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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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  •  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

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        •  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

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        •  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

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          •  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

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      •  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

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      •  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 ]

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