One thing that we in the so-called mainstream media — those of us who still believe in striving for some semblance of fairness and objectivity — need to avoid is adopting the partisan vocabulary of left or right and treating it as neutral. On Medicare, we’re flunking that test.
As is well-known, Medicare is the federal government’s third-largest program, with spending in fiscal 2010 of $520 billion, behind only Social Security ($701 billion) and defense ($689 billion). Moreover, spending is expected to balloon as baby boomers retire and health costs soar. Unless Medicare is controlled, curbing federal budget deficits without wrenching cuts in other programs or huge tax increases will be hard.
Robert J. Samuelson
Samuelson writes a weekly column on economics.
That’s where the problem begins.
One long-standing proposal to overhaul Medicare would transform it into a voucher program. Eligible seniors would receive a fixed amount of money (the voucher) that could be used to buy insurance coverage; they could choose among many different insurance plans. The theory is that competition among plans would lower costs and raise quality because Medicare beneficiaries would select plans that offered the best value for money. Vouchers are popular among Republicans, though some Democratic politicians and economists also support them. For example, a voucher proposal is a centerpiece of the budget plans offered by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee.
But many Democrats despise vouchers, which (they say) would “privatize Medicare” and “end Medicare.” The language is self-serving demagoguery intended to terrify seniors. Unfortunately, some in the media sometimes sloppily adopt these attack phrases as acceptable descriptions.
Here’s a Washington Post budget story calling Ryan’s voucher plan a “proposal to privatize Medicare.” Similarly, a Post columnist said a voucher-like proposal by Sen. Rand Paul, R-Ky., would “end Medicare” and “abolish Medicare.” The New York Times’s editorial pages often equate vouchers with privatizing Medicare.
These descriptions aren’t acceptable, because they don’t reflect reality. The fact that some voucher advocates also use “privatize” doesn’t change matters. Consider.
Vouchers would not “end Medicare.” Fundamentally, Medicare promises health-care coverage to most Americans 65 and over. We call this an “entitlement.” The entitlement wouldn’t end. The federal government would still pay for coverage. In this basic sense, Medicare vouchers don’t threaten the program.
But how government spends and the generosity of subsidies for wealthier recipients could change. One criticism of Medicare is that it fosters excessive spending because its fee-for-service reimbursement encourages doctors and hospitals to do more. Vouchers could cap spending by limiting the amount of the voucher and any annual increases. Depending on how much competition forces the health system to become more efficient, this might create large savings, curtail health services or force seniors to pay more out-of-pocket costs. Likewise, some voucher plans would make richer recipients pay more.