JONATHAN COHN AUGUST 10, 2010
Health care reform would mean rationing of care, the critics warned. The government would be slashing Medicare funding and, pretty soon, groups of experts--a.k.a., "death panels"--would be dictating the terms of coverage.
Sure enough, it's starting to happen. From the Washington Post:
Starting in January, the new health-care law will make it easier and cheaper for seniors to get preventive care. Medicare beneficiaries will be able to receive for free all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention. These measures include mammograms and colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for diet-related chronic diseases such as diabetes.
Medicare beneficiaries will also get a free annual wellness visit under the new law. The visit will cover a number of services, including a health risk assessment and a review of the person's functional and cognitive abilities.
Now, in all seriousness, health care reform does reduce overall spending on Medicare. That includes reduced payments to providers, who could react by seeing fewer Medicare patients, and to private Medicare Advantage plans, which might offer fewer benefits.
But for as long as I can remember, Republicans have also called for spending less on Medicare. Former House Speaker Newt Gingrich did it in the 1990s. Representative Paul Ryan does it now. The difference is that these Republican Medicare cuts (and others like them) have been larger and more crude. Both Gingrich and Ryan have sought, among other things, to turn Medicare into something like a voucher program that would not guarantee a level of benefits.
The Democratic reductions in the Affordable Care Act, by contrast, are part of a package that seeks to spend money more carefully--by fostering the use of medical homes, for example, or reducing payments to hospitals with high infection rates. Studies have shown that physicians frequently threaten to see Medicare patients as fees go down, but rarely do; the reduction in money to Medicare Advantage payments reflect the fact that, according to multiple independent authorities, the program has become a form of corporate welfare for insurers.
The Democrats were also careful to improve coverage in certain places, even as they reduce spending overall. The guarantee of free preventative care is one example of that. As the Post article notes, seniors who get free preventative care are more likely to get the checkups and tests they need, while developing better relationships with providers and developing more consistent patterns of care. Whether or not this turns out to save money, as some experts predict, it should make seniors healthier. And, through it all, the Democrats keep the promise of a basic level of benefits for all seniors.
If you think we must slow down the growth in Medicare spending--and I'm aware of no serious politician, in either party, who thinks otherwise--this strategy strikes me as a pretty sensible one. And while the calibrations of Medicare may not always work out precisely as planned, overall they seem preferable to the bigger, cruder cuts Republicans have in mind.
Update: I added links and clarified that Democrats, unlike Republicans, maintain the commitment to basic Medicare benefits.