Bernie’s Surprise Medicare Bill – WSJ

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Senator Bernie Sanders speaks with reporters at the U.S. Capitol on October 7.


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Rod Lamkey / Zuma Press

Contradictions continue to build up in the $ 3.5 trillion (over $ 5,000 billion) budget bill, and one of the biggest concerns is Medicare. The hospital trust fund is expected to dry up in 2026, and Democrats fear expensive drugs will not be affordable. But then why do they want to add extremely expensive new coverage for dental, hearing and vision care?

Democrats say half of Medicare beneficiaries don’t have dental insurance, but they are exaggerating the coverage gap. Almost nine in ten low-income seniors have access to dental coverage through Medicaid. The AARP sponsors dental plans with low premiums, and many senior dental schools offer charitable care to low-income seniors.

Seniors can also obtain dental, vision and hearing benefits through privately administered Medicare Advantage plans. Bill Clinton and Republicans in Congress created Medicare Advantage in 1997 to reduce unnecessary spending under the traditional fee-for-service model of the program and to increase competition in an effort to improve care.

The government pays a lump sum for each member to private insurers, who have the flexibility to design benefits, premiums and provider networks. The program has grown in popularity with enrollments more than doubling over the past decade to 24.1 million, or about 40% of the Medicare population. Competition from insurers has reduced average premiums by 34% since 2017, although most have added benefits. About 74% of Medicare Advantage registrants have access to dental benefits and 79% to vision care, including eye exams and glasses. Some 72% get help paying for their hearing aids.

Democrats don’t like Advantage because it reduces government control over health care. They therefore want to demand that traditional health insurance covers the benefits that older people already receive elsewhere. Talk about unnecessary expenses.

This expansion would also import health care price distortions from Medicare to dentistry and optometry. Because Medicare reimburses hospitals below the cost of care, privately insured patients are billed much more to compensate. The expansion of Medicare could cause privately insured Americans to pay more for contact lenses and dental crowns.

The Secretary of Health and Human Services would set payment rates for providers. Dentists and optometrists could refuse to participate in the program if the government pays too little, as many doctors already do with Medicare. But they will lose money anyway if their current privately insured patients switch to traditional health insurance.

The cost of the expansion is estimated at $ 81 billion per year when fully implemented, or more than $ 800 billion over a decade. So Democrats are hiding the real cost by delaying the dental plan in place until 2028. This saves $ 60 billion a year and helps squeeze the expansion into their 10-year budget window. But the total cost will explode in the future.

The hearing aid benefit also contradicts President Biden’s executive order in July to speed up the development of rules to allow over-the-counter devices to be sold. This could reduce hearing aid costs by 80%. Creating a new Medicare benefit would only boost business for specialists who are driving up the cost of devices.

Democrats are whipping polls that show expanding Medicare benefits popular. But few voters know any of these tax or other facts because the press does not report them and the Republicans dodge the subject. They are also unaware that the Medicare board recently reported that the hospital trust fund would face a $ 578 billion funding shortfall over the next decade.

All this proves that when it comes to rights, impending bankruptcy is not an obstacle to expansion. Bernie Sanders wants Medicare for All on the installment plan, and the reconciliation bill is a giant leap forward. The surprise medical bill will come later in the form of rationed care and higher taxes for the middle class.

Paul Gigot interviews Dr Marty Makary. Photo: Associated press

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Published in the print edition of October 11, 2021.


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