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Medicare revisions already in the works

In his recent, "get tough" Rose Garden speech, President Obama teed off at Republicans with the Democrats' best campaign issue: the GOP's proposed neutering of Medicare.

The difference last April, most people thought then, was between the Republican budget bill to totally revamp Medicare and the Democrats' apparent stance of "don't touch it." The difference looked pretty clear cut. It's not.

On the lawn behind the White House last week, the president told an audience of loyal staffers perched on little white folding chairs that he would "veto any bill that changes benefits for those who rely on Medicare" that does not also raise taxes on the rich.

Brave words. But Obama and the Democrats who voted in 2009 for the Affordable Care Act already have changed Medicare. And more Medicare revisions are in the works.

As a result, the riveting issue created by the 2012 House Republican budget last spring is so riddled now with parsed speech and perforations that the Democrats' best vehicle -- the one that elected Rep. Kathy Hochul in New York's 26th District -- may just as well have crashed and burned.

The GOP budget would substitute Medicare health insurance with a voucher with which to buy private insurance, allowing for modest increases annually for inflation. Passed by the House but stuffed in the Democratic Senate, the plan would end Medicare as we know it.

But the fine print in the Affordable Care Act and in the Budget Control Act of 2011 signed by Obama in August, as well as a new government agency, also guarantee that major limits on Medicare benefits and care are already in place or planned.

Here's how:

*Republican presidential candidate Michele Bachmann charges the Affordable Care Act will "steal" $500 billion from Medicare over 10 years to finance other expansion of federally mandated health care. "Steal" is rash and inaccurate. However, the non-partisan Kaiser Family Foundation figures the act prompts a net reduction of $424 billion in Medicare spending over a decade.

These cuts are supposed to come from lower fees for doctors and other providers, and assumed "productivity" improvements.

*The Budget Control Act created a 12-member congressional committee. It is supposed to find $2.1 trillion in spending cuts over a decade. The panel itself may recommend further cuts in Medicare. (The gang of 12 meets in secret, by the way.) Many Democrats voted for the committee on their way to vacation, and the president signed it. If Congress fails to approve the panel's budget-cutting bill, then automatic caps in spending will be set for Medicare: a 2 percent cap on increased outlays. Without any intervention, actual Medicare plan costs are expected to rise 6 percent a year.

*The Affordable Care Act created an entity called the Independent Payment Adjustment Board. Obama said recently he wants this board set up quickly, and wants the board to more tightly restrict increases in Medicare payments. Originally limited to an increase similar to the gross domestic product, plus 1 percent a year, Obama wants this squeezed down to one half a percent growth.

Guess who gets caught in these capers besides the doctors and private insurance plans? Uncle Japer, Aunt Ella, grandma and grandpa. In addition, the American Hospital Association claims members will lose $41 billion in Medicare money, prompting layoffs of more than 190,000 staffers over 10 years.

This calamity started because of bogus claims by conservatives that Medicare is broke, when it isn't, and because of Obama's refusal to support the public option or make the government jawbone prescription drug makers into lowering their prices.

Canada's single-payer system is looking better and better.


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