Thursday, February 14, 2013


"Modest reforms," that's what he said.

The president's state of the union address included this vapid and vague comment:  "Those of us who care deeply about programs like Medicare must embrace the need for modest reforms." Best we can tell, President Obama intends to skewer the wealthier beneficiaries of Medicare. The idea is to apply these "modest reforms" to hit wealthier Medicare beneficiaries by raising their premiums, delaying onset of Medicare eligibility by two years until age 67, and using the IPAB (Independent Payment Advisory Board) to ration or limit access to available services. In other words, kindly move over and die sooner.

While raising the age for full Medicare benefits may make sense, and while charging more to those whose incomes is above a certain level may also make sense, it smacks of hypocrisy for Congress and the President to allow an appointed IPAB bureaucracy to deny services to the public while specifically exempting themselves. In case it's not widely known, know this: the president and Congress exempted themselves from the Affordable Care Act (ACA, known as Obamacare). The president and Congress have their own (better) health care plan (no IPAB).

The ACA as currently written allows insurance companies to increase premiums as a way to defray the cost of covering the millions of added recipients who currently don't have insurance. The already-insured will pay more in premiums than they're currently paying to cover the millions of currently uninsured persons who will be covered by the ACA. At the same time the IPAB will be enabled to disqualify diagnostic and treatment protocols of their own choosing.

Here's what else Obama said: "The biggest driver of our long-term debt is the rising cost of health care for an aging population." I herewith forgive any elderly person for not volunteering immediately for ID (instant demise).  It's not a mystery as to why Congress exempted itself and why Nancy Pelosi asked to have the bill passed just to find out what was in it.

So let's repeat Obama's entire statement: "And those of us who care deeply about programs like Medicare must embrace the need for modest reforms -- otherwise, our retirement funds will crowd out the investments we need for our children, and jeopardize the promise of a secure retirement for future generations."

What wasn't said is that one way to start would be to include the president, the executive branch of government, and Congress in Obamacare as opposed to awarding them a better and more extensive program than the rest of us. Readers may like to know that Congress allows itself to use military hospitals on a "prn" or "pro re nata" basis (translation: "as needed"). Ordinary citizens don't have this privilege.

President Obama even had the temerity to say that "already, the Affordable Care Act is helping to slow the growth of health care costs." In fact, what we're seeing in the real world is increasing costs to cover enhanced executive compensation, not a penny, not a farthing, for increased access to specialty care for the elderly or for anyone else.  What doctors are seeing in the real world is increasing numbers of people ostensibly covered by the ACA, while, simultaneously, the IPAB mechanism is prepared to strip away currently available benefits and to put on hold future advances in available medical care. This two-pronged program takes away with one hand what it makes available with the other hand -- it's a fiscal device to make a flawed program appear more successful than it is.  We already know that businesses are switching as much of their work forces as possible to temporary hires so they'll not be obliged to provide health care.

Basically, as to health care and the ACA, president Obama's State-of-the-Union address was  non-responsive and disappointing. 

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