The Republican “Modest Proposal” for the Problem of the Elderly

It’s fascinating to consider turning Medicare over to the private insurers, who don’t really want the sick and infirm as  customers.

The republican approach seems to be to provide a fixed “stipend” to Medicare recipients and allow them to enter the private insurance market.  This of course will lead to chaos as insurers work to minimize  costs.

The republican proposals make no mention of:

  1. Guaranteed insurability for the sick and chronically ill.  Would community rates for insurance prevail or would these people be individually rated by insurers and either rejected or given unaffordable and/or inadequate coverage.  And of course there are those that think guaranteeing people insurance and access to care is in itself welfare (guess who?)
  2. Affordability:   Those with pre-existing illnesses (possibly as high as 2/3 rds of the elderly, would be at the mercy of insurers.  Their rates would without doubt exceed the republican Medicare “stipend” for the insurance, if indeed insurers would offer such patients coverage
  3. The 50 million people currently uninsured.

Medicynical Note: We shouldn’t accept the republican “modest proposal” (see Jonathan Swift) to financially eat alive our sick and infirm elderly and abandon the uninsured.

We need to cut health care costs.  Our non-system is the most expensive by an order of magnitude than any other in the world.  There are many reasons for this: inefficiency, over utilization, excessive administrative costs, a cost plus philosophy on charges, use of the most expensive diagnostic and treatment modalities when less expensive appproaches work equally well, excessive expectations of income from providers and suppliers, expectations of unlimited treatment by patients, underfunded public health and disease prevention activities.

There are problems, they are not insurmountable as indicated by the lower costs elsewhere in the industrialized world.

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