It depends who you are talking to what will be achieved by Privatizing Ryan's Roadmap to Ruin budget plan should it be enacted. Most people either come down on the side of "it ends Medicare" or "it ends Medicare as we know it," while the Randians like Ryan insist on pretending that it "saves Medicare (okay, something we will call Medicare) for future generations."
Those in the last group are engaging in that age-old-and-time-tested political tactic that we call "lying" when they make that claim. They may call whatever private-insurance apostasy that they want to foist on those of us under 55 "Medicare" but it will look as much like the Medicare our parents know and love as a McNugget looks like a chicken.
Medicare has been wildly popular and extremely effective at delivering healthcare to America's elderly and disabled people for nearly fifty years, and as a result of that, it has been in the crosshairs of republicans and other assorted miscreants and privatizers for it's entire existence.
It was Rahm Emanuel who said "never let a crisis go to waste" and immediately he got hammered by republicans and their mouthpieces, but they were only protesting because they wanted to deflect attention from their own pioneering work in that same field of endeavor. It was just short of brilliant the way they ran up the deficit and depleted the nation's coffers when they were in power, making it possible for them now to scream, wail, gnash their teeth and rend the cloth from their breast as they decry the deficit and insist that "we're broke!" and all the safety net programs have to be gutted, if not outright shut down, otherwise the republic is doomed.
Credit where credit is due: When they get rolling, they can be far more melodramatic than any 8th-grade girl's-school production of Romeo and Juliette, and just hope that no one fact-checks them.
For a plan that they insist is necessary because the current system is headed for bankruptcy, it sure doesn't save any money. In fact, according to the Kaiser Family Foundation, privatization would actually cost 11 percent more for the exact same services than leaving the current system in place -- and that cost disparity would widen over time, not shrink. The CBO, the non-partisan research arm of Congress, estimates that by 2022, the year the Ryan plan would start screwing retirees, it would cost a whopping 34% more than simply maintaining the current system.
The hard, cold truth is that those of us under 55 would pay more for less than our friends, siblings and spouses who are a little bit older. Our out-of-pocket expenses would skyrocket, amounting to about $6400 per year more than those born a year or two earlier.
Pity the person in their late forties who finds him- or herself struggling in this economy, underemployed, and likely to stay that way. Those poor folks get screwed seven ways from Sunday if Ryan gets his way. They will get no respite at age 65. The formerly middle class middle manager who is stocking shelves at Wal-Mart and depleting their 401K to pay the mortgage on a house that has lost a third of it's value is suddenly paying in a lot less in payroll taxes and this will affect the amount of benefit they are eligible for at retirement. Where they were on track to draw the maximum, they now stand to see their monthly benefit reduced by two or three hundred dollars, and they are depleting their savings now to save their house, so there may be nothing to supplement it. To add insult to injury, that thing they, in the spirit of George Orwell, want to call Medicare takes five hundred and change off the top of what they will get, eating up about half of their future Social Security checks, transfering that money directly to insurance companies and removing it from the economy of the areas where the seniors reside and spend their Social Security checks on living expenses.
The CBO also found that the greater cost-sensitivity could result less frequent use of newer and more expensive -- but frequently beneficial -- technologies and procedures than occur now under current law. In other words, the Ryan plan would kill that innovation that the republicans are forever insisting that free-market forces will certainly bring to bear if we just unfetter the market and let it work it's magic on our healthcare system.
There is one thing that republicans always say when healthcare is the topic that I can't believe they get away with. They always, without fail, say that they don't want a government bureaucrat between you and your doctor.
This has to register a full five cow-pies on the BS-o-Meter.
Let me provide a little anecdotal evidence and tell you about my experience with reimbursements and the filing thereof, since I did some of that in both of my two most recent jobs.
I was the second shift supervisor of a hospital phlebotomy crew...this meant that we had a waiting room full of patients up until 4:30 or so, and then we saw any stragglers that came in. I did the paperwork and filed for payment for the stragglers. When I went to another hospital and worked third shift, part of that job was processing specimens that came in to the hospital lab from doctor's offices and smaller hospitals either for in-house testing or as send-outs to Mayo, ARUP or Quest/Nichols. After I processed the specimens, I processed the "paperwork" for payment and filed the claims electronically.
I can count on one hand the times I had a Medicare claim bounce back requiring more information or a call to their offices during business hours that I had to leave in the day shift's inbox -- and it was almost always a coding error that was quickly resolved. Private insurance was just the opposite. The technologists on day shift in that facility finally revolted at the revolving insurance-resolution job that no one wanted to do, and the lab director had to go to the budget committee and add a full-time employee to her staff, an associates-level technician who did nothing but resolve insurance claims five days a week, eight hours a day.
The dirty little secret is this: There already is a bureaucrat standing between you and your doctor. But he or she doesn't work for the government. They are bean counters for an insurance company, and their bonus depends on them denying you the care your doctor deems you need.
If Ryan's plan were to see the light of day, every claim for every procedure would get that sort of unreasonable scrutiny by a Utilization Management Panel. You are familiar with these -- Sarah Palin called them "death panels" and they are the stock and trade of the private insurance / managed care / profit driven healthcare system she was desperately trying to preserve.
I realize that Ryan tends toward Randianism, and Randians are, by definition, emotionally stunted, amoral and selfish. Indeed, selfishness is not merely a virtue, it is the highest, if not only, virtue to the true Randian.
So I have to wonder, what's in it for Ryan to put in place a policy that would transfer massive amounts of formerly middle-class wealth to private insurance companies? If he is really a Randian, he has an angle he is working. And if he doesn't, he isn't a Randian, he's just a garden-variety sociopath.
After years of researching the perfect idea for a business, Oren Bloostein had finally created a solid business plan for a specialty coffee shop on the Upper East Side of New York City called Oren's Daily Roast. But like most entrepreneurs, he was soon faced with the daunting challenge of financing it. So, in addition to $30,000 of his own savings, his parents gave him $50,000, and he got a bank loan for $25,000, which his parents also guaranteed.
From that point forward, his parents would play a significant role in the company's growth.
"I started the company in 1986, but it took almost a decade before I could borrow using assets from the business. The first eight years of expansion, which included six more stores and a factory, the loans were all guaranteed by my parents' assets," says Bloostein. "But the lines were clear. My parents weren't part owners, but my dad and I would have regular meetings, at which I would present him the numbers, projections, revenue, and everything."
His savvy approach helped his company become what it is today—a nearly $10 million business with nine locations in Manhattan. The moral of the story? Mom and Dad can be a great source of financing, but there's a right way (and a very wrong way) to approach that initial conversation about money.
"Almost 90 percent of the small businesses in this country are family-owned, so it's no surprise that the first place entrepreneurs turn for financing is the family," says Tom Deans, family business expert and author of Every Family's Business.
Of course, the personal dynamic between parent and child can pose rather unique obstacles when it comes to financial agreements for a small business venture. In Laymen's terms: Beware of drama.
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"Families run on a value system of democracy and transparency," says Deans. "The value system of a business, however, is based on hierarchy and meritocracy. They naturally clash. But there are steps you can take beforehand that can make the merger work."
Here are a few things to consider to make that first sit down with Mom and Dad as drama-free as possible.
Avoid casual conversations. Keep quiet about your brilliant business idea until you have a fully developed business plan. Deans says this seems like common sense, but too often that carefree, casual relationship you have with your parents can cause confusion later on. Wayne Rivers, president of the Family Business Institute agrees. "It's the lack of formality in these informal conversations get people in trouble," he says. "You can end up making promises you won't want to—or can't—keep later on." For Bloostein, the financing sit-down didn't happen right away. "I had been working on a business plan for almost six years," he says. Though his parents knew of his small business ambition, it wasn't until he had a virtually "no-risk" plan that any money talk began.
Vet your business plan. Rivers says you should not only have a sound business plan, but a third party should vet it. "There's so many services online where you can have experts evaluate your plan," he says. "Give your parents, and yourself for that matter, the peace of mind that this business will be a sound investment, and not just another hobby." A good place to start is the U.S. Small Business Administration's list of local resources.
Write a promissory note. If you are asking for a loan from your parents, both experts suggest drafting a promissory note, or a simple document that outlines the terms of the loan. This will answer your parents knee-jerk questions: "How will you pay us back, what will the interest rate be, and how long will it take to repay in full?" It will also prevent any confusion later on. "Be as specific as possible in the note," adds Rivers. "You don't want to have a conversation about how you promised to pay back the money in two months and there's no written record of it."
The early inheritance option. If your parents are of means, you could also ask for early inheritance. "I am actually a big proponent of parents giving their kids wealth," says Deans. "The money is forwarded to the kid while they are still alive. There's an element of reward for the parents to see their legacy put to good use while they're alive." But Deans suggests that this arrangement should most definitely be written into a legal contract.
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Consider your siblings. Whether a loan or gift, remember that you are tapping into the family reserve—and your siblings might not like it. "If the parents are going to loan one kid $20,000, do the other kids get the same bite of the apple?" asks Rivers. "Or if the parents are of modest means, and one child wipes out all the savings, what happens to everyone else? You can't have the black sheep brother wiping out the family farm on a failed business venture." Deans suggests bringing the siblings into the initial conversation. "It will show your parents that you are serious, and show your siblings it isn't a rivalry," he says.
Get a small traditional bank loan, too. This might sound a little strange, but Deans says that going to a traditional lender for just a small loan can go a long way if your parents will be the larger investor. "If you can secure a small loan first, your parents, who are more likely to extend money based on good will, immediately have a sense of comfort that your idea is sound investment," he says. "The traditional lender will have looked at the business plan, executed the due diligence, and given the business a thumbs up."
Have a plan for future meetings. Both experts agree that managing transparency is key in keeping the peace between family and the business. Like Bloostein, work out a meeting schedule that works for you, your parents, and your business. And have this meeting schedule in place from the beginning, telling them how often they will get updates on how the business is doing and—more importantly—how their money is doing. Laying out the terms for the professional interactions in the first conversation will provide a less stressful framework from which you can go forward. "It doesn't have to be a daily conversation," says Rivers. "Set up quarterly, or semi-annual meetings where you will share the status of your business. Just something to give everyone a structure."
Finally, remember the other relationship at play. That is, the relationship between your parents and their money. Are they likely to finance this type of thing? Have they done it before? Can they handle the financial demands? "Remember, just because they are your parents, doesn't mean they have to say yes," says Rivers.
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