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View Diary: Open thread for night owls: Raising Medicare eligibility age would hurt minorities most (163 comments)

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  •  So...How much does it actually hurt to raise (2+ / 0-)
    Recommended by:
    BlueJessamine, Jeff Y

    the Medicare age in an ACA world?

    Barring a change to the Medicare eligibility age, I'm looking to receive it in another 5 years, and, frankly, the thought terrifies me.  My tiny little anecdotal sample of Medicare recipients among family and friends is extremely discouraging with regard to the quality of care.

    On the other hand, starting in 2014, ACA will make highly subsidized care available.  If I understand correctly, until such time as I reach Medicare age, I will be able to get affordable health care (at a cost that slides with my income) in the same way as everybody else.  No Medicare, no "no new Medicare patients" or anything like that.

    Sounds like a better deal to me.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Mon Dec 10, 2012 at 08:38:08 PM PST

    •  So we should be advocating for paying more into... (7+ / 0-)

      the Medicare system instead of all this nonsense about "only" cutting payments to providers.

      "The Democratic Party is not our friend: it is the only party we can negotiate with."

      by 2020adam on Mon Dec 10, 2012 at 08:53:06 PM PST

      [ Parent ]

      •  Yes, 2020adam, I think you shoud advocate for (2+ / 0-)
        Recommended by:
        JeffW, 2020adam

        raising the Medicare tax rate which has been at 1.45 percent (plus equal employer match) since 1986.

        We all know the price of health care has risen disproportionatey when compared to most other things wee buy since 1986, so the price of Medicare premiums paid during your working years should be rising, too.

        I have advocated increasing the premium on a couple of other diaries recently with little indication that I'm making the point clearly enough. I'm already "over 65," so it won't affect me much, but I'd like to be able to help assure the continuation of Medicare for future seniors (until single payer for everyone is available) if at all possible.

        “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

        by RJDixon74135 on Tue Dec 11, 2012 at 02:32:32 AM PST

        [ Parent ]

        •  Let's tackle the other side of the coin, (4+ / 0-)
          Recommended by:
          gramofsam1, RJDixon74135, JeffW, 2020adam

          which is the rising cost of health care.  The government should be negotiating drug prices, limiting overhead (as I think it does with ACA), and reining in private insurance companies.  We all know that we live in a society that reveres tests and drugs as the solutions to every medical problem. We also live in a litigious society, so health care providers do many unnecessary things to cover their backsides.

          Ed Schultz showed a table last night that indicated the cost of insuring and caring for people between the ages of 65-67 would go from about $5 bil to over $11 bil, if done by private insurers rather than Medicare.  If I haven't remembered the correct numbers, then substitute "double" for the numbers.

          •  Yes, that must be done, too (2+ / 0-)
            Recommended by:
            JeffW, 2020adam

            But I wouldn't depend on it if I were you.  

            Another thing that would help would be to get jobs for the millenials (aka the echo boomers) born between 1982 and 1995. Believe it or not, they make up about one third of the US population. Once they are working and paying in to Medicare and Social Security, both systems should smooth out. And, we should definitely NOT let Republicans plan for the future of those programs based on the notion that this economy, the worst since the great depression, will continue forever.

            But, if raising the Medicare tax one-half percent assures the future of the program, it's worth it.

            “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

            by RJDixon74135 on Tue Dec 11, 2012 at 10:55:21 AM PST

            [ Parent ]

    •  I'm probably about the same age (11+ / 0-)

      and frankly, I do not trust that we can be confident of "highly subsidized" care....from what I've read, the ACA plans will have much bigger co-pays and co-insurance (for the affordable plans) and the costs will rise with age. Depnding on your income, you'll probably get some sort of subsidy but you'll still have to shell out a lot to cover premiums and co-pays. It's private insurance, after all, and we don't actually know how much it will cost, unlike Medicare which we do. Many people will end up uninsured in places that don't extend Medicaid, and it's possible that if you make too much for Medicaid you may still be unable to afford the exchange plans, even with subsidies. All we have to go on is the Massachusetts experience, and health insurance is pretty expensive there and the state government is just starting to grapple with how to bend the cost curve downward.  

      What sort of problems have your friends had with Medicare?  

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Mon Dec 10, 2012 at 08:53:20 PM PST

      [ Parent ]

      •  yep Dinotrac assumes the federals will have (2+ / 0-)
        Recommended by:
        Heart of the Rockies, JeffW

        ultimate control over ACA in its implementation while it seems it may be more like an expansion of MCD than MC which would still leave some states with vulnerable populations since some governors and legislatures have made it very clear they have no intention of doing one iota than they absolutely have to

    •  Depends on income & cost controls (9+ / 0-)

      Purchasing private insurance under ACA isn't cheap, especially for those in the middle class.  

      The problem is compounded by the fact that the cost controls in ACA were significantly weakened.  Working class retirees (as well as those still working) are at significant risk of seeing their private insurance premiums skyrocket - there's really nothing to stop that from happening.  Add to it the fact that insurance companies are allowed to charge much higher premiums to older Americans.

      Medicaid expansions will only help those Americans earning 133% of FPL or less. For a family of 2, that means you have to have a household income of $15,130 or less to qualify for Medicaid.  Not good.  

      With Medicare, there's much less risk of premium costs skyrocketing, much greater chance that middle and lower income seniors will see their out of pocket costs increase.

      Then there's the big gap for out of pocket costs....

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Dec 10, 2012 at 09:00:44 PM PST

      [ Parent ]

      •  It does depend on your income, but... (2+ / 0-)
        Recommended by:
        BlueJessamine, DRo

        Let's see:

        If I were to make no more than 2.5 times the Federal Poverty Level -- which, btw, is right about the US median family income -- I would qualify for tax credits sufficient to make the second cheapest silver insurance plan cost no more than 8% of my gross income, PLUS supports in the plan would pick up 73% of out of pocket expenses.

        That doesn't sound too bad, especially since there are out of pocket expenses associated with Medicare, too.

        The downside, of course, is that the subsidies come in the form of tax credits.  If I'm not working and having taxes deducted, I have to pay up front and get the money returned at tax time.  That could hurt.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Mon Dec 10, 2012 at 09:16:48 PM PST

        [ Parent ]

        •  The other downside, of course, (3+ / 0-)
          Recommended by:
          DRo, RJDixon74135, JesseCW

          is that your government is then wasting all that money by insuring you in a less efficient manner.

          "The Democratic Party is not our friend: it is the only party we can negotiate with."

          by 2020adam on Mon Dec 10, 2012 at 09:27:31 PM PST

          [ Parent ]

          •  Wait a minute -- the ACA is supposed to save money (0+ / 0-)

            and besides, I'm more concerned with good care than efficient bad care.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Mon Dec 10, 2012 at 09:37:26 PM PST

            [ Parent ]

            •  It's supposed to save money compared to our... (5+ / 0-)

              current, less regulated private market, not compared to Medicare, which takes no profit at all.

              And all the horror stories you hear are simply and straightforwardly because we've accepted cuts to the "provider side" as No Big Deal, ignoring the plain fact that said providers are free to tell Medicare recipients to fuck off since they have bills to pay and Medicare no longer keeps up with those costs.

              "The Democratic Party is not our friend: it is the only party we can negotiate with."

              by 2020adam on Mon Dec 10, 2012 at 09:43:14 PM PST

              [ Parent ]

            •  ACA demands that 80-85% of premiums get spent... (4+ / 0-)

              on Medical care, while Medicare only spends somewhere between 1.5-5% on overhead.

              "The Democratic Party is not our friend: it is the only party we can negotiate with."

              by 2020adam on Mon Dec 10, 2012 at 09:47:30 PM PST

              [ Parent ]

            •  Good luck getting coverage you want. (5+ / 0-)

              We just went from a quite good (although not nearly "excellent) plan to one that is geographically limited and provides limited doctors because premiums increased so dramatically over the span of one year. Most of us at the company are being forced to change our doctors. Every specialist has to be pre-approved. If you get sick outside the geographically limited area, your option is the ER (subject to a huge deductible) or drive/fly all the way home. There is no "well, I'll just go to a local doctor for a much cheaper office visit" option.

              So if your family or friend says, "here, go to my doctor," that's not covered. If the hotel offers to call you a doctor because you're too sick to move, that's not covered.

              December 31, it is. January 1st it won't be.

              Want to pay the doctor yourself? Fine, but any prescriptions she writes won't be covered either. So that infection, pneumonia, etc that she diagnosed while you are across the country or simply a county away, you're totally on you're own to pay for.

              What were you saying about good care?

              That's how life in the private market works. ACA is life in the private market with few regulations about pricing.

              I'd rather stick with Medicare. But by the time I get to my 60s, the Rrpublicans will have destroyed it, with Dems idly standing by.

              © grover


              So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

              by grover on Mon Dec 10, 2012 at 10:59:46 PM PST

              [ Parent ]

              •  even if the doc participates (2+ / 0-)
                Recommended by:
                Heart of the Rockies, JeffW

                don't forget the carrier may take a year or more to reimburse the provider if the provider is ever reimbursed as you and your doctor try to navigate through a maze of private rules and preconditions

                •  I have had surgery twice in recent years, (2+ / 0-)
                  Recommended by:
                  dinotrac, JeffW

                  and my surgeons have yet to be paid.  Medicare pre-approves surgeries, then after they are done denies payment on the basis of the surgery being unnecessary. Congress is simply dicking around with health care providers who must maintain offices and staffs with a politically driven and uncertain income stream.  No wonder many of them don't want to accept Medicare patients.  Private insurers are no better.

                  There have to be better ways to control costs.

                  •  Nail. Hit. Head. Yup. (0+ / 0-)

                    Nothing has been done about the way we practice medicine.  
                    ACA was not about the problem.  ACA was about the way we pay for the problem.

                    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                    by dinotrac on Tue Dec 11, 2012 at 05:38:24 AM PST

                    [ Parent ]

              •  Am in the private market now, and appreciate (0+ / 0-)

                the crappiness of that situation.

                The subsidies in ACA change the picture dramatically, though, albeit with the problem that out-of-pocket costs must be managed for 1 year.

                I feel out of character saying nice things about ACA, but, really, it's more a matter of Medicare-fear.

                I have always considered ACA to be a steaming pile of crap with some good nuggets buried inside.  The biggest problem, however, is that it -- just like Medicare -- ignores the real problem: health care itself costs twice as much as it should, at least when compared to countries whose health care systems are superior to ours.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Tue Dec 11, 2012 at 05:30:36 AM PST

                [ Parent ]

                •  You think? (1+ / 0-)
                  Recommended by:
                  JeffW

                  It's become worse. The CA insurance commissioner is requesting an investigation because the private insurers are still raising rates and raking in record profits.

                  How? By increasing certain healthcare payments.

                  The higher payments are, the higher the total outlay. The higher the 100% is, the higher the 20% is.

                  So where do the "certain" payments go? Well, all I know is that the plan that we're being moved to is being offered by a major healthcare provider. There are a few minor providers included (but notably, not this provider's biggest local competitor) which keeps it from being classified as a true HMO.

                  Huh. Wonder who gets paid a little extra there.

                  It's all a scam.

                  ACA is better than nothing. Getting rid of caps and pre-existing conditions exclusions is huge.

                  But it's certainly not socialized medicine that conservatives fear. And it's not a panacea at all.

                  © grover


                  So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

                  by grover on Tue Dec 11, 2012 at 08:34:38 AM PST

                  [ Parent ]

        •  There's a fallacy in your argument (5+ / 0-)

          There's nothing in the law that guarantees your right to premiums equal to 8% of your gross income.

          The law does say that, if the lowest cost private insurance available to you (plus tax credits) exceeds 8% of your gross income, then you're not subject to a fine if you decide not to have health care coverage.

          Let me repeat that, there is no guarantee that your premium minus tax credits will equal 8% or less of your gross income.  

          The only guarantee is that you won't be subjected to fines if you drop a plan and become uninsured if that plan is too costly for you.

          Obviously, there aren't many seniors who are willing to become uninsured, so they'll be forced to pay premiums at anyway even if they are higher.  

          But there is no mechanism in ACA to force insurance companies to keep their premiums at an affordable level.

          Link to ACA Fact Sheet

          Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

          by Betty Pinson on Mon Dec 10, 2012 at 09:55:50 PM PST

          [ Parent ]

          •  I think the clearest comparison to being uninsured (0+ / 0-)

            under ACA is to compare it to state's where drivers can be uninsured.  The drivers pay a fee to the state and then no longer have to carry insurance.  Matter of fact, my car carrier has policies which offer uninsured driver insurance to cover me if I am hit by an uninsured driver

          •  The law makes tax credits available based on the (0+ / 0-)

            second lowest silver coverage available.

            Those tax credits bring the cost of that plan to 8% of your income if you earn the national median.  In an echo of the voucher plans that Republicans were pushing, that same subsidy can be applied to more or less expensive plans, but you don't get money back if you apply it to an approved plan that costs less than the subsidy.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Tue Dec 11, 2012 at 05:47:59 AM PST

            [ Parent ]

            •   If you earn the national medium (1+ / 0-)
              Recommended by:
              dinotrac

              that's an important caveat.  Many working class seniors will have incomes below the national median.  So its very possible many seniors won't have a choice but to purchase a plan that his costly - meaning more out of pocket costs.

              Add in the complexity and unpredictability of state plans and your have a mess on your hands.  

              I seriously doubt many people age 65 and older will opt for this over getting Medicare.

              Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

              by Betty Pinson on Tue Dec 11, 2012 at 07:12:02 AM PST

              [ Parent ]

              •  Oops, median (1+ / 0-)
                Recommended by:
                dinotrac

                Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

                by Betty Pinson on Tue Dec 11, 2012 at 07:15:32 AM PST

                [ Parent ]

              •  If you earn less than the national median, you (0+ / 0-)

                are likely to pay even less. For example, if you make about 80% of the national median, you will pay only 6% (or maybe it's 6.5%, I can't remember) of your income.

                Not only is your payment based on a percentage of your income --  8% of 50,000 = $4,000 but 8% of $40,000 is only $3,200, but the percentages change as you go down.

                So... that $40,000, depending on where you live, is right around the family threshold for the lower rate, so, if the percentage is 6.5%, you would pay $2600 for your insurance.

                Again -- there is a big asterisk: the subsidies come in the form of tax credits.  If you can't adjust your W-4 sufficiently, you won't get the subsidy until you file your tax return.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Tue Dec 11, 2012 at 07:18:35 AM PST

                [ Parent ]

        •  That leaves you lugging 27% of out of (2+ / 0-)
          Recommended by:
          Heart of the Rockies, JeffW

          pocket expenses.

          Medicare is at 20%, at most.

          What's more, we'd be paying three times as much for your coverage.

          Because you heard some bad things about Medicare?  We should skip a few million free school lunches, deny a few million kids a college education, and fail to fight global warming because you think for-profit private insurance might be better?

          This place needs a PVP server.

          by JesseCW on Tue Dec 11, 2012 at 03:27:17 AM PST

          [ Parent ]

          •  I'm telling you to do anything. (0+ / 0-)

            I'm talking about the choices available to me.

            So -- query me this, Batman:

            If YOU'd be paying 3 times less for my coverage through Medicare, even though I'd be paying less out of my pocket, and Medicare services are delivered through the very same health care system that delivers them for privately insured people:

            How in the Hell could I get remotely the same level of care?

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Tue Dec 11, 2012 at 05:51:03 AM PST

            [ Parent ]

    •  Don't be too terrified- (17+ / 0-)

      my husband and I have been on Medicare for a couple of years, and so far no problems at all. Neither of us had to change doctors. I don't really use it much, am ridiculously and inexplicably healthy, but my husband has had some problems ranging from minor to not so minor. He's always had his choice of specialists, and really everyone I know has had the same experience.

      I'd heard some of the same stories about quality and access, but so far have not seen it. In fact, my husband was just saying that he likes the system much better than our previous private insurance.

      •  I'm glad for you. You don't want the experiences (2+ / 0-)
        Recommended by:
        BlueJessamine, Eric Nelson

        some of my family members have had.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Mon Dec 10, 2012 at 09:17:29 PM PST

        [ Parent ]

        •  Maybe it depends on where you live- (3+ / 0-)

          we're fortunate to be reasonably close to Philadelphia, and there is a very extensive medical community. I do understand that in some parts of the country, a shortage of physicians can lead to doctors being very choosy about which patients they accept, and that can be a problem.

        •  specificity is always nice in personal testimonial (2+ / 0-)
          Recommended by:
          JesseCW, Heart of the Rockies

          so we can understand the exact anecdotal information on which you are relying

          •  Sure. (0+ / 0-)

            Long waits for treatment -- cataract surgery is the last one I remember.
            Cursory treatment -- heartburn...after a looong time, well -- I think maybe it's your gall bladder...Whoops! Ha! How do you like that? It was really esophogeal cancer.  Get your things in order. You've got six months tops.
            Inflexible treatment -- Medication making you vomit?  Here, take this ant-nausea med.  Combo making you vomit worse? Well, get over it.

            Etc.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Tue Dec 11, 2012 at 05:43:18 AM PST

            [ Parent ]

            •  care to provide an anecdote? The examples you (0+ / 0-)

              provide are a bit disjointed but as far as cursory treatment for heartburn, that is not unusual as 99% of heartburn is either trivial in causation and then you move to the other possibilities such as reflux disease or maybe a hiatal, unless there is some sort of red flag such as the pt being a heavy smoker or in certain industries such as farming

              There is a flow chart of treatments  for various conditions as you can't scope every pt with heartburn because if you did, you may find yourself up for fraud charges if you bill insurance or defending your license with the medical board if the hospital is not paid due to unnecessary treatment

              •  Ummm....All I ever claimed was that I am afraid (0+ / 0-)

                of Medicare because of the experiences of people that I know and love.

                I have not claimed anything beyond that.

                BTW -- My FIL was a heavy smoker and, yes, that should have been a red flag.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Tue Dec 11, 2012 at 07:02:59 AM PST

                [ Parent ]

                •  then there was a failure in the initial history (0+ / 0-)

                  and also in subsequent histories. With the advent of EMR systems instead of classical charts there is supposed to be less of this.

                  However having lived with MC and w/o MC. I find I prefer MC to no insurance at all

                  •  Hard to believe. My FIL was never shy about that. (0+ / 0-)

                    But I have to agree with you: Medicare is infinitely better than no insurance at all.

                    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                    by dinotrac on Tue Dec 11, 2012 at 07:12:32 AM PST

                    [ Parent ]

                    •  question is if the history taker felt it was (0+ / 0-)

                      important or if the history were ever reviewed. With paper charts, there is a lot of information which is never relayed up the feeding chain to the doctor.  In 1984, average time spent with a pt was around 30 minutes or so (from memory) while today it is around 10 minutes.  accurate histories are one casualty of the demand for productivity

                      •  Hit the nail on the head there. (0+ / 0-)

                        We spend more money for less time with the doctor.
                        That will lead to big misses in care.

                        That's my big disappointment with ACA.  Lots of making sure people have to send money to insurance companies.  Not so much making sure that care is done in a rational way.

                        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                        by dinotrac on Tue Dec 11, 2012 at 07:20:18 AM PST

                        [ Parent ]

      •  Medicare (5+ / 0-)

        for ALL! Been there done that. If Obama give's into rethugs on age eligibility he is hurting the people who voted for him. Call your congressperson.. No Change to benefits. They are NOT entitlements. We paid for it with payroll tax our whole life.

        "America is the only country that went from barbarism to decadence without civilization in between" Oscar Wilde

        by angry hopeful liberal on Mon Dec 10, 2012 at 10:05:00 PM PST

        [ Parent ]

      •  I have tried being insured commercially, (3+ / 0-)
        Recommended by:
        JesseCW, Heart of the Rockies, JeffW

        being uninsured and having MC. I prefer MC

      •  Ditto here. (2+ / 0-)
        Recommended by:
        gramofsam1, JeffW

        At our age, most of our family and friends are on Medicare.  Our parents were on Medicare.  We hear (heard, in the case of our parents) no horror stories even remotely comparable to what our children and their generation are going through with private insurance.

    •  I view ACA's subsidization scheme as little (3+ / 0-)

      more than a bit of corporate welfare for insurance companies.

      It's going to work out pretty well for families in a "sweet spot" where the subsidy actually picks up a good chunk of the tab. But it's going to hurt everybody in the long run without significant improvements to cost controls measures.

      For what it's worth, I've had nothing but uniformly positive feedback regarding Medicare coverage. Most of the people on Medicare I know complained more about attitudes of health care professionals and the relatively impersonal care that is increasingly common. Medicaid, on the other hand, is another matter--and probably closer to what the subsidized insurance plans will actually look like than anything an employer offers.

    •  And if it bankrupts a nation for the sake (0+ / 0-)

      of lining the pockets of the grafters in the middle, what's the big deal?

      This place needs a PVP server.

      by JesseCW on Tue Dec 11, 2012 at 03:22:35 AM PST

      [ Parent ]

      •  But it reduces the deficit. The CBO said so. (0+ / 0-)

        Come on, you guys. You aren't keeping up with your talking points.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Tue Dec 11, 2012 at 05:53:21 AM PST

        [ Parent ]

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