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Not Ending Medicare As We Know It

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Capitol Police recently arrested 89 protesters from the disability rights group ADAPT for occupying the rotunda of the Cannon House Office Building. They were demonstrating against the proposed changes in Medicaid in the recently passed House budget resolution that would reduce the program’s funding and turn it into block grants to the states. “Block grants kill,” read some of the protest signs.

This follows outrage by Democrats and senior-citizen groups over the proposed changes to Medicare in the same budget resolution. They are upset about the House Budget Committee’s plan to convert Medicare into a voucherized private insurance program. Said Obama press secretary Jay Carney: “The House Republican plan places the burden of debt reduction on those who can least afford it, ends Medicare as we know it and doubles health care costs for seniors in order to pay for more than a trillion dollars in tax cuts for millionaires and billionaires.”

According to the Budget and Accounting Act of 1921, the president is required to submit to Congress by the first of February a proposed budget for the next fiscal year (which begins on Oct. 1 of the current calendar year). Within six weeks of the president’s submitting his budget request, congressional committees are required by the Congressional Budget and Impoundment Control Act to submit their “views and estimates” of federal spending and revenues to the House and Senate budget committees. These are then used by each budget committee to draft and report a concurrent resolution on the budget by April 15. It is only then that appropriation bills are enacted.

It is H.Con.Res. 34, “Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021,” that recently passed the House by a party-line vote of 235–193. (Only four Republicans — including Ron Paul and Walter Jones — voted against this bloated Republican budget.)

Medicare and Medicaid are mentioned in two sections in the report (112-58) by the House Committee on the Budget that accompanies H.Con.Res. 34: briefly in the introduction under “Restoring America’s Promise,” “Components of the Federal Budget,” and “A Reform Agenda for the U.S. Government,” and in more detail under a “Function-by-Function Presentation,” where each of twenty-one budget functions represents a broad area of government activities.

Under “Function 550: Health,” we are told that “the principal driver of spending in this function is Medicaid” (other cost drivers in this function are SCHIP, the NIH, OSHA, and the FDA). Absent reform, “Medicaid will not be able to deliver on its promise to provide a sturdy health-care safety net for society’s most vulnerable.” Proposed is the conversion of “the Federal share of Medicaid spending into an allotment tailored to meet each State’s needs, indexed for inflation and population growth.” In other words, a block grant. This will improve “the health-care safety net for low-income Americans by giving States the ability to offer their Medicaid populations more options and better access to care.” After all, Medicaid recipients “like all other Americans, deserve to choose their own doctors and make their own health care decisions, instead of having Washington dictate those decisions for them.” This Republican plan to save Medicaid calls for $346.6 billion in spending for fiscal year 2012 on the category of “health.”

Under “Function 570: Medicare,” we are told that “letting government break its promises to current seniors and to future generations is unacceptable.” All seniors should have “secure, affordable health coverage.” Absent reform, “Medicare will be unable to meet the needs of current seniors and future generations.” Therefore, “the reforms outlines in this budget protect and preserve Medicare for those in or near retirement, while saving and strengthening the program so future generations can count on it when they retire.” For those 55 and older, “the Medicare Program and its benefits will remain as they are, without change.” For those under 55:

Starting in 2022, new Medicare beneficiaries would be enrolled in the same kind of health care program that Members of Congress enjoy. The Medicare recipient of the future would choose, from a list of guaranteed coverage options, a health plan that best suits his or her needs. This is not a voucher program; a Medicare premium-support payment would be paid, by Medicare, directly to the plan chosen by the beneficiary, subsidizing its cost. The program would operate in a manner similar to that of the Medicare prescription drug benefit. The Medicare premium-support payment would be adjusted so that the sick would receive higher payments if their conditions worsened; lower-income seniors would receive additional assistance to help cover out-of-pocket costs; and wealthier seniors would assume responsibility for a greater share of their premiums.

The Republican plan to save Medicare will cost taxpayers $481.8 billion for fiscal year 2012.

There are numerous problems with these GOP plans to reform Medicaid and Medicare.

First of all, according to a Henry J. Kaiser Family Foundation Medicare Fact Sheet, Medicare benefit payments totaled $509 billion in 2010, plus administrative expenses. The Republican “budget cutters” on the House Committee on the Budget are barely making a dent in Medicare spending.

Second, the head of the House Committee on the Budget with whom Democrats and their constituencies are so upset is Paul Ryan (R–WI). Although he has a reputation as a tough budget cutter, he voted for H.R.1424, the “Emergency Economic Stabilization Act of 2008” (the TARP bailout), H.R. 5140, the “Economic Stimulus Act of 2008” (the Bush stimulus plan), and H.R. 7321, the “Auto Industry Financing and Restructuring Act of 2008” (the GM bailout). In addition, Ryan supported funding for Head Start, extending unemployment benefits, and the expansion of Medicare. Some budget cutter.

Third, Republicans who complain about the high cost of Medicare, the waste in the system, and its impending bankruptcy have only themselves to blame. It was Republicans that came up with the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003” that greatly expanded the program. This Republican version of health-care reform was introduced by the Republican House Speaker, supported by the House and Senate leadership, passed the House and Senate with overwhelming Republican support, and was signed into law by a Republican president. Yet, most conservatives think it is only Democrats who favor a welfare state.

Fourth, the fact that Medicare is even in this Republican budget shows that Republicans don’t have a problem with Obamacare and socialized medicine. They just want to replace Obamacare with a Republicare brand of socialized medicine. In a speech late last year to students at American University in Washington, Eric Cantor, the new Republican House Majority Leader, expressed support for two of the worst provisions of Obamacare. Said Cantor:

We too don’t want to accept any insurance company’s denial of someone and coverage for that person because he or she might have a pre-existing condition. Likewise we want to make sure that someone of your age has the ability to access affordable care if it’s under your parent’s plan or elsewhere.

In other words, Cantor wants to use the heavy hand of government to force health insurers to do business with people the government tells them to and to keep doing business with others until they reach a certain age that the government decrees.

Fifth, and most important, since when is it the purpose of government to provide a sturdy health-care safety net for society’s most vulnerable or a prescription drug benefit? Where in the Constitution does it authorize the federal government to subsidize the cost of someone’s health-insurance policy or ensure that seniors have access to secure, affordable health coverage? Since when do Americans deserve to choose their own doctors and make their own health care decisions with money that has been forcibly taken from other Americans?

Reforming Medicaid and Medicare is not a return to a free market in medical care. Real medical freedom means a complete deregulation of the health-insurance industry, unrestricted freedom of contract, the freedom of insurers to discriminate, the absolute right of refusal of coverage, the repeal of all laws related to drugs, health insurance, or medical care, and the complete withdrawal of government from anything to do with health care. This means no medical licensing laws, no regulation of medical schools, no restrictions on organ sales or donations, no federal vaccination programs, no federal nutrition guidelines, no HIV/AIDS prevention initiatives, no restrictions on the sale of medical devices, no mandates on hospitals, physicians, nurses, pharmacists, or insurance companies, and no federal funding of medical research, laboratories, community health centers, clinical trials, or family planning.

Republicans don’t support a free market in medical care any more than they believe in ending Medicare as we know it.

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