The Incomprehensible Attack on Medicare

I understand a lot of the fixations of the far Right (although I disagree with virtually all of them). But I’m at a loss to understand their vendetta against Medicare, or their belief that access to healthcare should be considered a privilege, not a right.

If we take Paul Ryan and his ilk at their word, they evidently believe that market competition will bring healthcare costs down, and that guaranteeing access to healthcare promotes overuse (i.e. you’ll go to the doctor more frequently than you really need to). They believe these things–if they really do– despite overwhelming evidence to the contrary.

The great virtue of markets is that they enable voluntary exchanges; they provide an incentive to provide goods at a price buyers are willing to pay. The classic description of a market is “an exchange between a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.”

That is not a description of the “buyer” having a heart attack. Even in the absence of insurance requiring the use of specific providers, people do not–cannot–“shop” for medical care. We are  generally not “willing” buyers, and as non-experts, we certainly do not have sufficient “information relevant to the transaction.”

As Josh Marshall pointed out at Talking Points Memo,

You think it’s hard getting good insurance when you’re 30 or 50? Try getting good private insurance when you’re 70 or 80.

Providing health insurance coverage to seniors will unquestionably cost more if run through private insurance. No one who has looked at the comparative data on the cost efficiency of Medicare and private carriers can question this. There’s no money savings. Quite the opposite. The only difference is that seniors will pay vastly more out of pocket because the vouchers won’t come close to the costs of a policy. The upshot of the Ryan plan is significantly increasing the cost of what society pays for the medical care of seniors and then making seniors pay dramatically more out of pocket. All with none of the bedrock gaurantees Medicare provides.

There’s a reason administrative costs of Medicare–which doesn’t need to advertise, show a profit or cover outsized salaries to upper management– are dramatically lower than those of private insurance companies. As Marshall points out, the irony is that at the same time they are attacking Obamacare, Ryan and his cronies are proposing to replace Medicare with something that looks very much like Obamacare.

But building an exchange and subsidy adjunct for non-seniors onto an existing and fairly robust private health insurance system is one thing. Creating one from scratch for people who are all pretty much by definition bad risks is close to laughable. Laughable if you’re not bankrupted or dying because you couldn’t get care.

Remember the other things Medicare significantly guards against. If parents have insupportable medical bills or have no way to pay for care, they go to children. In the absence of any other options, that’s how it should be. But that money comes out of other things: buying homes, putting kids through college. The social insurance model of Medicare has positive effects well beyond direct beneficiaries.

Recent polls suggest that significant majorities of Americans don’t want to get rid of Obamacare, let alone Medicare. I still remember that senior at a Town Hall meeting carrying a sign that said “Keep Government’s Hands Off My Medicare.” He may not have recognized that Medicare is a government program, but he’ll certainly identify the perpetrators of attacks on it.

Fortunately, even in the Time of Trump, efforts to deprive millions of Americans of access to basic healthcare will not be a slam-dunk. As Marshall has also reported,

Many Republicans can see the political danger of touching Medicare. No one campaigned on this in 2016. Support for phasing out Medicare and replacing it with private insurance and vouchers is minimal outside libertarians and conservative ideologues. That’s why word play about ‘reform’ and averting ‘bankruptcy’ and ‘saving Medicare’ are the catch phrases. If anyone said, ‘We have an idea to have seniors get private insurance instead of Medicare and a check from the government to pay part of the cost’ they’d be laughed out of whatever room they were in. What’s most salient is that it is toxic within the coalition around which Donald Trump has at least temporarily remade the GOP.

In the real world, nothing about this Ryan/Trump effort makes sense. Practically, fiscally and politically, it would be a disaster. Given the characteristics of those who would be in need of coverage, it wouldn’t even benefit insurance companies or Big Pharma.

This is ideology-cum-religious fundamentalism: don’t confuse me with the facts.


  1. Without Medicare and the gap insurance we purchase at a not insignificant cost to our monthly budget, we would be unable to pay for the cancer surgery, the eye surgery, the ongoing monitoring that both of those procedures require, to name just a few. We spent our entire working lives paying into a system that was initiated to assist us in the very scenarios that we have encountered. It has cost us dearly but has saved losing our home, allowing us to keep our 14 years old car operating, and generally not having to make daily decisions about not what we will eat, but if.
    My husband has been an insulin dependent diabetic for more than 50 years. He has worked hard to stay as healthy as possible. Without insurance, he would likely be dead because we would not have been able to afford access to the healthcare he needed to stay alive. I would likely be gone now, too. There have been two surgeries of my own that were life-saving. The costs of our healthcare would have bankrupted us very early on. The cost of one surgery alone was in the hundreds of thousands of dollars.

    Those with resources are not entitled as much as they are lucky, especially if they have had the benefit of regular access to quality healthcare and not had to worry about price.

    A friend recently reposted a comment of someone in Australia who pointed out that our greatest natural resource is our people. We spend billions on the upkeep of security, safety and the infrastructure of our physical enterprises, but seem to forget that all of those things require people, healthy people, to be effective. We cannot afford to throw away one that is broken and buy a new one. It would cost us much more than money. Ultimately, it would cost us our rights and freedoms.

  2. Sheila:

    “In the real world, nothing about this Ryan/Trump effort makes sense.”

    Right. The Republicans are not about the real world, they’re selling to the world after death. But first, we need Armageddon to appease the Christian Right. That idiot, Donald Trump, with his attempt to change our relationship with Taiwan is surely speeding up that process.

    Who needs medicare in heaven?

  3. A personal account of a different “…Incomprehensible Attack on Medicare” by my Medicare supplemental through I.U. Health Care and Methodist Hospital.

    Two years ago I had a pressure sore on my big toe become a necrotic ulcer; diagnosed on Christmas Eve by my three medical family members. The day after Christmas my daughter-in-law Anne (formerly worked as a CNA) called my doctor, scheduled a 10:00 appointment. Primary physician was concerned about the lack of circulation in my foot and toes; refused to refer to circulatory tests 3 months earlier showing good circulation except in toes, told of frostbite damage almost 60 years earlier but both were ignored and an appointment was scheduled with a circulatory surgeon. We went directly, the tests of all pulse points took approximately 45 minutes. We were told primary physician said when scheduling the appointment we were not to leave till she had my test results. She was dissatisfied with them and sent us directly to the Methodist Hospital ER; who also ignored their own tests 3 months earlier and our information regarding my history, put me through several more tests, smeared Bacitracin on the ulcer, covered it with a band-aid and referred me to a podiatrist.

    The ulcer did require a surgical podiatrist who provided excellent care removing the necrotic area through a series of appointments in his office.

    I always receive copies of full billing of all medical treatments. The 45 minutes of testing in the circulatory surgeon’s office (I never saw him) totaled over $12,000! The bill from Methodist ER totaled over $8,000. The podiatrist’s bill was over $2,200. This “Incomprehensible Attack on Medicare” came from within their own supplemental system via I.U. Health Care/Methodist Hospital which is big business and operates under what appears, to me, to be a conflict of interest basis within it’s organizational system.

    “I have met the enemy and he is US.”

    “If we take Paul Ryan and his ilk at their word, they evidently believe that market competition will bring healthcare costs down, and that guaranteeing access to healthcare promotes overuse (i.e. you’ll go to the doctor more frequently than you really need to). They believe these things–if they really do– despite overwhelming evidence to the contrary.”

    I did need to see my doctor; she referred me to over $20,000 in unnecessary testing and retesting. Where in this situation, probably one of millions nationally, do you see market competition within the system itself? My $22,000+ big toe is only one of my medical needs which resulted in thousands of dollars of unnecessary testing and treatments, one unnecessary hospital in-patient stay with the ER doctor working against the cardiac specialist diagnoses of several cardiac tests with normal results when I had a viral flu and severe dehydration – no heart problems. We are REQUIRED to follow doctor’s orders to remain in their systems; this may be where to begin the salvation of Medicare, NOT by destroying it.

  4. A great piece as usual Sheila – thank you!

    On top of all the great things everyone is said in response to your article, Paul Ryan and all the other Republicans that agree with him, continuously fail to comprehend or consider why these laws were enacted and the main reason that this legislation was originally formulated, voted on, and passed. It’s the same reason that Social Security was enacted in 1936. It was to allay the justified fears of the elderly and infirmed regarding how they were going to survive when they were unable to work and pay their own way for food, shelter, clothing and their Health Care.

    That was the spirit in which these pieces of legislation came about in the first place. Ryan and his furious nihilism blinds him, and apparently all the others of his caucus, to the focus on being humane and charitable that runs through all of this. I can’t help but wonder when they all go to church if that even for one moment the thought why am I wanting to do this to my fellow Americans ever runs through their minds or their hearts. At this stage, when they have been wanting to do this for years apparently, I think not.

    If they perceive along these lines, as they no doubt will, the American people will have to speak up in protest with that righteous indignation that good old FDR often spoke about. I just wish we had him or someone like him leading that parade. Hopefully, the American people will find that voice and that leadership and take these people and there aberrant ideas to the woodshed where they belong.

  5. In these days when a huge portion of people get their news from Fox News, I wonder how many seniors tend to be tuned in to Fox News only for their news. I don’t watch Fox News unless I’m stuck in a hotel breakfast area, so I am guessing/assuming there may be a spin on the effort to ruin Medicare on Fox News that might dupe an unsuspecting audience. If so, how does the danger of Ryan’s unconscionable threat to Medicare be exposed to the light of day for those in danger of being harmed? Perhaps I am not giving my fellow seniors enough credit for arming themselves with a watchful eye.

  6. Jeff; while waiting to be called for an ex ray at my I.U. Heath Care facility, I noticed the big screen TV on the wall was tuned to Fox News…with closed captioning activated so no one missed the “news”. I working on my grocery list.

  7. Ryan is set to play the role of Lord High Executioner with his plot (not plan) to hand over America’s health care to insurance companies and HMOs under the guise of market ideology, as though health care is a mere commodity to be bought and sold like groceries and cars the rights to which are to be bundled as securities and bought and sold on the stock market. Such a move will add health care to (perhaps) education and social security to the corporate asset list as we move along to total ownership of America by the corporate world – my greatest fear.

    Sheila mentions in her piece that there is a lack of equal information between buyer and seller, and she is indeed on point. How equal is the information (including costs) between those with cancer and their cancer surgeons, or between lawyer and client in complicated matters? In classical economics Adam Smith assumed equality of information between buyer and seller, perfect competition etc., but while that may have been reasonably true during a less complicated age it is clearly not true today. Indeed Joseph E. Stiglitz, a noted economist (and a Hoosier from Gary, incidentally) won a Nobel for his work demonstrating the inequality of information between contracting parties these days.
    Market ideology may work in small and uncomplicated markets with seasoned buyers and sellers, but the nation’s health care is neither a small nor uncomplicated commodity nor are the actors seasoned. Many only have cancer once.

    The foregoing, and for a variety of other good reasons, suggest that the person holding the sign that says “Keep the government’s hands off my Medicare” may have been prescient, where Ryan and “the government” are one and the same, so let’s keep his hands off our Medicare.

  8. Remember that Ryan’s plan doesn’t affect current Medicare users. It only applies to those currently under 55. That way they get to tell seniors, who are a large and reliable voting bloc for Republicans, that the bill won’t touch their Medicare. Being secure in the knowledge that they will be okay, they won’t oppose the bill.

  9. Your use of the words “fixations,” “ilk,” “vendetta,” and similar slurs (and the fact that your source of information is a fake news site) tell me you have no interest in actual facts but…

    The movement to reform Medicare from the terrible low-benefit/high-cost Original Medicare set up by the Democrats in 1965 was begun by Democrats in 1995. All subsequent proposals (including the current bipartisan Wyden-Ryan proposal) are essentially the same as the 1995 plan by Aaron and Reischauer (copy still available on Health Affairs web site).

    Why is reform needed? Because the insurance is bad, the financing is nonsensical and unsupportable (unfunded liability north of $50 Trillion in the horizon), and fraud/waste/abuse (mostly waste) is unaffordable (net improper payments in old fashioned Democratic Party Medicare is over 11%, as compared to around 3% for premium-support Medicare). Any one who cared could find the sources of my data on the CMS and related web sites, not fake news sites like you use.

    And children are not responsible for a parent’s medical bills. Your blog post is full of a dozen other similar lies.


  10. I digress re Fox News. I travel throughout the USA and it’s exactly as you stated. Fox News on TV in hotels, in the bar, it is the only “news” many people see. Is it any wonder the American public is so terribly misinformed? The right has been skillful in its propaganda. In hoodwinking the American people. They have succeeded in their coup nearly everywhere. Be afraid, very afraid. I am.

  11. Since someone mentioned faux spews, I decided to check their web page (because I can’t get that awful station over here anyway thankfully) and you guessed it, not one word mentioned on their home page about Medicare. So I decided to do a search on the page. I got a few hits and one from yesterday’s date Dec 2nd, about cancer care while on medicare. There was a second article from Nov 30th about who trump will pick for his cabinet in health care. The next article link was from November 9th and the next June 23rd! That’s it folks! This is all of the news articles about Medicare onFox’s web site so unless you read or watch LIBERAL news station/web pages, you don’t know what’s going on with the GOP’s plans. Big surprise right?

    This search proves why half of the population doesn’t understand how Medicare works or how it is distributed, it’s just not reported on these right wing sites at all. This is why we can’t have nice things.

  12. Hmmm….I have an idea. Let’s pilot test this free market voucher system on Congress. Since “We the People” pay for their health insurance why not save us money and give them a voucher instead. Or even better, when they turn 65 they lose their “cadillac” government health insurance and have to enroll in Medicare. I think this would make them make sure that Medicare was fully funded.

    Fortunately, this is one area that both Republicans and Democrats agree should be funded. Paul Ryan and Trump would be stupid to try and voucherize Medicare. People will be up in arms.

  13. Here in NM, we have a serious shortage of doctors. Yesterday a 70-year-old,friend of mine who requires close dermatological monitoring learned that her health group is cutting the number of doctors on the assumption that the state will be given an inadequate block grant, which will mostly go to life-and-death areas like cardiology and oncology. So there will be even fewer doctors dealing with things that won’t kill you but can destroy one”a quality of life. She also has a,daughter with severe health problems, and if she loses her Medicaid, the family expects to be bankrupt in four years.

  14. Evelyn,

    The Congress already goes on Medicare when they turn 65, unless they are still working.

  15. Peggy,

    Thank you for the information. I thought Congress continued to get their “cadillac” insurance after they retired. Now it makes even less sense for them not to strengthen Medicare. Why would they want to harm themselves?

  16. I think they want to break the current Medicare model so it can’t be utilized as a Medicare for All single payer solution.

  17. Medicare administrative costs – last time I saw figures on it – were 1/8th those of private insurance. Medicare doesn’t pay for private jets for layers of executives making multi-millions of dollars. It’s people are government employees who make multi-millions less than their private insurance counterparts.

    The Indiana Manufacture’s Association is one of the most conservative business lobbyists whose testimony before years of legislative hearings were a one-note song – trust the free market to solve problems. Imagine my surprise when their lobbyist testified in detail how the free market isn’t working in the health care business. Competition isn’t keeping costs down, and in any event, if you have no health insurance or doctor and are really sick, you only go the NEAREST emergency room that will accept you. You won’t shop around.

    In the years before Obamacare, health insurance was sometimes increasing at double-digit inflation for everyone, pricing many employers as well as individuals out of health insurance. Seniors already know how expensive it is to gain medigap insurance to cover what Medicare does not.

    Standardization of forms is one way to decrease the paperwork costs of providers as well as insurers. I wish there were certificates of need established before additional clinics with expensive equipment sprung up and inflate costs to each patient to pay for the excess capacity of such providers and equipment. In the medical field, increased competition often raises rather than reduces costs.

    For many years I was skeptical of a single-payer system – but I’ve changed my mind and now support Medicare for all. Medicare now contracts with private insurance companies to do the paperwork. I don’t know how many jobs that creates in the insurance industry, but imagine how many more people they’d have to hire with Medicare for all with tens of millions more covered. No more private jets and multi-million dollar executive pay or golden parachutes on retirement or other departure.

    I LOVE my Medicare and will fight Paul Ryan and anyone who wants to take it away. (By the way, I don’t believe anyone saying they’ll protect Social Security and Medicare for those already on it. Younger people help pay the expenses of both. Without that help, Social Security and Medicare would be at greater risk for retirees, giving Speaker Ryan and other opponents of these programs more opportunity to say – “gee these programs cost too much or are inefficient. We must balance the budget. Entitlements are the culprit. Eliminate them”. You can see where this is headed, and it’s not good.

  18. Although it is a disputed quote the King of France Louis the 14th the Sun King (1638- 1715) supposedly said – I am the State. We have had in a sense an Aristocracy in government. These would be our Elected Aristocracy that serve for decades in safe districts totally immune from almost any political wind.

    Trump projects the aura of the Sun King. I am the State. It has been no secret some of our elected aristocracy wants to “reform” Medicare, Medicaid, Social Security and even the V.A. Reform in this case means destroy by what ever means possible. Under funding these programs or in combination with appointees dedicated to wrecking them is a valid approach – Ends justifys the Means. The Wall Street Vampires would like nothing better than to get their hands of these tax dollars that fund the programs.

    I receive E-Mail alerts about these various plans by Paul Ryan among others. It seems Elizabeth Warren or Bernie Sanders speak out against this looting. So where is Andre Carson among other Democrats in this state. I have no faith in the establishment Democratic Party to vigorously oppose these plans. It will be death by a thousand cuts of these programs.

  19. This is an example of an E-Mail alert I received –

    >> Medicare is a fundamental tool of economic security – a guarantee that seniors will not be denied health care just because they can’t afford it. But Republicans in Congress, led by House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell, are making plans right now to privatize Medicare and hand it over to greedy insurance companies.1
    The fight over the future of Medicare could come to a head as soon as the next session of Congress starts in January.

    Speaker Ryan has wanted to destroy Medicare for years. His ultimate goal is to end Medicare as we know it and replace it with a privatized program in which seniors would get federal vouchers to help offset the cost of premiums charged by commercial insurance plans. It’s a trick designed to create the appearance of cutting costs by shifting some of the financial burden from the federal government to America’s seniors.

    During the campaign, Trump repeatedly pledged that he would not attack Medicare. During the campaign, Trump repeatedly pledged that he would not attack Medicare. But then, just three weeks after the election, he appointed Rep. Tom Price – a leading proponent of privatizing Medicare – to run the Department of Health and Human Services. One thing’s for certain: We can’t trust Trump, Ryan or McConnell to do what’s right for America’s seniors.

  20. Dennis Bryon:

    Before one publicly criticizes someone, they should at least understand the common meaning of the words of the English language. The common definition of “ilk:”
    “a type of people or things similar to those already referred to.”

    In other words, Professor Kennedy merely wrote that Paul Ryan and those similar to him want to end Medicare. How is that a “slur,” a lie, or untrue? I presume Ryan would be proud to know that there are other people who think just like him and want to end Medicare.

    And “fixation” and “vendetta” (BTW: one definition of “vendetta” is “a long bitter quarrel with or campaign against someone or something”), while perhaps strong descriptive terms, seem fair and accurate given that Ryan and his “ilk” have wanted to end Medicare for years and years and keep coming back to it over and over.

    If there was a “slur” against Ryan and his ilk (i.e, “an insinuation or allegation about someone that is likely to insult them or damage their reputation), and I believe Professor Kennedy likely intended there to be one, it was her absolutely true and accurate allegation that Ryan and his ilk want to destroy Medicare. As they say, if the shoe fits, wear it.

  21. Since there is no opposition, why wouldn’t Trump/Ryan et al take everyting they can?

    And that’s exactly what they’re doing. To be honest, I don’t blame those who backed Trump as much as I do most of the FOOLS who opposed him.

    fool (fool) n. [<L follis, windbag] 1. a silly or stupid person 2. a jester 3. A VICTIM OF A TRICK, ETC.;DUPE–vi. 1. to act like a fool 2. to joke 3. [Inf.] to meddle (with)–vt. TO TRICK; DECEIVE–fool around [Inf.] to trifle–fool'er-y n.
    ~Webster's New World Dictionary and Thesaurus

  22. Dennis Bryon:
    I would also add for good measure:

    You are absolutely, 100% correct that children aren’t legally liable for their parents’ medical or other debts. But that is not what Josh Marshall, who Professor Kennedy quoted, wrote, intended, or meant.

    Perhaps you should go back and re-read what Marshall actually wrote:

    ” If parents have insupportable medical bills or have no way to pay for care, they go to children.”

    In context and the meanings of the words used, Marshall clearly meant that when parents can’t pay their bills, including medical bills, they often “go to (their) children” for help in paying their bills. He didn’t write or say that children are legally obligated to help or pay. And many children, who are fortunate enough to be able to do so, do help pay their parents bills for necessities such as medical care.

    Once again how is that a “lie?”

  23. Sheila: you are overthinking this. All Ryan and his ilk see is lots of $$$$$ that the government has the power to extort from people and which they can divert to their campaign supporters. They really don’t have any ideology behind what they propose other than here’s a lot of guaranteed money that the fat cats want to get their hands on, and now, those pesky Democrats are finally out of the way. They don’t understand the fallout in human terms, much less the implications for broader society, but, most importantly, they really, truly don’t care.

    The takeover of the government by Trump and the Republicans will absolutely result in people suffering and dying, and that’s not taking into consideration the fact that they might actually start a war or exchanges of gunfire someplace “over there” the first time someone pushes the buttons of the Alpha Orangutan with a fragile ego. Yesterday, Trump singlehandedly undid decades of diplomacy with China by having a telephone conversation with the President of Taiwan, where he is planning to build several luxury hotels. It’s not clear that he even understands the extent of what he has done because he refuses to accept daily briefings, but, again, he clearly doesn’t care. We owe the Chinese government billions of dollars, and he insults them by acknowledging Taiwan, something that the Chinese take as a symbolic flip of the bird or slap in the face. Dumbass would understand the tension between China and Taiwan if he were qualified to be President and did his homework. Actually, the US State Department has a little piece all about this topic on its website. Clearly, the risk of war just went up.

    My only question is: how much shit will the Republicans in Congress allow before they join with the Democrats and impeach this loser?

  24. As others have pointed out, all the attempts over the years to end Medicare have exempted those above a cut-off age, usually 55, whose Medicare benefits would be safe and continue. Since I and my wife are among those who’d be privileged to continue to get our “entitlement,” which of course we helped pay for our entire working life, I guess we should be thankful. Not sure how our children and grandchildren will feel about theirs never materializing. From what I’ve heard (a good Trump phrase), many of the younger generations already don’t believe Social Security or Medicare will be there for them anyway.

    Of course, Ryan and his ilk aren’t sparing us oldsters out of the goodness of their hearts. Rather, they know that a whole lot of always vote Repub, no matter who the candidate is or what he stands for, are older white voters, who would rise up in arms if the government took away their Medicare or Social Security. So I feel fairly confident that we older folks’ Medicare isn’t going to be on Ryan’s chopping block. Even he can’t be so dumb as to alienate the Repub party base. Can he?

    The only hope I see in all of this is the fact that the cost of privatizing Medicare and Social Security is so high that even Ryan and his buddies aren’t going to be able to make the numbers work without increasing the debt by billions. There is a syndicated column written by Tom Margenau that runs every Sunday in the Arizona Daily Star addressed to Social Security and Medicare issues. In the column that ran on 11/20/2016, Margenau spelled out why he believes Trump/Ryan won’t be able to privatize Social Security. Interesting reading, but I think Margenau might be overestimating Ryan’s rationality.

  25. A side note on the question of government entitlement programs. There appears to be abundant evidence that one of the significant reasons for the fact that the Great Crash of 2007-09 was not more serious was that the US government spent roughly 25% more during the period on those entitlement programs (I kept wondering why I was getting all those “cost of living” increases). One consequence of doing away with those same programs might just be to bring on another crash–but, one merely in the cause of the free market, of course. Thus, OK I guess.

  26. We all, and especially democrats in the media, need to stop talking about the details. Here is the message (which is the truth):


  27. This precisely why I stated that the democrats need to start campaigning against Ryan now and make sure he is defeated. I suggest using the republican model of fabricating and repeating whatever is necessary to defeat him

  28. I learn lots from FOX news….. More than the words spoken, study the mannerism and facial expressions, the contortions they must but their faces through. I enjoy seeing them squirm when they know and you know they’re lying!

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