Monday Editorial: Medicare and leftovers
Congress did the right thing last week by overriding a presidential veto of some modest Medicare reforms. But as welcome as it was, the quick and decisive response highlights a long-standing inequity in federal spending.
The measure will prevent a 10 percent cut in fees for doctors who treat elderly and disabled Medicare patients. It also slightly reduces overpayments averaging 13 percent to private insurance companies that sell what are called Medicare Advantage plans.
Both Republicans and Democrats wanted to avoid the fee cuts for doctors, but President George W. Bush balked at cutting insurance overpayments. He vetoed the bill on Tuesday. Within hours, Congress overrode his rejection. Thus, the political popularity of Medicare, a program that mainly benefits older Americans, was reaffirmed.
That’s a very different outcome from last summer, when Mr. Bush twice vetoed popular bipartisan bills that would have extended and expanded an important children’s health insurance program. Even though the children’s health insurance bills had attracted overwhelming support, Congress could not reverse the president’s vetoes because some conservatives who originally supported the bills switched their votes.
But this year’s vote concerned older Americans, and they have far more political clout than kids. This year’s bill actually received more votes after the president’s veto than it got originally. Among those to change their votes was Rep. Kenny Hulshof, R-Columbia, who’s in a primary fight to represent his party in the November election for governor.
Those changed votes might reflect the dwindling power of a lame-duck chief executive or politicians’ sensitivity to the upcoming congressional elections. It also could be a response to Mr. Bush’s cratering popularity.
But in recent years, the percentage of federal spending devoted to the elderly has grown far faster than the amount spent on children.
A recently released report from the Urban Institute found that federal spending on programs for kids increased by 0.7 percent between 2006 and 2007, while spending on programs for the elderly grew by 5.3 percent. That’s more than double the rate at which the nation’s economy grew overall.
Another report from a bipartisan children’s advocacy group called First Focus concluded that federal spending on programs for kids has grown only one-tenth as fast as the rest of the budget.
The political popularity of Social Security and Medicare often is ascribed to the voting habits of older Americans: They show up on election day. Children can’t, and their parents often don’t.
But there’s another factor that too often is overlooked: Medicare and Social Security are open to everyone, rich or poor. Since the 1980s, programs that benefit children have increasingly become needs-based — available only to the poor, America’s least-influential political constituency.
So it’s no surprise that, adjusted for inflation, the percentage of domestic spending devoted to children went from 20 percent of the federal budget in 1960 to 16 percent in 2007. It’s no surprise, but it is a shame.
It’s a mark of our compassion and decency that we care for the elderly, whether they are rich or poor. It’s a mark of our foolishness that too often we fail to invest in children. Whatever their backgrounds, those kids’ futures are our own.
Post-Dispatch file photo
Of course Pres. Bush bulked at cutting OVER-PAYMENTS to insurance companies, (big corporate America), how embarrassing and such a wrong set heart. Insurance companies certainly do not have a problem with messing over everyone members and doctors a like.
I sincerely believe that the only reason the rest of Bush’s Republican flock did not follow is because they fear losing their seats in the up coming elections, and not because their hearts and consciences wanted to do this.
Oh and how these diseased hearted ones choose the children in their corrupt minds who are worthy and other ones, they decide are worthless little beings. But, they are all pro-life, and that too is only for votes, what monsters these people are.
The editorial paints with a bruch that too broad. For it to be meaningful to anyone your statements of the percentages of increas that benefits children and percenage that benefits the elderly shoul have stated WHAT benefits you were talking about.
As one idea that would benefit the children, “our future”, how about Every newspaper in the country be taxed by 10 percent of their gross, and they not be allowed to pass the tax on to the consumer? I don’t think anyone I know would object to that if “it is for the kids”.
Further, your editorial board should call the company that processes and approved madicare payments they are located in Marion, Illinois. You could get accurate information and not speculate wrongly about works, and WHY.
Further, what overpayments to insurance companies is your editorial talking about that Bush vetoed? Fraud was prosecuted, and errors in billing or processing were collected from from the responsible party upon discovery.
Incidentally, the big cause of delay in payments to the providers os medicare is erroneous billings that are sent back to the billing agency for correction.
Each billing is coded. Send in a billing to Podiatry for sewing up a gash in some medicare patients head and the billing will be sent back for correction.
As baby boomers enter retirement and improved health care and wellness increases lifespan, the proportion spent on the elderly will continue to increase. Unfortunately, since our government does not have a bottomless pit of dollars with which to pay for their promises, the money has to come from somewhere.
And a side note to D. Walker - your moralistic, demonizing attacks on those with whom you disagree may sound good at church, but they have no place in a political debate. References to “monsters” and “diseased hearted” politicians serve only to demonstrate your lack of substance, and shed no light on the character of those politicians who make the hard budget choices that you choose to ignore.
The editorial board may be correct in their assumption that most of your readers are too ignorant to realize the difference in compulsory prepaid Social Security and Medicare benefits from federal child welfare programs. Of course, many others will recognize your arrogance along with your complete lack of journalistic integrity in the above editorial. If you would like to see child welfare funded like the others, propose yet another federal payroll deduction burden on the working people to cover it. Meanwhile, understand that many see through your transparent, dishonest, attempts to misinform and mislead your readers. Your platform has a couple of decayed planks, folks.
The Centers for Medicare and Medicaid Services (CMS), previously was called the Health Care Financing Administration (HCFA), is the federal arm that contract out to insurance companies such as United Healthcare to manage the medicare and medicaid programs. The federal government
pay these insurance companies extremely well to manage these programs, including the incentives paid to marketing reps etc..
These insurance companies are billing for work that they have not accomplished, and are being extremely poorly managed. These programs are not accomplishing much because of the insurance companies failures, that amounts to nothing more than government WASTE!
I can only imagine the over-payments due to the incompetence of insurance companies such as United Healthcare managing these programs. The management in St. Louis is one of the most INCOMPETENT ever because they could care less about placing competent people into these positions, mainly friends and family. Sooner or later it all had to come tumbling down. It is no longer part of the St. Louis operations.
They need to repay the government every red cent of money back that was wasted.
Nick Kasoff,
You ignore the fact that this country have a obligation to take care of the children needing care, in fact I would extend that to all human life.
You also ignore the fact that most Republicans and some Democrats have proven to care more about the interests of insurance companies, than citizens, and most definitely children. Call that what ever you like and I call it as I see it.
johnh,
I included links to various reports so you could get answers to just the sort of questions you raise. The programs for children all all spelled out in the reports by First Focus and The Urban League. The Urban League has been doing this kind of analysis for well over a decade, and has analyzed historic data going back to 1960. The amount of space it would take to list each of those 130 programs is greater than I have for the entire print editorial. The main programs for the elderly to which they are compared are Medicare (except payments for the disabled), Social Security (except survivor’s benefits for kids) and Medicaid coverage for the elderly (nursing homes, etc.)
Medicare over payments are also something I’ve written about often in the past. The Government Accountability Office (the GAO) and the Medicare Payment Advisory Commission (created by law to advise Congress about the sustainability and efficiency of Medicare) have both targeted them. I included a link to the most recent MEDPAC report that explains how they are paid and the size of the overpayments. The overpayments cited there — the 113 percent figure I used in the editorial — are actually low because of some complicated accounting stuff that has to do with estimated plan costs versus actual plan costs. The plans typically spend less than they estimated when setting rates, which increases their profits.
The short story on over payments is that Republicans wrote language into the bill that created a Medicare drug benefit to encourage private insurance companies to offer plans that “compete” with traditional Medicare. To get them to do it, it authorized a payment structure that is more costly than traditional Medicare, in hopes that insurance companies would provide additional services. The upshot is that Medicare Advantage Plans (offered by private insurance companies) are paid an average of 113 percent more per person enrolled than it costs for traditional Medicare to cover the same patients. For certain plan designs, the payments average 119 percent (you’ll see that detailed in the report I linked to).
These are not the insurance companies that administer Medicare — that do billing and collect payments. These are companies that offer an insurance plan to seniors, for which they are paid by Medicare.
Medicare has had private HMOs has an option for about two decades. These are the latest version of that arrangement. The GAO reported to Congress about 10 years ago that Medicare HMOs run by private insurance companies were being paid more per patient than it cost to provide coverage under traditional Medicare. What’s more, the GAO said those private plans were “cherry-picking” — they were enrolling the healthiest seniors and declining coverage of patients with expensive conditions.
D. Walker,
Each individual in the country may have an obligation in a religious sense. I do not and the constitution forbids government from the imposition of your or my religious beliefs on the remainder of the country. The collective country has no such duty.
Also, as I have said before, I am happy that you say things the way you do; it means no one will be persuaded to your positions.
John Deal, you sound like those who have told me that it is unconstitutional for the government to coolect taxes from its citizens. My suggestion to you is to pray this prayer:
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
John, you should have more of a problem with the mismanagement of government by unqualified and incompetent people, many who are corrupted, you vote into office who are making these kinds of decisions. That is the reason for most of the waste that John C. Carton is speaking about just above. He is absolutely correct.
Now you want to place as leader of our country someone with an even lower IQ and less motivation than Pres. Bush, and that is John McCain who ranked 894 out of 899 in his college graduation class.
John Carlton,
You must paste only one link per comment or else your comment will be held for review by the editorial section of the post. Usually they never appear. Would you please paste your links to reports separately, one at a time.
D. Walker,
I believe you are mistaken about the ability to change government. You have spoken about the mismanagement of government. I agree. None of the past administrations in the last 144 years has done a good job managing the government.
I believe you said in a previous post government can be nothing but corrupt, why then do you continue to suggest giving a corrupt government more control over our lives. Shouldn’t your argument then be — keep government as small as possible. Surely you do not believe Democrats will be any less corrupt than Republicans.
Also, who said I support John McCain? If he had a legitimate chance to win I would support Bob Barr, Libertarian candidate. I don’t agree with everything he has to say but he is certainly closer than anyone else on most issues.
I suppose I will probably end up voting for McCain, because I don’t care whether you edited the Harvard Law Review if you would support the destruction of 50 million babies since the 1970s by nominating folks for the Supreme Court who would do the same.
It will never be changed to cease collecting taxes or using this tax money towards social causes. I question one’s sanity who thinks otherwise.