On June 23, 2011, The New York Times reported that the US government is “now required to borrow more than 40 cents of every dollar it spends” (NYT 6/23/11 A17) according to the Congressional Budget Office report released on June 22, 1011.  We’re being warned that we have a debt limit of $14.3 trillion and are about to exceed it if the ceiling isn’t raised shortly.  Are we going to increase taxes?  Whose, and by how much?  Reduce spending?  Who’s going to give up something? Because the solutions inevitably become political and not just questions of health care policy, Medicare and the deficit are dinner table conversation. 

Remarkably, in a June 2011 Kaiser Health Tracking Poll, 32% of respondents said they would support major reductions in Medicare to prevent it from going bankrupt, and 42% would support minor reductions for this purpose.  If you think that’s generous, consider this: 21% said they would support major reductions to avoid tax increases for the wealthy, while 33% said they would support minor reductions to avoid such increases. 

At the heart of this is the question: will Medicare go broke, as is presently predicted?  Or is it “too big to fail”, a theoretical size no one seems able to determine until we’re at the precipice of the failure.  Is there such a thing as “too big to fail” with a federal program of this magnitude and with the consequences of failure being catastrophic for millions?  Even if it is “too big”, is there anything we can do about the apparently undeniable inability to survive without reforming the Medicare as we know it now? 

The Kaiser Poll results indicate just how little Americans really understand about Medicare and about the Patient Protection and Affordable Care Act and its provisions for changes to Medicare.  A third of all those polled, and 25% of seniors, incorrectly believe that the Medicare hospital trust fund will be bankrupt in 15 years, while 37% believe the hospital trust fund will face a shortfall but not be broke.  The Congressional Budget Office has said that the Patient Protection and Affordable Care Act will strengthen the hospital trust fund, so either this message hasn’t been received, or it hasn’t been believed by more Americans.  In any case, if the fund can’t pay even some of the anticipated bills we still need to know where the money will come from.  Or what will be cut, and when. 

The Patient Protection and Affordable Care Act has a number of provisions that affect Medicare:

1. Closing the “donut hole” of prescription drug costs
2. Improving health care delivery
3. Increasing access to preventive services by eliminating co-pays and deductibles
4. Reducing payments to Medicare Advantage Plans
5. Increase the premiums to higher income Medicare recipients
6. Increase the Medicare payroll tax on higher income Americans
7. Create the Independent Payment Advisory Panel of experts.

 

The greatest level of awareness in the poll concerned item 5, the increased premiums to higher income Medicare recipients; Of those polled, only 46% of seniors were correct in their awareness, while only 50% of all polled were correct.  Interestingly, the provision of which everyone was least correctly aware was item 3, a measure that would seem to be viewed as a major benefit for long run cost management of the Medicare program, assuming you agree that an ounce of prevention is worth more than the cure in restraining the growth of Medicare costs.  Parenthetically, according to Centers for Medicare & Medicaid Services, as of June 10, 2011, 5.5 million Americans, or 16% of the 33 million in traditional Medicare (ie, not Medicare Advantage), used one or more of the preventive benefits.  It’s a start in the goal of reducing the very high cost of care attributable to preventable, or at least manageable, chronic conditions.  Obviously, the word still has to get out about the availability of this benefit. 

Overall, the Kaiser Poll shows that 41% of seniors viewed themselves as worse off as the result of health care reform, while only 31% thought they would be better off, and 19% believe it won’t make much difference.  The public is divided on the law, with 31% and 20%, respectively, wanting to see the law expanded or unchanged, and just under 40% wanting it repealed or replaced with a Republican alternative.

Andrea Lowenthal, Esq.