Real Health Care Reform, Part III: Reforming Medicare
By David McKalip, M.D. 04/28/2011
David McKalip, M.D. is the founder of the Pinellas Medical Foundation (a new medical charity) and Doctors for Patient Freedom.
As Obamacare storm clouds continue to make our lives gray and scary, this series continues its proposals on real health care reform. Hopefully, the bright sunlight of freedom and market power can burn away the Obamacare clouds that threaten us all.
Real Medicare Reform
The year is 2020 and Joanne has entered Medicare and is overjoyed. Finally, after years of paying into Medicare she can get the free health care she expects! What’s this though? Medicare only covers 80% of the bill and she will have to pay an insurance premium to get that? Covering the other 20% means she must pay out of pocket, buy a second health insurance policy or must give away her assets and apply for Medicaid? Now her doctor tells her that she is not eligible for spine surgery she needs until she spends 18 months on a waiting list and that the less painful and more effective surgery is not on the approved list for cost reasons. Just last month her elderly Aunt on Medicare had her life support withdrawn in the hospital ICU since she was in a group with only about a 30% chance of surviving more aggressive and costly medical care. Well, Medicare doesn’t seem like all it was cracked up to be and now Joanne wonders why she didn’t just save her own money
and buy her own health insurance plan years ago? Oh yeah, refusing to allow the government to steal Medicare money from her paycheck is illegal.
It is time the face the fact that Medicare is bankrupt with over $45 trillion in unfunded liabilities. Because of this, the government is about to implement rationing with several tools. First will be the Accountable Care Organizations (ACO’s) that will penalize doctors financially if they spend too much money on patients. Doctors will be put on a budget. The more they spend on you, the less money they are paid and the smaller their “bonus” for cutting costs (as illustrated in this You tube video by Dr. Truth hurts). Second will be through Obamacare’s “Independent Payment Advisory Board” (IPAB) that will automatically cut Medicare spending every year. Paul Krugman recently crowed that
government panels will ” have to find a way to start saying no” to spending money on health care for Medicare patients. Krugman then attacks the ability of any consumer to make spending decisions themselves with their doctor as their advisor. Mr. Krugman, like all central economic planners, feels that he and his are better qualified to make life and death decisions than you and yours. Worse, Medicare patients are trapped in a cage and can only see the doctors approved by the government: the ones that are most thoroughly controlled by the government as the rationing agents for the state.
There is a better solution for real Medicare reform and it must be instituted for those under 55 years of age so that they may have some sort of health care security in their retirement. Those over 55 have been made a promise and our best efforts must be put forth to deliver on that promise, but there is even room to improve the situation for patients over 55 as well. Here are some good ways to improve Medicare.
• Protect the “Lockbox” or repeal Medicare payroll taxes. For years politicians have been
stealing Medicare money from the “lockbox” and replacing them with worthless IOU’s in the form of U.S. Treasury bonds. There is no money to pay for these without printing money from the Federal Reserve and more debt. There is no amount of tax increase that can cover the cost — they would be economically crippling. Congress should allow people to save their own money in private Medicare Savings Accounts or pass a law that prevent looting of the Medicare trust fund under any circumstance. They can fund their “bridges to nowhere” from the money they get or perhaps decide that handing out candy for votes is not in the best interest of American citizens.
• Create Vouchers for the poor in Medicare/let people opt out of Medicare. Paul Ryan has
advocated a plan to transition those below 55 to receive government vouchers to buy health insurance. Those of lower income would receive a larger voucher, which would essentially be a subsidy from the taxpayer. It still would require financing from the taxpayers through payroll taxes of Medicare or general revenue (income taxes) and is thus subject to thievery from others to pay the tab. There can be improvements to this plan. The most financially sound plan would provide government Medicare benefits only to the poor (sliding scale for those minimal mandated benefits with no community rating or guaranteed issue policies . This would drive down costs and improve quality.
• Portable Medicare benefits. Right now Medicare benefits can only be used to see doctors that participate in the Medicare system. As Obamacare expands, there will be fewer doctors willing to see Medicare patients as they object to becoming rationing agents, are driven out of business through a) lower physician payments, b) the enormous costs of complying with the cost–control bureaucracy, or c) failure to receive promised “bonuses” for keeping patient care spending “under budget”. More nurse practitioners will be taking care of patients in the place of actual doctors. As a Medicare patient, you should be able to escape this Medicare cage and take your Medicare benefits with you to see the doctor of your choice. If Medicare will pay $80 for the doctor visit, you should have the right to take that $80 to any doctor you wish. That may mean you will want to have a private contract with a doctor to take that benefit in exchange for your willingness to pay the other $20 out of pocket. This will be consumer power in your hands as doctors compete for your health care dollar, offering more time and providing you with a better understanding of your medical problems. They will also order less unnecessary testing and treatments to cover themselves from lawsuits or simply to make money off the third party payment system.
• Portable and lifelong health insurance — It is time to tie health insurance to the individual, and not the job or the government. If you were able to buy a health insurance policy at age 18 and carry it from job to job and state to state you would need no “Medicare program” to care for you at age 65. This concept was developed in part II of this series, but is possible with changes to existing law. Such insurance would create true competition for health insurance and drive down costs. This insurance, carried through life, would ensure that “pre-existing conditions” would be far less of a concern — since these conditions would usually develop while the person was already insured. If insurance is treated like the indemnity plan it should be, it will be used rarely and will be less costly and can be maintained through life. Routine medical care would be paid for through tax-free health
savings accounts which could also carry forward into Medicare age.
• Grow Charity and ensure a sound safety net for the poor. There will always be those who fall through the cracks and are too poor to buy health insurance or too ill to find affordable insurance. That is an appropriate place for government to step in. Medicare and other government assistance should be confined only to a very small population of chronically uninsured (currently about 8 million of our 300 million population). That safety net should pay 100% of true costs of medical care — unlike programs such as Medicaid that pay well under cost and lead to a shortage of physicians willing to see those patients. Further, charity care should be allowed to grow again to help fill in the gaps. Wonderful charity hospitals were the norm in America pre-Medicare and other wonderful charities exist today (Shriner’s, St. Jude’s, Catholic Charities and the like). When we have economically sensible policies (as proposed here) and sound money (through limits or abolition of the Federal Reserve) American charity will create the best safety net that will put government assistance to shame. These are reforms that empower the consumer and not the government — through freedom of choice, property rights and competition. They promote a real market for health insurance and physician care for all Americans. They create forces that drive down costs and increase quality of medical care and consumer satisfaction. In other words they act in exactly the opposite direction of a government run system that is built on impossible political promises that are bankrupting our country and endangering our children’s future.
But in order for real Medicare reform to happen, it is going to require enlightenment among several populations.
• Medicare-age people are going to have to work for and support reform in the system for those who will follow them.
• Working age and younger populations are going to have to demand empowerment in their hands and disempowerment of the government.
• All Americans are going to have to reject the scare tactics of politicians who care absolutely nothing about those they claim to want to help — and care only about staying in office on the backs of Americans dependent on the political class.
• Real Political leaders must stand up courageously and call for rational change — and they must be supported by Americans in the process. For those of you who have the attitude that “you put into Medicare” and you are going to get “what is yours” — realize this. Medicare pays out 2–4 times on average more than was put in per patient. The extra costs are paid by your children and your grandchildren. They are going to pay that debt by federal borrowing from foreigners and foreign bankers. In other words, the only way for you to get “what is yours” is to sell your children into slavery to foreigners. Those same foreigners will also own America piece by piece as American property is sold off by private citizens and the government to finance more out of control spending. These foreign bankers and foreigners will thus control the political class and the power structure and
America will end as a nation.
It is nearly too late. The choice is yours — keep Medicare as is and “get what’s yours” — or save your children and your country. I choose to save my children while I save for my own health care. I have no illusion that I will get a penny back of the money stolen from me to pay for the Medicare and social security benefits of others. I have given up that illusion so I can realize the dream of a better life for my children and their posterity.
Copyright © 2011 Campaign for Liberty
http://www.CampaignForLiberty.com/article.php?view=1425 Page 1/3