An Open letter to Congressman Kucinich and Other People about Health Reform and Medicare Cuts

Dear Congressperson Kucinich and any concerned people,

I’d like to respectfully bring your attention to the section in the reconciliation health bill establishes the Independent Payment Advisory Board (IPAB) empowered to slow Medicare’s expenditure growth to what appears to be historically low levels, with minimal checks and balances for IPAB’s power.

Overturning their recommended Medicare cuts would take the action of a SUPERMAJORITY of Congress, with no public comment permitted.  According to policy experts, this would likely lead to more difficultly in accessing providers.   Even worse, the HEALTH BILL MAKES REPEAL OF THIS VERY DIFFICULT by limiting Congressional debate of this to a small window of time in 2017 (page 1013  of SB Dec. 24th, 2009).

The mandatory target for medicare inflation ratchets its growth to levels that some experts predict will cause problems of access to providers. In a 3/17/2010 op ed on the Hill, former Representatives Ron Klink (D) and Deborah Price (R) states that these cuts to Medicare, when coupled with the 400 billion already proposed under the health reform bills, would inevitably lead to access problems. Eighty-five organizations also have signed a Jan. 15th, 2010 letter against setting up IPAC.

Starting in 2015,  IPAC would be required to cut Medicare any year its per capita growth exceeded the target about midway between regular medical inflation and the average inflation for all goods and services.
By 2018, the target shifts to a projected 5 year average of nominal GDP growth in percent terms, plus 1%.

Let’s look at this from a historical perspective. From 1998-2002, GDP growth per year averaged about 4.66%. Using the IPAC standards for 2019, Medicare per capital growth increase would have been limited to about 5.66% per year. By comparison, in 1997  President Clinton wanted a 7% yearly growth rate for Medicare, and Democrats argued that lowering it further would cause access problems.

Also, if the economy faltered after this takes effect and GDP fell to 2 or 3%, the Medicare mandated cuts would likely cause serious problems with access.

Medicare payments to doctors and other health care providers will face the ax first, since hospitals are excluded until 2020. As payments decrease, finding a doctor becomes harder. This undermines the strength of Medicare. Even without these cuts, people with Medicare can have difficulty finding a doctor who accepts Medicare.

I am alarmed about Medicare cuts lining the pockets of private insurance companies. I am distressed about sacrificing health care for the elderly, when there are so many other ways to fund health reform. I want Medicare to set an example of a system that people are satisfied with, not one where they struggle to get a doctor or clinic appointment. Nor do doctors want to act like gatekeepers, as a capitated system would tend to foster.

I hope you will take action by refusing to vote on the bill, unless they remove this section.  If they need your vote, you may have enough influence to do this. We need a system that treats everyone equally, and one that does not strip Medicare of needed funds.

Sincerely,

A Concerned Citizen

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