10-12-2011, 07:28 PM
Ted King wrote:
[quote=rjmacs]
I'm afraid that the Democratic Party's approach to Medicare isn't a whole lot more rational than this.
Could you elaborate?
Preemptive request: please don't reply to my comments below with "the Republicans did that too," or, "the Republican position was worse" - that is not a logical defense, it's a political defense. My comments below are about the Democratic Party, per Ted's request.
So far, the party has been similarly unwilling to insist on either fiscal responsibility or outcomes-oriented reimbursement re: Medicare. Overwhelming support for Medicare Part D (the drug benefit) with no funding source or insistence on price negotiation as a condition of passage was just ridiculous. Year after year of accounting that is completely dependent on cutting reimbursement to providers, accompanied by year after year of deferring those cuts out of political cowardice. During the healthcare reform debate, there was a total failure of Democratic leadership to insist on outcomes-oriented reforms or comprehensive, team-based care.
The issue of Medicare's future is saturated on all sides of the debate by political cowardice. The reality is that the system needs to change, eliminate its fee-for-service structure, and become much more involved in managing patient care if it is to survive as a public program. The alternative is to privatize. These are deeply unpopular and politically difficult ideas, discursively at odds with popular American notions of individualism, entitlement, and rights (which themselves are full of irony and contradiction, but that's not the present point).