And here we go again — another year of battling about health care costs and who pays. The Republicans want last year’s health care reform law repealed, and to move Medicare to a voucher system and Medicaid to block grants. Democrats want the hard-won health care law to stay, and for Medicare and Medicare to remain federal programs with infrastructure changes that save money. But do we, the people, know what we want? I don’t mean just the loud ones, either.
It’s hard to tell, isn’t it? When we get right down to it, most of us just want to pay less for our care. And many people don’t want to put the effort into becoming experts at how the system works, negotiate medical bills or take the time to find affordable facilities. In fact, studies have shown that employees spend less time picking out an insurance plan during enrollment than we do buying a new car. In other words, we liked it the old way — employers underwrote the cost of our care, and we went to the doctors when we needed medical services.
In 2010, about 38 percent of large employers offered consumer-directed health plans tied to health spending accounts with family out-of-pocket expenses topping out at $11,900, and more premium costs shifting to employees. Now Congressman Paul Ryan is proposing a voucher system for Medicare beneficiaries in 2012 that would be based on income and used to pay for a portion of the premiums private insurers would charge. This would move Medicare from a federal program to a privately administered program, similar to the Medicare Advantage program that was canceled by the new health care law because it added more than $20 billion to the cost of care. Some number crunchers are saying Rep. Ryan’s approach would cut Medicare costs, but the vouchers would underwrite only about 1/3rd of the actual premium cost. In other words, seniors would be responsible for 2/3rds of their premium costs. Federal dollars that pay for state Medicaid enrollees would be given in a lump sum or block grant to be used by states as they see fit. According to Rep. Ryan, these changes would save the U.S. government $1.4 trillion over the next decade. However, his proposal so far doesn’t include any specifics on how the cost of care will decrease, meaning our portion of the health care tab.
There really is no better option than to get involved in the health care conversation. Any way you slice it, consumers are going to be paying a larger portion of our health care costs. We need to be ready to push on the costs of care and find ways to influence that discussion as well as what we pay in annual premiums. There is no gravy train ride in health care funding — from cradle to grave we’re going to be more and more on our own when it comes to paying for health care. In case you haven’t heard, employers and government want out.
