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SATURDAY EDITION
❘ FEBRUARY 4, 2017
Siuslaw News
P.O. Box 10
Florence, OR 97439
NED HICKSON , EDITOR
❘ 541-902-3520 ❘
EDITOR @ THESIUSLAWNEWS . COM
Opinion
A Brexit-style exit from Medicare Legacy is reason for concern
T
he new administration’s
promise to move toward
“Medicare Reform” and
repealing the Affordable Care
Act (ACA) will be costly in
ways that stretch well beyond
dollars.
The ACA, passed in 2010,
significantly strengthens
Traditional Medicare. Revenue
sources were added to the
Trust Fund.
The ACA removed
Congressional blocks to lessen
expensive subsidies paid to
private health plans. Payments
were reduced and benefits
improved. This includes clos-
ing Enrollee Part D drug
“doughnut hole” costs by
2020.
Repeal of the ACA under-
cuts Medicare solvency, raises
Enrollee costs and shrinks ben-
efits.
An institution since 1964,
Medicare cares for 57 million
seniors and people with dis-
abilities. Enrollees, future sen-
iors, along with their adult
children, must cope with grave
uncertainties if this radical
transformation goes ahead.
Over six major GOP propos-
als seek direct ACA repeal,
either disposing of Medicare
improvements in whole or
part, or radically transforming
Medicare away from a
“defined benefit” institution to
a “defined contribution” mem-
bership plan.
This re-centers Medicare
around private insurance com-
panies with limited provider
networks similar to
HMO/PPO’s, such as an
expanding “Medicare
Advantage” program.
President Trump’s Secretary
of Health and Human Service
nominee, Rep. Tom Price,
introduced the “Empowering
Patients First Act” in May,
2015, repealing all ACA provi-
sions.
The Republican Study
Committee, in January, intro-
duced “The American Health
Care Reform Act,” fully
repealing the ACA.
Then, In 2016, Speaker of
the House Paul Ryan intro-
duced his policy memorandum
“A Better Way...” setting out
Medicare transformation via
premium “support” payments
and promoting Enrollees to
search out competing policies.
This was documented by the
GUEST VIEWPOINT
B Y R AND D AWSON
F LORENCE RESIDENT ,
RETIRED LITIGATION LAWYER FOR INSURANCE COMPANIES
non-partisan “Kaiser Family
Foundation” (Jan. 18, 2017) in
a table outlining GOP repeal
proposals.
One can be excused for not
appreciating “back-door”
details repealing Medicare via
the ACA.
“Repealers” are silent as to
specific impacts. Instead, their
gilded language touts buzz
words like “choice,” “flexibili-
ty,” “modernization,” “vouch-
ers,” “premium support,” all
the while forecasting “insol-
vency” if traditional Medicare
continues.
All the while, Medicare’s
long history offering defined
benefit levels and improved
national healthcare quality at
reduced costs is being ignored.
AARP (formerly American
Association of Retired
Persons) took due notice in its
December 2016 “Letter to
Congress,” in which it spoke
against ACA repeal, saying:
“The Medicare Part A Trust
fund is solvent until 2028, due
in large part to changes made
in ACA. We urge you to main-
tain provisions ... that ...
strengthened Medicare’s fiscal
outlook without shifting costs
to beneficiaries or cutting ben-
efits...”
Medicare is our most ambi-
tious platform seeking effec-
tive health cost and quality
controls. Internationally
respected healthcare econo-
mist, Uwe Reinhardt, said,
“Per capita health costs for
people with Medicare have
grown (annually at) 1.5 per-
centage points less than private
insurance from 1969 through
2012. This is something the
“conservative” American
Enterprise Institute calls
“Soviet-style pricing.”
Payment rules are tied to
care quality.
In 2017, six Oregon hospi-
tals face cuts after high rates
of patient injuries from infec-
tions, bed sores, falls and
nationwide, 769 hospitals were
penalized.
Private insurers lack this
leverage.
At individual level, it plays
a vital role. In 2015, 98.9 per-
cent of adults age 65 or older
had health coverage, account-
ing for nearly one-fourth of
U.S. personal health expendi-
tures.
Enrollees are not “free rid-
ers.”
From average annual
incomes under $25,000, they
spend one of every six dollars
on health care.
A stable Medicare national
membership “risk pool” forms
the essence of sustainable risk-
sharing, lowering average
costs.
Insurance history teaches
primacy of the “80-20 Rule.”
in which 20 percent of sicker
members account for 80 per-
cent of costs. Keep in mind
that 5 percent of U.S. popula-
tion consumes 50 percent of
health care spending.
Narrowing the Medicare
Enrollee “risk pool” promotes
insolvency.
Ryan’s Medicare age
increase instantly shrinks the
“risk pool” leaving more cost-
ly, sicker members, and rising
premium.
Another Ryan element is
private plans such as Medicare
Advantage, subsidized by the
public trust, attracting younger,
healthier Enrollees out of
Medicare.
In Oregon, 44 percent of
Medicare-age Americans are in
private plans, the second high-
est nationally.
This promotes an “adverse
selection” trend: as pool size
shrinks, doctors decline new
Medicare patients; Ryan’s lim-
ited “premium support” is
unlinked to health cost infla-
tion.
As such, a death spiral
ensues from a shrinking, more
sickly membership, facing
higher cost-sharing.
Political support for tradi-
tional fee-for-service Medicare
then withers.
The Public should be
alarmed and community lead-
ership should take notice.
— Rand Dawson is a
Siltcoos resident with long
interest in health care reform.
LETTERS
T HINGS
EACH OF US CAN DO
As part-time residents of Florence for the
past 25 years, nothing has made us prouder of
our fair city than to see how many of our fellow
citizens took to the streets to peacefully express
their beliefs in the values on which this country
was founded.
USPS# 497-660
And we were particularly heartened by Bob
Orr’s guest editorial (Jan. 25) which helped
remind us all that there is more at stake here
than differing political opinions, and that there
are things each of us can do every day which
improve everyone's quality of life.
Carole and Mike Babcock
Florence 97439
HEADLIGHTS
Now that I almost got broadsided by a fast-
moving powder blue pickup in the gray rain, I
have to ask: Why don’t more people use their
headlights in this town?
Apart from the safety factor related to limit-
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John Bartlett
Jenna Bartlett
Ned Hickson
Susan Gutierrez
Cathy Dietz
Ron Annis
Jeremy Gentry
U SE
ed visibility based on the weather and natural
light — particularly on cloudy and gray days
— isn’t it a law that people will use their head-
lights when it’s dusk, dark, early morning, rain-
ing... or just because?
Thank you for considering my question.
Ivy Medow
Florence
Pres. Donald Trump
The White House
1600 Pennsylvania Ave. NW
Washington, D.C. 20500
Comments: 202-456-1111
Switchboard: 202-456-1414
FAX: 202-456-2461
TTY/TDD Comments: 202-456-6213
www.whitehouse.gov
202-224-5244
541-431-0229
www.wyden.senate.gov
U.S. Sen. Jeff Merkley
313 Hart Senate Office Bldg
Washington, DC 20510
202-224-3753/FAX: 202-228-3997
541-465-6750
www.merkley.senate.gov
Gov. Kate Brown
160 State Capitol
900 Court St.
Salem, OR 97301-4047
Governor’s Citizens’ Rep.
Message Line 503-378-4582
www.oregon.gov/gov
U.S. Rep. Peter DeFazio (4th Dist.)
2134 Rayburn HOB
Washington, DC 20515
202-225-6416
541-269-2609/ 541-465-6732
www.defazio.house.gov
U.S. Sen. Ron Wyden
221 Dirksen Senate Office Bldg
Washington, DC 20510
State Sen. Arnie Roblan (Dist. 5)
900 Court St. NE - S-417
Salem, OR 97301
503-986-1705
FAX: 503-986-1080
Email:
Sen.ArnieRoblan@state.or.us
State Rep. Caddy McKeown
(Dist. 9)
900 Court St. NE
Salem, OR 97301
503-986-1409
Email:
rep.caddymckeown@state.or.us
West Lane County Commissioner
Jay Bozievich
125 E. Eighth St.
Eugene, OR 97401
541-682-4203
FAX: 541-682-4616
Email:
Jay.Bozievich@co.lane.or.us