By Jack Bernard
Ledger-Enquirer (Columbus, Ga.), Sept. 8, 2012
Rep. Paul Ryan (and, by extension, Mitt Romney) wants to start the process of getting the government out of our health care by going to a voucher program for Medicare. The problem is that the American people are clearly not with him or the GOP — my party — in this crusade.
August surveys by NBC/Wall Street Journal and the Pew Research Center confirm this fact. Pew finds that of the nearly three-fourths of Americans who have heard about the Ryan voucher plan, only 34 percent favor it while 49 percent oppose it. The NBC/WSJ survey finds that only 37 percent of the public believes Medicare needs a complete or major overhaul. When asked about the Ryan voucher concept, only 15 percent think it is a good idea, while 30 percent think it is bad. When asked do they favor Obama’s position against or Romney’s position for vouchers, 50 percent side with Obama as opposed to only 34 percent with Romney.
The response of the GOP to these polls has been to confuse the issue by accusing Obama of cutting $700 billion out of Medicare to fund Obamacare … which, while true, is very misleading. The Democrats have bumbled around, responding poorly to a surprisingly effective, although purposefully vague, Republican Medicare offensive.
Being disingenuous will work for a while for my fellow Republicans, but eventually the Democrats will figure out how to better explain the substantial impact of the voucher proposal on the lives of the voters. The GOP will then lose this battle.
Americans will understand that making Medicare a voucher program is simply a budgetary maneuver proposed by a Washington wonk (Ryan) to shift the constantly increasing cost of health care from one payer (the federal government/Medicare) to another payer (the patient).
It does nothing to make the health care delivery system more efficient or effective, unless you buy into the dubious argument that an individual patient has more power to correct provider behavior than does the government through control of the payment mechanism.
In any case, there is currently a private alternative to traditional Medicare. It is called Medicare Advantage. When it was proposed by Republicans and approved years ago, it was supposed to be the way to gradually get the government out of Medicare and save the government a lot of money. But it did not work; it costs the government 10 percent more than traditional Medicare. It just channels healthier seniors into private HMOs and PPOs, while costing the government (and taxpayers) billions.
By the way, this is a large part of the Obama “cut” in Medicare, bringing seniors out of Advantage and back into traditional Medicare, projected to save $117 billion by 2019.
There is an easier and much more effective way to save Medicare: Expand it to cover everyone, and not just seniors. Right now, Medicare covers only those over 65, the sickest segment of the population and the group which uses the most resources. By expanding it to cover all age groups, the risk is spread, causing average costs and premiums to decrease.
Is this a radical idea? Not really; many of the world’s democracies already have a single-payer system. Canada is just one example. Canadian costs per capita are much lower than ours, and their health care indicators (morbidity and mortality) are much better. As opposed to what you may have heard, providers are well paid and the public likes the program very much.
A full explanation of Medicare For All, including funding, can be found at the website www.pnhp.org, sponsored by the respected group Physicians For A National Health Program (PNHP).
I am a Republican fiscal conservative, and setting a global budget under Medicare for All makes sense to me. So does leveraging the power of the federal government to determine appropriate fee schedules to keep down costs.
From a societal standpoint, we are paying for many of the uninsured right now through our expensive ERs. The problem is that they are not served until they are very sick and require expensive care relative to what could have been given them earlier. A Grady Hospital physician recently told me of one example where an uninsured patient could not afford meds and went blind. After that happened, he was then covered by Medicare … at a much greater financial cost to the system, not to mention the irreparable cost to that person.
If the GOP really wants to do something innovative to control the cost of health care, improve quality and guarantee access, it must abandon ill-conceived private market solutions like vouchers. It should do what much of the rest of the world has already done and advocate a single-payer approach.
Jack Bernard, a Jasper County commissioner and former chairman of the Jasper County Republican Party, is a retired executive of for-profit health care services. He is now a private consultant for small business.