Medicare reform

Fighting Over Medicare May Not Be Good Policy, But It Can Be Good Politics


There are an awful lot of reasons why Medicare reform has been stalled. But one of them is that some elected Democrats aren't interested in working on any sort of Medicare deal as long as it remains an effective cudgel to use against the GOP during election season. President Obama has suggested in the past that he might be open to changing the seniors' health. And Politico reports that some Democrats on Capitol Hill are worried the president might actually pursue those changes in a second term because they believe it would hurt their chances at the polls in 2014:

What bothers Democrats on Capitol Hill, but not a lame-duck White House, is that any compromise that includes Medicare cuts would deprive the party of a significant issue heading into 2014.

"Look at the senators who are up next time," said the congressional Democrat, citing the many red-state and swing-state Democrats up for reelection in two years. "You'd chop them off at the knees right before they start running."

This isn't the first time Democrats have grumbled about the political problems they faced if they started to negotiate a deal on Medicare. Last year, The Washington Post reported that senior Hill Democrats were griping behind the scenes that agreeing to Medicare cuts would "risk squandering the major political advantage Democrats have built up on the issue."

Obviously, Democrats aren't alone in playing on fears of Medicare cuts to win votes. Republicans did it all throughout the ObamaCare debate. And the Romney campaign has been particularly aggressive about criticizing President Obama for reducing planned Medicare spending by $716 billion in order to fund the health care law's expansion of insurance coverage. But it does highlight the extent to which many of perenial entitlement fights are driven not by data-driven policy considerations or even basic concerns about what might be best for constituents, but by naked political self interest. The war over Medicare may not be good for the budget or for seniors, but it can be useful for those who want to get elected, which is one of the reasons why that war is likely to continue. 

That's a barrier to reform of a deeply dysfunctional entitlement program. It's also a barrier to creating and maintaining a functioning, effective, results-driven health care system. And it's a big reason why we ought to always be cautious about pushing for greater government interference in the health care sector: Inevitably, politicians end up pursuing their own interests instead of everyone else's. 

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  1. This is today’s “cop shoots dog” story, right?

    1. Its a “dog bites man”, “cop shoots dog” story in one. Its obvious, enraging and depressing all in one.

  2. No alt+text? I am disappoint.

    You Owe Me, America!
    Fork over the Pork, young’uns!
    I just want what was promised me!
    I am entitled to your work!

    1. Where’s the Pork?

    2. I just want what was promised me!

      All I want, is what I have coming to me! All I want is my fair share!


    3. alt text

      I’m bankrupting this country and you can’t stop me.

  3. I hope I die before I get old.

  4. Inevitably, politicians end up pursuing their own interests instead of everyone else’s.

    “BUT, if you vote for me, I promise to stop being a self-centered egomaniac for at least a few minutes before the following election cycle starts.”

    But it’s not extortion, no. It would only be extortion if they didn’t already have your money (and ready access to more of it).

  5. Leaving that pic bereft of alt text is hella lame.

    1. Alt-texted.

      1. I thought you didn’t negotiate with terrorists.

        1. Capitulation =/= negotiation.

          1. I pointed this out in a thread earlier today.

            Also, if demanding alt-text is terrorism, I must be history’s greatest monster.

      2. Well done sir.

  6. If safety nets for the old and infirm could be strictly limited, maybe I could accept them as a trade for massive deregulation, spending cuts, and a return to the concept of limited government. But that’s not how it works, and no one is offering the trade, anyway.

    1. “Trade? I intend to have your cake and eat it too.”

      1. Yeah, that’s another problem with the idea–can’t trust anyone at the table, regardless of the offer.

    2. We might not “need” these safety nets at all if there was a true free market in health care. I would have no problem at all with paying for my own care in return for an end to government enforced medical guild.

      But consumers of medical services are subject to artificial scarcity caused by regulation, licensing schemes, and other rent-seeking activities. In this environment it is difficult to impossible politically to effect any real change.*

      But to extend PL’s point above, no one at the table is offering that kind of trade.

      *SLD: Ultimately, we are going to run out of OPM. Only then will we see any change in the situation.

  7. Those are the women from the Chicago teachers strike photo, you can’t fool us.

  8. “Well, we’d me making them sickly by taking away their access to medical care, which I don’t find morally distinguishable from putting a gun to their head and killing them at whatever point their preventable sickness would have got them.”

    ^Tony quote from the other day. Let’s all marvel once more at how absurd it is.

    1. exactly the same, exactly, i can’t tell you how many times i’ve seen cancer gun down little biddies in the prime of their retirement, leaving them clawing, grasping in the middle of the road…its awful.

    2. Well, we’d be making them sickly pregnant by taking away their access to medical care free contraception, which I don’t find morally distinguishable from putting a gun to their head and killing raping them at whatever point their preventable sickness would have got them pregnancy happens

      Fair, or unfair?

      1. Fucking HTML. And lack of a functioning preview. Screw you, squirrelz.

      2. Fair, if your asking if this is something Tony would say.

  9. “taking away their access to medical care”

    Exploring this further — by 2015 most docs are required to use EHRs. if you’re nearing retirement (most docs are) do you invest the time and money (even with the incentives offered) or just pack it in. medicare enrolled docs have an average caseload of 250 medicare patients. if even a fraction decided to retire or drop Medicare and go boutique, the remaining will be overwhelmed and access will decline.

    we’re putting resources into insurance instead of care

    1. decided to retire or drop Medicare and go boutique

      They could try dropping dead, that option might actually work. I expect congress to close that loophole soon enough though.

      we’re putting resources into insurance instead of care

      Care doesn’t pay for liability settlements.

  10. Semi OT:

    Lest anyone think that healthcare is woefully bereft of regulation, JHACO just nixed toys and coloring books from our Family Clinic locations in the organization I work in.

    That’s right, when you bring your small children to the clinic, no more waiting room toys and coloring books. Because of the children.

    1. This is why I put a great deal of effort into ensuring that JCAHO never gets their mitts on our clinics.

      We need them at the hospital to participate in Medicare, but not at the clinic. Without their rent-seeking deal with CMS that appoints JCAHO as the gatekeeper for hospitals who want Medicare, they wouldn’t exist.

      1. I work in what’s known as an “underserved market”. Our clinics gotta certify Mediscare. But yeah, if I could keep JHACO (which everyone calls “Jay-Co” and should be called Jack-Ho) outta my clinics, I’d do it. Yesterday.

        1. I work in what’s known as an “undersea market”.

          *double take* *re-read* *dissapointment*

        2. which everyone calls “Jay-Co” and should be called Jack-Ho

          so we know where you stand on the THAC0 argument then.

    2. It’s cool, the gov’t will just pay for hearing aides when the faculty and patients go deaf from the pealing wails of the desolately inconsolable.

    3. Was it a budgetary or policy nix?

      1. Neither. Regulatory NIX. I believe the latest regulatory guideline is toys and coloring books may spread infection, so ixnay on the oystay. No mention of the furniture they’re sitting on.

        1. The whole concept of a non-emergency care center is flawed. “Hey, let’s encourage sick people to congregate, and we’ll even put out a communal water dispenser! We’re SUCH FUCKING GENIUSES!!! *highfives* ”

          Mobilize that care. You sick? STAY IN YOUR OWN FUCKING HOME, the doctor (probably a RN actually) will come to you. Combine it with a grocery service, so they can bring shit like soup, ginger ale, prescriptions, etc, as well.

          Ofcourse, I’m sure there are a million laws preventing such an innovation, so, Fuck My Idea, That’s Why, or something.

          1. What would be great is that they could bring you healthcare, medicine (as a licensed mobile pharmacy), and groceries.

            1. Oh, the government will be bringing you healthcare, whether you want it or not. And if Michelle Obama has her way, she’ll be bringing you your groceries, too.

              1. I was thinking the other thingee. More Walmart, less government. What do they call it?

                1. What do they call it?

                  Corporcratic Oppression.

                2. I was thinking the other thingee. More Walmart, less government. What do they call it?

                  Market Failure.

                  1. I was thinking the other thingee. More Walmart, less government. What do they call it?

                    Market Failure.

                    my response was another failure of the Free Comments Market.

              2. 700 calories a day, whether you need it or not!

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