The culture war is moving from when life begins to how it should end. Like a drum beat, supporters of the Obama agenda are protesting that the elderly are consuming too many health resources, and their care needs to be cut back.
The current target of this unrelenting campaign against the elderly is the Joint Select Committee on Deficit Reduction, which is charged with devising a plan to reduce federal deficit spending by Nov. 23.
Among those calling for less care for seniors is H. Gilbert Welch of Dartmouth Medical College.
“If you were hoping to play the ‘death panel’ card, now’s your chance,” Welch says to his critics. “But don’t play it and then pretend you care about the budget.”
That brazen statement — pitting grandma's well-being against the nation's fiscal health — is a false choice. Future federal healthcare spending can be significantly reduced by repealing the expansion of Medicaid and the billions poured into medical and interpreter services for illegal immigrants under the Obama health law before these provisions go into effect.
The Obama health law, enacted 18 months ago, raided Medicare to fund new entitlements for low-income groups — in essence, robbing grandma to spread the wealth.
The law reduces future funding for Medicare by $575 billion over 10 years, and applies most of it ($410 billion) to increase Medicaid enrollment and benefits. The Obama health law transforms Medicaid from a temporary safety net to a permanent alternative to private health insurance.
Medicaid spending will top $900 billion in 2020 (state and federal funds), costing about the same as Medicare. That’s amazing considering the wave of baby boomers entering Medicare in this decade.
In addition to expanding Medicaid, and contrary to the president's promise, the new law allocates billions of dollars to expand services largely for illegal immigrants, including $11 billion for community health centers serving those ineligible for Medicaid. Why should grandma's care be cut to free up resources for lawbreakers?
This year the Department of Health and Human Services announced an Action Plan to increase spending on “promotores” or “trusted local people to serve as community health workers” and software for people with limited English to enroll in government programs.
Cuts to Medicare are not about reducing federal spending. They are about redistributing healthcare.
To defend the enormous cuts to Medicare in the health law, Obama administration officials told seniors that hospitals are overspending on aged patients. But research indicates that is generally untrue. Hospitals that spend more on elderly patients and offer more intensive care have lower death rates, and their patients are more likely to survive their illness and resume an active life.
It is in this context that the calls for less care seem suspect. An article by Welch and colleagues in the Archives of Internal Medicine (Oct. 24, 2011) tried to counter the message uttered so often by breast cancer survivors that a mammogram “saved my life.”
Welch and colleagues suggest that routine annual mammograms are excessive. Their research found that a majority of women with breast cancer detected through mammography did not owe their life to the screening. They would have survived anyway because of effective treatment to eradicate the cancer after later detection or because the cancer was slow growing.
All that is true, but the data show that approximately 13 percent of 50-year-old women with screening-detected breast cancer would have died if they had not been screened. They owe their life to that routine test. That is a significant number. For 70-year-old women, the figure is even higher — far too high to dismiss.
Rather than limiting care options and forcing hospitals to operate in an austerity environment, the supercommittee should repeal the costly expansion of Medicaid, curb community organizing funded with health dollars, and gradually inch up the eligibility age for Medicare.
There are ways to reduce federal health spending without cutting short grandma's life.
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