Bush Medicare Proposal

Just because a president is generally awful doesn’t mean he is always wrong.

A week ago, President Bush sent a proposal to Congress that would raise Medicare Part D (prescription drugs) premiums for affluent elders. The premiums, for example, would increase for individuals with incomes higher than $82,000 per year and for couples whose incomes exceed $205,000 annually. According to The New York Times, premiums would triple for couples with incomes of more than $410,000.

Given that the average monthly premium this year for Part D coverage is $28 (and several plans cost a good deal less), this increase for only the well-off is not unreasonable. Health and Human Services Secretary Michael Leavitt, quoted in the Washington Post, says the proposal would reduce government Medicare spending over five years by $3.2 billion.

This shouldn’t be taken as a reason to stop thinking about universal coverage as people consider who they will support for president this year. Even if the new president begins working with Congress on a healthcare initiative on day one – and they succeed - it will be several years until it takes effect. Until that happens, this proposal is a small stop-gap in money flow from Medicare.

Two other provisions of the proposal would allow the HHS Secretary to require the use of electronic records, and to collect and release price and cost information to Medicare beneficiaries to, according to The Times, “help them select treatment options and choose among doctors, hospitals and health plans.”

“Currently, Medicare is a price-setting system in which the government makes decisions about who is covered and how much is paid,” [HHS Secretary] Mr. Leavitt said. “We have a better option, to provide beneficiaries with reliable information about the cost and quality of their care. When given that kind of information, we know that consumers will make decisions that drive costs down and the quality up.”

- The New York Times, 16 February 2008

Although the healthcare industry must move to electronic records for efficiency, safety and as a money-saving measure, and more transparency is always good, I can’t help wondering how such a program would be administered, particularly when a patient is sick, injured or unconscious. On the simplest level, when my leg is broken or I’ve had a heart attack, I won’t ask what the emergency room bill is and go to another hospital if I think it’s too high.

In the end, Mr. Bush’s proposal is as cynical as this last year of his presidency has become and he undoubtedly submitted it only because he is required to do so by law. $3.2 billion savings over five years is chump change to someone who happily spends that much on a war with no purpose about every ten days.

None of which matters because Democrats in Congress immediately pronounced the proposal “dead on arrival.” They prefer reducing federal payments to private – that is, Medicare Advantage – plans. That’s a good idea too, since those plans are subsidized by the 80 percent of beneficiaries in the regular Medicare plan. But Congress (and the president) are more focused on thwarting one another than coming up with money-saving devices and not one of these ideas will be seriously considered this year.

Meanwhile, the number of uninsured in the country grows.

[At The Elder Storytelling Place today, Rabon Saip explores one of the exquisite - and mysterious - pleasures of life in The Feeling.]