Wednesday, August 29, 2012

The Myth of the Unbiased Media

Rueters has published an article trying to debunk what they call the Top Six Myths of Medicare by Mark Miller:
The debate already is generating plenty of claims and counter-claims about what is and is not working- often based on misinformation about how Medicare actually functions today. Solet's take a look at the six biggest myths about Medicare, along with thefacts.”
The “facts” as outlined by Mr. Miller are as believable as Rep. Todd Akin (R-MO) being endorsed by NOW.  Let’s take a look at his Myths and the reality in Medicine today.


This myth assumes that once you agree that the government should be in the business of managing healthcare and that secondly that even though “Medicare spending will soar in the years ahead as the number of seniors grows” it is okay because” its per-capita growth is slower than private health insurance”.  The problem is that my tax dollars do not go to supporting private health insurance, yet a deduction for Medicare is taken out of every one of my paychecks.  Comparing Medicare to private insurance is inappropriate since they operate on different guidelines and financial contributions, i.e. Medicare being mandatory by the government and private being a choice by the consumer (for now).

Finally, let’s go with Mr. Miller’s assumption that Medicare is needed, then let’s look at a true representation of spending of a government agency by comparing it to growth in the economy.  In a report by the Center for American Progress it states that  “{a}lthough Medicare spending perenrollee has grown more slowly than private health care spending for most ofits history, health care spending in general and Medicare in particular havegrown faster than the economy.”


Mr. Miller reports his fact as “The government funds Medicare, but healthcare delivery is entirely private.

Mr. Miller argues that since the government does not actually provide the medical care, as in England under the National Health System or here in America as the Veteran’s Administration, it is not government healthcare.  He offers as further proof a quote by Richard Kaplan, a professor at the University Of Illinois College Of Law who specializes in elder law matters:
"The government provides the financing, so it's appropriate to say the government is the health insurance company… But all the doctors, pharmacies, and nursing homes are private. The provider sends a bill - instead of Blue Cross Blue Shield, the federal government writes the check. But you go to whatever hospital you want."
Thus Mr. Kaplan argues that Medicare is not government health insurance due to the right to choose your own hospital.  However, in an article on the BBC reviewed by Dr. Gill Jenkins on Oct. 2010, patients in England were being offered more choice about where they want to be treated.

So, like England, the US government offers choices of where a patient can go to be treated and then pays the doctor for that treatment.  So in going back to Mr. Miller’s “fact,” what is the difference between Medicare and other government healthcare?

Finally, to argue that Medicare is a government entity, Medicare was voted into law by the United States Congress and Senate and signed into law by President Lyndon B. Johnson on July 30, 1965.  As a medical practice manager, I am directed by the Center of Medicare and Medicare Services (CMS), a government agency, on how to distribute care, how to bill, and most importantly what I will be paid by the government for treating patients with Medicare.  In all cases the doctor is paid directly by the federal government for services rendered, based on a fee schedule designed by the government


This is my favorite myth of all: how defenders of Obamacare state that a reduction of payment to doctors is not a cut but instead a savings.  First, let’s go back to myth 2, that Medicare is not government healthcare because the government does not provide healthcare, but only pays for it.  Mr. Kaplan even confirms that Medicare is an insurance company.  Now, the purpose of any insurance company is to pay doctors for medical treatment performed on their beneficiaries.  If what the insurance company reimburses, i.e. pays, a doctor is too low, then the doctor will not see patients under that insurance.  If Medicare does cut reimbursements, i.e. pay, to doctors by $700 billion over 10 years, reducing an already meager payment to even less, then how many doctors will continue to provide treatment to Medicare patients? Not Many.

Mr. Miller reports that “Obamacare does cut $700 billion in Medicare spending over a 10-year period. But the cuts are adjustments in payments to Medicare providers, which are mostly meaningless to patients.” (emphasis added)  Really? When doctors begin dropping patients then these cuts will become very meaningful.


Please re-read  answer to Myth 3 while I laugh hysterically.

Mr. Miller reports that “Most Medicare patients do not have trouble finding doctors who will see them.”  What he neglects to recognize is that Medicare patients are finding doctors under the current fee schedule, but doctors have already reported that any cuts to the Medicare Fee Schedule will result in them dropping patients.  Thus he cannot extrapolate circumstances in the future based on current conditions.


Mr. Miller reports joyfully that those individuals who earn more money have the honor of paying more to Medicare.  Why should the amount of one’s income affect how much an individual pays to Medicare?  As a medical practice manager, I am not allowed to discriminate in health care to a person by income, why does the government discriminate based on income for a service that pays equally for all individuals across the board? 

Medicare is defined on the government website as “the federal healthinsurance program for people who are age 65 or older, certain younger peoplewith disabilities, and people with End-Stage Renal Disease (permanent kidneyfailure requiring dialysis or a transplant, sometimes called ESRD).”  The definition does not include the words “of a certain income” or even “rich” or “poor;” only people age 65 or older.

Never fear, to ensure that Medicare does stay funded Mr. Miller points out that “Wealthy Americans - of all ages - also will start paying a new 3.8 percent Medicare contribution tax on unearned income. The tax affects individuals with more than $200,000 in modified adjusted gross income (MAGI), and married couples filing jointly with more than $250,000 of MAGI.” 


So let me get this straight: health care insurance designed for individuals age 65 or older, entering a stage of life when more health care is needed and health care is more expensive and when more people in America are turning 65 and living longer, as a result of better medical care, will not affect Medicare?  Really??

The average life expectancy of an American today is 78.5 years, thus a person will be on Medicare for an average of 13 years.  Beginning in 2011 the first boomers turned 65 and for the next 18 years 10,000 baby boomers will become eligible for Medicare every day.  The current structure of Medicare is unsustainable under these facts. 

Not to worry though, because as Mr. Miller points out, “It is true that people are living longer, and Medicare's eligibility age is fixed for everyone at 65. But that does not mean Medicare costs are rising as a result. That is because nursing homes, which are the biggest area of expense incurred in advanced age, are not covered under Medicare.”

Living expenses are not covered, but medical expenses provided by visiting doctors are covered and paid for by Medicare. Thus regardless of where these old people are living, they will still need to be treated by doctors, who will need to be paid.


Mr. Miller’s "myths" are, in fact, facts.  Medicare is costly, cuts to doctors will result in doctors closing doors to Medicare patients and the onslaught of baby boomers will crush the system.  I understand that for supporters of Medicare and Obamacare, the reality is difficult to swallow, but the reality is that Medicare is a doomed social experiment.  Since this is difficult to accept, they resort to playing the game of if you repeat a lie often enough and loud enough then maybe people will begin to believe it, even if, as in this case, it is laughable.
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