The New York Times ^ | September 16, 2012 | Steven Rattner
Posted on Wednesday, September 26, 2012 9:16:09 AM by ConjunctionJunction
WE need death panels. Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget. But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical. Most notably, President Obama’s estimable Affordable Care Act regrettably includes severe restrictions on any reduction in Medicare services or increase in fees to beneficiaries. In 2009, Sarah Palin’s rant about death panels even forced elimination from the bill of a provision to offer end-of-life consultations. Now, three years on, the Republican vice-presidential nominee, Paul D. Ryan, has offered his latest ambitious plan for addressing the Medicare problem. But like Mr. Obama’s, it holds limited promise for containing the program’s escalating costs within sensible boundaries. The Obama and Ryan plans are not without common ground; both propose an identical formula for capping the growth in Medicare spending per beneficiary. And both dip into the same toolbox (particularly lower payments to providers) to achieve a reduction of nearly $1 trillion in Medicare expenditures over the next decade from projected levels. That’s where the agreement ends. Mr. Ryan believes that meeting the goal over the long term requires introducing more competition into Medicare through vouchers to purchase private insurance.