Everything’s Fine, Just Fine by Pat Conrad MD

Sooo, in and around all the good will and happy thoughts surrounding the coming out for the Affordable Care Act, how is the first U.S. program for coast-to-coast health care going?  If you ask CMS officials, they’ll tell you Medicare is going great, seniors love it, and doctors are not bailing on the program just as soon as one of their adult children will let them live in the guest house.  Fine.

The original program, launched in 1965, was already running out of cash in …1972.  After some actuarial alchemy, a couple decades of DRG’s, and a near-monolithic voting bloc of golf cart charioteers, good ol’ Medicare is still going…how, exactly?

Medical Economics magazine was kind enough to give me some ink this summer addressing the program’s effects on primary care, and of course I got the philosophical bit in my teeth and took off.  But hey, I’m no accountant.  So where are we on the Big Ledger?

Last year, Forbes reported that the Medicare Trustees calculated that the program would be bankrupt by 2024…or possibly 2016, unless you factor in the Administration’s tax increases and spending cuts.  Of course I trust the White House implicitly, but some of you skeptics will want more.  Say, how about the idea of raising the Medicare eligibility age from 65 to 67?  Apart from the enormous threshold that would have to be crossed with the AARP crowd, wouldn’t that result in big, big bucks saved?

Again, I’m no accountant.  But the Congressional Budget Office has weighed in, and projects this move to save a piddly $19 billion over the coming decade.  Savings would be expected to rise in subsequent years, thusly:  “The CBO report says many people who otherwise would be on Medicare would be eligible for subsidies under the new health care law and that many others would receive primary coverage through their employer or their spouse’s employer. And those entering the program at 65 or 66 are, on balance, healthier than other enrollees.”

So the folks we’re going to be purportedly saving money on will be getting taxpayer subsidies from elsewhere?  Can we really count on “many” getting coverage from an employer (or spouse’s) in a flat job market, as more and more companies are considering dumping coverage for the miracle exchange?  Folks in the mid-sixties are “on balance healthier than” …who, exactly?

Again, Medicare is fine, just fine.  Move along now, nothing to see here.