Tuesday, September 4, 2012

Election Primer 2012: 8. Who Will Pay for Health Care?

    My mother is slowly losing her hearing. Hearing aids allow her to talk with us, if we are close and speak loudly. Pretty good for 90, I could say, but that’s not much consolation to someone who is 90 and going deaf.
    Modern medical science has created amazing devices to perform functions our bodies can no longer do. Here’s one you may not know about, if holding back deafness is not part of your family life. A cochlear implant is an electronic device which replaces the normal process of sound transmission to the brain with a series of electrodes. Cochlear implants have been used successfully in infants born deaf and in older people who have lost hearing.
    These tiny devices are expensive, at least $45,000 each. So insurance providers restrict the circumstances under which they will pay. My mother can understand words now at 70 decibels, but not less. Only when her hearing gets worse will her doctor recommend an implant, unless she pays herself. So we have an appointment for another test a year from now. The same is true of the more common and much cheaper operation to save eyesight from cataracts. Sight must deteriorate to 20/40 before insurance will cover an artificial lens.
    In both kinds of operations, private insurance companies and Medicare have similar thresholds to determine when they will pay. That’s the meaning of rationing care. People at the top of giant organizations decide when and where and by whom health care is provided to all of us. Health care is already rationed and private insurers also specify which doctors they will pay.
    Where do the parties stand on cochlear implants? By her next appointment with her ear doctor, we could have a Republican or Democratic President, implementing their party’s platform. The trouble is, it is very difficult even for experts to figure out the long-term effects of the Democrats’ Affordable Care Act, usually called Obamacare, or the Republicans’ proposals contained in Paul Ryan’s  budget plan. Factcheck.org says: “The presidential campaign is overflowing with claims from both sides designed to scare seniors into thinking Medicare is being gutted or about to end altogether.”
    The Republican proposal for cochlear implants, and for the whole Medicare system, is to do nothing to the system for my mother and me and anyone over 55, and to completely change it for everyone under 55. Instead of Medicare’s specific benefits, like payment for cochlear implants or prescriptions, younger people would get a voucher from the federal government to pay insurance premiums when they retire. Would the voucher pay for insurance plans as good as current Medicare, or would seniors have to pay much more out of their pockets? Since this would not take place for a very long time, nobody knows.
    But there are some hints in their party platform.“Medicare . . . is the largest driver of future debt. . . . Without disadvantaging retirees or those nearing retirement, the age eligibility for Medicare must be made more realistic in terms of today’s longer life span.” Since Republicans emphasize reducing the debt by spending cuts alone, younger people will be “disadvantaged”, most obviously by raising the age eligibility.
    Obama’s Affordable Care Act envisions considerable cost savings in Medicare over the next 10 years by reducing payments to hospitals and insurance companies. Democrats propose no reductions in benefits or eligibility. The hope for these future savings may be wishful thinking, because nobody knows how much medical costs will rise.
    For all the hullabaloo about Medicare, however, the real difference between the parties is on Medicaid, the health care program for the poor. The Affordable Care Act would expand Medicaid coverage from about 60 million people to 77 million by 2016, as part of the Democrats’ effort to provide health care insurance to everyone. Costs would be shared between the federal and state governments, and it is not clear how that would be financed.
    Republicans want to end the federal program and have the federal government give grants to the states for 50 different Medicaid programs. The Ryan budget plan would make cuts of $1.4 trillion to Medicaid over the next 10 years, although that is not mentioned in the party platform. According to the non-partisan Kaiser Family Foundation, that “would almost inevitably result in dramatic reductions in coverage.”
    Those cuts would mainly affect the poor, typically invisible in American politics, and completely invisible in the Republican Party platform. During their working lives my parents saved well more than the average for people who are retiring now. But that nest egg is being spent on nursing home care for my mother. Modern medicine has brought about 1.4 million seniors like my mother into nursing homes, because they need 24-hour professional care. In a couple of years, her savings will be gone, and then she will qualify for Medicaid. Right now about 60% of all nursing residents get Medicaid, which also assists paying for one-third of all babies born in the US.
    By that time, the Republicans might have severely cut Medicaid, as the Ryan budget foresees. That would certainly disadvantage her and millions of seniors like her.

Steve Hochstadt
Jacksonville IL
published in the Jacksonville Journal-Courier, September 4, 2012

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