Another "End of Medicare as we know it" scare from the right

by gravlax    Wed Mar 14, 2012        Original

Remember when all you heard from the right was that government in healthcare was bad? Maybe the left won a framing battle over the right to medical coverage in the form of Medicare. Of course, the right is still attacking medical coverage while, at the same time, claiming to want to preserve it. Same old conservative double-speak.

Hollywood Tea Partier Pat Boone, recipient of the 2011 CPAC "Lifetime Achievement Award", is the "star" of a new ad by the 60 Plus Association, the conservative alternative to AARP.

          Pat Boone told a whopper

The ad is part of a $3.5 million campaign asking Democratic Senators Jon Tester (D-MT), Ben Nelson (D-FL), Sherrod Brown (D-OH), Claire McCaskill (D-MO), and Debbie Stabenow (D-MI to eliminate part of what is known as "Obamacare".

See this article in The Washington Post's Fact Checker, "More ‘Mediscare’ hooey, GOP version". Glenn Kessler gives the Mediscare claims 3 Pinochios, for "Significant factual error and/or obvious contradictions".

I give it four capers, for "complete b.s.".

Pat Boone at 2011 CPAC (photo by Gage Skidmore)

The ad concerns the Independent Payment Advisory Board, set up by sections 3403 and 10320 of the Patient Protection and Affordable Care Act.

While the GOP has yet to come up with the equivalent of "Death Panels" for the IPAB, this ad is part of an ongoing effort to convince voters that this board can ration care and deny certain Medicare payments, as well as cut up to $500 million from Medicare.

The 60 Plus ad ...
Attacking the IPAB is another front in the "War on 'Obamacare'".

I, for one have not seen this particular attack before, but according to the WaPo article, this is nothing new.

Perhaps it is because I don't live in a highly contested area or that I am not watching the right channels on the teevee or visiting the right sites on the intertoobs.

Either way, this is new to me. So I will try to wade through the issue with the help of Glenn Kessler and the help of teh google.

(also, see this article from TPMDC about the efforts to repeal the IPAB and positions taken by both Democrats and Republicans re: its repeal)

follow below the Orange Squigglies of Mediscare for more ...

“President Obama’s health care law cuts $500 billion from Medicare.”

from Kessler,
"This is another oldie but goodie.
Under Obama’s health-care law, Medicare spending continues to go up year after year.
...
Moreover, the savings actually are wrung from health-care providers, not Medicare beneficiaries."

So, that part seems to be WRONG. I believe that Kessler uses the term "oldie but goodie" as a euphemism for total malarky. He is much too evenhanded for such a term so I will use it in his stead.

The $500 billion figure comes from an accounting method in which one takes the anticipated spending on Medicare, known as the baseline, and compares it with anticipated savings from the ACA. See slide 15 of this tutorial from the Kaiser Family Foundation for a chart of year-by-year savings.

In 2015, the new healthcare law is expected to save $50 billion, a baseline of $725 billion and projected spending after the bill of $675 billon. In 2019, the new law is projected to save nearly $100 billion, a baseline of $943 billion and and projected spending of $845 billion.

That is a significant saving but it is still nowhere near the $500 billion claim that comes from the right. Either that is some really fuzzy math, or just plain old making up numbers. I lean towards the latter.

"It's like a Medicare IRS"

from Kessler,
"In effect, the IPAB appears designed to mimic the Defense Base Realignment and Closure Commission, which was designed in the late 1980s by then Rep. Dick Armey (R-Tex.) with the backing of the Reagan administration."

The 15 members of the IPAB will be appointed by the President and subject to Senate confirmation. The board's purpose is to make recommendations for reducing costs should the rate of growth exceed a certain target, beginning in 2015.

Beginning in 2018, should spending still exceed the target, the board would then submit a cost-cutting plan to the White House and Congress. The Senate would be able to pass a different set of cuts or reject the IPAB proposal by a three-fifths vote.

The IRS, on the other hand, is tasked with estimating the amount of taxes owed and recording payments made, with the odd audit thrown in. The audit rate for 2010 was 6.5 audits per 1,000 taxpayers.

Granted, the IRS is an easy target for anyone trying to create populist outrage. I know that I don't enjoy paying taxes but I do acknowledge their need and celebrate all the groovy things that those taxes pay for. Also, I should note, all of the things that I wish my taxes weren't spent on like rising incarceration, the War on Drugs, and war in general.

Unlike many on the right, and pretty much anybody at a Tea Party rally, I believe in taxes AND single-payer healthcare. So, I take this claim to be a cheap ploy to drum up anti-government sentiment on the right.

“This IPAB board can ration care and deny certain Medicare treatments”

from Kessler,
"The health-care law, by the way, explicitly says that the recommendations cannot lead to rationing of health care. (See page 428 of the law.)"

Again, WRONG. I am having a hard time trying to find a better way to say this than Kessler. But here's a shot.

Lying-pants on fire-malingering-no good-rotten-dirty-lying-liar!

"Your choices could be limited and you may not be able to keep your own doctor"

from Kessler,
"The law also limits recommendations that would change benefits, modify eligibility or increase Medicare beneficiary cost-sharing, such as deductibles, coinsurance and co-payments."

The only way this could be true would be the case of a doctor not choosing to accept Medicare payments. I have run across many physicians who have made this choice for various reasons. The most common is the complaint that the rules for submitting payments are onerous.

But, any medial insurance system might result in a patient not being able to keep their own doctor. Fee for Service programs might see doctors raising prices, which could result in a patient no longer being able to afford that particular doctor. HMO's restrict patients to in-network providers. PPO's allow you to see out of network physicians but at a higher co-pay.

So this is more pandering and fear-mongering from 60 plus. Everyone wants to have a relationship with their doctor. Everyone wants that continuity of care. Also, everyone wants the ability to find a doctor that they feel comfortable with. While I am not a professional, my reading of the ACA does not say anything about keeping patients from their doctors.

Certain Republican legislation regarding abortion and contraception, on the other hand, certainly does seem to be a way to get between a patient and their doctor or at least to get into the room with them.

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