Paul Krugman Medicare killers 2012

Nobel Prize winner Paul Krugman’s column in the NY Times (8/31/2012) is a must read for everyone – not just health policy wonks, but everyone – because we all have a stake in healthcare. During this election season, we are being barraged by the Romney-Ryan campaign with half-truths and outright lies about what Obama care is…and isn’t.  Using plain talk, Mr. Krugman spells out what you need to know.  Here are some highlights from the column:

“Mr. Ryan’s brazen dishonesty left even his critics breathless…Some of his fibs were trivial but telling, like his suggestion that President Obama is responsible for a closed auto plant in his hometown, even though the plant closed before Mr. Obama took office. Others were infuriating, like his sanctimonious declaration that “the truest measure of any society is how it treats those who cannot defend or care for themselves.” This from a man proposing savage cuts in Medicaid, which would cause tens of millions of vulnerable Americans to lose health coverage.”

“But Mr. Ryan’s big lie — and, yes, it deserves that designation — was his claim that “a Romney-Ryan administration will protect and strengthen Medicare.” Actually, it would kill the program.”

Yes, not change…but kill the program. Paul Krugman Plain Talk: The Medicare Killers

“But back to the big lie. The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.
Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs.

Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies.”


Can’t we all just get along?

If the anti-Obamacare folks can just take a deep breath and listen up, they would probably agree with the following:

  • Health insurance premiums go up every year, sometimes by double digits
  • Many health insurers in this country are for-profit entities – they are in business to make a profit for themselves and their investors
  • The Voucher subsidies are highly unlikely to keep pace with the rate of rise of health insurance premiums
  • Therefore, the percent of the premium covered by the voucher will decline over time and the amount of money Seniors must pay out of pocket will rise
  • Some Seniors will be unable to afford their out-of-pocket, and so will be forced to join the ranks of the uninsured.

Is that really what we want???
You may say, come on now, the free market is going to keep costs in check so your first premise (that premiums will go up every year) is incorrect.  Per Krugman:

“Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs.

I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs.”

So, what about the Romney-Ryan call to repeal Obamacare (on day one, per Romney – another lie as it is not technically feasible to do this):

“For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees.”

It would also reverse benefits that under 65’s now enjoy, including the popular ban on pre-existing condition denials and the ability to keep your kids on your policy to age 26.

So, as Mr. Krugman says,

“The question now is whether voters will understand what’s really going on (which depends to a large extent on whether the news media do their jobs). Mr. Ryan and his party are betting that they can bluster their way through this, pretending that they are the real defenders of Medicare even as they work to kill it. Will they get away with it?”



Let’s not let them!  We have gotten so used to politicians, on both sides of the aisle, twisting the truth, that I think we fail to really hear what is really being said and what it really means.  But this time the consequences will be serious. If we end up buying the Medicare snake oil that the Romney-Ryan folks are selling, both Red and Blue grandmas and grandpas (and their kids and kids’ kids) will suffer. It will be back to the past for Seniors (as in the bad old days pre-enactment of Medicare). That would be a shame (and shameful).


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