Seniors: Who do you want rationing your Medicare?

My dear brother and sister seniors,

Someone has to say it: You and I will have to sacrifice, like everyone else, to help pull America back from financial disaster. Just like the sacrifices demanded of public employees and government beneficiaries. Just like the millions of private-sector unemployed and underemployed have already sacrificed.

Without some sacrifice, Medicare — our lifeline to health care — may expire before some of us do and, on its present course, it surely will die before our progeny are around to enjoy the same benefits we have received. With the boomer generation joining our ranks, Medicare will have to support almost twice as many seniors in a couple of decades as it can now. No telling what the bill — which now accounts for more than 13 percent of the federal budget — will be.

Sure, we've paid into it, just like we've paid into Social Security and just like teachers and other public employees have paid into their retirement benefits. But the undeniable reality is that what we've contributed into Medicare doesn't cover what we get back. Far from it.

As much as our personal budgets are strained now, worsened by the recession and a slow recovery, we have to face the prospect of doing with less. Any politician who feeds the idea that we can "save Medicare as we know it" or that we can escape with little or no pain takes us for dotards. Both parties are guilty.

A truly courageous politician would lay it on the line. But he'd also be a "dead" politician because too many of us seniors, just like so many others, see elections as a means to bettering our own lives. "What can he do for me in the next four years" is the deciding factor for too many Americans, leaving what's good for the commonweal (some may have to look it up) out of the equation.

Proposed changes to Medicare, (but not discussed often enough) include raising the Medicare eligibility age; increasing premiums for the wealthier or for everyone; subsidizing premium payments for private health insurance (so-called vouchers); increasing supplemental insurance premiums; hiking deductibles and cost-sharing for such services as home health care; slashing Medicare reimbursements for doctors, hospitals and other health care providers; generating new revenues by increasing the payroll tax rate, and on and on and on. (Check the AARP website for more detailed discussion of the options.)

All involve some sacrifice. For example, if you think that forcing doctors to receive smaller fees won't affect you, then consider: More doctors will refuse to take Medicare patients, creating pressure for cost-cutting elsewhere and reducing your choice of doctors.

So many options, it's hard to cut through the politically inspired baloney. For me, the most important question comes down to: Who decides? Who sets the standards for what health care expenses will or won't be covered by Medicare? Simply stated, there are two choices: Insurers or the government. Do you put your faith in people who can lose their jobs if they make the wrong decision or do you want them made by unelected bureaucrats who can ration care to their heart's content without oversight?

Or as others might ask, do you put your faith in people who are motivated by profit or by insulated health care and other experts who know what's best for us and the country?

President Barack Obama's preferred answer, encapsulated in his ironically named Patient Protection and Affordable Care Act, is a panel of supposed experts free of political pressure —meaning, of course, that they ultimately are not responsive to us. The panel, called the Independent Payment Advisory Board, consists of 15 appointed people whose decisions are mostly exempt from congressional review or democratic oversight.

Frankly, it scares the bejabbers out of me.

As seniors, we need to be responsible for our choices. Do we really need the X-ray or visit to a sawbones for every ache and pain? Are we overusing and abusing "preventative care"? Most important, we need to think about "end-of-life" care, which accounts for 25 percent of Medicare's costs.

If we have to sacrifice — and we do — and if government has to run it — and Obama says it must — then I'd prefer we have some say in it through the democratic process. Instead of leaving it in the hands of a health care oligarchy.

This is my regular Chicago Tribune column.


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