The Medicare scare 

Rare is the day for oldtimers that the postman does not deliver from one to three pieces of mail from insurance companies urging us to switch from regular Medicare coverage to their Advantage plans. Newspaper ads and pop-up ads on the Internet carry the same appeals.

If you just look out for yourself, it's a no-brainer. Your expenses could be lower. You can get a few services like annual vision and hearing-aid screenings that regular Medicare doesn't cover. The insurance companies will get much richer so you're doing your part for capitalism. And that reliable old packhorse, the U.S. taxpayer, will pay for all of it — about 14 percent more than he or she pays for your regular Medicare protection.

Since 2003, when the Republican Congress and President George W. Bush made the private Medicare plans so appealing, about a fourth of Medicare recipients (not me, yet) have switched, increasing the Medicare payout immensely and speeding the program toward insolvency. They didn't pay for the expanded program in 2003 but merely lied about its cost.

The blizzard of pitches from insurance companies this season (you get a chance to switch at the end of each year) persuades me that it has more than a little to do with the industry's campaign to stop the health-insurance bills that are moving toward law in Congress. The major obstacle to reform is the fear among many seniors that they are going to lose Medicare or have their coverage reduced, and the more of us who sign up for Advantage plans this month the more people who can get mad at Congress over health reform.

Blue Cross Blue Shield has been especially tough, writing what amount to extortion letters to their Advantage customers in some states, saying they would have to raise their premiums if the insurance reforms become law. They would have to raise premiums, of course, or else lower their immense profits from Advantage plans. Most of the extra federal payment for Advantage policyholders goes for insurance profits. A study in the international Journal of Health Care Finance and Economics showed that only 14 cents of each subsidy dollar actually paid for benefits, the rest for profits and administration.

Were it not for the rising tide of seniors who tell pollsters that they hate the health-reform bills and relay the message to senators and congressmen when they get phone calls offering to hook them up with the congressional offices, legislation would have passed weeks ago. But senators and congressmen in target states like Arkansas have been petrified at the opposition of Medicare beneficiaries. Tune in the next time that Senator Pryor or Senator Lincoln has a mass conference call to talk to constituents, and you'll hear the anger.

Seniors are the linchpin in the health-care debate. The drive to scare them may be the most cynical, dirty, expensive and effective political marketing campaign in history. The capstone came Thursday when Senate Democrats, most of them, voted down an amendment by Sen. John McCain that aimed to get Democrats like Lincoln on record as voting to cut Medicare. McCain will be in Northwest Arkansas this week to exploit the votes and to drive a stake into the re-election campaign of his colleague.

You need a little history to understand the special cynicism in this ruthless ploy.

When Republicans pushed through the Medicare prescription drug program, which contained the huge new federal subsidy to insurance companies so that they could entice seniors into buying Advantage plans rather than enrolling in traditional Medicare, McCain was one of the handful of Republicans who voted against it. Lincoln, incidentally, voted for it; Pryor voted against it. McCain said the program wasn't paid for and would be a huge drain on the Medicare Trust Fund and the treasury. He was right then. He was still running the Straight Talk Express.

Running for president last year, McCain hammered away at Medicare's spiraling cost and said he would get Medicare spending under control. He said he would slash the subsidy for Medicare Advantage because the insurance companies ought to compete with regular Medicare on an even field. That is exactly what both the Senate and House bills try to do, the House bill especially.

But the game has changed in 2009, and the united Republican agenda is to prevent President Obama and the Democrats from enacting a comprehensive health program and, while they are at it, knock off shaky senators like Lincoln by persuading large quotients of the elderly that the Democrats betrayed them.

McCain denounced the Democrats last week for wanting to cut $150 billion from the Medicare Advantage subsidy over 10 years and to reduce payments to providers, both positions directly contrary to his campaign's positions in 2008. Back in the campaign, his senior policy adviser, Douglas Holtz-Eakin, said McCain would slash Medicare costs by reforming payments to providers.

Not today. Cutting Medicare and Medicaid, he said last week, is just “a price that Americans should not be asked to pay.”

The truth is that seniors by and large would profit from either the Senate or House bills because their drug coverage would be improved and neither bill would threaten any of the guaranteed benefits that every Medicare beneficiary is entitled to.

When the Fear Talk Express comes to Springdale Sunday, McCain won't be explaining his contradictions. He won't even be asked.





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