Posted by: theoptimisticconservative | April 14, 2010

Beneficiary Limbo

Those of us who are covered by TRICARE insurance – military retirees and military family members – are in a holding pattern this week, along with Medicare beneficiaries.  The provisions of the 1997 Balanced Budget Act require a dramatic, 21.3% cut to physician reimbursements this year by both Medicare and TRICARE, whose policies generally proceed in lockstep (with changes implemented to TRICARE about a month after they are implemented for Medicare).  The cut was originally to take effect on 1 March, but Congress postponed it to 1 April.  Technically, the cut has taken effect for Medicare, but the program is waiting to process new claims to see if Congress will, in fact, override the automatic cuts as it has done in the past.

Jim Bunning and Tom Coburn have affected the progress of related legislation in the Senate, with their “holds” on it to require that Congress’ various routine authorizations – which include this on along with renewal of unemployment benefits – be paid for.  So not only are we all in limbo – patients, doctors, hospitals – but we are being besieged with requests for us to contact our Congressional representatives and make our concerns known.

This development comes at a time when virtually all 50 of the states have made significant cuts to Medicaid reimbursements.  A whole lot of people have lost their access to physicians who can’t afford to treat Medicaid patients any more.  The cuts to Medicare and TRICARE will guarantee more such losses:  as reimbursements drop across all government-subsidized programs, doctors will be able to carry fewer and fewer underpaying patients.  (TRICARE is private insurance, but government-contracted and subsidized.)  Maybe I’ll be one of the losers.

I’m not relating this to build up to an impassioned plea that there be no cuts to TRICARE.  I’m not relating it to rant against Bunning and Coburn for their principled stand on pay-go.  I’m not even relating it to score points against Obama.  The situation we find ourselves in is the product of government programs and rules that were instituted long before he entered the Oval Office – and of an economic recession he didn’t create.

No, I’m relating it because it’s a perfect example of what we’ve been signed on to with Obamacare, for everyone in America.  Government health-care subsidies become uncontrollable costs, always and everywhere.  They are the big violators of balanced budget amendments.  They are the expenditures that have to be cut to balance budgets.  And the more people who rely on them, the bigger the constituency for deficit spending.

The beneficiaries are very often people we just can’t demonize.  Retired military who spent 20, 26, 30 years in uniform?  Their families who make big sacrifices on a daily basis?  The Amen corner for belittling this demographic is very, very small in America.  The demographic itself is small; can we really not afford to provide this benefit to military retirees?

Seniors who worked hard for decades, building our nation and our economy, paying taxes, raising taxpayers for the future; our parents, our grandparents – who hates seniors?  To even be eligible for Medicare as a senior, you have to have worked and paid taxes for at least 10 years, or been the spouse of someone who did.  Medicare isn’t a “fog a mirror” entitlement liked Medicaid.

But who wants to make it even harder for the poor on Medicaid to find doctors either?  I’m not seeing a lot of hands out there.

It’s informative to ponder how much we are already taxed and how comparatively few people are covered by the programs in question – and yet we can’t pay for them.  There are about 9 million TRICARE enrollees (military retirees and the family members of active duty and retired).  There are about 44 million on Medicare (seniors and disabled).  Medicaid patients are the largest group at 60 million, with their costs shared between federal and state funding.

Their status is also different from that of TRICARE and Medicare beneficiaries, because the latter two involve private insurance programs (most of the elderly on Medicare do purchase supplemental private insurance) whose premiums are paid by the beneficiaries.  This means their payouts, while tied to government reimbursement tables, are still above the government program’s base figures.  Medicaid is straight government payment for services.  So it’s no surprise that, with states strapped for funds, it has taken the earliest and biggest cuts in the present recession.

Think about it.  This is the future of your health care access as government assumes more and more control of it.  It won’t be long before you’re the one waiting on Congress to yet again authorize deficit spending, for one more fiscal year, so that your family doctor doesn’t have to drop you from his patient list because she can’t afford to treat you anymore.  And that’s if you’re lucky:  you could just be waiting months, or even years, to be seen by a doctor whose schedule is controlled by government regulators anyway, and perhaps simply dying of what ails you before he gets to you.

Consider that the great majority of people on Medicare and TRICARE got to where they are the same way you did:  by working to pay taxes to all levels of government between 4 and 5 months out of every year of their working lives.  If they had been able to keep even one more month’s worth of their annual earnings for themselves, they could have put more aside for medical savings and insurance premiums, just as you could if you had that month’s earnings back. They’re almost all paying insurance premiums now anyway, but the subsidies that make the premiums affordable turn them into a constituency that has to worry about filibusters and senatorial “holds,” and annual Keep up the Deficit! votes that come down to the wire.

There’s supposed to be a vote tomorrow that will extend current Medicare reimbursement rates to 1 May.  Another one-month extension so Congress can put off deciding whether this year is the one in which to go ahead and comply with the Balanced Budget Act of 1997.  Millions of people’s near-term access to medical care depends on what Congress does about this.  Just think:  the day is approaching when you’ll be one of them.

Cross-posted at Hot Air.


  1. I hope you are comforted to know that Sen. Scott Brown voted along with 3 other Republicans (Snowe, Colllins and Voivonich (?)) who are certainly, lamentably and loudly being condemned/trashed as useless RINOs in the blogosphere by now for standing up in behalf of veterans and other people affected by the cuts in TRICARE, as he promised.

    He didn’t give an explanation for this vote and I had wondered if he made an unwise decision voting with the Democrats on this.

    Had read about this upcoming vote, but had picked up a specific negative comment on a Brown Snubbed Tea Party story today that said “he voted with the girls” which made me curious what he had voted for this time.

    I first came across an article of yours (about Israel or Scott Brown?) in Hot Air after Sen. Brown’s election, but couldn’t comment due to their policy on new readers’ registration.

    Bless you for such excellent writing! May your tribe increase =)

  2. Sorry, but there should be a NOT between Had and read in the 3rd paragraph of my comment above.

  3. Indeed, and in effect this is a demonstration of our future with Obamacare. The govt models of TRICARE and Medicare and even the federal employee system are built on unsustainable models. The difference with Obamacare is there just won’t be any doctors available.

  4. I agree that we will all be sucked into the black hole that is the government entitlement approach.

    The irony is that none of this need be a government program. You allude to the alternative– with the reference to “what if we had been allowed to make those decisions for ourselves.

    But we ate of the poisonous fruit of government “support” and now we are doomed.

    The new preventative medicine mantra: Stay healthy, or die!

  5. Welcome, cody, and my apologies for the time it took to “approve” your comments yesterday. That’s a one-time requirement; you’re now permanently approved, and I hope you’ll comment often. Thanks for the kind words.

    JEM, Darkness — yep. It seems that the attitude about preventing the reimbursement cuts, once again, is different this year. I don’t know if that’s just because of the “holds” in the Senate, or if it’s because our great lawmakers figure this is the year to start putting the bite on the old folks and retired soldiers — after all, they’re on a roll.

    The House did vote in March to stave off the cuts to 1 April, but in previous years they haven’t needed to keep it all in suspense for months on end. They’ve just voted expeditiously to prevent the cuts for that year. This year is different. I may be wrong, but I have a sense that they’re wrestling with the prospect of having us suckers right where they want us, and working themselves up to deliver the big blow.

    If it comes, it will be Obama’s real shot across the bow. If he and this Congress will really cut reimbursements so drastically for previously “untouchable” constitutencies, then there’s no one — except SEIU and the UAW — they won’t sock with cuts down the road.

  6. If Obamacare is not repealed, I predict that there will be a huge increase in medical tourism. Many Americans are already traveling to places like India, Mexico, and the Philippines to have medical and dental procedures done much cheaper than they can be done here.

  7. Fascinating, your support for socialized medicine. For yourself.

    Your concern that budgetary considerations might effect you seems oddly inconsistent with your harping on about the presumed disasterous bugetary effects of Obamacare (aka Romneycare).

    You and other government employees and retirees, the indigent, and the elderly enjoy socialized medicine at taxpayer expense. Why do you so resent the working lower-middleclass and poor having the benefit, not of socialized medicine, but of reform of the health-insurance industry? Why should you and other civil servants enjoy such a priviledged position vis a vis our taxes?

    And your reference to “demonization” is absolutely hilarious. Who exactly have you in mind? Jews? Hispanics? Immigrants? Or perhaps what you unsubtly refer to as “ghetto mums”? (aka pregnant teens who aren’t lily-white or have Palin as their surname). Let me guess………….

    You have no shame.

  8. “You and other government employees and retirees, the indigent, and the elderly enjoy socialized medicine at taxpayer expense. Why do you so resent the working lower-middleclass and poor having the benefit, not of socialized medicine, but of reform of the health-insurance industry? Why should you and other civil servants enjoy such a priviledged position vis a vis our taxes?”

    peterwise, I notice that you often harp about the govt sponsored health care that J.E. and other military retirees have. For what it’s worth, I am comfortable with the govt providing some sort of benefit for health care coverage to those who have served (and especially fought) with the military. They are in a different category to me than some bureaucrat who works behind a desk in the Dept of Education.

    You seem to think that socialized medicine is a wonderful thing and we’ll all be just fine to have it. This “reform” is nothing more than another govt entitlement program. The most massive one in our history. Medicare, Medicaid and Social Security are ALREADY slated to send us to bankruptcy and ruin our economy, unless drastic changes are made. But now we’re going to add this “reform” that covers *everyone* in the country. How can we possibly afford this? How do we avoid economic ruin? And perhaps worst of all, it takes away our liberties to such a degree that it may eventually tip the balance and cause Americans to become so dependent on the state that we slip pathetically to mediocrity. Sweden West. Who is going to fill the void in the world as we shrink from it? Most likely expansionist types like Russia, China or Iran. Mafiosos, communists and Islamists are not the ones I want exerting influence across the globe. But that’s what will happen when our democracy nanny states itself into submission. Just like Europe has.

    I would prefer that the govt have virtually nothing to do with health care. It should set some basic regulations so that people have legal protections from abuse or neglect. Aside from that, I’d prefer that it mostly just get out of the way. I could go on with more specifics, but don’t have the desire to spend the time on such a thing.

    As for your above comment, you (intentionally?) miss the point. Your implication that J.E. and those of us on the right “resent” various economic others having the same benefits as “we” “privileged” is borderline disgusting. And if you want to claim that I have no sense of irony or something, I’m afraid you have forfeited that right with your final “You have no shame” line.

    • The US military have socialized medicine. Aren’t you concerned that it will encourage our armed force to slide into mediocrity? Or do you think this fate is only something that might happen to categories of folk whom its ok to “demonize”? Come to think of it, the notoriously effete Israelis have socialized medicine. Perhaps the Iranians are paying for it as a means of rotting the jewish state from within as an alternative to nuclear armageddon.

      (p.s. Try to read what I say a little more carefully. Nowhere have I ever objected to our military – or vets – having socialized healthcare provision. My point was all about hypocracy, not healthcare for vets)

  9. RE — thanks for the assist, but I pretty much expected our friend peterwise to comment in this manner.

    I didn’t bemoan the possibility of Congress cutting TRICARE reimbursements in this piece, so basically everything peterwise accuses me of is an invalid charge. I pointed out that soon ALL Americans will have to worry about existential tradeoffs between current medical outlays and unsustainable public debt, played out on the floors of Congress.

    Millions of Americans don’t have to worry about that today. In the next decade, unless Obamacare is repealed, they will have to start.

    The best thing for all of us would be to get government out of the middle between us and our health care, and indeed from out between us and a number of other things. Government’s function is invariably to make things more expensive when it regulates and allocates them. Health care would cost everyone less if it weren’t so heavily regulated. There are ways to help the indigent with health care without having government intervene in EVERYONE’s health care. Such measures — e.g., county hospitals, public clinics — are exactly what we used to do in localities across America.

    I suppose, in the matter of military retirees and military family members, that this is the one demographic peterwise does think it’s unconscionable to subsidize. One of those many differences between right and left.

    For my part, I’d like to have back the whole separate mortgage’s worth of federal taxes I was paying every year for the latter half of my time in service (with, of course, the exception of the months spent in combat zones). That would have gone a long way toward beefing up a health savings account and paying for unsibsidized private insurance on retirement.

    • Easy peasy. Write to your socialzed healthcare provider and tell it you don’t want to sponge on the taxpayer any more. Then go out and buy a private healthcare policy like millions of other Americans.

  10. your argument about government and health care remains gaseous.
    the single feature of added expense that you choose to assert to be primary in government/health care interaction is anything but.

    get some more legs for your stool.

    • See the link provided below in my comment to J.E., for another leg of the ‘stool’.

      In support of that link, there’s this; “Rep. Tom Perriello (D-VA) comments; “If You Don’t Tie Our Hands, We Will Keep Stealing”

    • Geoffrey, I would enter your links, but they seem not to open when I knock.

  11. “I pointed out that soon ALL Americans will have to worry about existential tradeoffs between current medical outlays and unsustainable public debt, played out on the floors of Congress.”

    ‘Soon’ is already here:
    Congress Is Looting Federal Worker, Military Retirement Funds

  12. At no time have I ever objected to taxpayer subsidized healthcare for those serving in the armed forces or vets.

    What I have pointed out again and again is the utter hypocracy of complaining about “socialized” medicine for other people while at the same time one’s own snout is burried deep in the taxpayers trough.

    And if the argument against universal health insurance is the forced subsidization of other people’s healthcare (particularly, people who come within a category we feel we can “demonize”) why not take this argument to it’s logical conclusion and allow everyone dine a la carte on the tax system, and not just our Kind Host? For instance, if I think we have a bloated military, and civil servants shouldn’t have preferential pensions and healthcare, shouldn’t I be allowed a pro-rata tax-rebate to reflect my consciencious objection to paying for these things from my hard earned money?

    I am more than delighted that our serving servicemen and women have such excellent provisio at taxpayers expense. I for one am glad to pay for it as recognition for their service. However, to my knowledge, ex-servicepersons in other democracies have no special priviledges as regards healthcare provision and enjoy the exact same healthcare entitlements as any other private citizen.

    By the way, is any one here concerned about all this socialized healthcare sapping the morale of our vets?

    • Labeling people who volunteer to literally risk life and limb in your defense, at low pay and with substantive sacrifice to family.. as having, one’s snout “buried deep in the taxpayers trough” is a particularly loathsome charge and amply demonstrates your unworthiness of that defense.

      “why not … allow everyone dine a la carte on the tax system, and not just our Kind Host?”
      Because the military is the sole exception, their pay essentially fixed and the nature of their mission uniquely important and necessarily unresponsive to capitalism’s incentives.

      “For instance, if I think we have a bloated military, and civil servants shouldn’t have preferential pensions and healthcare, shouldn’t I be allowed a pro-rata tax-rebate to reflect my conscientious objection to paying for these things from my hard earned money?”
      No, for the same reason that I can’t ask for a tax-rebate to offset my tax dollars going to pay for public abortions.

      Ex-servicepersons in other democracies reside in socialistic economies where universal heathcare is the norm. The problem for those other democracies, other than the inherent injustice of society stealing from those who have, to give to the have-nots is that those societies are not self-sustaining. Even with US subsidization of their defensive needs, those entitlement societies are collapsing financially.

      The only thing sapping the moral of our vets is the correct assessment by them of liberals and Democrats having abandoned a belief in victory. A word almost non-existent in the modern liberal lexicon. When Obama retreats from Afghanistan, the military and those families of the killed and maimed will know that Obama and the liberals will have made their sacrifice in vain.

      Infamous is too polite a word to use when describing such perfidy. Sedition, an inadequate description of the offense. If not semantically correct, treasonous appeasement the blunt truth of the matter.

  13. A couple of peterwise’s points are worth responding to.

    One is the claim that the military has “socialized medicine.” It doesn’t. If it had socialized medicine, everyone in America would be eligible to receive it. But, of course, the only people who have access to military medicine are those in uniform, and, on a more limited and selective basis, their families, and veterans under specified circumstances.

    Military medicine is also selective within its already discriminatory boundaries. Except for life-threatening emergencies in situations where family members have no alternative emergency-care options, the active-duty uniformed are ALWAYS seen first. They can show up last for clinic walk-in hours and still be seen first. Everyone understands this is how it SHOULD be. There is naturally no such understanding in socialized medicine.

    What the military has is dedicated medicine. Socialized medicine is the opposite. And since socialized medicine can’t discriminate regarding its clientele, it limits costs by limiting treatment options and providing less service than the clientele would be willing to pay for on an individual basis.

    peterwise makes (by implication) another invalid point, which seems to be that accepting the benefits offered for military service is inconsistent with regarding such benefits as unsustainable for the entire population. This is the simplest of logical distinctions. Whether one has served in the military or not, one can quite consistently believe that a benefit extending to fewer than 6-8% of all Americans at a given time is appropriate and sustainable, whereas that same benefit is unsustainable for 100% of Americans.

    If you don’t think military retirees should receive this kind of benefit, peterwise, just say so. That would at least be a consistent position, and one you are perfectly free to hold.

    • It IS socialist medicine. Just because it’s socialism for a favoured few and not universal doesn’t mean it’s not socialist medicine red in tooth and claw. In trying to redefine your nice little perk you are tying yourself in knots.

      So, lets play along with your little word game. Why should you and other government retirees have the priviledge of “dedicated” healthcare provision while the other taxpayers who pay for your perk don’t? Now, I can see why serving members of the armed forces should have their healthcare looked after by the government – particularly given the fact that it is a risky profession for some – but why military retirees and their families should have a special place at the forefront of the tax-payer’s trough beats me.

      I don’t resent your socialist healthcare (even though I am not a supporter, not of the socialist healthcare you enjoy, but of universal private insurance). What really gets my goat is your hypocracy and your resentment that others (from he private sector working poor and other categories you think its ok to “demonize”) shouldn’t have what you seem to see as your God given entitlement.

      Your final point is equally specious. It’s essentially the same argument that the robber-bankers from our taxpayer-bailed financial institutions use to justify keeping their bonuses for losing our money. In fact, lets re-introduce the nobility altogeher. After all, in the wider scheme of things, if there are sufficiently few of them it won’t make much of a difference. Come to think of it, perhaps we Have re-introduced a new nobility.

      To misquote, Kind Host, you are all noblesse and very little oblige……

  14. “Whether one has served in the military or not, one can quite consistently believe that a benefit extending to fewer than 6-8% of all Americans at a given time is appropriate and sustainable, whereas that same benefit is unsustainable for 100% of Americans.”

    …..and how many non-Americans?

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