I've always operated under the assumption that Medicare probably wouldn't be adequate to meet my needs by the time I needed it. So perhaps you could explain why it shouldn't be allowed to die on the vine, as it were. I'm not asking this argumentatively, I'm just attempting to enhance my admittedly limited knowledge on the subject. I understand that people have paid into the program and certainly think they are entitled to the benefits, but why should the program exist in perpetuity without exploring alternatives?

Indeed. But why should it just be destroyed arbitrarily?

This bill is not an "exploration"; it's part of Newt Gingrich's plan to see it "wither on the vine" (said by him 1995).

Personally, I think the country would be better off if, instead of dicking around with a program that works, Congress took a step back and addressed the overall healthcare issue. There are still 43 million Americans with no health insurance.

The current bill does not do that. Aside from subsidies to HMOs ($14 billion) and increasing taxpayer costs ($400 billion over the next ten years), there's not much good in it :-)

I agree with you on the health insurance issue, but why do you think this will destroy Medicare, and how? From outward appearances it seems to be an expansion of Medicare, if anything.

Medicare is one of the most succesful social programs in the history of the world; it has saved literally millions upon millions of Americans from poverty upon retirement.

The right hates succesful social programs like Medicare even more than it hates unsuccesful ones like welfare. Conservatives want a rigidly class stratified society with plenty of poverty to keep people scared and working. This is the kind of society we live in mow; they have succeeded in their goals.. It sucks, and I can't wait to move to Canada.

It appears to be an expansion of Medicare; but over the long run, it is designed to cripple the program by forcing people into HMOs, and denying the poorest of the poor access to adequate health care. In the short run, it guarantees Bush's re-election by deluding people into thinking they're getting something; in the long run, it represents nothing more than a giant welfare program for drug companies and HMOs. Disgusting.

Hal, the pics aren't showing up and at least one f them appears to be skewing the page to the right as well - maybe remove them?

Thanks mike, but your bitterness and partisanship kind of detracts from your credibility or authority.

Well, then, go look up the speeches by John McCain and Lincoln Chafee, two Republican senators, on this topic.

I'm familiar with the political aspects of the issue. I'm more interested in the practical side of it.

A few data points:

1. The HMOS and insurers would be allowed to cherry-pick the youngest and healthiest oldsters, leaving those who are most expensive to service with Medicare. This eliminates the "averaging" of costs for Medicare.

2. "... a truly bizarre section of the legislation ... literally prohibits the government from bargaining over price with the drug companies and other suppliers to beneficiaries." (I wonder how that got in?)

3. "it also tweaks the antitrust laws enough to enable drug companies to conspire to reduce shipments to Canada in order to reduce the supply available to Americans." (Same question.)

4. "proposals to greatly speed up the availability of generic products as a substitute for patented medicines have been greatly watered down." (Same question.)

5. "while the program's cost over the next decade is budgeted at $400 billion, an educated guess about the following decade is more like $1.5 trillion."

6. "Republican Senator John McCain of Arizona, one of the few conservatives to stick to his principles in opposition to the creation of a major new entitlement program, added that the subsidies to "special interests" like insurance and drug companies stand in stark contrast to the absence of any means of keeping costs from skyrocketing."

Etc.

You can get tons more on this issue, from all sides, at Google news

Interesting points, on the other side of the first one though, if you've gone out of your way to maintain a healthy lifestyle you end up paying more due to averaging. On the third point, I'm pretty sure that drug companies are already able to limit the supply to Canada, just not formally. How would you feel about means tested coverage?

On point 1 my experience has been that genes have more effect than lifestyle, ignoring extreme self-destructive behavior - how old was running guru Jim Fix when he died? 43 or something?

As far as means tests go, I guess it depends on how you look at government's place in social policy, and what Medicare was designed to do.

From the standpoint of pure fairness, even Warren Buffet should be able to daw on the benefits if he paid for them.

On the other hand, if you must have a means test, I don't know that it's fair to deny benefits to someone who happens to own a "$5k used car and a burial plot" but has no income, nor any hope of any because they're too old for anyone to hire.

The original thinking on Medicare began with FDR and Social Security in 1934. Thinking changed somewhat by the time the first bill was passed in 1965, but at that time it became compulsory health insurance for the elderly, possibly meant to be a "foot in the door" for a complete national health scheme (Democrats loved it, doctors hated it).

Because it's compulsory, my first reaction would be that the means test shouldn't be applied - "I didn't want to be in it in the first place, but now that I've paid for it, I deserve it".

Over the years there have been numerous changes, both in the bill and in attitudes towards Medicare. It transmogrified into a safety net. On that basis, a means test is a reasonable way to provide the safety net to those who need it.

My bottom line is that the bill itself and alone is too narrow an issue. What is needed is a comprehensive approach to health care.

Costs in this country are about $5000 per annum per capita. In Canada they're around $2000. In Canada you may have to wait months; in the US 43 million will wait forever because they're not covered.

So what's the answer?

Beats the hell out of me.

But I think it's an issue that should be addressed in a more rational, thorough manner than tinkering with pieces of what exists and works, like Medicare.

43, see that's ancient! But you sidestep the point that someone with a healthier profile still ends up getting gyped. Again, I'm with you on the healthcare system. But is Medicare actually a system that works and does it need to be improved? I seem to remember Al Gore in a campaign flap on some point about his mother's prescriptions? Not a slam on Gore, just pointing out that the issue has been around for awhile.

"But you sidestep the point that someone with a healthier profile still ends up getting gyped."

If that's what it looked like, that certainly wasn't my intent - there's nothing to side-step.

The program is insurance and that's the way insurance works: some people get a lot from a policy, some get nothing (besides peace of mind).

Surely you don't go out and prang your car every couple of years to get your money's worth :-?

"But is Medicare actually a system that works and does it need to be improved?"

Both.

No, that would loosen the duct tape and baling wire holding it together. But insurance does make exceptions which is why smoker's pay more than non-smokers. Maybe thats the way it should be, that Medicare is reserved for the higher risk cases. Because of the numbers involved the averaging might not be as diluted as you'd suspect. I guess I'm just saying I'm not sold on the argument.

"Maybe that's the way it should be, that Medicare is reserved for the higher risk cases. Because of the numbers involved the averaging might not be as diluted as you'd suspect."

Well, we're about the find out - the Senate passed the bill.

Note that whatever it does in delivering medical services, it will give $15 billion of your tax dollars to the HMOs and insurers almost immediately in subsidies, adds another $40 billion per year to the same goups in higher costs paid by Medicare (legally forbidden to negotiate lower prices), and in ten years will rise to nearly $120 billion per year.

Don't you think that kind of money might be better spent?

My impression is that you don't take kindly to having the government's hand in your pocket. In this case, it's in up to the elbow.