RUTHFULLY YOURS

Piously posturing as the savior of Medicare, President Obama lashed out at the House Republicans for embracing the budget proposed by Budget Committee Chairman Paul Ryan (R-Wis.). But a comparison of the president’s own plans for Medicare with those in the Ryan budget shows that the Democratic cuts are far more immediate and drastic than anything in the GOP proposal.

While the Republican Medicare changes only take effect in 2021, Obama’s cuts will begin hurting seniors right away. The president’s healthcare legislation imposed a hard spending cap on Medicare 
– the first time it has ever had one — which he has just proposed lowering by another one-half of 1 percent of GDP (a further cut of about $70 billion a year).

Obama’s cuts, which will take effect immediately, are to be administered by his newly created Independent Payment Advisory Board (IPAB) of 15 members appointed by the president. Its recommendations for cuts in Medicare services or for reductions in reimbursement will not be subject to congressional approval but will take effect by administrative fiat. Right now.

The IPAB will be, essentially, the rationing board that will decide who gets what care. Its decisions will be guided by a particularly vicious concept of Quality Adjusted Life Years (QUALYS). If you have enough QUALYS ahead of you, you’ll be approved for a hip replacement or a heart transplant. If not, you’re out of luck. Perforce, many of these cuts will fall on those at the end of their lives, reducing their options to accommodate Obama’s mandate to cut costs. If death comes sooner, well, that’s the price of aging in Obama’s America.

Ryan’s approach is totally different. First, he does nothing at all to cut benefits for those now on Medicare or for anyone who turns 65 before 2022 (leaving me in the clear!). Second, the Republicans would leave the elderly in charge of their own medical decisions by letting them spend their Medicare money as they wish. The subsidy they would receive for health insurance would permit them to buy plans tailored to their needs. Just as a myriad of insurance-company plans sprang up to fill the mandates of the new prescription drug benefit, there will likely be quite an array of choices for the elderly of 2021. Finally, the savings from Ryan’s plan will be plowed back into Medicare, prolonging its life, rather than being diverted, as Obama would do, into paying for a new entitlement for younger people.

But the most important difference is that Obama’s cuts are now and Ryan’s are not. Any budget projection is a guess. When the projection is made two to three years in advance, it is conjecture. Ten years away it becomes fantasy. Who can possibly tell how the American economy will be doing a decade hence? What revenues will it generate? And the only thing less certain than guessing about the economy is projecting healthcare costs.

Medicine is on the verge of a revolution akin to that which followed the creation of antibiotics. Genetic medicine and ultimately nanotechnology are about to change everything. No longer will we fight cancer by cutting or burning or poisoning diseased cells. Instead, we will use DNA and RNA to predict cancers and grow healthy cells. Who knows what the costs will be? Possibly, they could be lower than our current range of therapies.

And, between now and 2021, Congress will be able to change the Ryan plan as it chooses. But the early deaths triggered by the rationing decisions of Obama’s IPAB cannot be saved. Their decisions are, for the elderly of today, irreversible.