It is possible to change Medicare to solve its future funding problems without alienating seniors or allowing the other political party to negatively categorize the changes. Increasing the supply of alternative low cost trained medical providers is one way.
What do we know about Medicare funding and assets?
We know, according to the 2011 Medicare Trustee Report, that Medicare has enough revenues and reserve assets to continue for at least another decade despite above inflation rate medical cost increases and increasing enrollment rates due to changing demographics. That means there is some breathing room, but changes must be implemented soon to achieve cost benefits within a decade or so.
We also know that increasing taxes, whether on just the wealthy or on a broader segment of the workforce, will not cure the future funding shortfall problem. Future Medicare enrollees and medical costs are growing at too fast a rate compared to future workforce growth for taxes to be able to fund Medicare as is.
What do we know about Medicare enrollees, especially seniors?
We know that seniors vote, are knowledgeable about issues affecting them and want Medicare benefits preserved, the structure left alone and the cost to them not increased, or at least the risk of substantial cost increases not passed on to them.
What do we know about vouchers and proposed Medicare reimbursement cuts?
Seniors, other Medicare enrollees, and approaching future Medicare enrollees do not like vouchers because they fear they would lose their existing benefits and be unable to afford medical care.
We know that legislative cuts in Medicare doctor reimbursement and other Medicare funding cuts are always overridden by Congress for fear of losing a reelection because the cost cuts affect the supply and availably of medical care to seniors.
Despite the independence of the cost cutting panel in Obama's health care legislation, when the panel and its cuts go into effect, Seniors' wrath will be vented against their elected Congressional members. As the Medicare Trustees recognize in their alternative scenario, the law very likely will be amended to override the panel's Medicare reimbursement cuts, or Congressional incumbents will lose their seats.
How do we make changes to Medicare and get voters to agree?
We know that price controls, cost controls, limits on Medicare reimbursement and limits on medical care (aka death panels) will not work because incumbents very likely will lose reelections unless they override the proposed cost savings.
We know seniors do not want the payment risk passed on to them through vouchers or any other funding mechanism.
If you cannot change the cost reimbursement, the demand for or access to care or shift any of the increasing cost risk to seniors, then Congress is left with only one option to reduce and limit its and taxpayers' future Medicare funding liabilities.
Congress needs to pass legislation that will increase the supply of medical care providers and lower medical care delivery costs to seniors and other Medicare enrollees.
Congress needs to override state laws that restrict doctors certified in other states from practicing in a state, directly or through threatened federal reimbursement loss to states; allow more foreign trained doctors into the US and allow them to practice medicine; find ways to motivate undergrad colleges and nursing schools to offer an degree equivalent to a 2 or 4 year doctor associate degree that will allow the associate to takeover many of the routine functions and routine examinations of a doctor and change reimbursement rules to allow payment for associate doctors and other equivalent licensed medical providers.
Increasing the low cost medical provider supply instead of restricting access or limiting reimbursement
Increasing the supply of low cost medical providers will provide more care to seniors. It will also put pressure on doctors to lower their costs, to use more associates and to pyramid themselves like law firms that use associates instead of partners for routine law firm work to lower cost. It will also alleviate doctor shortage problems by providing a trained alternative to 4 year medical school doctors.
Firms like Walmart that are experts in cost controls could use associate doctors to set up alternative first line medical care providers to meet many mundane medical needs of consumers. Doctors will face patient competition, lose some of their routine patients to associate doctors and need to lower their costs to survive, especially if they are reimbursed at the same rate as an associate doctor for mundane, routine care. The lower reimbursement rate will stick because a doctor backlash will not affect associate doctor medical care to seniors.
Additionally, hospital costs have to be lowered. Also, changes to the FDA need to be made lower the cost of drug approvals.
In the end
Congress need to substantially increase the supply of first line low cost medical care providers to lower the cost of medical care and to create cost competition to medical doctor services.
Changes to the FDA to lower costs of drug approvals and changes to hospital care are also needed to lower all Medicare reimbursement costs.
With an increase in the supply of low cost medical providers to seniors, Congress will be able to lower reimbursement costs to doctors without affecting primary care to seniors and other Medicare enrollees and without losing reelection.
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