文章来源:太平洋电脑网软件资讯频道|彩摘网布衣天下删除彩摘网布衣天下删除发布时间:2019-12-11 06:43:36  【字号:      】


  Senate Democrats, including several of the party’s presidential candidates, have savaged President Trump for proposing to reduce Medicare spending by several hundred billion dollars over the next decade.

  Senator Kamala Harris of California said the proposed changes in Medicare “would hurt our seniors.”

  Senator Elizabeth Warren of Massachusetts tweeted, “The Trump administration wants to cut hundreds of billions of dollars from the #Medicare budget, all while giving billionaires and giant corporations huge tax breaks.”

  The Hawaii senator Brian Schatz, the rare Democrat who is not running for president, offered the following summary: “One party wants to expand Medicare and Medicaid, and the other wants to cut them.”

  But some cuts to Medicare make sense. Several sought by Mr. Trump closely resemble cuts that had been proposed by President Barack Obama. And the indiscriminate attacks by Senate Democrats are a reminder of how hard it has become for Congress to perform even the most basic kinds of prudent housekeeping in the public interest.

  When Americans with Medicare visit a doctor’s office, the federal government pays a higher fee if that office happens to be owned by a hospital. This bonus payment serves no obvious purpose. A federal advisory board created to monitor Medicare spending has called for its elimination. And this month, the Trump administration proposed the change in its 2020 budget, along with several other measures recommended by nonpartisan experts to reduce payments to service providers without directly affecting the cost or availability of care.

  In total, Mr. Trump’s budget would cut proposed Medicare spending by 5 billion over the next decade. About a third of that money would come from moving funding for certain programs to other parts of the federal budget, and pruning, so the actual reduction in spending would be in the neighborhood of 0 billion. The largest chunk of those cuts would come at the expense of hospitals that are paid more than independent doctors’ offices to treat patients.

  The two-rate system has its roots in the real differences between a hospital and a doctor’s office. Hospitals tend to treat less-healthy patients; they provide a safety net of related services if something goes wrong; and they must comply with more stringent rules. But that line was warped as hospitals acquired physicians’ offices, taking advantage of their eligibility to collect larger payments from Medicare. Also, advances in medical technology have increased the range of services that can be provided outside a traditional hospital.

  In 2015, Congress sought to stem the trend by barring higher payments to any new offices acquired or established by hospitals — but existing practices were grandfathered in.

  The Medicare Payment Advisory Commission, a federal panel created in 1997 to provide advice on Medicare spending, has recommended the end of that exemption. The White House budget estimates the change would save .7 billion between 2020 and 2029. A pair of more complex but related changes intended to equalize billing for procedures including medical imaging and drug management would save 0 billion more over the same period.

  Hospitals understandably dislike these proposals, and there may well be a better dividing line. It’s also possible that in some cases, the federal government should pay higher fees to private practices rather than pay lower fees to hospital affiliates. The administration’s budget contains only a thumbnail sketch of its own ideas, and the details clearly matter.

  But Democrats are not debating the details. Instead, a proposal to improve the efficiency of health care spending is being treated as an attack on the availability of health care.

  This is not a new phenomenon, of course. The Affordable Care Act included substantial reductions in Medicare spending. Those cuts, like Mr. Trump’s proposals, came mostly at the expense of providers rather than patients. But Republicans chose to attack the changes in language strikingly similar to the language Democrats have used in recent weeks.

  Both parties have fallen into the unfortunate habit of characterizing every proposal to reduce Medicare spending as an attack on the program’s beneficiaries. In fact, careful stewardship of spending is necessary to ensure the program can help as many people as possible.

  Mr. Trump is guilty of contradicting his campaign promise that he would not seek to cut Medicare spending. But it is the promise that was irresponsible, not the budget proposal.

  Some items on Mr. Trump’s list of proposed savings have obvious downsides. For example, he has proposed to cut federal spending by increasing the annual amount that several hundred thousand Medicare beneficiaries are required to pay for needed medications. The budget also proposes large cuts in Medicaid that would reduce the availability of health care for many lower-income and disabled Americans.

  But a president’s budget is just a list of ideas. It's up to Congress to pick the good ones.

  Support for past cuts in Medicare spending was driven in part by concerns about the growth of the federal debt. Both parties lately have taken a more relaxed view of the government’s borrowing capacity, in part because apocalyptic predictions about the current level of federal debt look rather silly in retrospect. But the government’s ability to borrow money is not a justification for the wasteful spending of tax dollars.

  Maintaining tight control of Medicare spending is good government in its own right. Congress ought to feel a sufficient urgency about eliminating unnecessary spending even if the federal government were running an annual budget surplus.

  Ms. Harris, Ms. Warren and other Democratic presidential candidates — including Senator Kirsten Gillibrand of New York, Senator Cory Booker of New Jersey and Senator Bernie Sanders of Vermont — have become vocal proponents of expanding Medicare eligibility.

  The case for such an expansion would be strengthened if proponents showed greater concern not just for broadening the availability of health care, but also for managing the cost of care.

  The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.

  Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.



  彩摘网布衣天下删除【在】【即】【墨】【西】【城】【的】【指】【导】【下】,【沐】【泽】【吹】【奏】【笛】【子】【越】【来】【越】【好】,【魔】【法】【实】【力】【也】【越】【来】【越】【强】,【与】【即】【墨】【西】【城】【也】【越】【来】【越】【熟】【悉】。 【沐】【泽】【把】【即】【墨】【西】【城】【看】【做】【最】【好】【的】【朋】【友】,【最】【知】【心】【的】【大】【哥】【哥】,【有】【什】【么】【心】【里】【话】【也】【会】【告】【诉】【他】。 【即】【墨】【西】【城】【大】【部】【分】【时】【间】【都】【在】【听】,【只】【偶】【尔】【说】【几】【句】,【看】【起】【来】【很】【高】【冷】,【但】【是】【只】【有】【他】【自】【己】【知】【道】,【沐】【泽】【对】【他】【来】【说】【有】【多】【重】【要】。 【沐】【泽】【是】【他】【孤】

“【老】【高】!”【因】【为】【路】【途】【遥】【远】,【途】【中】【还】【要】【办】【公】,【所】【以】【杨】【齐】【是】【坐】【在】【车】【驾】【里】【面】【叫】【道】:“【前】【面】【是】【什】【么】【地】【方】?” “【大】【人】,【还】【有】【几】【十】【里】【就】【是】【保】【定】【府】【了】。”【高】【诚】【贞】【骑】【在】【马】【上】【在】【车】【驾】【的】【旁】【边】【说】【道】。 “【外】【面】【情】【报】【如】【何】?”【杨】【齐】【问】【道】。 “【这】【一】【个】【来】【月】,【从】【全】【国】【各】【地】【陆】【陆】【续】【续】【起】【兵】【的】【有】【五】【十】【余】【万】【人】!”【高】【诚】【贞】【仔】【细】【回】【想】【着】【各】【地】【送】【上】【来】【的】

【心】【里】【迫】【切】【的】【不】【得】【了】。 ***【时】【间】【吃】【饭】【啊】? 【不】,【当】【时】【他】【压】【根】【没】【有】【想】【到】【吃】【饭】【这】【回】【事】。 【孟】【缉】【熙】【很】【是】【清】【晰】【的】【剖】【析】【了】【自】【己】【当】【时】【的】【心】【态】。 “【现】【在】【都】****【了】。” “【再】【迟】【些】【就】【可】【以】【直】【接】【吃】【晚】【饭】【了】。” 【孟】【缉】【熙】【向】【后】【靠】【在】【椅】【背】【上】,“【反】【正】【现】【在】【该】【跑】【的】【地】【方】【都】【跑】【完】【了】。” “【接】【下】【去】【我】【也】【不】【知】【道】【要】【去】【哪】【里】【了】。”

  【一】【声】【惊】【天】【动】【地】【的】【爆】【裂】【从】【古】【树】【之】【中】【传】【来】,【巨】【大】【的】【树】【木】【顷】【刻】【间】【簌】【簌】【抖】【动】【着】,【化】【作】【了】【一】【颗】【颗】【晶】【莹】【剔】【透】【的】【小】【珠】【子】,【簇】【拥】【着】【一】【颗】【暗】【红】【的】【灵】【珠】【缓】【缓】【升】【起】。 【那】【两】【只】【帝】【江】【哀】【嚎】【着】,【在】【古】【树】【寂】【灭】【之】【后】,【飞】【鸟】【的】【形】【态】【顿】【时】【化】【成】【了】【无】【数】【流】【光】,【流】【光】【之】【中】【有】【一】【个】【闪】【着】【荧】【光】【的】【铃】【铛】【浮】【现】【了】【出】【来】。 【展】【青】【痕】【射】【出】【那】【一】【箭】【之】【后】,【整】【个】【人】【都】【虚】【弱】【了】【下】【去】彩摘网布衣天下删除【林】【飞】【一】【进】【入】【天】【地】【谷】,【就】【马】【上】【向】【天】【残】【发】【送】【传】【音】。 “【主】【人】,【你】【终】【于】【来】【了】!” 【天】【地】【谷】【的】【深】【处】,【某】【一】【处】【隐】【蔽】【的】【虚】【空】【之】【中】,【正】【在】【盘】【膝】【打】【坐】【的】【天】【残】,【收】【到】【林】【飞】【的】【传】【音】,【不】【由】【得】【大】【喜】。 “【主】【人】,【我】【去】【迎】【接】【你】!” 【惊】【喜】【之】【下】,【天】【残】【立】【即】【想】【站】【起】【来】,【去】【接】【林】【飞】。 【几】【个】【月】【不】【见】【主】【人】,【天】【残】【有】【点】【心】【急】。 【要】【知】【道】,【凡】【是】【被】【木】【偶】【之】【线】【收】【服】

  【庄】【青】【不】【会】【让】【这】【个】【事】【发】【生】,【他】【也】【不】【会】【让】【这】【些】【发】【生】,【因】【为】【他】【本】【身】【就】【不】【是】【那】【种】【属】【于】【喜】【欢】【别】【人】【怎】【么】【样】【怎】【么】【样】,【喜】【欢】【别】【人】【如】【何】【如】【何】,【喜】【欢】【别】【人】【在】【他】【面】【前】【一】【个】【劲】【的】【唠】【叨】,【甚】【至】【于】【说】【个】【没】【完】【没】【了】,【甚】【至】【于】【他】【自】【己】【都】【不】【知】【道】【应】【该】【怎】【么】【去】【面】【对】【那】【些】【人】【的】【事】【情】【出】【现】。 【因】【为】【太】【麻】【烦】,【因】【为】【太】【辛】【苦】【太】【累】。 【庄】【青】【是】【一】【个】【嫌】【弃】【麻】【烦】【的】,【是】【的】【了】,

  【花】【梦】【影】【手】【中】【的】【飞】【刀】【丝】【毫】【没】【有】【松】【懈】,【问】【道】:“【你】【是】【何】【人】?”【女】【子】【一】【步】【一】【步】【地】【接】【近】【他】:“【我】【是】【谁】【不】【重】【要】,【重】【要】【的】【是】【你】【的】【事】【情】。” 【花】【梦】【影】【道】:“【你】【有】【话】【直】【说】【吧】。”【女】【子】【道】:“【天】【竺】【迷】【圣】【已】【准】【备】【率】【领】【诸】【多】【高】【手】【前】【来】【中】【原】【挑】【衅】,【并】【且】【列】【了】【一】【个】【名】【册】,【各】【大】【门】【派】【的】【掌】【门】【人】【以】【及】【帮】【派】【等】【人】【物】【都】【被】【列】【入】【其】【中】,【你】【也】【在】【里】【面】,【并】【且】【是】【他】【的】

  【白】【木】【天】【继】【续】【说】:“【但】【是】【这】【样】【做】【有】【一】【个】【缺】【点】,【而】【且】【这】【个】【缺】【点】【在】【其】【他】【生】【物】【实】【验】【上】【都】【出】【现】【过】。【就】【是】【实】【验】【样】【本】【太】【小】,【短】【短】【几】【代】【人】【能】【够】【繁】【衍】【出】【来】【的】【后】【代】【太】【少】。【这】【些】【人】【都】【来】【自】【相】【同】【的】【祖】【先】,【他】【们】【或】【许】【都】【带】【有】【某】【种】【相】【同】【的】【基】【因】【缺】【陷】。 “【说】【不】【准】【因】【为】【某】【个】【意】【外】【发】【生】,【这】【些】【人】【会】【在】【同】【一】【时】【刻】【集】【体】【死】【亡】。【历】【史】【上】【多】【次】【出】【现】【物】【种】【灭】【绝】【事】【件】,【每】