Older and younger voters are split this year as never before. And the future of the massive Medicare health program for the elderly promises to pit generations against each other, even more as retiring baby boomers prepare to swell its ranks.
Older and younger voters are split this year as never before. And the future of the massive Medicare health program for the elderly promises to pit generations against each other, even more as retiring baby boomers prepare to swell its ranks.
Reforming Social Security now would be prudent. Reforming Medicare now is urgently needed.
I will be on Medicare in six years and I do not look forward to the experience. Fix it.
I AM on it….and the V.A. medical system, and they BOTH need fixing!
The fix is in, and you will not like it. It will be called “Evidence Based Medicine” and will scientifically prove that since an overweight 70 year old diabetic has a “3x worse outcome” having neck surgery to prevent paralysis, than a healthy 40 year old, that therefore he should not get it. The fact that the difference in mortality would be something like 3% rather than 1% will not change the fact that it will be “a 300 percent increase”. It will be considered “fraud and abuse” to suggest treatment outside these “scientifically established guidelines”.
This wil be similar to the “fix” in the educational system whereby we learned that every child who struggles in school has a “verifiable disease” such as ADD or bipolar (all of which were dreamed up in committee) which “proves” that less should be expected of them.
I am old enough to remember sitting in a Washington DC public elementary school with 30 other children, none of them wealthy, all of whom were well behaved, and most of whom could read and write adequately if not brilliantly.
In the same school, almost half the kids have some sort of “diagnosis” now…
I imagine that the new Medicare/Hillarycare whatevercare will look very much like education does now, with “scientific reasons” why none of us will qualify for the care that is considered normal today.
Clueless [#4]: What would be the best way to deal with health care in general and Medicare in particular?
The federal government give a tax break to the health insurance industry by excluding some health insurance payments from income. I wonder what additional revenue would come to the federal government if all such payments were taxable.
The whole system is very complex and all the players seek to game it for their own benefit More money is needed and so are greater economies in delivery of service.
My husband and I refuse to enroll in medicare. I figure the one who pays the piper calls the tune, and where our health is concerned, we will be the ones who call the tune, not the government.
#4 Then you’d put the government in the position of deciding who lives and who dies…..simply because they can’t afford to get sick? That’s SICK!
#8 That has already happened in every country that has a national health service.
#5: It is necessary to do several things:
1. Control costs to providers
2. Increase competition between providers
3. Remove third parties
If it were up to me I would propose the following:
1. Reform malpractice by having a “loser pays” system and by permitting people to agree to binding arbitration on condition of coverage/provision of care.
2. Reform education by permitting people to decrease their medical school costs by taking non-clinical courses on line, and by taking exams that permit them to test out of non-clinical courses. (Right now future physicians graduate 150,000 in debt).
3. Have patients pay their costs up front and get reimbursed by insurance companies, rather than the other way around. Insist that insurance companies publish their criteria for getting various services in easy to read format on the web.
4. (Alternately to #2, have a large deductable with
catastrophic care coverage).
5. Force physicians to publish their fees for office visits (which would be standard, and not linked to which insurance company you belong to).
6. Force physicians to publish their mortality rates (stratified by age and by severity of illness) for all surgeries.
7. Force physicians to see all comers (after all they will be paid in cash – the patient, whether medicaid or blue cross would get reimbursed later for anything other than catastrophic care).
8. Permit non physicians to prescribe most non-addictive drugs (particularly psychologists, optometrists, dentists, pharmacists etc. as long as they took let us say a three to six month course on prescribing). Most interactions with a nonspecialist (ear infection, urinary tract infection etc) is not rocket science. Right now, the only reason it hasn’t gone further is because the malpractice risk to nonphysicians prescribing is so high.
9. Finally, understand that we all die. All of us. In point of fact there should be some limits to care. A 98 year old man who is unable to feed himself or walk should be DNR. Malpractice forces physicians to act as though everybody could live for ever. There needs to be guidelines as to who gets care, because care is expensive. Those guidelines, however needs to be published on the web in language that ordinary people can understand. Those who don’t like the guidelines should be allowed to pay for supplimental insurance to cover specific situations that will be expected to fall outside the guidelines.
Shari (who is not betting on any of this happening).
Katherine (#2),
I’m disabled and finally completed my two-year mandated wait for Medicare. (LOL, another story, I won’t even go there!)
I’m very pleased with it, actually. I signed on with a Medicare Advantage company rather than traditional Medicare. It’s only costing me an additional $15 per month, it has excellent coverage with no deductible, and it even covers preventative dentistry, eye exams and glasses, and a health club membership. Frankly, it’s a HUGE improvement on the Blue Cross/Blue Shield plan I had when I was still able to work.
If anyone in Washington would simply employ common sense, they could save big by fixing stupid rules and tweaking policies. For example, my GI doctor wanted to do both an endoscopy and a colonoscopy on me. I asked him if he could do them both at the same time and he said, yes, HE could but the insurance rules wouldn’t permit it. I had to have one done, wait a day, and then have the other done. Two anesthesias, two teams, two physicians’ fees, two facility fees, etc. That doesn’t make sense!
As the candidates point out, simply mandating electronic med. records would save big bucks. Many of us have had tests repeated and illogically done because the doctors don’t have our medical records handy and they can’t take our word for the particulars.
I pay $110 per month, with the Medicare premium and the Advantage plan fee. I also have copays, of course. But, obviously, the private company that provides my Medicare Advantage plan is making money (even with covering a high-risk population!) or they wouldn’t participate.
Electronic medical records would save big bucks in about 20 years, but would greatly increase costs immediately. Who would pay these costs? The physicians and hospitals passing the costs to the folks with private insurance? Or will the government pay for it running up the deficit?
The reason “teatime” that your bill is so low is because you are not paying your full price. Instead the “uninsured” are required to pay full charge (physicians are not permitted to write off the charges to the uninsured as this is considered “medicaid/medicare fraud”) and private insurance picks up the rest.
This worked as long as there were enough working folks with Blue Cross Blue Shield. However as more employers drop these policies, more physicians are being forced to limit their medicaid and medicare population. Thus, here in Missouri I am the only person who sees kids with neurological disease (almost all medicaid) between Little Rock and Springfield (and I limit them to 2 new patients a week) and if I did not my practice would go bancrupt, and I wouldn’t be able to pay my overhead. Every other pediatric specialty has vanished from this area, and usually care is found in either Kansas City or Little Rock, and most kids wait over 6 months.
In Northwest Arkansas seniors with Medicare are also waiting over six months for a new patient appointment (no wait for Blue Cross/Blue Shield).
The trouble with price controls is that you can’t make a provider sell a service for less than cost. They will either find a way to stop providing the service (limiting their services to “tummy tucks etc.) or they will go out of business.
If you insist on price controls, then waits increase (as has happened in those countries with a national health system) and nature controls costs “naturally” as folks die while waiting for their hip replacement or stint.
I would be very happy to think that “tweaking” the system would work. Unfortunately, we have been tweaking away since 1981 when DRGs came in. We have now run out of individuals to shift costs too, and real choices will need to be made.
Shari
To explain, the reimbursement from Medicaid does not cover so much as the receptionist and office rent, let alone transcription, malpractice, nursing support, billing and equipment. Most physicians office running overhead runs about 150,000 a year before the physician sees a dime. (That does not include medical school costs).
Medicare almost but not quite breaks even. Thus, if you were to limit your practice to private pay only a nonsurgeon would make about 300,000. If you limited your practice to Medicare and private pay only, a nonsurgeon would make about 200,000, if you saw all comers you would be overun with medicaid and would go out of business (I know, I tried) or else be forced to run a “mill” seeing patients at 5 to 10 minute intervals.
Medical costs are high. This is largely because of all the other regulations that physicians bear. Adding the cost of a national data base will increase those costs (which will need to be transfered to somebody, usually those with Blue Cross). Nobody has a money tree in their back yard. Not patients with Blue Cross, not the federal government and certainly not physicians.
#11, I find it interesting that you hold up BC/BS when I’ve heard my doctors’ staffs and hospital people groan about BC/BS. Their reimbursement rates are incredibly low. When I would get my bills and see how incredibly little they paid for visits, lab work, etc., I was shocked. Sometimes their allowable amount was one-tenth of the billed amount!
My former employer paid all of my med. insurance; when I took it over under COBRA, I paid the premium myself, which was about $345 per month. My share of the Medicare premium is $115 which, of course, isn’t the total cost but the government is kicking in, I’m sure, just as my former employer paid for all of my premium.
Again, Medicare Advantage isn’t mandatory; I chose it because it made sense for me and the company (in my case, Sterling) must be making money or they wouldn’t choose to participate. Are you saying that people who have other private insurance, such as BC/BS, are subsidizing Sterling and the other companies who provide Medicare Advantage?
Yes, folk with private insurance are subsidizing Sterling and the other companies, but most of all the Federal government.
And while Blue Cross reimbursements are low, they are still higher than most other private insurers, and are incomparably higher than Medicare, let alone Medicaid.
This is why folks around here who only have Medicaid can’t find a physician unless they go to the ER. (This has been true for some 0 years). Those who only have Medicare have been having the same problem for the past 2-3 years. The problem is more severe here (Southwest Missouri/Northwest Arkansas) but is also a problem in the larger cities such as Kansas City or Washington St. Louis. This problem is spreading to even “wealthy” areas, particularly given the downturn in the economy which has resulted in fewer patients having private insurance.
Sorry that was medicaid patients have had trouble finding a doc for about 10 years not “0” years.
As for the Blue Cross price being 1/10 the “list price” this is because Medicare will reimburse only a certain percentage of the “standard price”. Medicaid is required to get the lowest price no matter what. Thus, every insurer fixes itself to a percentage of the “usual and customary charge” (usually a notch above medicare). The only person who is required to pay full freight is the uninsured. Since everybody else gets discounts these must pay full fare or else the physician is charged with “Medicare fraud” as somebody (usually impoverished) is being charged less than medicare.
It is really a problem. Today there were a couple of folks whom I saw a year ago who thought they had Medicaid but apparently had been dropped from the rolls, and were seen in the hospital. My hospital is insisting that I send them to collections, because if one doesn’t pursue this aggressively, then fraud is suspected. I am not permitted to write off the charge or reduce it. (We did suggest they apply for charity care, but they never filled in the application). I am not permitted to set up a little account to put pre tax monies in to pay for the visit. If I wish them to not have to pay, I not only have to see them for free (already done) and then pay the hospital the full undiscounted amount that they would normally have paid me, which cannot be a tax write off as it is not considered charity but transfer of funds.
Shari
Oh obviously the uninsured are also subsidizing you, Teatime. (Not just the folks with private insurance)
Electronic medical records sounds good but it has been proved they don’t work. It took the government 15 years to get the electronic billing to work and not keep changing it just as you have gotten a programmer to comply with the latest version. They have now been 3 years trying to get the national provider number and it still is a disaster waiting to happen and it is just a one item program! Electronic medical records will take the government at least 20 years to get a standardized program that all doctors can use. As for all the cost and availability problems, first there is no free care. Someone must pay. As long as everyone wants to have someone else pay but still get what ever they want there will be chaos. Health savings accounts are the obvious answer, but the real deficite is leadership that will get away from the idea that big government is the answer to all our problems. Just enjoy it all.
I work in the health insurance field and have for almost 12 years. One of the basic problems that we have is that the person receiving the service does not pay for the service. Can you imagine what the price of lunch would be if we all had “lunch insurance” where we were responsible for a small copay or 10% of the bill? A McDonald’s lunch would probably run about $50 rather then $5. There are several things that can help with reducing the cost of insurance.
1. Have high deductible plans where the patient is responsible for the first $1000 or $2000 per person per year. After that, the insurance company picks up the costs.
2. Simplify the billing and payment procedures so that 99.99% of all professional service (i.e. doctor claims) are processed and paid electronically and about 80+% of the institutional (hospital) claims are processed and paid electronically. Right now, the HCFA1500 and UB04 books in the layout are several hundred, if not several thousand pages in length.
3. Privatize Medicare (and possibly Medicaid) such that seniors are given vouchers to purchase basic insurance. That way, the administration of the medicare system is less mired in bureauctratic BS. CMS (Combined Medical Services – Medicare and Medicaid) make it very hard to know the rules, let alone follow them.
4. Provide for significant malpractice tort reform. Binding arbitration should be a condition of coverage and contingency based lawsuits should be limited to 1.5 times the “normal” fee for lawyers. Thus, the person getting the settlement is the person injured in the case, not his or her attorney.
YBIC,
Phil Snyder
#17 — If, by repeating how others are subsidizing my care, you’re trying to make me feel badly for being on Medicare, I’m sorry but it won’t work. I didn’t design the system that bases health insurance on employment or else the government must step in; nor did I expect or ask to get Systemic Lupus that would render me critically ill at middle age. My life isn’t pleasant but I would like to live it for as long as God will give me.
As for the uninsured “subsidizing” my care, fat chance. Most of the uninsured — and I was among them in the gap period between COBRA and Medicare — avoid going to the doctor if at all possible. It’s just too expensive! I could afford one $200 visit to my rheumatologist and he kept me alive with prednisone prescriptions until I could once again have regular care and my disease modifying drugs. The uninsured generally won’t go to the doctor unless it’s an emergency.
Walk-in clinics are another viable option for those without insurance. We went to one that had a small “membership” fee that offered reduced cash prices for those who signed up. A good GP who isn’t afraid of treating the tough cases is worth his/her weight in gold. It’s ridiculous how “specialized” medicine has become and that costs, too.
Teatime- the implicit suggestions of most of the people trying to reform medicare so that you’re more responsible for the cost affirm the sentiment that you’re to blame for your illness, so you should pay. The universal single payer system implies that we’re all trying to help one another out. It’s a much more humane way to manage illness and disease. The consequences for large parts of our economy would be miraculous.
Small businesses and large corporations would be liberated from this very expensive burden because the cost per person would drop enormously. The corporate bureaucracies of insurance would be eliminated with a simple electronic transfers. There would be people paid to audit unusual payments. In sum – nobody’s insurance would increase. If anything, insurance would decrease, and people would be healthier and happier.
This would probably be a payroll tax, except for the unemployed, who would still be covered.
The system would encourage early testing and preventative care. Further, with the guarantee that pregnant women would be cared for, abortions would decrease. Abortions are much cheaper than good pre-natal care. Free prenatal care might allow some women to opt-in to having their child.
annr, what are you doing for medical coverage if you haven’t signed up for Medicare? I didn’t know there were options.
#21 is fantasy, not reality. Check the places where single-payer government medical care has been done. Price controls result in rationing.
Shari describes what worries me most individually. If I stay where I am, my very good internist will keep me after I turn 65. If I move somewhere else, I become a financial liability even though I would be able and more than willing to pay an extra fee to bring the cost of my care up to what others are charged. The doctors can’t take it because it’s “fraud,” as I understand it.
It is a fact that some people have conditions that cost more than other people’s. I’ve been paying a bundle for vision correction all of my life, because I have myopia. Is this “unfair”? Yeah, but it’s life. I don’t ask my neighbors to pay for my expensive progressive lenses so long as I am able to pay for them myself. My eyes aren’t my fault, and my daughter’s asthma isn’t her fault, but we pay more, and that’s the way it is.
John Wilkins, I agree, but I doubt it will happen in the U.S. UNTIL the blame game gets so bad that genetic testing is required to even get insurance coverage at an affordable price.
Heh, but if we let the unfortunate people with diseases die because no one wants to help find a way to provide care for them or, God forbid, contribute any money toward their coverage, then the fortunate, healthy ones only will remain. Doctors, hospitals, and the like will go broke because their services won’t be in much demand. (I guess they can retrain as plastic surgeons, OBs/pediatricians, or ER/trauma physicians for those nasty, unforeseen accidents and violent acts.) Maybe only the healthy, genetically untainted will be allowed to have children, too, so that every child is healthy and won’t be a health-care “burden” on society. Of course, the fetuses would have to be genetically screened to determine if they should even enter the world, and abortion would be advised if any genetic fault or undesirable pre-disposition was found. :>(
When people in a society talk of not wanting to help provide care for other members of that society, we’re on a very slippery slope. I pay taxes to help educate children who are of no relation to me, to provide police protection and help I don’t need, to improve roads I don’t use and parks I’ll never visit, and on and on. I’m happy to do it — it’s called being part of a “community.” It comes with costs and with societal benefits. But those who aren’t willing to contribute toward the common good best THINK before protesting too much. If “ME and MINE” becomes the name of the game, I’ll be happy to buy my own health insurance with all of the money I wouldn’t have to pay in various taxes for schools, highways, police, infrastructure, etc.
Paying in common for services and facilities used in common is a reasonable function of government; for instance, roads, sewers, waste disposal systems, and so on. In addition, America has a long-standing commitment to an educated citizenry, and indeed the continuation of our system of government depends upon an educated (and our founding fathers agreed, virtuous) citizenry, so we can view public education as necessary to the whole even if we don’t have children.
The distinction arises when we begin to talk about the wants and needs of individuals and families. Who pays for my house, my car, my clothes, my food? I do; and if I become impoverished, I look to the generosity of my fellow citizens to help me out, just as I contribute, when I am able, to their assistance if they need it. Is medical care a public service, like roads, or a private need, like food? I certainly don’t argue that nobody should help those who can’t afford doctors — far from it. But experience shows that in general separating the consumer of the service from its cost is a prescription for driving its cost and availability all out of control.
It is precisely because nobody wishes to make the difficult (but rather obvious) choices that need to be made to keep both Medicare and the country solvent that the problem will be “solved” by default.
And the default is and will be “Evidence Based Medicine” which will ensure that folks with significant disabilities will find themselves “scientifically” ineligible for most elective surgeries, anasthesia and procedures as they will be “higher risk” than those without disabilities. Docs who say differently will be accused of commiting “fraud” just as are Docs who try to give free care to the uninsured.
As to teatime, the uninsured are about 15% of hospital ER visits, and about 5 percent of office visits. They do go to walk in clinics however folks who (like you Teatime) need chronic care such as prednisone cannot get this from a walk in clinic.
So yes, the uninsured (most of whom young) do subsidize folks on Medicare. Medicare is and always has been a wealth transfer from the young to the old. That made sense when the young tended to be wealthier than the old. It makes less sense now that the old tend to be wealthier than the young.
Please see the article linked above on “For the Elderly, being heard about life’s end” as a positive view of what “evidence based medicine” is likely to look like. (It’s not all bad, and as noted it is indeed “grounded in research”.
Katherine asked how we manage without medicare. We do have health insurance, from my husband’s company where he worked over 40 years. They at first ( and again and again) insisted that we sign up for medicare. When we made it very plain that we would not, now or ever, they accommodated us. We have $1500 deductible, and since they figure that for both of us it translates to $3000 deductible. My husband has Parkinson’s. We discovered that his meds cost half as much at the local pharmacy for cash than they did through the mail order his company insisted we use. We keep sufficient in a savings account to pay more than the deductible when/if necessary. We keep our cost of living very low, so we are not using every last cent that comes in. Our dentist gives discounts for cash. We subscribe to the county life support co-op for emergency transport ($40 a year). A local bar owner had a fire, and the paper noted he was uninsured. The fellow wrote the paper a few weeks later and pointed out that he had paid into a savings account the amount he would have paid in insurances, and the fund had increased enough (and was drawing interest) that he was able to rebuild and have money left over. In our locale, when folks are uninsured (as I’ve mentioned before on T1:9) other local folks pay their bills with spaghetti feeds and bake sales. The local small appliance repair guy needed hip surgery. A fund at the bank for local contributions plus some money raisers paid it all. Same with the local bus driver who had a brain tumor. Now I know you city folks don’t enjoy the blessings of a small community, but churches form small communities, and church members should be offering more support for one another.
RE: “the implicit suggestions of most of the people trying to reform medicare so that you’re more responsible for the cost affirm the sentiment that you’re to blame for your illness, so you should pay.”
No — they simply affirm the sentiment that individuals are responsible for their health care costs, as with their food costs, and their car costs. I have two serious medical conditions — one of which will NEVER be covered by any health insurance at all.
Life’s hard sometimes for all of us — and I’m responsible for the costs incurred. I feel privileged to live in a country with such immense wealth and medical care. Someday, hopefully, we’ll all have HSAs and consumers will have both the choices and the responsibilities *directly* that the insurance companies have taken from us.
When third parties get the choices and the responsibilities that is a massive mistake, the consequences of which we will continue to reap.
Thanks, annr. My husband’s company has stopped completely offering any health insurance after 65 for retirees. Since we both have pre-existing conditions (how many people in their sixth decade don’t have something?), we can get Medicare+ sorts of coverage, but not basic coverage, even at high deductibles.
#24 — Health care used to be a service and a ministry. Now it’s a big business, unless you happen to have non-profit church-affiliated hospitals in your area. I do. However, the physicians who affiliate with it are part of a very tight network.
Frankly, I prefer the secular hospital in town for care and cleanliness but the specialists I require were recruited by the Baptist hospital and don’t work at the secular hospital. My rheumatologist coordinates my care, he is the only one in town, and so I’m stuck in that network because he’ll only refer me and correspond with other specialists in the Baptist network.
Is there ANY other personal “need,” as you call it, that is so restrictive as health care? Are you restricted by supermarkets as to where you can shop, what you can buy, and what you have to spend? If a store refused to sell to you because you might not be the type of customer who would ensure them big profits, you could sue them for discrimination. You absolutely could shop around and be assured of getting what you need at the price you are willing to pay elsewhere. Not so with health care. And the government protects these practices under the banner of “free enterprise” but recognizes, at the same time, that by sanctioning and even encouraging it, government must then step in to protect the people who would die because of how they let the big business “health” companies operate.
Turning up one’s nose at Medicare and Medicaid and castigating the people who use these programs reinforces Big Business’ domination of a service in which human lives literally hang in the balance. Great that the community will pitch in to fund little Johny’s needed surgery when it becomes public knowledge but there are many fewer little Johnys and millions of elderly and disabled who are chronically ill and need care every day of every month of every year. Our society doesn’t have the attention span to deal with that.
RE: “You absolutely could shop around and be assured of getting what you need at the price you are willing to pay elsewhere. Not so with health care. And the government protects these practices under the banner of “free enterprise†. . . ”
No, quite the opposite. The government forces upon those grocery stores a sliding scale, which charges one below-cost fee to one segment of society, and grossly inflated fees to another segment, [i]then doesn’t even allow grocery stores to give away free groceries to those in need [/i]. That is precisely the opposite of “free enterprise”.
The problem is that grocery shopping isn’t anything like health care. In someone get sick, it is intrinsically a burden for other people. At least if there is any sense that empathy has any worth or merit. Look – if I get a contagious disease, its in everyone’s interest I get treated.
Just becomes one person has a disease shouldn’t mean we have to suffer it alone. NOr should it mean that we should be condemned to poverty for reasonable medical care. And besides – we’re a wealthy enough country that we could care for everyone with no increase in cost. In fact, it would decrease because we’d be eliminating the corporate bureaucracy.