Be careful what you wish for Speaker Ryan. A Medicare history lesson. | THE POLITICUS

Be careful what you wish for Speaker Ryan. A Medicare history lesson.

     Those of you who know me know that I love reminding all and sundry that I’m an old fart. You can be nasty and sarky and people have to be nice to you because everybody is taught to respect their elders, and you’re gonna die soon. BUWAHAHAHAHAHAHA!

     But there’s another benefit to being an old fart, you remember a lotta shit. I may not be able to remember what I had for lunch yesterday (I don’t eat lunch), but I can remember the name of the first girl I held hands with on a date. And Paul Ryan’s latest Machiavellian scheme regarding Medicare set my mind wandering back in time, and he’s playing with fire.

     You know, for the last 30 years at least, Medicare and Social Security have had an ominous nickname on Capitol Hill, they’re called the “third rail of politics”. Basically, you touch them and you die. Anybody who has a family member or relative on Medicare knows that they don’t want it gutted, they want the goddamn thing improved! It doesn’t pay enough. The success of Medicare is the entire foundation for the push for universal health coverage.

     Back in 1988, Congress thought they had found a way to improve the system. Not to demolish it, or cut it, but to improve it. This was a bipartisan effort, led by the powerful House Ways and Means Committee chair, Dan Rostenkowski (D-IL). After several months of negotiations, wrangling and reconciliation, it sailed through both chambers of Congress. At the time it passed, it even had pretty widespread public support.

     I’m going to ask you to indulge me here, I’m going to do things in reverse. Normally a salesman tells you what you’re getting first, then tells you how little it will cost. I’m going to do it in the opposite direction. While I remembered the basic outlines, this was 28 years ago, and I wanted to get it right, so I got some help from an ARTICLE on Heritage.org. Here was the cost to Medicare beneficiaries for their new and expanded coverage;

The new benefits were to be financed through a three-tiered payment system. First, all Medicare beneficiaries were to pay an additional monthly premium of $4 for the catastrophic coverage. Second, Medicare beneficiaries were to pay a new income-related supplemental premium. This was in fact a sliding-scale tax, up to $800 per person or $1,600 per couple annually. And third, senior citizens were to pay a flat monthly drug premium of $1.94, beginning in 1991 and a drug deductible of $550 and co-payment of 50 percent.

     Sounds like a lot, but was it really? Everybody on Medicare ponies up a $4 a month premium for the catastrophic coverage. The “sliding scale” was based on income, so in reality your monthly sliding premium could be anywhere from $5-$68 or so a month depending on how much you were raking in. In reality very little of the country would be paying anywhere near $800 a person annually. The prescription benefit is too complicated to go into, but let’s just say that it had more holes in it than a wheel of Swiss cheese.

     So much for the cons. But what were the pros? What kind of a bang were you getting for your buck with this catastrophic coverage? Theoretically, you were getting the Leprechauns pot of gold;

The initially popular new Medicare bill provided unlimited annual hospital coverage for catastrophic illness, 150 days of skilled nursing care, unlimited hospice care, and 38 days of home health care. It capped Medicare beneficiary out-of-pocket expenses for Medicare Part B (physicians' services) at $1,370 in 1990.

Beyond the generous new hospitalization and home health care services, the bill added a variety of new benefits to beneficiaries of the Medicare system, including mammography screening, respite care, and outpatient prescription drugs. Moreover, states were mandated to pay the Medicare premiums, plus deductibles and coinsurance, for millions of low-income elderly and disabled individuals. (Bold mine)

     So, there’s the first bugaboo taken care of right off of the bat. The lowest income elderly recipients would have their premiums, deductibles and co-payments covered by the states. No more annual caps on hospital stays for catastrophic illnesses, and a cap on out of pocket Part B expenses. What’s not to like? If you’re unfortunate enough to get an illness that’s pumped up to go the distance, you don’t end up living out of a cardboard box trying to foot the hospital and prescription bills. Finally, government works for the people for a change. Paradise found!

     Except, no. Not really. For a couple of reasons. First of all, the basic math in the bill was flawed, the calculations were shit. Almost immediately the program began experiencing large cost overruns, and a realization that the actual “cost” numbers were off, far to the low side of reality. Also, it turned out that more bureaucracy was going to be needed to manage the new program.

     But there was an even bigger problem. I know from personal experience as one myself, nobody tells a crusty old fart what they’re gong to do, not even Uncle Sam! You want me to chip into a program that is going to benefit me?!? Up yours! I already paid into the system, the kids owe me! Besides, this was 1988. A lot of retirees already had similar coverage being provided from the medical benefits portion of their company retirement plans, why pay a second time for the same coverage, but the law covered everybody. If you’re on Medicare, you chip in, redundancy be damned. The results were quick and easy to predict;

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     That sliver of metal and a window in the lower right corner of the picture is Representative Dan Rostenkowski’s car, and those frost tops are letting Congressman Rostenkowski know exactly what they think of him, in terms not heard outside of a bar on shore leave in Singapore. Police had to be called in to clear a path for him to get to Capitol Hill. All in all, it took less than a year for the law to be repealed and peace and tranquility to be restored to the Medicare world.

     So, I’ve got a question for you Speaker Ryan. Do you honestly want to lose your Speakership? Do you want to ensure ushering in a midterm wave election that not only puts the Democrats back in control of both the House and Senate, and sets up a Tsunami election  in 2020 that hands the whole enchilada back to the Democrats, possible for a generation? Then you go right ahead and fuck with Social Security and Medicare, but just remember two words my friend. Seniors VOTE! We are the most reliable voting bloc in the country, and we’re well organized for our own self interest. “Those who do not learn from history are doomed to repeat it”. Here endeth the lesson.

     Thanks as always for reading, you are ALL the wind beneath my wings!

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