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A Rant On Medicare

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posted on Aug, 5 2007 @ 03:46 PM
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Tuesday, I watched Michael Moore’s SICKO and last night I went to the “Harry Potter and the Phoenix” movie at I-Max with my 2 grand-nieces from Atlanta. There are at least a dozen women richer than Potter's creator J K Rowling that Forbes.com lists at $1 b. including Oprah Winfrey at $1.5 b. Rowling is not richer than the Queen of England.

I thought you might have a passing curiosity in America’s health care delivery system. I’m a Medicare person. Medicare is distinguished from Medicaid which is a general fund financed program aimed at helping the destitute. Medicare is sometimes called the engine that pulls the American health care system. Medicare pays 18% of all health care bills.

Medicare is - so far - operating in the black, that is, it takes in more money than it pays out. The excess is held in “Trust Funds” that are routinely spent down to -0- but the Trust money does earn interest. There are legitimate non-conspiratorial reasons for that. Aside: It is an interesting exercise in macro economics to understand and explain why a government like the US cannot “save” money. End.

Medicare Part A covers hospitals and very little else. In 1965 when Medicare was enacted hospitals were the creme de la creme in health care delivery systems. Now we’re back to where we were 100 years ago, when hospitals were places most people went to die. Today 90% of other treatments received are “out-patient” in smaller local facilities. Part A is a “paid up” type policy. That is, you pay 1.45% of your wages matched by a like amount from your employer (2.9% for self-employeds) all during your working life, then when you retire at 65, you have a paid up Part A without further payment required.

Well, that’s not exactly true. You have a yearly adjusted annual deductible, currently $975. That’s your walk in the door payment due. Then you have a daily co-pay, currently $210 a day. That’s about it. Stay 10 days and you owe $3,075. Personally. Plus 100% of any other charges for items furnished but not medically indicated. Telephone. Tv. Single rooms. Toiletries. Special diets. Other consumables. Every patient is viewed as a money making opportunity! God Bless America!

Medicare Part B covers doctors, x-rays, labs, and stuff like that. The monthly premium is adjusted always upward and today it is $88.50 a month. It was $45 in 1999 when I started on Medicare. The premium is deducted from your monthly social security check in advance so they have no collection problems but that’s ok. What you never see you hardly miss. Part B has a deductible also adjusted yearly to reflect the increase in the cost of living. For 2007, its $135. So, you might owe 100% of the first two visits to your doctor’s office. Then there is the 20% co-pay. Just say your annual deductible has been met and now you owe the doctor or lab $400. Medicare pays $320 and you owe $80. God Bless America!

These deductible and co-pay concessions were made necessary when the Dems tried to pass a 100% comprehensive Medicare act in 1965. The major PLAYERS, the AMA, for doctors, AHA, for hospitals, PMA, for drugs companies, and AIA, for the insurance industry, all of which allied with the Republican Party rejected that outright.

Deductibles and co-pays were forced on the Dems. This had the effect of creating a NEW risk free insurance industry, MEDICARE SUPPLEMENT INSURANCE overnight! The Dems - to their good credit - did extract one minor gain from the GOP and their health industry allies. STANDARDIZED policies. The value of a standardized policy is the customer can compare the prices assured he is getting the same product. Almost a unique circumstance in corporate operated America of 2007. Hey, it’s a FREE market! (But FREE means we are FREE to gouge YOU!) God Bless America.

Standardized policies called Plan A thought Plan J with variations on Plan F and Plan J, making 12 plans altogether. Every private company that wanted into this guaranteed gold mine scheme had to offer Plan A and one other plan. In addition , the companies could then offer any plan of their own devising they choose. Enterprise, free market and all that you know. Harvard MBA stuff. For some strange reason none nay not one have done so. There is too much money to be made on the standardized plans because there are no restrictions on premiums. Charge anything you want! Hey, this is a free country is it not? God Bless America AGAIN!

Shucks, I haven’t even come to Medicare's Part D. This was a Republican plan to guarantee Bush43's reelection in 2004. As if it was ever close. OK, so the Dems joined in too, but they were sort of dragged along by the momentum of the moment more than any wish to be associated with this Part D I call a plan made in Hell! Actually it was made by the PMA. The drug industry lobbyist.

First, the administration of the Plan is totally in the hands of private industry. Next the plan requires the US Government to pay the costs the drug industry bills them without negations or alternate buying plans. A blank check down on the US Treasury and signed by George W. Bush. Each and every company may choose for itself what drugs they will cover. That is called a formulary. Suppose a company does not like the formulary they “sold” to the public. Without prior notice the company can add, drop or alter the formulary. You are stuck for the reminder of the year. How’s that for consumer protection?

Then there is a purposeful GAP in coverage. The Part D pays for medicines up to $2,500 then skips until the incurred changes exceed $3,500. You are totally without coverage at a time when logically you would need it most! Sweet Jesus, Come Quick! The Devil is already here.

The only good thing fo consumers is they can change plans at the end of each year and choose any plan they want that is offered in their smallish neighborhood in each state. In Florida, 34 companies offer Part D coverage. Sounds competitive? Hey, “competitive” is a dirty word in health insurance and Republican politics. In Jacksonville, only 6 plans are available, for example. Fewer in smaller cities.

Can anyone reform the American Health Care Delivery System? To be concise, NO. Not when every medical doctor can become a millionaire every 3 years. There is too much money being made by too many people to let anyting happen to it. We're stuck where we are.

Since 1999, when the Health Care industry took in 11-12% of the country’s GDP, that has rose to today's 16-18% and will pass the 20% marker by 2010. Different people give different numbers. With 45,000 unrestrained lobbyists and the open season on buying our Congress and presidential candidates, who is going to help us bottom-feeders?

[edit on 8/5/2007 by donwhite]




posted on Aug, 5 2007 @ 04:55 PM
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Medicare is going to be put under tremendous strain as the boomers start using it, to think otherwise is just foolish. There needs to be reform with all medical insurance IMO and probably one of the easiest ways to reduce costs is to just streamline the whole billing and invoicing process. The paperwork for that now accounts for, I'm just guessing but I know I am in the ballpark anywhere from 12-20% of the actual bill.

Want a shock, see how much a doctor will charge for a procedure or test through Medicare or any Health Insurance then go to another doctor and tell them you will be paying cash out of pocket for the same procedure. The difference in the amounts is rather significant. Your Insurance will pay the doctor 600 for a MRI where the doctor might only charge 400 if you have no insurance and pay cash. How messed up is that?

As for Medicare Part D, I am quite familiar with it and sure it's not perfect, but it is just as surely, better than what many had prior to it, which was basically nothing.

You say there is only 6 plans in Jacksonville yet I see over 57 on Medicare's website and many of them are much better in price than here in Michigan. The plans I reccomend to many are on that same list. It is confusing with so many plans to pick from but that is because there is probably a "best" plan for your particular situation.

For the average senior with average medicines there can be as much as a $1,300 difference from the best plan to worst plan for your situation. Some plans out there are far as I am concerned are stupid for most consumers and I have found that most seniors are probably paying 200-400 dollars too much for their medicines as they have not picked the optimal plan for their situation.

One single standard plan would not be any better in my honest opinon. There are planes for heavy drug users, users that are one generics mainly, ones for people whole have specific conditions ect. Proper choosing by a Senior allows them to find the most cost effective plan for them, not that they do that all the time, but thats another story.

Most people I have helped with Part D have saved about $500 -$1000 a person over what they were paying previously for their medicine. Some couples I have helped have saved in excess of $6,000 in just one year. Without the Donut hole gap in coverage Part D, which is already the largest new entitlement in Medicare, would have totally torpedoed the Budget without the money coming from somewhere else in cuts or new taxes. While Privatization through the various plans out there has been confusing for some, it has lowered the anticipated costs by quite a bit as well. Competition does seem to have reduced the overall costs of Part D. Say what you will, but overall Seniors overwhelmingly approve of Part D, even though it could be better.

If you think Medicare is messed up now just wait about 5-7 years when the boomers start hitting it big time.

[edit on 5-8-2007 by pavil]



posted on Aug, 5 2007 @ 06:55 PM
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posted by pavil
Medicare is going to be put under tremendous strain as the boomers start using it, to think otherwise is just foolish. There needs to be reform with all medical insurance IMO and probably one of the easiest ways to reduce costs is to just streamline the whole billing and invoicing process. The paperwork for that now accounts for, I'm just guessing but I know I am in the ballpark anywhere from 12-20% of the actual bill.


Yes exactly, Mr P. I don’t know if you are a Medicare beneficiary or not, but if you aren’t then let me report I get TWO returns, one from Medicare and the second from my Supplemental carrier. Why can’t that dual accounting be combined into one? I know paper is cheap but Medicare sends a second page in every mailing notifying me of my appeal rights and how to do it. I have signed up for e-billing with my cable company, electric utility, telephone, cell phone, internet service provider and my bank. I’d do that with Medicare and the supplemental if that was an option. That would save a lot of trees if not much money.


Want a shock, see how much a doctor will charge for a procedure or test through Medicare or any Health Insurance then go to another doctor and tell them you will be paying cash out of pocket for the same procedure. The difference in the amounts is rather significant. Your Insurance will pay the doctor 600 for a MRI where the doctor might only charge 400 if you have no insurance and pay cash. How messed up is that?


I have been fortunate for all my life I have had either military health care, private insurance, Veteran’s Administration or Medicare with supplement. I have never had to do that life or death bargaining on my own. Although I knock doctors as a group, 80% of doctors I have known personally gave more than they charged for. It’s their union I object to. The AMA. Not necessarily the members. That has its own dynamics.


As for Medicare Part D, I am quite familiar with it and sure it's not perfect, but it is just as surely, better than what many had prior to it, which was basically nothing. You say there is only 6 plans in Jacksonville yet I see over 57 on Medicare's website and many of them are much better in price than here in Michigan.


Uh, well, 6 sure is not even close to 57. I was harkening back to when the program was first introduced. I have been with the same company and have found it satisfactory and so for me. I’ve had no reason to hunt for another company. I’m paying $38 a month. Anyone reading this should look it up for himself or herself.


Most people I have helped with Part D have saved about $500 -$1000 a person over what they were paying previously for their medicine. Some couples I have helped have saved in excess of $6,000 in just one year. Without the Donut hole gap in coverage Part D, which is already the largest new entitlement in Medicare, would have totally torpedoed the Budget without the money coming from somewhere else in cuts or new taxes. Competition does seem to have reduced the overall costs of Part D. Say what you will, but overall Seniors overwhelmingly approve of Part D, even though it could be better. If you think Medicare is messed up now just wait about 5-7 years when the boomers start hitting it big time.


These variations in coverages and wide disparities in premiums should not be happening. We are not selling used cars nor a pig in a poke. We are supposedly providing a live or die essential service to people who cannot understand complicated contracts nor predict what medicines they will need after their next visit to the doctor. The Part D as written is fundamentally flawed. I am satisfied the PMA wrote the plan.

Yes, seniors do overwhelmingly approve of the Part D. “Approval” only means it is better than no coverage at all. There is no justifiable pride in Part D. It is the ONLY plan available and could have been so much better. And this from the 'No Child Left Behind' inventor?

Yes, as the 55 million baby boomers come on-line, and everyone is living longer, the system as currently operated and financed is not going to be sustainable without drastic reform in delivery and costs incurred there or in financing. Or a combination of both.

I do not see any place in the mid-term future for private capital in the health care delivery system. Health and profit just do not meet. The two are mutually exclusive. The sooner we accept this, the better off we will all be.

[edit on 8/5/2007 by donwhite]



posted on Aug, 5 2007 @ 07:48 PM
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donwhite and pavil

Nice overview of Medicare and Medicaid, guys.
This affects each and every American in one way or another. Unfortunately, most people's knowledge of their health care system is limited to a desire for a socialized medicine system, because of the perceived "free cost".



posted on Aug, 5 2007 @ 08:20 PM
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Originally posted by donwhite
I have been with the same company and have found it satisfactory and so for me. I’ve had no reason to hunt for another company. I’m paying $38 a month. Anyone reading this should look it up for himself or herself.
In my professional opinion your are paying $38 too much. At the Least you should review your Part D every year, sure it's a headache but you can save substantial dollars by doing so. You should be able to get your drugs from the VA for at most $8 a script without even being on Part D. I have helped numerous Veterans that way. Your situation may be different but I doubt it. U2U me if you want more info.



These variations in coverages and wide disparities in premiums should not be happening.


Yes but there is substantial differences in premium for Medicare Supplemental insurance and people don't raise a stink about it. And that's been going on for decades. Two people in Michigan for example can have the exact same Medicare Sup coverage and one will pay about $90 and another will pay $230, for the EXACT same coverage just because they are from two different companies. At least with Part D you can customize it for your particular drug use. Some plans do a very good job of taking care of specfic medicines whereas a "one size fits all' plan would probably cost them more. Perhaps having Medicare negoiate prices for drugs would work, but then you are messing with something that is already working fairly well. If medicare could emulate the VA drug plan, I am sure Seniors would love it, but it comes down to fiscal reality. I don't think the numbers would work in without cuts from other programs or other ways of raising revenue (new taxes).




Yes, as the 55 million baby boomers come on-line, and everyone is living longer, the system as currently operated and financed is not going to be sustainable without drastic reform in delivery and costs incurred there or in financing. Or a combination of both.

I whole heartedly agree, the same goes for Social Security. However those are the two sacred cows Congress does not like to mess with, but inaction will surely doom them or at least create trememdous burdens on future generations.


I do not see any place in the mid-term future for private capital in the health care delivery system.


You may be right, but I don't see Government controlled Universal health care working too well either. I would expect an overload of the system with an increase in people using general healthcare and less medical professionals at the same time. I don't know which way would be better. Already with Medicare, many doctors in 2008 with not be adding new Medicare patients as there are changes in the Medicare payment structure to Doctors that will have the Doctors earning less than they do now for Medicare patients. That's Congress for you.



posted on Aug, 5 2007 @ 08:58 PM
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posted by jsobecky
donwhite and pavil

Nice overview of Medicare and Medicaid, guys.
This affects each and every American in one way or another. Unfortunately, most people's knowledge of their health care system is limited to a desire for a socialized medicine system, because of the perceived "free cost".


Thanks for the kind words.

If you include the Armed Forces, the VA, the Federal Civil Service and most state and local govt. workers, along with Medicare and Medicaid, you might say 40% of the American public is already on one form or another of socialized medicine.

This month’s Discovery Magazine has a very interesting article how America “gave” socialized medicine to the South Vietnamese who just loved it. This was sharply constrasted to the disaster that we have vistied on Iraq.

As for FREE, nothing on this planet could cost more than the $1.8 t. we now pay for a system that does not cover 57 million people and lets 16,000 people die each year for lack of money. That statistic from SICKO. Germany at No. 2 in health care costs, spends just over 50% of their GDP percent compared to us, ie, about 10%. The German system covers everyone, citizens, guests or just passing through. And they get better numbers than we get. See CIA World Factbook. Maybe “free” is the wrong issue?

[edit on 8/5/2007 by donwhite]



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