Viewpoints: Ryan's efforts on Medicare leave Republicans 'howling;' Retirement may be too expensive for seniors

Mar 7 2013

The Fiscal Times: Only Ryan Takes On The 800-Lb. Gorilla – Medicare
Paul Ryan is one of the few considering the long-term trajectory of federal spending who is also preparing a solution without artificial fiscal cliffs. Perhaps surprisingly, his ideas for structural budget and entitlement reform have some Republicans howling even before Democrats get an opportunity to speak up (Edward Morrissey, 3/6).

The New York Times: From One Budget Fight To The Next 
The Republicans have made it clear that the spending fight will never cease. They haven't promised not to abuse the next debt-ceiling increase, necessary in the next few months, to get further cuts. And Paul Ryan, the House Budget Committee chairman, will soon unveil his caucus's 2014 budget, which will start to make good on the party's ruinous plan to balance the budget in 10 years. To do so, he is reviving his discredited proposal to turn Medicare into a voucher program, and considered making it worse by cutting benefits for people who are now 56 and younger; an earlier plan cut benefits for those 55 and below (3/6).

The Washington Post: Post Partisan: Paul Ryan To Change Medicare For Boomers Over 55? Good.
If Ryan follows through, Democrats would no doubt brutalize him for it. But promising current and soon-to-be seniors -; who vote in droves – that they would not be expected to participate in righting the program set to bust the federal budget was bare election-year cowardice, fiscally unwise and deeply unfair. Even if Ryan's next budget proposal is inadequate for other reasons, if he believes that Medicare reform is necessary, he should have the backbone to apply it to the boomers (Stephen Stromberg, 3/6). 

Medpage Today: About The Sequester
This Congress has not even begun to grapple with what the Congressional Budget Office (CBO) has called our greatest fiscal challenge: rising health care costs. In fact, the debate around the sequester has diverted attention from the more fundamental goals of "bending the curve" of rising per capita health care costs and getting more value for our public and private health care dollars. The need for further action to address these longer-term problems remains. Congress has three choices: continued, indiscriminate meat-ax cuts like the sequester; shifting of federal costs onto consumers, health plans or employers; or a smart savings approach that finally addresses the enormous levels of waste and inefficiency in our health system (John Rother, 3/6).

The New York Times: Opinionator: The War On Entitlements
The debate over reform of Social Security and Medicare is taking place in a vacuum, without adequate consideration of fundamental facts. These facts include the following: Two-thirds of Americans who are over the age of 65 depend on an average annual Social Security benefit of $15,168.36 for at least half of their income (Thomas B. Edsall, 3/6).

The Washington Post: Steering America Toward A More Secure Retirement
To the let's-cut-entitlements crowd, what's wrong with America is that seniors are living too high off the hog. With the cost of medical care still rising (though not as fast as it used to), the government is shelling out many more dollars per geezer (DPG) than it is per youngster (DPY). The solution, we're told, is to bring down DPG so we can boost DPY. We do indeed need to boost DPY. And we need to rein in medical costs by shifting away from the fee-for-service model of billing and paying. But as for changing the way we calculate cost-of-living adjustments for seniors to keep us from overpaying them -; an idea beloved of Bowles, Simpson, Republicans and, apparently, the White House -; this may not be such a hot idea, for one simple reason: An increasing number of seniors can't afford to retire (Harold Meyerson, 3/6).

New England Journal Of Medicine: A Path Forward on Medicare Readmissions
October 1, 2012, marked the beginning of the Hospital Readmissions Reduction Program (HRRP), an ambitious effort by the Centers for Medicare and Medicaid Services (CMS) to reduce the frequency of rehospitalization of Medicare patients. ... The latest evidence suggests that the readmissions-reduction program has potential: it can change the hospital business model by asking institutions to become increasingly accountable for what happens to their patients beyond their walls. ... However, the latest data also make it clear that the HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home (Dr. Karen E. Joynt and Dr. Ashish K. Jha, 3/6).

New England Journal Of Medicine: Generalist Plus Specialist Palliative Care -; Creating A More Sustainable Model
Palliative care, a medical field that has been practiced informally for centuries, was recently granted formal specialty status by the American Board of Medical Specialties. The demand for palliative care specialists is growing rapidly, since timely palliative care consultations have been shown to improve the quality of care, reduce overall costs, and sometimes even increase longevity. The field grew out of a hospice tradition in which palliative treatment was delivered only at the end of life, but its role has expanded so that palliative care specialists now also provide palliative treatment in the earlier stages of disease alongside disease-directed medical care, improving quality of care and medical decision making regardless of the stage of illness (Dr. Timothy Quill and Dr. Amy Abernethy, 3/6).

JAMA: The State Role In Health Care Innovations
A couple of weeks ago, the Centers for Medicare & Medicaid Services (CMS) announced a new round of grants from the Center for Medicare and Medicaid Innovation (CMMI). If you didn't pay much attention to the announcement, it's worth a second look. ... The most recent grants went to states to support policies and approaches that can transform payment and delivery of care. Large grants of $30 million or more went to Oregon, Minnesota, Arkansas, Massachusetts, Maine, and Vermont. Smaller planning grants went to 25 states, including Maryland. The summary page is worth a read to see what the future of health care may hold (Dr. Joshua M. Sharfstein, 3/6).

Health Policy Solutions (a Colo. news service): Domestic Violence And Guns A Deadly Combination
As the gun debate heats up in Colorado, it is victims of domestic violence who could be most affected by its outcome. On Monday, a Senate panel approved a bill that would require domestic violence offenders to relinquish their guns if a restraining order had been filed against them. When an offender has easy access to guns, there is nothing more dangerous for a victim (Sam Cole, 3/6). 

Health Policy Solutions (a Colo. news service): Getting Patients To Choose A Honda Over A BMW
As a part of CIVHC's Colorado All Payer Claims Database  team, I'm working to develop publicly available consumer information on cost and quality for health care services. The primary purpose of the patient focused information (planned for release by the end of 2013), and the Colorado APCD in general, is to provide transparent health care data to support driving the market towards low cost, high quality care. So a study showing that insured consumers would select the most expensive procedures even when provided with transparent information about their effectiveness is disheartening to say the least. Then I stopped and asked myself -- if I were given those same two choices, would I have answered differently?  I'm not sure I would have (Cari Frank, 3/6).

Oregonian: Portland's Sick Leave-Mandate Fever: Agenda 2013
Forget for the next few paragraphs about the details of Portland Commissioner Amanda Fritz's sick-leave ordinance. Consider, instead, some of the reasons why she and others believe it's a good idea. Paid sick time, the ordinance reasons, "results in reduced worker turnover, which leads to reduced costs incurred from advertising, interviewing and training new hires creating a better trained and more reliable workforce." The Fritz plan also would dissuade people from coming to work with "conditions that reduce their productivity -- a problem that costs the national economy an estimated $160 billion annually" (3/6).