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Allowing younger people to buy into Medicare sounds like a good idea. Medicare is a well-run and cost-effective program. The problem is that the latest reports indicate this “Medicare buy-in” idea might not really be Medicare at all, it might in fact be fake Medicare:
Sens. Chuck Schumer (D-N.Y.) and Max Baucus (D-Mont.) said efforts were under way to address concerns raised by senators, including the low reimbursement rates for hospitals and doctors.
“All of the problems that people have mentioned, we are mindful of,” said Schumer, who worked to develop the package with 10 moderate and liberal senators. “Every one you have mentioned has been brought up in our discussions, and we didn’t ignore any of them.”
The AP is also reporting that there is talk about “fixing” the reimbursement “problem.” The reason Medicare is such a cost-effective program is due to its ability to use its large size to negotiate very good rates. The lower reimbursement rates are a-cost controlling feature, not a bug. Remove that advantage, and Medicare buy-in becomes dramatically more expensive.
Now, if the “fix” was to just have this group of people reimburse providers at Medicare rates plus 5%, that would be a pure giveaway to the doctors and hospitals, but at least a workable program. If the “fix” were to use “negotiated rates,” that is when things all start falling apart. You can’t really have negotiated rates with providers without allowing providers to opt-out of the Medicare buy-in program, but stay in the Medicare program. Given the small number of people able to use the program, it will not be able to negotiate rates that are nearly as good.
This change would result in this fake Medicare program having much higher premiums and a smaller provider network. It would also result in greater administrative overhead. This fake Medicare would lack almost all the benefits of Medicare. A Medicare buy-in program that does not actually allow people to fully buy into real Medicare is a farce. Beware: it looks like we are about to get fake Medicare for Christmas.
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Question, if Medicare is well run as you suggest, then why is it on target to be in the red in the near future (assuming no healthcare change)?
Are you aware that hospitals and Doctors try to limit the number of medicare patients? As the pay rates are equal to about 85% of actually cost of service?
Please consider: http://www.smallbill.org/Small_Bill_Proposal_For_Health_Care_Reform.pdf
Cheers!
loosely related o/t
Senator Baucus has um, other problems
it wouldnt be in the red and would be solvent forever if the Medicare tax on payroll didnt stop at 100k.
make the medicare payroll tax the same for millionaires as it is for working stiffs.
I agree that the reimbursement rate must be addressed. Yes. In fact physicians’ reimbursements does not cover cost of the services and materials. And until we drop fee for service faux private practice I believe physicians will continue to limit numbers of Medicare patients treated.
Hospitals I think but don’t have data do better on all kinds of Medicare and other grants.
Personally I think a better immediate fix would be to increase Medicare fees across the board and use just the one system. It should keep administrative costs to the minimum.
it wouldnt be in the red and would be solvent forever if the Medicare tax on payroll didnt stop at 100k.
make the medicare payroll tax the same for millionaires as it is for working stiffs.
Equal care for equal taxes.
Because the “cost for service” include much unecessary “administrative (claims)” overhead”
See peterboy. It’s in the red owing to a lack to tax revenues not because the spending is excessive.
I’ve noticed this is how “reform” works. What is done is going around and asking what the corporate healthcare lobbyists want and if anything offends them and if anything offends them, the offending bit is removed. This is setting up to be the biggest corporate bailout in history by having no cost controls combined with a nation turned into insurance company serfs.
The reimbursement rate is too high. The costs are caused by the “claims” model of reimbursement, not the cost of care.
Why does a transplant cost $200,000 in the US and $25,000 in europe?
Why does the UK treat its whole population, cradle to grave, for the same percentage of GDP as Medicare?
my daughter was in a hospital in Prague for a concussion. She stayed three days, had two MRIs and saw several doctors.
the bill was $1000.
the only thing it didnt cover was meals. friends brought her those.
i think it sounds most likely to be a very bad idea (there might be a way to make it work, but the downside dangers are great and congress has shown no sign of being aware of those issues). here’s jane’s post and thread on the topic: PNHP Statement on Lowering Medicare Age to 55. more here and here.
The levees of decency have broken to unleash a torrent of venality and greed.
“Yer doin’ a heckuva job, my Democratic Party”.
With regards to Medicare reimbursement, I’ve had work experience not only with the state doctors’ association, but also in the upper management of a community hospital.
For many practitioners, reimbursement actually is too low. Many family practice physicians actually lose money, or barely break even if they’re lucky, on Medicare. Also many non-specialty hospitals lose a small bit of money on each Medicare patient – an exception being the few designated as “critical access” hospitals which are reimbursed at cost + 1 percent.
On the other hand, some specialists and specialty hospitals are reimbursed very generously and could probably stand to have their rates reduced.
What I think needs to happen is that reimbursement rates need to be re-evaluated across the board and lowered or raised as appropriate. Then you won’t get so much resistance from medical providers if you want to expand Medicare for all or even just the paltry Senate suggestion of bringing in a few more people.
Of course none of that addresses one of the biggest costs throughout the medical system which is drug prices. But that’s another piece to this puzzle.
We don’t even know what this all means and already the Obamatrons are urging us to call our electeds and support the “White House health care plan” and don’t forget to send $$$$.
“We must continue to build out our campaign — to spread the facts on the air and on the ground, and to bring in more volunteers and train them to join the fight. I urgently need your help to keep Organizing for America’s 50-state movement for reform going strong.
Please donate $5 or whatever you can afford today:
https://donate.barackobama.com/FinalStretch”
I think I need a little lie down.
O/T: Good News for Republicans…
I am pleased to here that your daughter recieved good care.
Considering the huge success of the British healthcare system I can understand why you want to follow that model.
Frankly I believe in the patient/doctor relationship.
i really hate the idea of being asked to support some policy without even being able to see it (let alone have evidence, studies, etc on how it is expected to work).
evidence based policy? we don’t even get evidence based talking points from obama and the dems.
Can Howard Dean come to FDL for a visit a talk?
re primary care vs specialist reimbursement. see montanamaven’s diary on that:
http://seminal.firedoglake.com/diary/9748
he has not exactly been a fountain of accurate info on this issue. i’m willing to believe his heart is in the right place, but i don’t know where his head has been. :(
…. gotta go, later friends….
Schumer is my Senator. That SOB must do my bidding! What do I tell him?
Jane has a fresh cross-post up: “…And That’s What Happens When You Take Your Story From A DNC Press Release”
Everytime there’s an iota of good news, it backtracks to more gain for the insurance industry & less for the population. This country is permanently destroyed by corporate greed. “Change we can believe in”, NOT.
It still will cost 7,600 a year, 15,000 for a couple (about the same as ins. companies) and no subsidies til 2014. And many many doctors won’t even take Medicare patients.
A majority of us won’t even be able to get this.
So why is this a good thing?
I think it sucks.
if you are a 60 old man with pre-existing conditions 7,600 a year is sadly very cheap, relatively speaking.
Tell me anyone, how those 5 “progressives” (as defined by Harry Reid) can go into a private meeting with 5 Conserva-Dems and come out yapping like Conserva-Dem’s pet poodles??
This is getting obscene, really. I mean are the ‘progressives’ that hard up and the lobbyists that good??
On Medicare’s viability, please note some of you: it’s the cost of the services that blow budgets. Which shot up due to the uninsured and just plain greed.
My doctor’s also report it isn’t Medicare that doesn’t pay them in a timely way -it’s the insurers who are chronically late.
Nor is the doctor-pay problem Medicare’s fault. Republicans and ConservaDems have refused to fix what’s called a funding ‘glitch’ in Medicare that automatically cuts doctors pay every year. (Who thought that up?)
Congress could easily fix that by cutting payments to private insurance plans that serve Medicare patients. Fat chance of that.
In 2008 Bush threatened to veto any such bill because it takes funding away from his cherished give-away to insurance companies, the Medicare Advantage, plan in order to fund the physician reimbursement fix.
So here we are again, letting a few squealing lobbyist pets get away with turning the remaining Dems into whining sycophantic pussies.
ML Harry Reid is hammering the final nail to the Democrats coffin. Democratically controlled rin Senatewas the worst thing that ever happened to
When I first heard about this I had “hope” [there's that word again]. But the more I read, the sicker I become. I should have realized from the get-go it would end up being bullshit. $7600. Are you kidding me? That’s no goddamn saving at all. I hope the progrssives in the House don’t fall for this. I would rather see no bill at all, than this oiece of trash obviously written by the health insurance industry. Public option or nothing!
Another day, another devil. A buy-in without piggyback rates will not fly. It’s just more bait-and-switch politics, misappropriating a brand name.
But there’s one thing I’ve never understood. Most complaints about “low reimbursement rates for hospitals and doctors” come from members of Congress in rural states. I’d like to disentangle the ideology from the legitimate complaints here but don’t know how to. Can anyone here help me?
An ideological element is surely at work since these politicians never suggest a change in the formula to fix the problem. Instead they rant against Medicare. But reimburssement rates do vary from state to state. For instance, New Jersey doctors get more than South Dakota doctors.
What is the formula? Could it be improved? Does anyone here have hard information?
You are saying Medicare spending is not excessive?
That about says it.
So am I. That’s why I want to get rid of the for-profit health insurance co’s that denied me access to my doctor(s) repeatedly.
The reason Medicare’s finances are shaky is because of the pool of people it covers–those over 65 and people with significant disabilities. These are people who would (and did, pre-1965) have great trouble getting “insurance” elsewhere. Let Medicare cover everyone. You would have a more normal risk pool. Rates would be reasonable and finances would be in solid shape.
Given that there is no chance of that happening, the buy-in idea has a lot of merit. There are many people in their 50′s who have been laid-off, downsized, etc., who have great difficulty buying individual insurance policies. Pre-existing conditions, age, etc., too often mean exhorbitant premiums. That is why the period from 55-65 is called the “dangerous time” in health care coverage. If this leads to demands from younger groups down the line to buy in, great. We will be closer to getting the health care solution that we should have, but could not have gotten in the first place. And, oh, it might force private insurers to be more competitve and customer-friendly in order to hold onto custmers that now have a viable choice. A real public plan.
You can be sure that health care opponents know these things as well. Which is why the prospect of a Medicare buy-in fades by the hour!
Uhhh..better check that out, my friend. There is no cap on the Medicare tax. Only social security.
How much do you expect it to cost?? $7,600 or $633/month is pretty cheap for someone in their early 60s, compared with whats available today.
I wouldn’t vote for this health care plan now even if they let me include my dachshunds in my “family” coverage.
Oh, yeah … and here’s a another feature of The Plan that I just can’t seem to muster a lot of enthusiasm about
http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande
Salaried employees, government wage and price control, single-payer
I must be stupid or not very political, or both? But, it seems to me that if there is a concern that affects every location (Medicare/Medicaid reimbursement and believe me, it is a real problem), then a simple, blanket fix it seems to me is is the “fix.”
Establish and set a FLAT rate for doctors/hospital reimbursement no matter which state or location they are in… and if they want, within reason, allow them to negotiate changes based on their costs and not political “perceived” costs …
1. “Actual cost of service” is not a Natural Law, but a price set by those whose profit it creates – for-profit providers (including doctors, who have become businessmen instead of professionals.) It consists mostly of greed, i.e., the demands of “Investor/gamblers” – Wall Street.
2. Medicare (and S.S.,) are NOT “going broke,” They never were, and in fact ALWAYS produced surpluses, and still would if they had kept their own funds. But those entitlement “funds” were incorporated into the General Fund, partly to hide the deficit (which is now being attributed FALSELY to Medicare and S.S.) and absorb their surpluses, and partly to discredit or hide the spectacular success of these “Socialist” programs.
This is from old CBO records – not some conspiracy theory.
http://www.forbes.com/2001/08/28/0828topnews.html
budget.senate.gov/democratic/background/2001/medicare_trustfund_factsheet072301.pdf
http://hotair.com/archives/2009/12/08/social-security-hits-six-month-mark-on-cash-deficits/
I have been pointing this out ever since the AMA people shamelessly cajoled their patients (including me) into calling their Senators and ask them to pass the so called DOC-FIX bill (3962) ahead of or at the same time as the HCR bill (HR3961). They threatened if 3962 did not pass Doctors wont be able to provide proper care, thus spoiling the Doctor Patient Relationship. I wrote to PAN/AMA several times urging to refrain from this shameless Blackmail. I also wrote to the Whitehouse and a few Senators. The only response I have received so far is an angry message about me posting this message on the AMA Facebook page as a comment on every one of their many notes to their members about the urgency of topics and the efforts AMA was making.
Here is a letter I wrote to my Congressman Pete Stark:
“Pete, Say No to HR3962″
For those who like to pick on Medicare, a few facts are in order. Medicare covers the most expensive segment of our population: Seniors, AIDS patients, patients with End-Stage Renal Disease, patients with Amyotropic Lateral Sclerosis (Lou Gehrig’s Disease), and people disabled by illness or injury for two years. No for-profit insurance company will cover these people. They represent the quintessential pre-existing conditions. The total number of Medicare Beneficiaries in 2008 was 44,831,390 (15% of U.S. population). Perhaps, a few may obtain insurance at exorbitant costs, probably with a rider to exclude any pre-existing condition; but the vast majority would not be able to obtain private coverage. Vouchers for private coverage would be prohibitive.
MORE MEDICARE REFORM AND MEDICARE FINANCES FACTS:
Medicare is subject to the same cost pressures as the private sector. Yet, Medicare has done a better job of containing costs than the private sector.
Medicare’s administrative costs are approximately 3% compared with the private sectors 15%. Unfortunately, the Bush administration and Republicans pushed Medicare Advantage to get seniors into various forms of managed care. The Medicare Payment Advisory Commission found that Medicare could save approximately $17 billion per year by eliminating this program which, in essence, just gives creates additional profits. The Medicare Modernization Act of 2003 which created the Drug Benefit Program, Medicare Part D, forbade Medicare from negotiating with the drug companies, something that all for-profit insurance companies, the military, the VA, and Medicaid are allowed to do. Estimates put savings at $20 billion per year if Medicare negotiated the same prices as the VA.
Medicare does suffer from fraud; but fraud is endemic to the entire U.S. health care system, far more than in other systems.
Medicare is not facing bankruptcy. It will, however, have a shortfall, that is, revenues coming in will be less than expenditures in a few years. But our GDP will also have grown so that, as a percentage of GDP, we will manage. On the other hand, our entire current health care system’s projected cost increases are unsustainable.
Imagine the consequences if Medicare were to fail. Besides watching our loved ones face premature disabilities and death, anticipating the same for ourselves, our already overcrowded emergency rooms would collapse under the added burden. Medicare pays additional monies under the Disproportionate Share Program to hospitals who treat high percentages of the uninsured and/or poor. These hospitals would be the first to close followed by many more hospitals closing and doctors offices going out of business. And since Medicare pays for all residencies, in the future we would have fewer specialists.
Is Medicare Underpaying Doctors? A doctor at Congresswoman Maxine Water’s town hall August 22nd in Los Angeles said that Medicare actually pays more for some services than private insurance and that private insurance pays no better overall. However, even if in some instances Medicare pays less, do doctors lose money on Medicare patients?
Airlines often offer half price or less for standbys for last minute boarding. Since they only need to fill a percentage of the seats to cover costs, another percentage to gain profits, then any monies received from the remaining empty seats just add to their profits. Standard economics says that as the number of patients increase, the average costs, including fixed costs (office expenses, including building, equipment, and staff), decrease. Currently, approximately 10% of doctors’ billings are to cover the excess administrative costs of dealing with our fragmented for-profit system. Why should Medicare fees cover the excess administrative overhead?
Imagine what would happen if all the patients currently on Medicare ceased to be insured. Would doctor’s incomes then go up? So, as far as I can tell, the claim that doctors lose money on Medicare patients is simply a statement that they don’t make as much as they would like.
Joel A. Harrison PhD, MPH
references below
White, Joseph, “Markets and Medical Care: The United States, 1993-2005,” Milbank Quarterly, 2007, Vol. 85, No. 3, pp. 395-448, http://www.milbank.org/quarterly/8503feat.html
Malcolm K. Sparrow. “License to Steal: Why Fraud Plagues America’s Health Care System,” Westview Press, 1996
Kaiser Family Foundation. “Total Number of Medicare Beneficiaries 2008,” http://www.statehealthfacts.org/comparemaptable.jsp?ind=290&cat=6
Woolhandler, S. et al. “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine, Vol. 349, 2003, 768-75, http://www.pnhp.org/publications/nejmadmin.pdf