Posted by Sappho on October 16th, 2012 filed in Election 2012
I’m sure my blog readers won’t be surprised that I voted again for Obama. There are several reasons for this vote. One is that, however far short Obama has fallen of my hopes on civil liberties, it’s still the case that he ended torture, that Romney promises to bring it back, and that Romney doesn’t object to those practices of Obama’s that I’d actually criticize. And sometime I do want to do a blog post on why torture still matters, and the things on which there’s a bipartisan consensus that we need to change also matter. But this isn’t that post. Another reason is that I believe that Democrats are better for the economy than Republicans, for all the reasons Clinton phrased so well in his convention speech, and that, anemic though our recovery is, it will fare better under more of Obama’s policies than under a return to Republican ones.
But one that weighs particularly on me this year is health care. I know that some people who care about me honestly hold different opinions about what’s the best policy here. My own belief, though, is that I personally have a better chance of living to an old age if Obama wins than I do if Romney wins.
1) Obamacare: Romney promises to repeal Obamacare. It’s true that he said, during the first debate, that he would somehow or other protect those with preexisting conditions. But the day after the debate, Romney’s campaign spokesman said that Romney’s plan only provided for coverage of those people with preexisting conditions who maintain continuous coverage.
I’m a cancer survivor. I have to face the possibility that, at some point during the next few years, something could happen to my company, I could get laid off, and I could lose the ability to maintain continuous coverage on employer-sponsored plans. Romney has said that people don’t die because they lack insurance because we have emergency room care. But emergency rooms don’t provide the regular scans that I now need to catch my cancer if it returns, and emergency rooms don’t provide the regular chemotherapy that I’ll need if it does return.
2) Medicare: Paul Ryan was added to the ticket because he had won praise, among a certain set of people, for the Ryan budget, a budget that called for replacing Medicare with vouchers, as soon as my husband and I are old enough to qualify. Initially, the plan was to completely eliminate traditional Medicare for my generation and younger, replacing it with vouchers for private plans. Later, after that first plan got pushback, the plan was modified to include a Medicare public option, but with the amount that government pays for healthcare, whether through fee for service or through vouchers, being held constant.
As a failsafe, Ryan’s plan would also impose a spending cap requiring that per capita growth not exceed nominal GDP growth plus 0.5%
How much would the plan save?
According to a CBO analysis of Ryan’s 2013 budget, average Medicare spending for new enrollees in 2050 would be between 35% and 45% below what it would be under the current program. The analysis found that possible consequences of the dramatically lower spending could include higher out-of-pocket healthcare costs for seniors; reduced access to health care; diminished quality of care; increased efficiency of health care delivery; and less investment in new, high-cost technologies.
Now, I’ve been told that I should ignore Ryan’s initial plan, since it’s been replaced. Fair enough. I’m willing to look at the voucher-plus-public-option plan rather than the vouchers-only plan that’s been abandoned. But I’ve also been told that neither of Ryan’s plans counts, since it’s the nominee for President, Romney, whose plan matters.
The problem with this is that Romney’s plan appears to be, “Be very vague about all of your numbers, and promise everyone a pony.” Going by the various things that Romney has said at different times, he is apparently going to cut taxes for the rich, cut taxes for the middle class, balance the budget, and somehow ensure that, when Medicare gets voucherized to whatever degree he’s going to voucherize it, it happens in such a way that it saves the government money without placing any significant burden on any senior who has any difficulty paying for medical expenses. He hasn’t supplied any numbers for how all these things add up, because he can’t. They simply don’t add up.
So, I decided to make my vote based on the most recent numbers that did add up, in however unpalatable a way, those numbers being Ryan’s most recent Medicare proposal. (After all, Ryan was put on the ticket for a reason, no? And Medicare proposals are his passion and the thing that’s brought him the most acclaim.) The non-partisan Kaiser Family Foundation has produced a new report: Transforming Medicare into a Premium Support System: Implications for Beneficiary Premiums.
Assuming full implementation of such a system, and assuming current plan preferences among beneficiaries, the study estimates that:
Nearly six in 10 Medicare beneficiaries nationally could face higher premiums for Medicare benefits, assuming current plan preferences, including more than half of beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage enrollees. Even if as many as one-quarter of all beneficiaries moved into a low-cost plan offered in their area, the new system would still result in more than a third of all beneficiaries facing higher premiums.
Premiums for traditional Medicare would vary widely based on geography under the proposed premium support system, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming and the District of Columbia, but an average increase of at least $100 per month in California, Florida, Michigan, New Jersey, Nevada and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California’s San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums in their current plan. Many counties in those states have relatively high per-beneficiary Medicare spending, which would make it more costly to enroll in traditional Medicare rather than one of the low-bidding private plans in those counties. In contrast, in areas with relatively low Medicare per-capita spending, it could be more costly to enroll in a private plan.
Now, Romney and Ryan have assured us that, after all, this plan (and the Social Security privatization that they have also advocated) applies only to far distant retirement, that everyone 55 and over is exempt. Guess what? Joel and I are just a little under 55. So the plan does apply to me. Since I’m over 50, I’ve already been in the work force for 30 years; it’s unlikely that I’ll keep working for 30 more. So I’ve spent most of my retirement earning years already, under the expectation of the old system. Your early working years bring you a bigger bang in retirement earnings than your later ones, because, even though you’re making less money, you can invest it for longer, and it will earn more interest. So most of my retirement planning is a done deal. I will also have to pay taxes sufficient to fund full Social Security and Medicare for absolutely everyone who is even five years older than me, a huge Baby Boomer age cohort. So, as with everyone else, the money I spend on Social Security and Medicare is not available for me to invest for my own retirement; I am paying it to the government with the understanding that they fund my retirement later, as I funded the retirement of the people who preceded me.
So, voting for Romney and Ryan means voting for Medicare to become a substantially worse financial deal, suddenly, sharply, the minute I retire, after I’ve paid the same taxes as everyone else. I’m not voting for this.
I realize that we need to bend the cost curve on health care somehow, and I realize that will involve some limits or other on my future Medicare. But I don’t want to vote for a plan that appears to particularly disadvantage me, and I don’t want to vote for bringing back preexisting conditions just at the point where doing so might mean that I, personally, die prematurely.
If I am not for myself, who will be for me?
Thus, Obama got my vote. The absentee ballot is already in the mail.