In the News
In the Know
How much does it cost?” President Lyndon B. “
This Is Not a Mathematics Exercise
Johnson asked Wilbur Cohen, his health care expert, who
was on the phone. Cohen had just negotiated final details
of the bill establishing Medicare in March 1965. “It would
This is an
change the way we
health care, its
costs and delivery.
be around $450 million more,” Cohen replied, referring to
a last-minute accommodation that added coverage for
doctor visits. In 45 years, that annual $450 million portion
of Medicare has grown to nearly $200 billion. ; Six years
ago, when Congress was expanding Medicare to include
prescription drugs, the Bush administration estimated
that the drug benefit would cost slightly more than $100
billion a year. Today, the actual cost is 40 percent less.
; Clearly, projecting the cost of health care is no easy task.
COVER: CAST, DARR YL ESTRINE; HAND WRITING, SEAN SHANAHAN; UNCLE SAM, COUR TES Y THE LIBRAR Y OF CONGRESS. THIS PAGE: ISTOCKPHOTO
That adds an unsettling but essential ingredient to the
effort to overhaul the
nation’s health care system. Lawmakers are hotly
debating how to extend
health care to 46.7 million
uninsured Americans, expand Medicare to people
under 65, help business
meet the soaring cost of employee
health insurance, improve quality, and trim the excesses from
the $2.5 trillion the nation spends
each year on health care. But little
attention has been given to how
we’ll actually pay the bill.
Here’s what we know for sure:
To his credit, President Obama has laid out financing options. But
they are just the start of a discussion that has yet to take shape.
His plan includes: limiting deductions for charitable contributions, mortgages and medical expenses for those earning more
than $250,000 (to raise $318 billion over 10 years); trimming $175
billion from Medicare Advantage plans, the private fee-for-service
Medicare plans now serving 10 million people; saving $38 billion by
paying doctors according to the outcome of treatment rather than
per visit, and limiting hospital readmissions; requiring individuals to
enroll in a plan; and requiring business to provide health insurance
for employees. Other ideas range from taxing high-income workers
for their employer-provided health care to a tax on junk food.
Both the president and Congress acknowledge that
health care cannot be financed by adding to the already staggering national debt.
But the essential point is this:
This is not a mathematics exercise.
This is an opportunity to change the way we think
about health care, to change the course of health care
costs and to change the pattern of health care access
and delivery. We’re not talking about socialized medicine here, but rather a uniquely American system built
on the existing network of employer-provided care,
private insurance and a strengthened Medicare. AARP
has a specific interest in making Medicare available
to those between 50 and 65, in narrowing the prescription drug program’s doughnut hole, in financing
home- and community-based caregiving, and in encouraging preventative medicine. The ultimate goal is
to raise the quality and lower the cost of the nation’s
medical care. —Jim Toedtman
JUNE 2009 AARP BULLETIN 3