Wednesday, September 23, 2009

An Uncomfortable Skepticism

Today I break my silence.

In principle I am in favor of universal healthcare, possibly single payer. But sadly, I wonder if it could really work here. Unfortunately, the climate for rational discussion has been poisoned by the absurd rhetoric on the right. Anyone who feels skeptical about the workability of the proposals is afraid to be lumped in with the hateful wingnuts, and so true discourse has languished.

Many people supporting the current efforts to extend coverage talk about how you could consider it like extending Medicare style coverage to a larger segment of the population. OK, now they have really lost me, because Medicare is a DISASTER.

Sure, people who have Medicare say they like it, except that they do sometimes complain about how expensive it is (Big eye roll here). Mostly they just say, "Keep your hands off of our Medicare benefits!" But it stands to reason that Medicare, as is has been experienced thus far, should seem like a good deal------a really good deal! Most current recipients have paid in approximately a total of $68,000, but can expect to have used around $190,000 of medical care (paid for by Medicare) when all is said and done. What a bargain!!!!!! No wonder current seniors are wildly enthusiastic about it. It's a free lunch. A free $122,000 lunch!

Because the spending has so wildly outstripped revenues, the Medicare trust fund paid into by all of us for all of our working lives has been all but used up. That's right, the big lump of cash meant to pay for the health benefits of future generations has been sucked almost completely dry by former and current seniors. The pace of technology, medical advancement and demographic shifts doomed the plan as it was originally formulated.

The really interesting thing is that the original plan for Medicare included a clause that made certain funding and payment adjustments automatic to keep the plan solvent for the long haul.

But the problem has been with our political system. Every time that the automatic adjustments were about to kick in, Congress would vote to override the change because of pressure from the AMA and seniors. This is what makes me wonder if we can get anything to work in our democracy. Our citizens want the very popular benefits, but are always reluctant to pay the necessary taxes. And our congressional representatives know that they cannot effect the necessary changes (increase taxes or limit benefits) and stay in office.

Many things should have already happened to make Medicare viable down the road. Benefits could start a little later since we live so much longer now. Taxes would have to be higher, and possibly some "treatments" (the sort that merely prolong the final days without offering any hope of a cure-----you know, comatose people on ventilators indefinitely......) should be taken off the table. This is a plan that no one likes, not seniors, not tax payers, and not people who are afraid of death. Any yet this is what is necessary to save the system. But no one running for office is going to say any of this out loud.

So I guess I want the government to fix Medicare before they try to make it bigger. Or perhaps make it all one big system and then make Choices. Choose to prioritize medical spending on younger people, patients who have a lot of life ahead of them. Seniors won't like this, but when they complain that they have paid into the system for so long, we need to be ready to say that they are getting WAY more than they ever paid for!

So I suppose it is funny, I make fun of Republicans for speculating wildly about death panels, but then argue that that is, of course, just what we really need. That and higher taxes.

1 comment:

djinn said...

Yay for higher taxes! Yay1!!!one! Also, end-of-life care must be handled on a reasonable (i.e., when the health costs someone racks up in the last month of their life are 10X the rest of their health costs) must be handled rationally. Rationally = curtailing care when it will no longer help. You rock, Kerfuffler.