GOP Tax Plan: Corp. & Estate Tax Cuts- Repeal Of Medical Expense and Student Loan Deductions

The biggest load of hype for the just announced GOP tax "reform" plan is the much ballyhooed corporate tax cut from 35 % to 20 %. But let's not fool ourselves, no one - certainly no CEO - really believes the typical corporation pays the full 35 percent rate. It's more like 10-15 %

But this is the codswallop attached to this misbegotten plan, along with the balderdash that it will "pay for itself with economic growth".  In a pig's eye.  No tax reform based on supply side baloney has ever done that.  The most recent stark example were the Bush tax cuts.

The layout of the first iteration of the Reepo "tax reform" or "the cut, cut, cut" plan in Dotard parlance - has now been spelled out in today's Wall Street Journal. Before I list the aspects of it I will quote finance specialist Jill Schlesinger, asked by Gayle King on CBS Early Show:  Who "wins" with this tax plan?  Ms. Schlesinger's  response: "The ultra-wealthy are the main winners".

Let's also back up and note that a "reconciliation" with an already passed  Senate budget is part of the deal. As I noted in a previous post (Oct. 24th), "The plan is also to cut $1 trillion from Medicaid and $473 billion from Medicare over ten years."   The latter alone, if integrated into the tax reform, would clearly mean either major cuts in benefits, and more likely some form of "premium support" or  voucher program.  In this case seniors on Medicare are given a set amount each year, as opposed to having most costs covered.

As I examined the CMS Summary sheets for the procedures carried out this past year I noted a total of more than $60,000 for the 3D staging biopsy and cryotherapy cancer treatment at UCHealth.  The ultrasound guidance part of the cryo treatment alone came in at $16,000 and the anesthesia just for that treatment, not including the 3D biopsy anesthesia, was $3,149..

If I had to operate under a $20,000 per annum GOP voucher plan, I'd have ended up shelling out nearly $40,000 out of pocket for the uncovered procedures. And none of that even includes the cost for wife's hip replacement surgery, including 7 days in rehab.. By contrast, the estimated "payoff" I\we can expect in tax cuts from the proposed GOP tax reform is about  $450.  Do the math and compare that chump change with the $40,000 cited earlier and you will see why I'd rather pay the taxes - any day, twice on Sunday - just like our European friends are happy to do. Given they know which side their economic bread is buttered on, and it ain't the tax cuts side!

Now, let's move on to the aspects of this tax reform deal as revealed in the WSJ today (p. A1, pp. A3, A4): 

- The current seven income tax brackets are now reduced to four: 12 %, 25%, 35% and 39.6%

- For new home purchases, the mortgage interest is deductible only on loans up to $500,000, no more. If enacted it will apply retroactively to mortgages on home purchases starting Friday. (Existing homes would be grandfathered under the $1 m limit).

- - Deductions for state and local income and sales taxes are wiped off the board.  Tough luck if you happen to live in CA, NY, NJ, MD, MA and IL)

- The deduction for property taxes will now be capped at $10,000.  Tough luck if you live in a high property tax state.

- The deduction for medical expenses will now be repealed. Medical expense write offs are currently allowed if they exceed 10 percent of annual income. So, if your income was $60,000/ yr. and medical expenses came to $7,000, you could deduct that. No longer.

- The standard deductions are increased to $12,000 for single filer and $24,000 for couples. Already 70 percent of filers (according to Jill Schlesinger) go this simpler route and that's now expected to increase to 84 percent.

- At the same time, the "personal exemption" each individual normally gets is now eliminated.

- The "child tax credit" for children under 17 now goes from $1,000 each to $1, 600 and clearly only benefits one subset of married couples - which even the WSJ editors had a problem with, noting it's a: "forlorn attempt to appease the income redistributionists on the Right"  adding, "Does anyone think a mid-level manager at JP Morgan really need a subsidy to raise children?"

Indeed, and as I've posted on before, we ought to actually be going the route of repealing the child tax credit given a global warming planet where each  additional person (especially in developed nations) leaves an ever larger carbon footprint, adding to the 41 gT a year of carbon expelled into the atmosphere.

-  The tax plan calls for $65 b less in tax benefits for post-secondary borrowers over the next decade. That includes repealing a provision that allows taxpayers to deduct up to $4,000 a year in tuition and related expenses if they earn less than $65,000/ yr.

- The estate tax benefit per person is now doubled from $5 million to $10 million - along with inflation adjustments, giving a massive boost to the ultra-wealthy.

So there you have it in a nutshell. The layout of the current GOP tax plan before any budget reconciliation occurs, which might also mean deep cuts to safety nets like Medicaid and Medicare.

As I wrote earlier, I will happily do without any tax cut - and wifey will as well - if it means our Medicare is left alone.

I am sure others will also have their own opinions, depending on which tax  'ox' is gored in the above proposals.

Continuation: How Repukes Plan To Eviscerate Obamacare

New HHS head Tom Price, another architect for the destruction of the ACA.

Another sadistic aspect of the Republican proposal scraps the income-based Obamacare subsidies that help families buy affordable insurance. Instead, Ryan wants to offer a flat subsidy that would be the same whether families earn $500,000 or $50,000. Residents of Minnesota, for example,  would get the same support as residents of Alaska, where premiums on average are three times as high. The subsidies would vary by age to give older people more support, but the Republicans have not said how much more.

Anyone see any similarities to Ryan's "premium support" or voucher plan for Medicare? If so, good for you! You recognize limited "block" allocations for medical funding, similar to the Ryan Medicare vouchers, which may not even cover one fourth of medical costs for even a relatively healthy senior or working class citizen.

And note that last week, the Department of Health and Human Services under Price proposed regulatory changes to the law, one of which allows insurers to reduce benefits and force people to pay higher deductibles on future policies. And to the point concerning the cessation of the individual mandate I noted earlier,  the Internal Revenue Service will no longer require people to answer a question on their tax returns about whether they had insurance the previous year. The question remains on the form, but filers can chose not to answer it.

Under Obamacare, people must buy insurance or pay a penalty enforced by the I.R.S. By backing off, the I.R.S. will encourage people to forgo insurance and take a chance that it will not seek more information or penalize them. When fewer people, especially the young and healthy, buy insurance, overall costs go up, because the people who do sign up tend to need more medical care.

The GOP in its plans has processed this, and therefore opted to do a "replace" using a plan with a double -edged sword. One edge allows pre-existing conditions to be covered but only if the person has been on such a plan for no less than 18 months of continuous coverage. The other edge places the sickest (as well as those with serious pre-existing conditions) in high risk pools. This means they can be charged up to double the cost of those with no serious ailments.

As a matter of record, in the recent past it was found that in more than 30 states that had such high risk pools net losses added up to more than $1.2 billion. That was in 2011, the height of such pools before the ACA took effect. Most of these pools also had lifetime and annual limits on coverage. So, if you got breast or prostate cancer, for example, your coverage might be capped at $25,000 a year whereas you needed at least $50,000 for full tests (e,g. followup biopsies) treatments.  In addition, waiting periods were imposed of up to a year to get even this limited plan.

This is where we are headed with the GOP's "repeal and replace" and why so much rage has been stirred at town hall meetings, which assorted numskulls have blamed on  astroturf" activisim with protestors being "paid". (The recent FAUX News claim is "$1500 a week", prompting Esquire contributor Charlie Pierce to joke, 'Hey, sign me up! I'm available!")

Will Trump voters be as outraged as Dems currently on the ACA, but who stand to be displaced? They should be! And now is the time to strike when their Reepo vipers... errrr reps.... are still on recess so they can be ambushed at town halls and asked what's up. All citizens who stand to be victimized by their chicanery  can reach their representatives and senators and give it to them. Alas, too many lawmakers have cowardly canceled town halls to avoid angry constituents. Never mind, pissed off voters - just by showing up to sn empty hall-  can still send a strong message that Americans want legislation that improves health care and makes it more affordable for everyone, not the opposite. Just stand outside the empty hall with your placards aimed at the vermin cowards, and scream  - and let the optics deteriorate as local TV cameras roll.

No more time for nicey nice, folks, it's time for political combat - given lives and futures are now on the line.  I'm also glad to see that even the usually Spock-like, 'no drama' scientific community is finally getting riled up for more emotional protests, displays - given what Mr. Dump has in store for them, with cuts.

See also: http://smirkingchimp.com/thread/dean-baker/71265/paul-ryan-has-a-plan-to-take-away-insurance-from-tens-of-millions-of-people

How The Repukes Plan To Eviscerate Obamacare

As I wrote in my post from December, 2nd, the way forward to the  demolition of the Affordable Care Act was cleared by the  appointment of Tom Price (R, GA) to the Dept. of Health and Human Services. Now, with his nomination secured, the Repukes have their "replace and repeal" deal all but drafted - needing only the legislative cooperation between Paul Ryan's anti- Obamacare gang on the Hill and the Trumpites. 

We also know Price, along with Paul Ryan,  wants to replace Medicare with a "voucher" system where each person gets a small amount per year ($10k is often cited) to buy whatever insurance possible - and to cover all medical incidents, emergencies. If I'd been reduced to such a yearly voucher I'd have had to file for bankruptcy since getting cancer treatment 4 years ago and having gall bladder surgery (which came to $28,000 ) this year.

Meanwhile, many experts as well as independent groups,  have warned of the economic fallout if a $3 trillion total market (involving insurance companies and total stock capitalizations) were to suddenly be eviscerated with no genuine support for the 20 million on the ACA. Already Trump, using an "executive action",  has wiped out the enforcement aspect for the individual mandate. This was by no longer requiring the IRS to monitor or impose annual penalties for those who eschew health insurance.  Without that mandate, certainly enforcement of it, too many will avoid getting any insurance and thus the best aspects cannot be preserved. Those included the one for pre-existing conditions (insurance companies had to accept them), and also enabling adult children to stay on their parents' plans until age 26. Now those goals are no longer feasible, minus the mandate.

We knew, given Dump's bloviations on the campaign trail,  that the ACA would be in danger. Now we know how bad it will be.   In his half-baked policy paper released on Thursday, Ryan trotted out washed-up, recycled ideas (originally proffered in his 2010 'Path to Prosperity'),   for “improving” the country’s health care system..  The problem? His plan would actually make things a thousand times worse.

 For example, Ryan's paper calls for reducing spending on Medicaid, which now provides insurance to more than 74 million poor, disabled and older people. If enacted, many millions of these vulnerable citizens would be cast out of the program. The Republican plan also forces most people who don’t get their health insurance through an employer to pay more by slashing subsidies that the A.C.A now provides. The same proposal also allows families to sock away more money in health savings accounts (HSAs).  This  may sound good in theory, but it won't really help the 4 to 5 million lower class Trump voters whose fate and future now hinges on ACA changes. The reason is that the HSAs would primarily benefit affluent people who can afford to save more.  In other words, you need to have ample disposable income to shell out of pocket for your care, and then you can make effective use of the HSAs. But if you're a Walmart or Burger King worker, that's about as pie in the sky s expecting to win your state lotto just as your health care is demolished.

Price hasn't even entered the picture but we know from his own history and statements that he has a fondness for tax credits and high deductible plans. At the same time no surprise Ryan’s blueprint for repealing and replacing Obamacare offered no estimates of how many people would lose coverage or how much premiums and deductibles would rise for middle-class and poor families. But hey, what are a few niggling missing details?  Those didn't stop the new HHS head Tom Price, - a former Ryan lieutenant in the House - from embracing the Ryan plan. According to BLOTUS Price:  “is all in on this.”

Well, God help all the Trump voters and other poor or unemployed if he is. They will now face steep costs for dealing with everything (in the coming years) from antibiotic resistance, to worm infestations of their brains, to new drinking water threats given that coal companies - thanks to a Trump "executive order" can now dump coal waste into fresh water streams at will.

This will be reminiscent of the 2014 Elk River (West Virginia)  chemical spill -  of  the coal cleaner  methylcyclohexane methanol (MCHM).)  which caused enormous problems and a massive cleanup effort.

This time there will be no cleanup efforts because Trump doesn't give a crap. So all the millions who stand to be affected ought to brace for the many cancers now ready to be unleashed upon them, including of the pancreas, liver, kidneys, stomach, testes, breast and prostate. According to one of the West Virginia families affected in 2014, they were  informed their water was "so contaminated it was only fit for flushing toilets." 

Alas, when all those cancers, skin diseases, gastro intestinal reactions and others break out, people will no longer have the ACA to help carry the costs of their infirmities. Thank Mr. Dump!

The Grand Old Party wants to slash spending on Medicaid over all by giving states the option of a "block grant" or a per capita allotment. So here in Colorado, for example, that may mean allocating the state a fixed amount for next year of $100m. That then will have to suffice to cover the needs of some 125,000  citizens, mainly frail elderly, poor, unemployed or under-employed. But if those people normally need some $4,000 a year each for their medical needs, just doing the math discloses the shortfall will be nearly a factor 5 less than needed ($500m vs. $50m).

The current program pays for the health care of everyone who is eligible. During recessions, when the number of people in poverty increases, the government spends more. Without that flexibility built into Medicaid, Congress would have to vote to give states more money when health care costs rise. (Say if there is an outbreak of Avian flu).  But politically, that's in the “impossible dream” category. So most health care experts worry that, over time, states will just cover fewer people and cut benefits. Or, they may make the thresholds for care so low that few qualify: say not earning more than $300 a month - for a family of four.

(Continued)

Medicare Reaches 50 - And There Is No Such Thing As "Mediscare"!

Seniors marching on behalf of Medicare in the early 1960s. At that time, adult children had to declare mortgages, assets etc. to pay any extra money for medical care for their elder parents the state wouldn’t cover. Many seniors,  rather than burdening their charges, simply died alone.

"Mediscare" is the word conservatives use to mock the Democratic strategy of warning seniors what would happen if the Reepos alter it, i.e. according to "free market" value such as issuing vouchers.

Is it all really harem, scarem? Don't believe it for a nanosecond!


Yesterday, the 30th of July, marked the 50th anniversary of the government health benefit program called Medicare. While predictions of its demise have been with us almost since it's inception, all have been proven to be false or overblown. The one thing that has remained constant, however, is the conservative elites' belief it is "socialism" in disguise and needs to be dismantled - replaced by a "free market" solution.

In the December 19, 1960 issue of LIFE magazine, President -elect John Fitzgerald Kennedy referred to a few of the modest requests he would make in his new administration. Modest, because he recognized he had won the popular vote by the barest sliver of a majority- a mere 113,000 votes.

 His ‘requests’ included (p. 31):

-          a higher minimum wage

-          urban renewal

-          Old age medical care operating under Social Security

The last would evolve and become known as "Medicare" which is the system JFK originally foresaw and which is operating today as an ancillary benefit to Social Security. JFK understood that as powerful a benefit as Social Security was, it fell short if seniors' health issues were not attended to. The pre-Medicare era was indeed nasty, brutish and saw most elderly either dying in an impecunious state, or simply alone.....of some disease or infection. This is why JFK felt the issue of elderly medical care as an assured benefit could no longer be excluded.

Over the decades numerous attempts have been proposed to kill it or replace it, but all have been stymied as poll after poll has shown popular support for the program. Indeed, it is so popular that "Medicare for all" has been proposed as an alternative, e.g. to the too center-right formula of Obamacare - where citizens still have to cough up for increasingly higher premiums.  But since all the usual conservative tactics have basically been exhausted, the only one left is to brand any defense of Medicare as "Mediscare". But if seniors probe the underbelly of what's alternatively offered, they should be scared!

Most recently, Sally C. Pipes in her WSJ op-ed from yesterday (p. 11) has advanced the thesis that "Medicare spending is unsustainable" and so a new model must replace it. What is this new model she advances that she claims will provide greater access to medical care and lower costs? She sets out the following aspects:

- The eligibility age to get it ought to be increased to 67 because today life expectancy is 79 - up from 70 in 1965  - and those extra years "put additional strain" on the system.

-The postponement to 67 isn't enough and Medicare also needs to be "converted from an open-ended entitlement to a system of means-tested vouchers."

How would these vouchers work? According to Pipes:

"The government would give every senior a voucher based on health status, income and age. Seniors in better health and those who are wealthy would receive smaller vouchers. Sicker or needier seniors would receive larger ones.  Seniors would then choose from among privately administered health plans the one that best suited their needs and budget."

 What are the cutoff thresholds? She doesn't say. But, based on past gov't standards we can be sure if it's a Republican congress and President issuing them, they will be stringent to say the least. Probably the "neediest" will have incomes of $13,000- 14,000 a year or less. This would leave open what happens to a middling income couple - say with $50,000/year - who is also initially healthy at time of issuance - but then the husband develops prostate cancer and the wife breast cancer. It could happen! Then what?

Well, she says seniors can "choose" from among private insurance plans for needs and budget, but how would that work out? Really? Let me provide some perspective - including based on her desire to increase the eligibility age to 67.

At the age of 66 - one year short of Pipes' eligibility cutoff- I was diagnosed with stage T1c prostate cancer in six cores, Gleason scores of 3+3, to 3+4.  I elected high dose rate brachytherapy treatment and that bill tabulation, for those who might be interested, came to $42, 776 . This encompassed a breakdown of different contributors, from (epidural) anesthesia ($4,124) to radiology services ($16,768) to recovery room ($2, 090) to operating room services ($14,994).   The bill, after Medicare Part B kicked in, came down to $1,299 of which most was paid by my Medicare Supplement Plan (F).

It doesn't take a genius to see that had I been left with that bill at 66 - and no Medicare to depend on - with Obamacare still years from being formalized - I'd likely have gone bankrupt. By extension, many millions of other 65 and 66 years olds would too under Pipes' plan.

My other alternative, of course, would have been to skip any immediate treatments and hence, do nothing. In that case, the cancer would plausibly have metastasized until - by the time I finally did qualify for Medicare  - the costs of treating advanced prostate cancer would've been drastically more.

Pipes also claims that according to her proposal (ibid.):

"Insurers would have to compete for beneficiaries' business and providers would have to compete to get on the most popular plans".

But one has to wonder what fantasy world she inhabits. Compete for sickly (or soon to be) old folks? You have to be kidding me!

NO private health insurance companies are going to want to compete for senior health care! They only do it now because the Medicare Advantage plans are paid more for their services than the government pays in standard Medicare. Hence, contributing to the standard program’s insolvency (by an excess $12 billion a year according to the GAO).

Let us assume an elderly woman requires hip replacement surgery at an on-paper cost of $30,000. Today, Medicare - standard Medicare, will pay 80% of that or $24,000, leaving her with $6,000 to pay on her own. A goodly amount, but not insuperable. In premium support at the maximum level, however, the woman would use ALL her allotment for one operation and still have $15,000 left to pay, and no more "premium support" voucher for any other needs that may arise.

Worse, why compete for a pool of citizens which is basically going to be sickly most of the time? This is self-evident. Even now health insurance companies factor in the medical loss ratio (the ratio of unhealthy subscribers to the healthy ones that support them via fees, costs) as the most important in getting continued profits. That means they already know that any private plans for seniors on the open market would have vast medical loss ratios meaning the proportion of insurers' profits would be next to nil. Thus, seniors will clearly be shut out, translating to a no win situation for them. (No Medicare, and no private insurer to take them)


As Economics Professor Fiona Scott Morton aptly put it several years ago in referring to any such "voucher" plan, it is merely a demand shedding plan. As she puts it:

 “there’s no evidence many companies will be rushing in to provide health coverage to ailing boomers with competition that ought to lower any premiums"

BINGO!

She added:

"The Republican voucher plan is not solving the problem. It’s solving the problem of the cost of government health care. You have people who can’t afford it and they’ll just die. Economists call that demand shedding”.

Thus the “Medicare revolution” proffered by Pipes and earlier Paul Ryan is NOT to engender market competition to "lower health premiums for seniors", but to shed market demand (by seniors) so they'll be unable to enter or access any private health care, period. And since no government help or insurance will be available (other than other than a meager voucher to try and purchase private insurance in an open market with seniors the only and largest risk pool) the senior will have no choice but to die.)

Thus, we effectively have a "death policy" and there's no gaming it with euphemisms or trying to put any lipstick on this pig.

Apart from that, we know purchasing health care isn’t like buying a car, or i-pad or TV. The elements of objective and cool rational choice aren’t available mainly because the time when people most need health care is when their lives may be on the line: after a serious auto accident or fall, or appendicitis, or contracting pneumonia. Then, they simply need care and cost may not factor into it given that we know costs vary across large geographical regions, see e.g.

http://brane-space.blogspot.com/2012/02/why-cant-colorado-follow-grand-junction.html

As shown in that blog post, there is a way to control medical costs, but it doesn't depend on "premium support". It requires a provider network than mandates FIXED pricing for each procedure irrespective of what insurance vehicle one has....or doesn't. In this way, the delivery of care is rendered uniform without wild variations in costs, and in addition, costs can be controlled - especially as unnecessary procedures.

Other ways Medicare's costs can be controlled to ensure it's sustainable into the future include:

1) Allowing Medicare to bargain for the lowest cost prescription drug costs like the VA does.

2) Transferring those currently on "Medicare Advantage" (based on more expensive private plans for which standard beneficiaries must subsidize) to standard, gov't run Medicare.

3) Implement new computer software to detect fraud, e.g. that can distinguish fake M.D. addresses - given by those trying to bilk the system - from actual ones of genuine providers.

The problem with all conservative solutions is that they're based on an exaggerated assumption that ascribes more power to the majority of people than they actually possess. Hence, the conservos can insist with a straight face (cf. WSJ, July 25-26, p. C2 )that "limited government allows individuals to take responsibility for themselves and their families and communities".

Yes, in an ideal world of limited corporate influence, that might be so. But not when corporate power and money can purchase political influence that undermines democracy and inveighs against the will  of the people as well as the general welfare. Then, "limited government" becomes exactly what the corporatocracy wants, a government too weak to protect the interests of its citizens against the array of private power. As FDR once put it:

"The liberty of a democracy is not safe if the people tolerated the growth of private power to a point where it becomes stronger than the democratic state itself. That in its essence is fascism: ownership of government by an individual, by a group, or any controlling private power.”

Is Proton Beam Therapy Worth It?

Comparing degrees of localization of proton beam therapy with other treatment  modalities, in terms of dose v,  tissue depth. 'SOBP' denotes 'spread out Bragg peak' - or the collation of several such peaks via different beams, for different depths. Red line denotes depth dose plot of x-ray beam..


The Wall Street Journal article 'Making A Case for Proton-Beam Therapy', to treat cancer - actually posed an interesting conundrum. On the one hand "six new proton beam centers are set to start delivering state of the art radiation to cancer patients around the country by y ear's end" - with no fewer than ten additional centers expected by 2018 bringing the total to 30.

On the other hand, these centers are "entering an uncertain market" since the therapy still "lacks evidence that it is better than traditional radiation despite costing significantly more".   Indeed, as the WSJ piece notes, Aetna and United Health Group, Inc. have stopped covering it for prostate cancer, "once seen as a main source of patients".

I also (briefly) considered getting proton beam therapy when my prostate cancer was diagnosed back in July, 2012.  However, my wife (a former radiotherapy software specialist) convinced me that high dose rate brachytherapy - which her company specialized in - was the better option.  Plus,  she knew the best center in the nation to get it: the Helen Diller Cancer Center at University of California - San Francisco and had worked with the world-famous oncologists there .  She was  also  skeptical proton beam centers existed that could give 100 percent assurance and confidence that through all the 30 or so days of treatment one would not see a "geographical miss". That is, the proton beam hitting a critical region like the bladder or lower bowel instead of the cancer, putting an  unwanted micro-hole in either..

For those not aware,  proton beam treatment is a form of external beam therapy in which positively charged particles (protons) are accelerated to 60 percent of the speed of light, or 180,000 kilometers per second. They are constrained to form a powerful beam that can be programmed to deposit most of its energy directly into a target tumor - say in the prostate gland - minimizing radiation exposure to surrounding healthy tissues (say bladder and lower bowel in the case of prostate tumors)

While the therapy - according to existing evidence - isn't necessarily "better" than traditional radiation treatments, the proponents (which include now the top ten cancer treatment centers)  insist it can reduce many harmful side effects, especially for localized cancers.  As the WSJ noted:

"The benefits are undisputed for rare pediatric brain cancers, adult eye tumors and cancers at the base of the skull."

But for prostate cancer the jury is still out, and certainly the benefits of the radiation treatment I received have to be considered at least as good and much more cost effective. (I was in the treatment center for one day, and received one high dose of 1930 cGy via Iridium 192 needles introduced in situ, see e.g.

http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html

While the advocates for  proton beam therapy brag of its accuracy - assuming it's done in the right hands- my own therapy relied on a specialized inverse planning, or "IPSA" software, see e.g.

http://radonc.ucsf.edu/research_group/jpouliot/pages/ipsa/ipsa_hdr.htm

For which testing of the algorithm at multiple sites disclosed  automatic protection for critical organs  achieved by generating contour solutions that cleared a 3D "tunnel" around the urethra and rectum (for example)  to spare them from the maximum delivered dose.
 
The worst side effects for me were in the immediate three or four month aftermath and included frequent urge to urinate and some burning upon urination. Also burning accompanying sexual activity. (Only a bit later I learned I could control the burning effects by taking one cranberry sofgel a day)

Medicare covered almost 95% of the total treatment costs, which - if I'd  had Paul Ryan's stingy "premium support" (voucher)  plan - would have likely bankrupted us - given it would only cover $10k or so a year.

It should also be known, as the WSJ notes, that Medicare also covers proton beam therapy  "at about $1,100 per treatment session" . Nonetheless,

"several major insurers stopped after a 2012 study found it has no long term added benefit. "

Originally, as the WSJ notes,  men with prostate cancer had made up 70 percent of patients at some proton centers, and that is now 50 percent.  

Meanwhile, the manufacturers themselves are designing more compact machines as opposed to the Hitachi machine - nearly the length of two thirds of a football field. But smaller is no guarantee of success and as the Journal piece pointed out, ProTom International Inc.  - maker of compact systems- already had to file for bankruptcy protection.

My advice to anyone considering this option is to look into it carefully, also consider that a simpler, less complex system might actually be better for your cancer treatment needs!

Joe Klein – Exasperating “Mediscare” Idiot

Joe Klein is nothing if not predictable. In his latest column ‘Return to Mediscare’  (TIME, April 28, p. 25) he castigates both parties for running ads trying to scare the bejeezus out of seniors in the run-up to the November mid-terms. For Repukes, it’s a chance to once more seek to undermine the Affordable Care Act, while for the Dems in assorted locales, it’s a useful cudgel to go after Repub opponents.

Klein cites Arkansas as a case in point where Dem moderate Mark Pryor is using a woman named “Linda” to warn of his opponent Tom Cotton’s plans to wreck Medicare. The “Linda” ad states that “Tom Cotton voted to turn Medicare into a voucher system”.

Klein then asks" 'Is this accurate?', then replies, “Well yes and no” and classifies it as a “brilliant Mediscare ad.” In qualifying his answer he goes on to write:

“Cotton and 218 of his House colleagues in the House did indeed vote for the Paul Ryan budget, which would slash costs by moving to a privatized (‘premium support’) or voucher system of health care for senior citizens. Is this a bad idea? Probably not.”

Is this guy mad, or just suffering from every day delusions? Of course it’s BAD!

 Let us bear in mind here the maximum "premium support" ever suggested for this absurd program has been $15,000/yr. But the current average senior in Medicare requires support (or if you want, assistance) in the vicinity of $30,000/yr and much more post-86 years of age. This means that at the level of only $1,250 a month, most seniors - unless spectacularly healthy - won't get much help.

Let us assume an elderly woman requires hip replacement surgery at an on-paper cost of $30,000 somewhere in FLA. Today, Medicare - standard Medicare, will pay 80% of that or $24,000, leaving her with $6,000 to pay on her own. A goodly amount,  but not insuperable or break the bank. In premium support at the maximum level, however, the woman would use ALL her allotment for one operation and still have $15,000 left to pay, and no more "premium support" for any other needs that may arise.

In the case of my prostate cancer radiation treatment 2 years ago, “premium support” would have covered $15,000 at most – leaving me with over $35,000 to cover on my own for just the basic high dose radiation treatment. In addition, I’d not have been able to use any further “support” money for any other problems that arose.

 Is Klein this ignorant, or is he just plain stupid?

Economics Professor Fiona Scott Morton (The Market Can’t Cure Medicare’, May 2, 2011) observed that  indeed any such premium support plan, is merely a demand shedding plan. As she puts it, “there’s no evidence many companies will be rushing in to provide health coverage to ailing boomers with competition that ought to lower any premiums"

BINGO!

She added:

"The Republican plan is not solving the problem. It’s solving the problem of the cost of government health care. You have people who can’t afford it and they’ll just die. Economists call that demand shedding”.

Klein then actually compounds his ignorance or stupidity by blabbering:

“”In fact, a more generous version already exists in the form of Medicare Advantage, the private sector Medicare alternative that seems to be going great guns in the Obamacare era.”

But he’s mixing chalk and green cheese. There’s actually no comparison since Medicare Advantage is actually MORE generous than standard Medicare (which the Neolibs keep yapping about cutting).

 Under traditional Medicare the coinsurance is pegged at 20%, but the actual amount out of pocket can be higher since specialists generally charge more for services.  This is not the case for the private Medicare Advantage plans for which the payout limits are often under 20% for special services, because the premiums from standard Medicare beneficiaries are used to subsidize higher specialist and other costs.

This is exactly why, in previous reports, the GAO has reported that the cost -burden of Medicare Advantage plans has added up to $12 BILLION a year to the cost for traditional Medicare and why the latter's headed toward insolvency. Of course! Because the Advantage plans are like parasites bleeding it down! Does Joe Klein mention any of this? Of course not!

The point is the Advantage plans are required to offer a benefit “package” that is at least as good as Medicare's and cover everything Medicare covers, but  usually they offer much more!  Plans that require higher out-of-pocket costs than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits, plus use some of the excess payments they receive from the government for each enrollee to offer supplemental benefits.

But this in NO way is similar to Ryan's voucher ("premium support") plan which would offer a single fixed voucher in a designated amount (e.g. $10,000) - from the government - to have to go out and actively snag a private plan (hoping it will accept the senior)  and the limits of the voucher to cover future costs of visits, care over the year. By contrast, once a senior chooses a private plan in the sphere of Medicare Advantage there are no 'ifs, ands, or buts' - he will be allocated a  private plan and can't be denied for pre-existing conditions or any other balderdash.  The private insurers also know it's a good deal for them since they're assured of regular monthly payments from the gov't which have the potential of increasing each year! No fixed, one time, voucher pays!

Another goodie for the Medicare Advantage senior: Advantage plans typically do not contain deductibles, thereby giving members "first-dollar" coverage. (Original Medicare has a potentially recurring (more than once per calendar year) deductible for Part A and an annual deductible for Part B.) Ryan's plan by contrast will likely see private health insurers attaching massive deductibles, on the order of $3,000 -$5,000 or more, for the simple reason that the insurers will be having to take chances (with no regularly promised gov't subsidies, only the single voucher payment) with a person in a putative high risk health pool! It doesn't take a genius to see that with such deductibles in play, and assuming the private insurer even accepts the senior, much of the voucher will be eaten up before the first real care is even delivered.

The sad fact here? Klein actually has the freaking nerve to assume (and entice his readers to believe)  that Ryan’s premium support voucher plan is little different from Medicare Advantage and would not be different if the Repukes ever got to implement it.  The Pryor ad which he castigates as “Mediscare” by contrast, is realistic enough to grasp that would no more transpire than aliens landing from Tau Ceti landing and abducting the whole GOP House.

What can we conclude? That the Mark Pryor ad is spot on in its perceptions, and that Klein’s bullshit is not to be trusted. But then, no Neolib hack’s is, whether Klein, Robert Samuelson or any other puppets.

Why I am Thankful......for MEDICARE

Seniors marching on behalf of Medicare in the early 1960s. At that time, adult children had to declare mortgages, assets etc. to pay any extra money for medical care for their elder parents the state wouldn’t cover. Many seniors, rather than burdening their charges, simply died alone.

The pre-Medicare era was nasty, brutish and saw most elderly either dying in an impecunious state, or simply alone.....of some disease or infection.

By 1960, the then Democratic contender for the presidency - John Fitzgerald Kennedy - had seen enough and as documented in a period issue of LIFE magazine (December 19, 1960, page 31) proposed for the first time a program of elderly medical care and insurance operating under the Social Security System.

Now, as I glance at the recently tabulated bill (from UCSF Hellen Diller Cancer Center)  for my treatment of prostate cancer, I thank JFK and my lucky stars (my 'lucky stars' in the sense of detecting the cancer this year and not when I was scrounging for a private plan prior to Medicare) that Medicare was available and still essentially intact.

That bill tabulation, for those who might be interested, came to $42, 776 and this encompassed a breakdown of different contributors, from anesthesia ($4,124) to radiology services ($16,768) to recovery room ($2, 090) to operating room services ($14,994).   The bill, after Medicare Part B kicked in, came down to $1,299 of which most will be paid by my Medicare Supplement Plan (F).

Now, flash back to when I was 62 and the best insurance on offer to me was an AARP plan with $15,000 deductible and only  limited coverage. Had I been detected with prostate cancer back then, I'd have had to come up with virtually all of the $42,000.  At most, the private AARP plan might have covered $11,000 or so. (And this is assuming the cancer was detected after enrollment and not before - else I'd have been denied based on having a "pre-existing condition".)

In that case, having been given the diagnosis, I'd have had little choice but to skip any immediate treatments and hence, the cancer would plausibly have metastasized until - by the time I finally did qualify for Medicare (last year) - the costs of treating advanced prostate cancer would've been drastically more expensive. (In that case I'd have likely required multiple treatments, including external beam radiotherapy, androgen suppression in addition to high dose brachytherapy)

I point this out because one of the alleged "solutions" to the "fiscal cliff" - grabbing so many hysterical headlines right now - is to extend the age to 67, to qualify for Medicare. To say this is monumentally STUPID, is putting it mildly! In fact, rather than limiting Medicare costs it will explode them - which doesn't require Mensa-level intellect to figure out!

If Dems yield on this to the Ryan-led "fiscal cliff" wheeling and dealing Repukes, then all hell will break loose on the Left flank. The Left understands that those 65-67 yr. old seniors caught in the proposed 'donut' coverage wait, will be like I might have been - and postpone essential medical care rather than go broke. Then, when they do finally qualify for Medicare, their problems will be much worse and require far more resources, medical costs to fix. This ain't rocket science!

As it is, Medicare is NO freebie! This needs to be repeated over and over again! The supplemental Part F insurance that paid the balance of my prostate cancer treatment bill comes to $139 a month alone. This is in addition to the regular Medicare premium (Part B)  of $99 a month. In addition, no dental coverage exists, so my wife and I had to cough up over $2,700 recently to cover the costs of new crowns, fillings and dental cleanings. This isn't any kind of luxury because most people know that once your dental health goes, the rest of your health generally follows. Healthy teeth, after all, are critical to good nutrition and avoidance of chronic inflammation! We aren't talking 'cosmetic" dentistry here!  And I won't even add the $1, 500 or so every other year or so for new glasses.

Another BIG Thankfulness acknowledgement here - that Ryan and Romney LOST the election! Imagine the path we'd now be on if the Ryanesque "vouchers" were the new Medicare? Hell, I'd have exhausted my $10,000 voucher in a heartbeat then have had to pay the balance of the $42,776 bill and that isn't even looking at any other health problems that I've had the past six months (inlcuding ear infection, strained back muscle).  

Under Ryan's plan and with no government mandate for providing care, why should the profit -oriented insurance companies put themselves on a downward treadmill or "losing wicket" as we call it in Barbados? They wouldn't if they had any grain of sense. Without a mandate or order from the government, you can also bet your sweet bippy they'd reject any elderly person with a pre-existing condition. This would be the proverbial no-brainer for them!


Thus, by the time JFK proposed a government health plan linked to Social Security, in 1960, America's seniors were more than ready. More than ready to stop being parasitized by commercial outfits, or humiliated by the likes of states under the odious Kerr-Mills plan (which required adult kids to cover costs). The only main opponents were the AMA which (One Nation Uninsured, p. 68):  "ran newspaper ads and TV spots declaring Medicare was socialized medicine and a threat to freedom" while blowhards like Ronnie Reagan made idiotic recorded talks trying to scare people by asserting (ibid.): "One of the traditional methods of imposing statism on a people has been by way of medicine".  (Reagan also suggested Medicare was a means of "communist intervention in a free nation.")

Fortunately, most seniors who'd actually experienced the dregs of capitalist medical bestiality didn't buy this hog swill. They organized under groups like the National Council of Senior Citizens (see image) and turned the tables by imposing relentless pressure on representatives (the most intransigent of whom were Southern Democrats, who LBJ had to finally confront and read the 'riot act'). Eventually, the opposing voices were muted and Medicare was passed in 1966.

For those interested in what elder health care was like before Medicare get the Oxford University Press monograph, entitled: One Nation Uninsured, by Jill Quadagno, which also gets to the bottom of why there is such massive political aversion to any kind of genuine health care coverage in this country which doesn't drag in the profit motive.

As for the "fiscal cliff" - let's not let our reps toss us over it for the sake of bankster slime (like Lloyd Blankfein) and return us to an era where seniors had to sink or swim medically!




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Miscast Economic Questions from A Media Neoliberal

The WaPo’s Ruth Marcus, in a recent column, posed several “mock debate” questions for Barack Obama, obviously trying her best to be too clever by half. But this Neoliberal denizen of the corpora-media merely came away appearing half clever. The two ‘questions’ I will focus on concern Obama’s “deficit commission” and the Ryan-Romney Medicare voucher system.

Let’s then cut to the chase with Marcus’ first question:`

“President Obama, you have been criticized for not supporting the recommendations of your own fiscal commission. Why didn’t you? Do you regret that choice?”

Answering for Obama:

I am certain he does on further investigation!

The “recommendations” Marcus is referring to are actually private proposals put forward by Alan Simpson and Erskine Bowles, the co-chairs of the Simpson-Bowles Commission. Those proposals would cut Social Security through a variety of means, would cap the Medicare budget (which is effectively the same as cutting it), and - once you cut through all the doubletalk - would actually cut tax rates for corporations and the wealthiest Americans, while raising them dramatically for everyone else.

Apart from the negative economic justice aspects, which play to a Neoliberal market imperative, there is the underlying rot and corruption of the persons, networks, groups behind it – which (based on Michelle Obama’s convention speech) I cannot believe Barack knew about before he appointed this duo.

Simpson is a former Republican Senator who (during the budget impasse in 2010-11) also insulted the Social security program and those on it, once referring to it as “310 million teats” – implying those dependent on it are moochers or slouches, n’er do wells. Simpson never ought to have been appointed to ANY commission, including oversight of hog farms.

Meanwhile Ernest Bowles is an ex-Democratic staffer and Morgan Stanley Director. In addition, a champion of the Neoliberal ethic that people ought not be dependent on “entitlements” but earn their keep via their own hard work or investment acumen. In any case, citizens are expected to rely wholeheartedly on personal initiative and industry not government “handouts” (Despite the fact, as noted in the latest TIME – ‘One Nation Subsidized’ – 99% of the country already depends on such “handouts”)

More to the point regarding incipient corruption, both Simpson and Bowles are longtime allies of conservative hedge fund billionaire and former Nixon Cabinet member Peter G. Peterson, a long-time adversary of Social Security, Medicare, and government's rightful role in our society. Peterson-funded organizations provided staffers, as well as ideological guidance, to the Simpson Bowles Commission.

This alone, had Obama known of their background, ought to have led him to quash it one time and either initiate a re-do or put it aside altogether (I favored the latter)

Those staffers worked under the direction of David Walker, who was CEO of the Peter G. Peterson Foundation until he left to lead an affiliated Peterson organization called “The Comeback America Initiative”. Who is David Walker? He's a former Comptroller General of the United States, a longtime Peterson operative, and a featured figure in the rabidly anti-Obama film (“Obama’s America”), just released by Dinesh D'Souza, the far-right apparatchik whose attack book against the President was hilariously entitled The Roots of Obama's Rage.

Worse, Walker is given five minutes or so in the dastardly movie, wherein he disses the leader who allowed Walker's own staffers to affix the Presidential seal to their own work! Some fucking gratitude!

In other words, NONE of the primary subjects involved in the Simpson-Bowles commission have the nation’s interests at heart, certainly not the Middle Class interests! This is another reason I winced on watching Biden’s and Obama’s convention speeches and references to this commission – as if conferring some bipartisan reasonable patina. No, it was a major mistake. Fortunately, it didn’t matter at the time, since most viewers were not remotely aware of the background of the players in the commission.

But this is a big reason it’s advisable for no Democratic candidate to mention it any more, lest the background and connections to the anti-Obama filth and muckrakers be exposed, as well as the base objectives of the Peterson group. This is also why I’m convinced Obama appointed his commission without realizing the background and why he MUST disown it now, he must “abort” it as an infant mutant that cannot be allowed to survive.

The Peterson network is determined to foment hysteria about something that is not our most urgent economic problem. As Joe Firestone notes, government spending (as a percentage of GDP) has been higher in this country at other points in history, and many economically healthy countries spend more.

Hopefully, this addresses Ruthie’s concerns.

Her next question is equally lame:

“President Obama, you have denounced Gov. Romney’s Medicare plan for putting too much risk on seniors. But isn’t the idea of providing subsidies, adjusted for health status and income, to let individuals purchase insurance on well-regulated exchanges, just like Obamacare, except with a public option in the form of letting seniors buy into traditional Medicare?”

My Response:

What Marcus refers to as Romney’s “subsidies” are really vouchers. They represent a limited amount of money allocated each senior and for which he is responsible for getting his own insurance. There is NO assurance, however, that any senior will be accepted by a private insurance plan and in fact there’s no mandate for any private insurance company to do so. This is how the Obama plan for medical exchanges differs from Romney’s. On Obama’s exchanges as spelled out in the Patient Protection and Affordable Care Act, any person will ultimately get insurance. On Romney’s exchanges, no similar guarantee is offered. As a senior you may, or may not be accepted.

As for what Marcus calls Romney’s “public option” (i.e. to remain on traditional Medicare) this would not be the same as using traditional Medicare (as opposed to Medicare Advantage) under Obama. Let’s also bear in mind this “option” was only added after D-Ron Wyden (OR) suggested it, whereupon it mutated to the “Ryan-Wyden plan” but there’s no assurance it’ll be retained if Romney and Ryan are elected. Why keep a “half Dem” plan?

Even if it is retained, seniors will be at a disadvantage because as hundreds of billions worth of vouchers for the private plans are doled out, traditional Medicare will be weakened. This is given that the voucher money (which would ordinarily have gone to support Medicare) is now funneled into “private premium support”. Thus, it will become insolvent even more rapidly and force major cuts in the benefits now provided for. These cuts will most likely arise by eliminating a spectrum of procedures currently covered under Medicare (at least at the 80% co-share rate), including cardiac stents, hip replacements and prostate cancer treatments. Also look for beneficiaries to have to pay for all the preventive services now covered under the Affordable Care Act, including: colonoscopies, mammograms, PSA tests, prostate biopsies etc.

To believe that Romney’s vouchers and Obama’s health plan as it applies to Medicare are anywhere close to being the same is to be totally deluded. But then delusion is the alternate reality within which the Neolibs operate. Look at the mythical "fiscal cliff" , for example, which they've now blown into some nefarious monster resembling an economic Kraken!

Want To Vote Romney-Ryan? Better Have $1 MILLION Saved!

Watching the morning news this morning I almost laughed so hard that my toast nearly was ejected across the room. It appears while "seniors in Florida" don't desire any major changes in Medicare, by something like 64%, the actual polls don't bear this support out. We know Romney and Ryan intend to implement a voucher plan for all those under 55 but these seniors still plan to  vote for that pair by nearly 61% to 39% over Obama. What gives? Are they all suffering from dementia or just slow on the uptake? (One of the analysts on MSNBC observed with great pith and moment that "seniors still haven't connected the Ryan plan with any changes to Medicare")

Of course, many seniors will fall for the selfish meme that "they" - have nothing to fret over if they're in the goodie age bracket of being 55 or over. This is a crass, narcissistic mindset, as I observed before, because by taking such a myopic stance these seniors are spitting on their nieces, nephews and progeny who will be hostage to the Ryan voucher system.

But let me examine the consequences of a Ryan plan in more detail, say for a "marginal" couple (one of slightly different ages).   The real case I will be looking at,  was outlined in an AP story today. Mike, the older O'Malley is 55, and Sharon is 53. As the piece notes:

"Under Ryan's plan, Mike, the older O'Malley would qualify for traditional Medicare in about another decade. Nothing would change for him."

The piece notes that Mike ecstatically replied: "Well, I'm covered."

Yes, indeed, you are. But what of wifey, Sharon? According to the AP piece:

"But Sharon in the new program, would have decisions to make. Whichever way she chooses, eventually she might have to pay more for health insurance than Mike, if costs grow faster than the amount the government provides"

Good! We have a fiducial mark! Now, let's cut the crap and acknowledge that based on the history of medical costs in terms of treatments, premiums, prescription meds the past ten years, the probability of such costs not going up is about the same as space aliens  landing on my lawn tonight and inviting me to go on a jaunt to Zeta Reticuli. In other words, essentially zero.  In fact, medical costs overall have risen at an average annual inflation rate of as high as 14% and as low as maybe 9%. Let us assume a median rate then of about 12.5% for the forseeable future, well into 2040 for the "Ryan plan" seniors like Sharon. (Assuming the Romney-Ryan axis gets in, which believe it or not, one computer model from the Univ. of Colorado has actually forecast. I don't buy it, of course, unless the Dems sit on their butts and don't react to all the nascent GOP voter suppression tactics.)

Right now, seniors on Medicare are advised to have at least $250, 000 or a quarter million saved - to cover just their extra medical costs. These are things the senior must pay which the gov't won't. Let me give a bit of a rundown now for myself. I am paying $4,900 out of pocket a year now, for the Medicare standard premium ($100 a month) and the balance for a Medicare "Plan F" supplement, and the Prescription D drug plan.

Covered in my Plan F so far have been seven sessions prescribed (by my primary doc) for physical therapy (pulled back muscle)  at $180 per session, and a $985 prostate biopsy. Not covered have been expenses for new eyeglasses ($375 - including eye exam) and dental work (new crown) including two dental cleanings, for about $1,500. As people can see this isn't chump change, and nooooooo.....you don't get to say you will "do without" the dental work, or the glasses! Also not added is $500 for deductibles for Part F and Part D plans. Oh, I also forgot $175 for dermatological exam and about the same for ENT exam and vacuum cleaning of the right ear.

Anyway, the total costs via traditional Medicare come to $5, 900, and if the total is added up - as it would be for voucher recipient who's allotted a fixed amount of money each year: $9, 870.

In other words, if you are awarded a $10,000 voucher - as Sharon is liable to be (I believe the $15,000 is total bunkum given a Ryan-Romney ticket and their doubled down Bush tax cuts will have compiled another $10-15 trillion in deficits by 2023 - even if the Ds get back in in 2016) you will have used up almost all your allottment. And that is based on costs THIS year! In fact, Sharon will not be on it for another twelve years, meaning 2024.

Projecting her annual medical costs by then (from a similar layout of needs such as I had, but excluding the prostate biopsy) we come to $13, 333. And that's just her first year.

Bear in mind also, I am making ginormous and likely totally fantasy -based assumptions. The first is that the actual voucher given her IS really $10,000 and not $7,000 or $6,000 ("Oops! Sorry, folksies, the deficits the last five years have been much bigger than we planned, 'cause of all the Bush tax cuts we extended!")

The second assumption is that she's actually able to obtain a private insurance plan! Bear in mind, for what it's worth, if Romney -Ryan get in and have the benefit of a large enough GOP edge in congress, they plan to kill "Obamacare". That means insurance companies will again have "pre-existing conditions" on the table, and for her own sake, Sharon better not even have one pre-cancerous mole!

More likely, insurance companies will hedge their bets on taking chances by adding a large deductible - similar to the ones I encountered while seeking private plans when I was 63-64. The lowest one I could find was $5,000.

If then this is added to the tab, we come up with $18,333 for Sharon's first year of being on Ryanized vouchers. That means she will have to cough up $8, 333 out of her own pocket. Project that ahead for 30 years, as do most financial planners, and it comes to $249,990. But this isn't factoring in enhanced medical inflation owing to the "Boomer demand effect" (recall the law of supply and demand!) - and bear in mind the demand for medical care will likely explode with all us geezer Boomers also seeking it. I don't think, in such a case, that 15% a year inflation is too much.  Assume then a "steady" medical inflation uptick rate of 15% per year, and you obtain the new total that Sharon will need to save up to cover 30 yrs. of out of pocket expenses as: $1.12 million.

Ok, look, some nabobs and nitpickers will assert this is "exhorbitant", and I do agree- but don't blame me- blame Ryan's voucher system. Nonetheless, it's still a practical estimate since one huge item I've left out (to reinforce that), is the cost she'd have to absorb for any major operations, say like open heart surgery, or hip replacement or whatever.

Right now, under standard Medicare, those major operations are covered up to 80%, meaning the beneficiary pays 20%. So for a major cardiac operation, costing say $750,000 in 2026, Sharon would have to cough up $150,000. BUT, that'd be under traditional Medicare! Under Ryan's voucher system, that wouldn't apply and there'd be no regs to cover patient costs. I suspect a good estimate is the patient contribution would be 40% so she'd have to pay $300,000 for such an operation. If she got breast cancer, and needed a 6-12 week chemo regimen as well as surgery (mastectomy) , the cost would likely come to over $280,000. But in my calculated scenario for out of pocket expenses, I am excluding all such major expenses  Hence, by way of the typical "Fermi problem" while some factors may be over-estimated, others are under-estimated to compensate.

Here's the real kick in the gut, according to Bonnie Burns, a 25-year Medicare couselor in charge of advising people about benefits and quoted in the piece:  The spouse with the Ryan voucher plan will suffer from "health care envy". Well, you don't say, Bonnie! If I had to pay hundreds of thousands for health care more than my spouse I guess I'd be envious too! Question is, why don't today's seniors simply avoid that fate altogether and not vote the Rich Guy ticket?

Bottom line: Sharon better have saved a lot of moola  (just for her medical care) by the time she turns 65 if the Romney-Ryan axis prevails in November! If not, she better hope hubby Mike wins a lotto, or leaves her with the equivalent of a lotto-magnitude life insurance policy....if he croaks before she does.

Samuelson at it again: Mixing Medicare Advantage with Ryan's Medicare Vouchers

Leave it to Neoliberal hack Robert Samuelson, in his yen to sell the Neoliberal prescription for our economic problems, to once more dip into his confusion and conflation barrel and muddy waters! This time about the vouchers (called "premium support") proposed by the Romney -Ryan ticket, and Medicare Advantage plans currently implemented by private insurance groups like Kaiser-Permanente.

In his latest piece ('Why Ryan Plan Might be Right', in The Sunday Denver Post. Aug. 17, p. 2K) Samuelson claims to cite a "just published study in the Journal of the American Medical Association suggesting that....well, Ryan might be right".

Really?

He goes on to write:

"The study finds a voucher -type system might noticeably reduce costs compared to traditional 'fee for service' Medicare. Three Harvard economists did the study including one prominent supporter of President Barack Obama's health overhaul".

Samuelson goes on to claim that the study "compared the costs of traditional Medicare with Medicare Advantage, a voucher-like program that now enrolls about 25% of beneficiaries."

This is the first hint of dishonesty in using the term "voucher-like" to describe Medicare Advantage plans when they bear no resemblance to the absolute voucher plans proposed by Ryan. For reference, let's understand that for seniors who choose to enroll in a Medicare Advantage plan, Medicare pays the private health plan a set amount every month for each member. Members may have to pay a monthly premium in addition to the Medicare Part B premium, but many companies offering Medicare Advantage plans make them available for a $0 monthly premium in addition to the Medicare Part B premium, which the member pays directly to Medicare.

Under traditional Medicare the coinsurance is pegged at 20%, but the actual amount out of pocket can be higher since specialists generally charge more for services.  This is not the case for the private Medicare Advantage plans for which the payout limits are often under 20% for special services, because the premiums from standard Medicare beneficiaries are used to subsidize higher specialist and other costs.

This is exactly why, in previous reports, the GAO has reported that the cost -burden of Medicare Advantage plans has added up to $12 BILLION a year to the cost for traditional Medicare and why the latter's headed toward insolvency. Of course! Because the Advantage plans are like parasites bleeding it down! Does Samuelson mention any of this? Of course not!

The point is the Advantage plans are required to offer a benefit “package” that is at least as good as Medicare's and cover everything Medicare covers, but  usually they offer much more!  Plans that require higher out-of-pocket costs than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits, plus use some of the excess payments they receive from the government for each enrollee to offer supplemental benefits.

But this in NO way is similar to Ryan's voucher ("premium support") plan which would offer a single fixed voucher in a designated amount (e.g. $10,000) - from the government - to have to go out and actively snag a private plan (hoping it will accept the senior)  and the limits of the voucher to cover future costs of visits, care over the year. By contrast, once a senior chooses a private plan in the sphere of Medicare Advantage there are no 'ifs, ands, or buts' - he will be allocated a  private plan and can't be denied for pre-existing conditions or any other balderdash.  The private insurers also know it's a good deal for them since they're assured of regular monthly payments from the gov't which have the potential of increasing each year! No fixed, one time, voucher pays!

Another goodie for the Medicare Advantage senior: Advantage plans typically do not contain deductibles, thereby giving members "first-dollar" coverage. (Original Medicare has a potentially recurring (more than once per calendar year) deductible for Part A and an annual deductible for Part B.) Ryan's plan by contrast will likely see private health insurers attaching massive deductibles, on the order of $3,000 -$5,000 or more, for the simple reason that the insurers will be having to take chances (with no regularly promised gov't subsidies, only the single voucher payment) with a person in a putative high risk health pool! It doesn't take a genius to see that with such deductibles in play, and assuming the private insurer even accepts the senior, much of the voucher will be eaten up before the first real care is even delivered.

In many ways this is analogous to the sort of private insurance plans I was offered, at age 63 - before going onto Medicare. In nearly all cases, I'd  have had to cough up a mammoth deductible, $5,000, and then the premiums themselves were sky high - like $600- $700 a month. And that was BEFORE I'd learned I had prostate cancer(this year). Now, if I had to go cap in hand with a $10-15k Ryan-voucher to try to snag an insurance company to pay for my care, I'd likely be laughed out of their offices! They'd probably think I was some kind of comedian out to try his new shtick.

No wonder, given all the above, Samuelson can make the bald and devious claim that "Medicare Advantage has cost less for identical coverage. From 2006 to 2009 the gap averaged 11 percent between traditional Medicare and voucher plans similar to that under the proposal by Ryan, ..would serve as a price benchmark"

Of course, as I already showed above,  the "voucher" plan of Ryan is NOT the same as the Medicare Advantage private plan! Hence, Samuelson's use of the phrase "voucher plans" in the context is misleading, and egregious. As for that "11 percent gap between the traditional Medicare and Medicare Advantage" that price gap comes to almost exactly $12 billion, or the total amount the Advantage plans bleed away from the traditional Medicare to support their higher level of "penthouse" caliber choices, perks each year. The same 11% difference bleeding the original Medicare into insolvency!

If anyone, any senior, believes the Ryan plan vouchers will deliver to him or her a  Medicare deal even remotely comparable to the existing Medicare Advantage plans, he or she needs to be escorted to an Alzheimers' ward.

Please Tell Me That Seniors Can't Be THIS Dumb!

WHY are these seniors fawning over Paul Ryan when his budget - if passed in a Romney adminstration- will send most to the proverbial poorhouse? (Or at least dumpster diving).

Okay, let me clarify that: By seniors I mean those over 59 and to about age 70, who assorted stats disclose are leaning ever more heavily GOP. Are you effing kidding me? What's in their brains, or is it early dementia? On the other hand, the older - much older- Depression era seniors like my 90-year old mom get it. They came up under the Great Depression, saw the breadlines first hand and know what a difference FDR meant.....which was why so many of them broke down like babies and cried when he died.

These seniors lean heavily Democratic by almost 2:1 and with good reason! They've been under no illusions, thanks to their Depression-era experience, that individuals can do everything for themselves. They know, at critical junctures, government must step in to assist the most pummeled and vulnerable....not simply toss them to the wolves or yelp to "pick yourself up by your own shoe strings!" Yeah.....what if they have no shoes, far less 'strings'!

But when large subsets emerge that have never fallen on hard times, especially individuals, it is too easy to become smug and complacent. Their motto is "Hey, I got MINE (e.g. health care) adding.... 'Fuck you, and get your own! Don't ask me to spend my tax dollars on YOU!'

The hard thing is that more seniors in the above -named age group, including baby boomers, appear to be falling into this trap. Why, I have no idea! According to an analysis by the Pew Research Center for the People and the Press, it concluded that the "over 65 set is now more conservative on social issues, angrier about the direction of the country and uneasy about the growth of diversity in the U.S." - say compared to the younger demographic. (WSJ, April 9, p. A4)

What these conclusions also telegraph to me is that most of the respondents are likely white and entitled, and safely ensconced in their gated villages or communities and.....like the infamous George Zimmerman - plausibly cowering every time a kid of color walks by ....if they see any at all. I mean "uneasy about the growth of diversity"? You have to be kidding!

Further stats disclose that "seniors favored John McCain in 2008 by 53% to 47% over Obama".(ibid.)

What's mystifying in the latter case, is that by favoring McCain (72 at the time) these seniors also would have favored his running mate - a know-nothing airhead from Wasilla, AK who couldn't even name one newspaper she read regularly in an interview with Katie Couric, and who believed Vladimir Putin sometimes "intruded over Alaskan airspace"! And this was the person they wanted merely three heartbeats from the 'football' with the missile codes?

What is it these seniors don't get?

Moreover, why (as in the photo shown) are they cozying up to a guy like Paul Ryan, whose budget will effectively toss all of them - especially the younger ones - into a kind of senior "hunger games".

Do these smiling fools think that if they're given a "voucher" for $5,000 or $10,000 they will be able to buy their health insurance on their own? I have news for them: they're dreaming! I saw that when, as a healthy 62-year old, I attempted to buy my own and was told that the only insurance available was a high-deductible plan for $15,000 /yr. Oh, and you had to cough up the first $5,000.

In the case of Medicare vouchers, the so-called "premium support" can be totally exhausted merely by premium payments (currently $100/month for standard Medicare, but more than $180/mo. for private plans). Add in a needed operation, say for a hip replacement surgery (after a fall) and the senior has not only exhausted his or her voucher, but ends up in debt (on account of having to likely use a credit card or loan to cover the cost of the operation since Ryan's meager voucher won't. Meanwhile, standard Medicare covers 80% of an operation's cost).

If seniors want a Romney-Ryan ticket, are they also prepared to have their Social Security privatized? Will they be deliriously happy living off of peanuts if the privatized version of Social security experiences losses in either equities, or bond funds? (Often loaded with "toxic assets" as observed by the author of 'License to Steal'.)

Bear in mind that Romney, given he's planning to bring on tax cut specialist Glenn Hubbard (doyen of the Bush Tax cuts that increased our deficits by nearly 30% over 10 yrs.) will likely also go with Bush's Social Security Privatization plan, patterned after the Chilean pension privatization scheme of CATO Institute's Jose Pinera. That scheme was implemented because it was realized the Chilean gov't had inadequate monies to pay out safe, secure pensions so had no choice but to tie them to the phantom money of the Chilean stock market. Pinera also tried to foist the plan on New Zealand, but that nation - after running the numbers and seeing how it would impoverish their elderly -said an emphatic 'No!'.

At root, the plan allows only a minimal monthly payout if any investments lose beyond a threshold level, of about 3%. Below that, and the recipient (likely the millions of seniors that are agog at voting in Romney because they are "reassured by his reputation for pragmatic competence" (ibid.) will get only about $400 a month. This was decided as the "baseline" level allowed under the Bush-CATO Pinera scheme.

Now, how many seniors really believe they can live on a $400 pittance, while also receiving only about $10,000 /yr. (if lucky) to pay for all their medical costs? If they believe they can, or have enough extra money to cover costs, then they shouldn't be out and about at political events but strapped into a firm seat in an appropriate institution with thorazine as their main supplement .

Are they even grounded remotely in reality that they'd so carelessly toss their future and that of millions of others to the four winds? Evidently for too many older Americans, added age doesn't necessarily mean more wisdom!