Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


December 3, 2012: Where Is The Outrage?

By Rob Tenery, MD on December 3, 2012

Sometimes injustices stare us right in the face and we don’t recognize them. The shift of $716 billion out of Medicare barely raises a ripple in the pond of discontent.

The election is over and the voters have spoken. By reelecting President Obama to a second term, any chance of repealing the Affordable Care Act (ACA, Obamacare) is essentially nonexistent. However, even the President and his most ardent supporters have agreed to look at changes that would improve the law as it rolls out over the next five years.

All of the concerns over the ACA seem to have been focused on the constitutionality of the individual mandate, the Accountable Care Organizations, the Independent Payment Advisory Board and the outcome of the Presidential election.

What about the obvious? What about any concerns that a substantial portion of monies will be moved out of Medicare to fund the newly uninsured? What will that due to access for our seniors? What will the loss of funding do to curtailing health care services for a group of individuals who have built and defended this country to make it what it is today?

Why did the authors of this legislation single out the elderly to help pay for these changes? The answer appears to be because the seniors are the least likely to speak up and defend themselves.

Look at the positions taken by the entities that purport to represent the elderly: AARP, the American Medical Association (AMA), the American College of Physicians (ACP) and all the legislators that pleaded for the seniors’ support in previous elections. Where are they when our elderly needs them?

The American Association of Retired Persons (AARP) abandoned seniors when their Board of Directors threw their support and millions of dollars of their constituents’ monies toward gaining passage of the ACA. It seems ironic that AARP’s leadership campaigned for legislation that would make it more difficult for their members to access affordable health care services. For what reason--- corporate greed for profits from their Medi-gap insurance coverage?

The largest doctors’ organization, the AMA, seems to be more concerned with a fix in the Sustainable Growth Rate and changing Medicare into a defined contribution plan (both laudable and necessary), than rescuing Medicare recipients from this significant burden. What about any concerns from the ACP, since a large proportion of their members’ patient base are senior citizens?

In the August census report, 47 million people were listed as uninsured. Of that group, over one-fourth were undocumented aliens. 37 million of our citizens were listed as 65 or older.

Why not spread the additional costs of this new legislation over all of the population, not just the seniors? Probably because the administration feared the public would balk at an even larger tax hike in entitlement funding. In some ways, this could be considered a regressive tax on the elderly!

John Goodman, the President of the National Center for Policy Analysis in his November 12, 2012 blog, Did the Election Save ObamaCare?, put it succinctly when he wrote:

This reduction will primarily consist of lower payments to physicians, hospitals and other providers — reductions that are so severe that they will seriously impair access to care for senior citizens.

Harvard health economist, Joe Neuhouse, envisions that seniors may have to seek care in the same places that now cater to Medicaid beneficiaries: at community health centers and in the emergency rooms of safety net hospitals.

During the election campaign, President Obama claimed that the money would come out of the pockets of doctors, hospitals and insurance companies, with no bad effects on seniors.”

It is naïve, and the reasoning not well-founded, to believe that $716 billion dollars can be diverted out of Medicare by increasing efficiencies and cutting down on unnecessary care, without adverse consequences to those who are covered under this program.

Recently, a patient told me that he and his son were visiting about the growing medical costs for the elderly. His son’s comment stopped me cold: “Maybe, we can’t afford you anymore.”

The Medicare program is already being pummeled by the reimbursement cuts legislated by the dictums of the Balanced Budget Act of 1997. Now coupled with the egregious ‘robbery’ of another $716 billion dollars over next ten years and the so-called ‘fiscal cliff’ that currently holds this country in a death grip, our seniors are ‘on the ropes.’

This issue is much more important than whether the law was initially a Democratic or a Republican initiative. It is ‘our’ issue! And if the leadership in Washington DC, does not come together, ‘our’ seniors will pay the price.

If there is a chance to protect Medicare, it’s time for the seniors and their doctors to speak up, since the doctors’ organizations, AARP and the legislators apparently aren’t doing it for them. Maybe, with a groundswell of support, we can reverse the injustices that are about to be heaped on our senior citizens.

The original title of this new legislation was The Patient Protection and Affordable Care Act (PPACA). Lately, the first two words have been dropped from the title to read the Affordable Care Act. From the seniors’ perspective, it’s easy to see why!

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Reference:

http://healthblog.ncpa.org/did-the-election-save-obamacare/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-27826




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