Saving Medicare the Republican way

It's a promise: "A Romney-Ryan administration will protect and strengthen Medicare, for my mom’s generation, for my generation, and for my kids and yours." That's what Paul Ryan told the Republican National Convention last night in his acceptance speech.

How do the Republicans plan to do this? The Republican Platform spells it out: "The first step is to move [Medicare and Medicaid] away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model."

Right--that has worked so well for pension plans.

Once upon a time we were told that the 401(k) defined-contribution plans would let us retire rich. We could choose our own investments! No intermediaries would take hefty cuts! The miracle of compounding interest would do the rest!

But then interest rates tumbled, and financial institutions took hefty cuts anyway, and our houses lost a third of their value, and most of us forgot that we really needed to be socking away the maximum allowable percentage of our salaries if we planned to continue eating in retirement.

You might want to check out David Callahan's article, "A Perfect Failure: Why the 401(k) Has Been a Flop." Or you might just want to consider your own 401(k). Will you have saved a million dollars by the time you retire? That's how much you'll need if you want to draw out a modest $40,000 a year, and if you want your savings to last as long as you do.

Now ask yourself: do you really want an individualized, free-market Medicare along with your individualized, free-market 401(k)?

Soon-to-retire Boomers will remember a sentence reportedly uttered by an American officer in Vietnam: "We had to destroy the village in order to save it." That's pretty much how Mr. Ryan plans to save Medicare.

I do hope Messrs Obama and Biden come up with a better idea.

Four countries that already meet the Republican Platform's health-care goals

Health care in the Netherlands, 17th century
(Jan Steen: "The Doctor's Visit)

Friday evening we were having supper with friends who make frequent trips to Israel. One of them commented that Israeli doctors don't have a lot of administrative expenses. To arrange for payment, to transfer records, or to prescribe or check medications, all they have to do is swipe a patient's health-care card. "We could learn a lot from them," she said.

Saturday evening we were having supper with friends whose families live in Canada. One of them commented that Canada's health-care system gets a bad rap in the U.S., and that nearly all the complaints are nothing more than political propaganda. "Most Canadians are satisfied with their health care most of the time," he said. "The only complaint you hear is that sometimes the waits are too long."

I just read the Republican Platform section on health care (it starts here) in which they promise to repeal the loathly Affordable Care Act and replace it with something magnificent (as yet undefined). "Our goal," they say, "is to encourage the development of a healthcare system that provides higher quality care at a lower cost to all Americans while protecting the patient-physician relationship based on mutual trust, informed consent, and privileged patient confidentiality." Now there's a goal I can agree with 100%.

Interestingly, it well describes health care in Israel and Canada, which are single-payer, tax-financed systems--what Americans correctly call "socialized medicine." It also is a perfect description of health care in, for example, Germany and the Netherlands, which are multi-payer systems that combine some government funds with funding from competing private insurers--what many Americans also call "socialized medicine" because they don't know any better.

Let's look at how these countries measure up to the Republicans' wish list. (All information unless otherwise attributed is from the World Health Organization's data tables.)

Higher quality care. Mothers and infants in Canada, Germany, Israel, and the Netherlands are less likely than American mothers and infants to die in childbirth. People in those four countries live two or three years longer than people in the United States. Interestingly, this may not be due to better health habits: Only Canada has fewer smokers than the U.S.

In addition, Germans, Israelis, and the Dutch have many more doctors per 10,000 population than we do (Canadians have fewer, which may explain their long waits). All four of the other countries have a higher ratio of hospital beds than we do.

Lower cost. Somehow these four countries have figured out how to deliver good quality health care without paying astronomical costs--their total health-care costs per capita range from 24 to 58% of ours. Oddly, our government actually paid more per capita than the governments of Canada, Israel, and Germany; the Dutch government paid about the same as we did.

Subtract the government contribution from the total bill, and you get what you and I are paying out of pocket. Americans, of course, are paying vastly more than citizens of the other four countries: $3074 per capita in 2006, the last year for which WHO has comparative data. (Canadians paid $1158, Germans paid $860, the Dutch paid $687, and Israelis paid $562.)

All Americans. Canada, Germany, Israel, and the Netherlands, like all other developed nations with the exception of the United States, have universal health care. That means that every citizen is covered. In the United States, by contrast, "nearly half (44%) of U.S. adults—81 million people—were either underinsured or uninsured in 2010." So says the Commonwealth Fund, who note that among low-income families, that figure rises to 78%.

Protecting the patient-physician relationship based on mutual trust, informed consent, and privilege patient confidentiality. Yes, of course. That is also the goal of every other developed nation. Contrary to public misinformation, by the way, Europeans do get to choose their own doctors--and they have more to choose from than we do.

So, Republicans, we have a long way to go in order to achieve those excellent health-care goals. The Affordable Care Act moves us slightly--not nearly far enough--in the right direction. How are you planning to improve on it?

If you were smart, you'd study countries that already have higher quality care at a lower cost that covers all citizens. That happens to be true of every other developed nation, so it shouldn't be too hard to find resources. But what you'd learn is that their health-care efficiency comes from price controls, strict government regulation of private insurers, and an adequate tax base.

Oops.

Mme Neff's Salon

"La Lecture de Molière" by Jean-François de Troy 

In the early 1600s certain French people, disgusted with the crudeness of Henri IV's court, began meeting in private homes to discuss art and literature. They called their groups salons, after the room in which the larger gatherings took place, or ruelles, after the space between bed and wall in which the smaller ones met.

By the 1700s salons had expanded their areas of interest to politics, philosophy, and religion. In theory, at least, they were places where anything could be discussed as long as participants were polite, civil, and well behaved.

Most salons were hosted by women, who provided invitations, food and a place to meet. The guest list was subversive: it included women as well as men, bourgeois along with aristocrats. Prominent intellectuals and artists spoke freely of their vision for liberté, égalité, and fraternité--dangerous ideas in an age of absolute monarchy.

In the early 2000s certain American people, disgusted with the crudeness of the current and seemingly eternal political campaign, decided to drop out of the political process altogether. They are doing their best to ignore politically motivated ads, commercials, and phone calls. According to a recent USA Today poll, some 90 million of us will not vote in the November election.

I sympathize. The constant name-calling and mud-slinging, whether paid for by super-PACs or freely offered by friends, is depressing. Hesitant to say anything political on Facebook or here on my blogs, I've stopped saying much at all. Since I've used Facebook updates to promote my blogs, I feared my friends would weary of me if I posted such updates too frequently. Some of them no doubt roll their eyes if I post them at all.

"In the salon of Mme Geoffrin in 1755" by Lemonnier, c1814

And then I had an idea. I'd like to discuss politics--and philosophy, religion, art, literature, food, wine, travel, language, dogs, and many other topics--with people who also want to discuss these things, and who share the salons' ideals of politeness, civility, and good behavior. It's a bonus if these people disagree with me: then I might learn something. Alas, nowadays a physical salon isn't too practical. My rooms are not as large as Mme Geoffrin's.

So I set up a Facebook page, "Mme Neff's Salon," that is supposedly accessible whether or not you're on Facebook. If you are on Facebook, and if you LIKE the page, you will get updates in your news feed whenever I post to Lively Dust or The Neff Review. Then, if you wish, you can join a discussion, or initiate one.

Now I feel free to go back to writing. If you want to hear from me, please LIKE the page. If you change your mind, you can easily UNLIKE it later. But whatever else you do, even if you resort to earplugs and blinders to keep out the shouting and turmoil from now until November 6, please vote.

A financial report from someone who has been on Mr Ryan's Medicare plan since 1999

For details, check out "The Dog Maxed Out My Credit Card" from the November 2, 2011, Wall Street Journal.