Poisoning the Medicare Debate
WASHINGTON -- One thing that we in the so-called mainstream media -- those of us who still believe in striving for some semblance of fairness and objectivity -- need to avoid is adopting the partisan vocabulary of left or right and treating it as neutral. On Medicare, we're flunking that test.
As is well-known, Medicare is now the federal government's third-largest program, with spending in fiscal 2010 of $520 billion, behind only Social Security ($701 billion) and defense ($689 billion). Moreover, spending is expected to balloon as baby boomers retire and health costs soar. Unless Medicare is controlled, curbing federal budget deficits without wrenching cuts in other programs or huge tax increases will be hard.
That's where the problem begins.
One long-standing proposal to overhaul Medicare would transform it into a voucher program. Eligible seniors would receive a fixed amount of money (the voucher) that could be used to buy insurance coverage; they could choose among many different insurance plans. The theory is that competition among plans would lower costs and raise quality because Medicare beneficiaries would select plans that offered the best value for money. Vouchers are popular among Republicans, though some Democratic politicians and economists also support them. For example, a voucher proposal is a centerpiece of the budget plans offered by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee.
But many Democrats despise vouchers, which (they say) would "privatize Medicare" and "end Medicare." The language is self-serving demagoguery intended to terrify seniors. Unfortunately, some in the media sometimes sloppily adopt these attack phrases as acceptable descriptions.
Here's a Washington Post budget story calling Ryan's voucher plan a "proposal to privatize Medicare." Similarly, a Post columnist said a voucher-like proposal by Sen. Rand Paul, R-Ky., would "end Medicare" and "abolish Medicare." The New York Times editorial pages often equate vouchers with privatizing Medicare.
These descriptions aren't acceptable, because they don't reflect reality. The fact that some voucher advocates also use "privatize" doesn't change matters. Consider.
Vouchers would not "end Medicare." Fundamentally, Medicare promises health care coverage to most Americans 65 and over. We call this an "entitlement." The entitlement wouldn't end. The federal government would still pay for coverage. In this basic sense, Medicare vouchers don't threaten the program.
But how government spends and the generosity of subsidies for wealthier recipients could change. One criticism of Medicare is that it fosters excessive spending because its fee-for-service reimbursement encourages doctors and hospitals to do more. Vouchers could cap spending by limiting the amount of the voucher and any annual increases. Depending on how much competition forces the health system to become more efficient, this might create large savings, curtail health services or force seniors to pay more out-of-pocket costs. Likewise, some voucher plans would make richer recipients pay more.
But similar changes can occur -- and already have -- under the present system. If the government cuts reimbursement rates for some services, those services may become less available. In 1997, that's precisely what happened with home health care services. The American Medical Association has repeatedly warned that if Medicare reimbursement rates are held down, fewer doctors will see Medicare patients. Similarly, premiums for wealthier recipients have already been raised for doctors' services and drug coverage.
Vouchers wouldn't "privatize Medicare." The reason is simple: Medicare has always been "privatized." Most doctors who receive Medicare reimbursement aren't government doctors. Similarly, most hospitals are private, whether for-profit or not-for-profit. Drug and device companies are private. Under the Medicare Advantage program, insurance companies already offer competing plans for about 25 percent of recipients. They offer "Medigap" insurance (plans that cover what Medicare doesn't) to another 18 percent of recipients.
By casually adopting partisan language, editors and reporters make it harder to have a sensible debate about Medicare's future. It's already tough, because the program's 48 million recipients are presumed to support the status quo. But unless major changes are made, the burden on taxpayers -- particularly the young -- and other government programs will grow.
There's a legitimate disagreement over whether the best way to control spending is through tougher regulation or voucher-like schemes. The first could involve more oversight of reimbursement rates and closer monitoring of specific medical procedures and therapies to disallow those deemed ineffective. The second would try to create "market incentives" that would supposedly suppress wasteful care, with insurance companies, doctors and hospitals receiving enormous latitude as to how. Each approach has pluses and minuses; neither is likely to be popular.
My purpose here is not to favor one or the other. It's simply to assert that we in the mainstream media shouldn't distort the argument by the careless use of language. Voucher proposals would "overhaul" Medicare, "transform" it or "convert" it. They wouldn't "end" or "privatize" it. Words matter. Let's keep the debate honest.Copyright 2012 Washington Post Writers Group