President Obama has been attacking Republicans on Medicare, claiming that they will end Medicare as we know it. Yet, the President’s health care reform law has put in place measures that assure that Medicare as we know it will no longer be available for seniors in the very near future. As a physician, I believe seniors should know what those changes are.
First, the Affordable Care Act – or as the president likes to refer to it, ObamaCare – cuts $716 billion out of Medicare to pay for ObamaCare. The president claims that seniors do not need to worry because this massive cut does not change what Medicare recipients are eligible for.
While that is technically true, it is also profoundly misleading.
President Obama pays for this cut by dramatically decreasing reimbursements to physicians and hospitals, reimbursements that in many cases are already below cost. As a result, many physicians will no longer be able to care for Medicare patients because of prohibitively low reimbursement rates. How does it benefit someone to have Medicare coverage if you cannot find a physician to care for you? Further, reimbursements to hospitals for procedures will be so low that many will no longer be able to provide many services. This is back-door rationing.
Second, approximately $200 billion has been eliminated from the popular Medicare Advantage program which gives seniors choice in how they receive their Medicare benefits.
Those cuts were supposed to take place several months ago, but the services were conveniently extended until after the election, thanks to a “pilot program” from the department of Health and Human Services. After the election, many will lose the option to be in Medicare Advantage. “If you like your health insurance, you can keep it.” Really?
Third, the Independent Payment Advisory Board, or IPAB is a panel of 15 unelected, unaccountable bureaucrats who are charged with cutting the growth of Medicare spending. The cuts they make will be deep. The recommendations of this board are law and can only be overturned by a supermajority of Congress, something which almost never happens. The only tool IPAB has to reduce spending is to further cut reimbursements to hospitals and physicians. So when services are no longer available to seniors, legislators will simply say, “It’s out of our hands – it’s IPAB’s doing!”
Fourth, President Obama is preparing to require drug companies to pay a rebate to the federal government for prescription drugs sold through the popular Medicare Part D. This prescription drug program utilizes market competition to get the best drug prices for seniors. Medicare Part D has been so successful that the costs are 40% below their estimate when the plan was passed into law. The average monthly beneficiary premium for Part D coverage is about $30 in 2012, virtually unchanged from 2011, and far below the $56 originally forecast.
The proposed rebate tax would force some drug companies out of the program, resulting in decreased competition and increased cost that would simply be passed on to seniors. Douglass Holtz-Eakin, the former director of the Congressional Budget Office, estimates that this tax would increase premiums up to 40%, as well as increase annual out-of-pocket costs an average of $200 for as many as 17 million seniors.
So why would President Obama take these actions that are clearly detrimental to seniors? To answer that question, consider the philosophy embraced by the architects of the President’s health care law.
One of the chief architects of the law is Dr. Ezekiel Emanuel, a bioethicist. He was appointed as a health policy advisor at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. Dr. Emanuel has been critical of the Hippocratic Oath (Journal of the American Medical Association, June 18, 2008), claiming that adherence to it led to the overuse of resources as a result of a physician’s sense of obligation to “help the sick to the best of my ability and judgment as an imperative to do everything for the patient regardless of cost or effect on others.”
Alternatively, Dr. Emanuel has advocated a “complete lives system” in which scarce resources can be allocated. In this system, patients between age 15 and 40 get the most care, while the very young and the elderly have a lower chance of intervention; the young because we have not “invested” in them as yet, and the elderly because there will be less “return on investment” (Lancet, Jan 31, 2009).
As a physician, I have taken an oath to do everything in my power to promote the health and well-being of my patients. I, and many of my colleagues, will refuse to practice medicine if the government starts making decisions that should be reserved to patients and their physicians.
We are at a crossroads in American medicine. We will either accept a top-down, central command-and-control model of medicine as embodied in ObamaCare, or we will fight to restore the best health care system in the world.