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When Stark claims Medicare is “efficient,” one can only presume that he is referring to Medicare’s supposed lower administrative costs. It certainly isn’t efficient when it comes to paying for care. There are wide geographic disparities in Medicare spending: Miami spent an average of $8,414 per beneficiary in 1996, while Minneapolis spent only $3,341. While some of the difference can be explained by higher-spending regions having sicker beneficiaries, much of it cannot. Indeed, one study “found no evidence to suggest that the pattern of practice observed in higher-spending regions led to improved survival, slower decline in functional status, or improved satisfaction with care.” Thus, Medicare is wasteful, with one study suggesting one dollar in five spent by Medicare is for care of no obvious benefit. AmeriCare would replicate Medicare’s waste on an even bigger scale.
The notion that savings will kick in over time is equally risible. The main culprit of our rising health care costs is that we do not pay enough of our money out-of-pocket for health care. Stark’s AmeriCare program only worsens that problem. Recipients will probably pay about $93 per month for their premiums since that is what Medicare recipients will pay for their premiums for Part B in 2007 (only a few wealthy seniors pay premiums for Part A). Deductibles under AmeriCare are $350 for an individual and $500 for a family. Total out-of-pocket costs are $2,500 for an individual and $4,000 for a family. However, if you make less than 500 percent of the official poverty level — about $47,000 for an individual and $87,000 for a family of four — government picks up the entire tab once your total costs for premiums, deductibles, and out-of-pocket expenses reaches 7.5 percent of income. And for those under 300 percent of the poverty line, it is only 5 percent of income. With such generous coverage, AmeriCare will control costs the way gasoline controls fire.
Rep. Stark further claims that premiums will be kept affordable using Medicare’s low administrative costs and discounts through mass numbers. Looking at Medicare’s recent history, it is hard not to conclude that Stark doesn’t know what he is talking about. Premiums for Part B of Medicare have risen by an average annual rate of over 10 percent from 2000-2006. For 2007, the increase will be considerably lower, 5.6 percent. Yet that is due to a slowing in health care costs and that, for the first time, Part B will require wealthier seniors to pay higher premiums, thereby subsidizing the premium costs for non-wealthy seniors. In short, Medicare’s recent history should inspire no confidence that premiums can be kept affordable.
So let’s see: Restricting individual freedom, immense waste, and rising costs — what else? Oh yes, bureaucratic micro-managing. Under AmeriCare the Department of Health and Human Services will keep a lid on prescription drug costs by encouraging “the use of more affordable therapeutic equivalents to the extent such practices do not override medical necessity, as determined by the prescribing physician.” That would seem to give the physician the final say, but the term “medical necessity” can be broadly defined. You say Drug A does a better job of treating your arthritis pain? Well, it’s not medically necessary since Drug B controls enough of your pain, according to the omniscient bureaucrats running AmeriCare. Oh, and did we mention Drug B costs less?
None of this even gets into the part of Stark’s bill that micro-manages electronic medical records. But hey, the federal government excels at simpler tasks like stemming the flow of illegal immigrants. So why not let it tackle something more complicated like putting all your medical records into computer-readable form?
While Rep. Stark’s AmeriCare bill may be too ambitious to be passed any time soon, it does give us a useful guide to how the Democrats would tackle health care. Any proposal will move toward forcing everyone to buy health insurance, providing overly-generous coverage, and increasing bureaucratic meddling. To sell it, they will employ a smokescreen of “lower costs.” But don’t be fooled. In the long run, programs like AmeriCare will increase costs and exert more government control over your health care decisions.