OP-ED

The Debt Ceiling and Health Care

Over the weekend, I watched Twitter as drops of information about the debt ceiling leaked out bit by bit. There was a deal. No deal. Well, maybe a deal.The deal would require Congress to wait until a Balanced Budget Amendment passed in the states before it acted. Well, no it actually didn’t include that. Medicare was on the chopping block. Well, not cuts to members, only cuts to physicians and other providers. What’s an ordinary person to think?

There was plenty of humiliation to go around. Speaker Boehner didn’t return the president’s phone calls. Speaker Boehner couldn’t rally his own party to support his deal. Majority Leader Reid couldn’t get Republicans to talk to him. Sen. McConnell would only talk to Biden not Reid, and his unfortunate facial expressions left us with the impression that he had a serious digestive problem. The classic picture was Boehner in the House elevator letting out a long groan as the doors closed. He was not the only one groaning.

Pundits made the worst cliché pronouncements. Everything was a “crisis”; there was lots of “kicking the can down the road.” TV time had to be filled and fill it they did. Those smart folks who spent the weekend outside, barbecuing or swimming, were the wise ones. We all knew it would come down to the last moment, but oh, was it painful to watch those last agonizing hours.

Now that the debt ceiling will be raised and we can pay our bills (for a while at least), we are left to wonder — what will it really mean for some of the programs we care about? The predictions have ranged from death to resurrection for Medicare and Medicaid. But somewhere in this pile of doo-doo there may be a few ponies. The details of the debt ceiling “deal” require that some programs be kept off the table in the negotiations of the “super committee.” Those programs include Medicaid (remember almost half of Medicaid goes to nursing home care and the rest to health benefits for the disabled, poor women and children, and the elderly), Social Security, military salaries, and veterans’ benefits. Cuts to Medicare cannot affect “benefits” (although the committee can raise eligibility age and potentially copayments), only payments to providers. The military and Homeland Security are not exempt as they have been in the past.

While there is some protection for the programs that serve our most vulnerable citizens, it is hard to claim that these are victories we should cheer about. Some of the key aspects of the health reform law may be affected negatively by the need to make these deep budget cuts. Funding for the subsidies that will allow people of limited income to get health insurance in 2014 may be severely constrained. The new Independent Payment Advisory Board (IPAB), which has been under fire for some time, may be eliminated, leaving decisions about how to contain costs in Medicare to the politicians — the same politicians that have proven themselves unable to do that very thing up to this point. While many of the health reform law’s provisions are already being implemented (e.g. closing of the donut hole in prescription drug coverage for seniors, allowing young adults to stay on their parents’ plan until 26, tax credits for small business to help them provide coverage, the establishment of state-based exchanges, demonstration programs to cut costs and maintain quality in Medicare — to name a few things), the full roll out of the law very much depends on who wins what in 2012. If the Republicans keep the House, win the Senate and the Presidency, the ACA will most definitely be repealed.

Meanwhile? There is no Republican plan to fix health care, other than Rep. Ryan’s proposal to give seniors some money and toss them into the health insurance marketplace to find coverage. Oh yes, and more “personal responsibility” for health care, translated as shifting costs to us and requiring us to try to figure out which doctor or hospital is cheaper and better, when that is almost impossible to do with the information we currently have. The trifecta of Republican options remains the same: 1) personal responsibility 2) malpractice reform and 3) selling insurance across state lines. Have these solutions brought down health care costs? Not so much.

I am generally a pretty optimistic person. If you read my blogs, you know that I try to find something positive in almost every aspect of health reform, even though many of you have tried to disavow me of that optimism and have accused me of pollyanism or worse! Still, I have found plenty of ponies in the last several years — the bookstore owner who was able to give her employees coverage because of the tax credit; the family whose son had cancer but could keep him on their insurance plan while he underwent chemotherapy; the savings for seniors from the closing of the donut hole for prescription drugs; the state programs for people who are uninsurable.

What I tell my family and friends now is the following: 1) This is not the worst deal ever. There are some wins for health care programs and some small potential for meaningful tax reform. 2) If you care about keeping Medicare and Social Security solvent you need to speak out and organize, but also be willing to be flexible about what changes to those programs will keep them solvent and 3) While you may not think that the president negotiated as well as he could have, we don’t really know all the details and the background of what went down. I do think it could have been worse and so do many others.

Linda Bergthold, PhD, is an independent health policy consultant and researcher and Senior Advisor at the Center for Medical Technology Policy. She currently serves as on various boards and committees to evaluate new technologies and review research from the consumer perspective. Follow her on Twitter: @lab08

This post first appeared at The Huffington Post.

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Online Doctors
Guest

I am totally agree with you. Thanks a lot for such a wonderful information

MD as HELL
Guest
MD as HELL

Appointing senators connects the states to the Congress directly, as was the intent of the framers. Very smart.

The worldwide economic meltdown of the first world is going to put a crimp in the socialist agenda.

Probably want to keep your cash and not send it to Washington.

Margalit Gur-Arie
Guest

Appointing senators was intended to minimize the public (rabble) influence on government. Considering that most “representatives” in congress seem more concerned with their patrons and their own hides right now, there’s no worry of excessive influence of citizens on government right now.

What is melting down is unbridled selfish capitalism and myopic avarice which advocates keeping the unethically obtained fruits of other people’s labor under the mansion floor instead of sending some to Washington where it could be put to good public use and bring you even more cash in the long run.

MD as HELL
Guest
MD as HELL

BS

BobbyG
Guest

Abolish the Senate.

Margalit Gur-Arie
Guest

“Time to appoint senators again.”

…and this will help you/us in some way? maybe it’s time to appoint presidents too…..

Peter
Guest
Peter

“Medicare canpay whatever it wishes. The patient should be on the hook for the rest.” Ah yes, provider prices/utilization is not part of the problem, it’s all the patients’ fault. Certainly wouldn’t want any income reductions for providers who can set whatever price they want. “Time for the gov’t to get out of the direct benefit game. It was never their call to be rescuing people from life’s misfortunes.” I guess that would include FEMA bailouts for so called, “natural” disasters? The states would be the first to scream. Strange you also want the “government” to rescue you from the… Read more »

MD as HELL
Guest
MD as HELL

The legislature of each state used to appoint the senators. That was the last time the country had balance between atate and federal government.

Only the government can create the litigation hazard for me, so only the government can rescue me from it.

FEMA is a joke. Natural disasters are the business for the states.

Time to dismantle Soc. Sec. and Medicaare.

They are toast as soon as the younger voters get tired of carrying your dead wood.

MD as HELL
Guest
MD as HELL

That would be larger provider bills and balance billing. Medicare canpay whatever it wishes. The patient should be on the hook for the rest. I promote death with dignity all the time. i preach against feeding tubes case by case all the time. Doctors used to have the stature to tell the family to let grandma go. Then consumerism took over around 1988. Customer ssatisfaction rose its ugly and unprofessional head at the same time. The malpractice crisis took off. It all costs. Futile end of life care should not be publicly financed. The Republicans are politicians, too. They did… Read more »

Tracy
Guest
Tracy

Wwll I partially agree with the thrust of the blog, it seems like one important element is missing and that is to do the will of the people who elected the Congress. Also, many of the reforms passed by Congress and called healthcare reform were actually already passed in many states years in advance of Obamacare. As someone who has dealt in healthcare and specifically health insurance for nearly 25 years, these reforms were not a game changer. The game changer will come if we have the courage to take on malpractice reform. That will be the cost shifter or… Read more »

Peter
Guest
Peter

“It is time to stop buying scooters and time to stop placing feeding tubes for futile end of life care.” I’d have to agree on the scooters, “at no cost to me”, but who would you give the authority to decide tube/no tube that would get past the right-to-lifers? The ACA did have in it provision to promote living wills but your cherished Teapublicans screamed DEATH PANELS!!! “It is time for nursing homes to not send me every patient they find uninjured on the floor.” Would you remove liability for nursing homes? “It is time for the growth in government… Read more »

Vivek Rao
Guest

I think the real issue is not the debt or the money. For one we are a non social-welfare state. Looking at the experience of social welfare states in Europe one can indeed see that half the problems of health care related debts is the lack of the government’s initiative to put health before business. Right now it is the insurance companies that are raking in the moolah in the name of healthcare, not to mention the ongoing bleeding of insurance money through fraud. Welfare state would also put a lot of other things in line with keeping our debt… Read more »

MD as HELL
Guest
MD as HELL

The super committee will end up with no power at all. Continuing to borrow to fund mindless healthcare is insane. No one should have public debt incurred for healthcare costs live linger than they do. It is time to stop buying scooters and time to stop placing feeding tubes for futile end of life care. It is time for nursing homes to not send me every patient they find uninjured on the floor. It is time for MediCare preadmission denials to mean something. It is time for the growth in government healthcare outlays to shrink. It is not the job… Read more »

William Capers
Guest

By William Capers The Associated Press PREV of NEXT AP A 2004 photo shows Air Force Staff Sgt. Dean Witt with his wife, Alexis, after a mistake at a military hospital left him in a vegetative state. His family is fighting a law that has protected the hospital from a negligence lawsuit. Related Top comments Hide / Show comments It’s just a simple question of providing the same rights to our nation’s military that… (April 23, 2011, by southkingcounty) Read more As long as one part of society makes the decisions about war and another part of… (April 23, 2011,… Read more »