have supported in the past, this is their response:
First, it's notable that ThinkProgress sidesteps the question of Obamacare's significant Medicare cuts, arguing that it increased spending on the margins. Second, their description of Obamacare's Independent Payment Advisory Board is just beyond rosy. For one thing, they don't really go into detail about how the board will work -- and for good reason. They know it will scare voters.
Essentially, members of IPAB -- appointed by the president -- will set Medicare's budget for the year by making the program hit certain predetermined spending targets. ThinkProgress is right that the law nominally says that IPAB is forbidden from rationing, but if IPAB can't raise revenues, cut premiums or adjust cost sharing mechanisms in Medicare, how is it supposed to cut Medicare's budget?
Just about the only think IPAB can do here is slash Medicare reimbursement rates to doctors. Now Medicare reimbursement rates are already below market rates and we're already seeing a huge uptick in doctors refusing to treat Medicare patients for this very reason. Last year, USA Today reported that the number of doctors refusing Medicare patients hit an all-time high and it's getting worse:
Low reimbursement rates are already a huge problem in Medicaid -- over half of all specialists in many major metropolitan areas are refusing to take on new Medicaid patients, according to a 2009 survey by Merritt Hawkins and Associates on physician wait times.
Even if IPAB can't ration directly -- and that's a big "if" considering the President spoke of further "strengthening" IPAB in April -- the result is almost worse than rationing, many Medicare patients will have a hard time getting medical care, period.
So then, if you object to IPAB's decisions to lower costs what can you do about it? Well, IPAB's recommendations automatically become law. There's no administrative or legal process for challenging the board's decisions -- and Congress can only override IPAB with a two-thirds majority vote. That's an awfully high legislative hurdle to clear.
Paul Ryan's plan involves bringing "premium supports" and leveraging private insurance markets, which make it similar to to the very popular Medicare Advantage and Medicare Part D programs. In theory, what he's proposing shouldn't be all that unfamiliar to current Medicare recipients.
Obamacare is bureaucrats setting dubious price controls that are very likely to limit access to medical care. (Say it with me, Obamacare fans: Having insurance coverage does not mean that a doctor will treat you.) Further, there's absolutely no recourse for doctors or private citizens to challenge these bureaucratic decisions. Even Congress' hands are largely tied. In fact, taking 13 percent of the federal budget away from Congress and giving that responsibility to executive branch bureaucrats may well be unconstitutional.
So you tell me which plan is more like Medicare as we know it? Ryan is absolutely correct to say "Obamacare itself that ends Medicare as we know it."
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