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This Morning on MTP, David Axelrod mentioned that there are "Progressive Solutions" out there to the "Medicare Problem." But then he refused to elaborate, within the 15-second timeslot that referee Gregory had just granted him.

Well ... that got me thinking ...

What are the Progressive Solutions to the "Medicare Problem"?


First off what IS the "Medicare Problem"?


Health Spending Growth Projected To Average 5.7 Percent Annually Through 2021

by Chris Fleming, healthaffairs.org -- June 12, 2012

New estimates released today from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project that aggregate health care spending in the United States will grow at an average annual rate of 5.7 percent for 2011 through 2021, or 0.9 percentage point faster than the expected growth in the gross domestic product (GDP). The health care share of GDP by 2021 is projected to rise to 19.6 percent, from its 2010 level of 17.9 percent.
[...]

The major effects of the Affordable Care Act on overall spending levels are expected to be felt most acutely in 2014. The coverage expansions associated with the Affordable Care Act for Medicaid and private health insurance are expected to increase the growth rate for health spending to 7.4 percent in 2014, with notable increases in spending on physician services and prescription drugs by the newly insured. Throughout the latter half of the projection period, incomes are expected to be higher, and a large number of baby boomers are anticipated to be receiving coverage under Medicare. Among others, these factors are expected to drive health spending up around 2 percentage points faster than overall economic growth by 2020, consistent with trends in the United States for about the past thirty years.
[...]


A measly "2 percentage points faster than overall economic growth"

-- that's some problem.  

There must be an extra 2% in spare change, that they can "shake out of the couch cushions" somewhere.


Is raising the Eligibility Age for Medicare participants, a good way to bring that 2% rate down, in order to bring down the cost of effective care?


Raising The Medicare Age May Be Good GOP Politics, But Single-Payer Is The Better Solution For All Americans

by Rick Ungar, Contributor, forbes.com -- 12/03/2012

As the GOP pursues its 'War on Entitlements' as a part of the fiscal cliff ballet, the notion of raising the age for entering Medicare has been gaining steam as a focal point of reform for the financially stressed government health care system.
[...]

According to the Congressional Budget Office, immediately increasing the Medicare age to 67 would save about 5% in the annual Medicare budget -- not an insignificant amount of money. Such a move would also have a positive impact on general tax revenues as more 65 and 66 year olds would remain in the work force in the effort to protect their company-provided healthcare benefits or, if they are self-employed, continue earning enough money to pay for their private health insurance premiums for an additional two years.

But then comes the bad news:

With any significant savings to a large government program, there is always a counter-balancing cost to someone. In this case, the cost of saving Medicare that annual 5 percent would reverberate throughout the entire healthcare system in such as way as to negatively impact on virtually everyone with a health insurance policy.

Why?  [...] -- we are removing the healthiest people from the Medicare insurance equation.


It seems like "raising the Eligibility Age for Medicare" is more a gimmick -- an accounting trick -- than a solution.

What are people supposed to do for those extra 2 years, those without private insurance, those with taxing physical jobs -- just get extra-ill?


Perhaps we should figure out what are the real drivers of that 2% care-cost growth rates are first, before we try to "fix the problem" ...


Medicare -- ourfuture.org

[...]
Medicare proves the success of progressive health care policy. Before Medicare, approximately half of America’s seniors lacked health insurance; today, virtually everyone over age 65 is covered by Medicare. [Kaiser Family Foundation] Because Medicare is a health-care-for-all plan for the elderly, it allows the government to pool risk and lower costs. [...]

Conservatives are wrong about the challenges facing Medicare. Conservatives argue that rising enrollment in Medicare is driving up costs. However, the Congressional Budget Office has reported that “the aging of the population…accounts for only a modest fraction of the growth” in Medicare costs. The main factor is the growth of health care costs -- the extent to which the increase in health care costs has exceeded the growth of the economy.  

Conservative attempts to privatize Medicare have been disastrous. President Bush’s Medicare prescription drug plan forced seniors to deal with hundreds of private insurers and prohibited the government from negotiating lower drug prices. The plan’s “doughnut hole” saddled 3.4 million Medicare beneficiaries with high drug costs. [ Kaiser Family Foundation] [...]


"The main factor is the growth of health care costs" and one of the main cost factors there is "prohibition against the government from negotiating lower drug prices"

ie. Pharmaceutical profit margins are still being protected.  


SO, an out of control driver for profit -- non-negotiable drug prices -- just might a contributing factor to the outsized growth in the cost of Health Care. It's not like we can "shop around" for the best price, when we are ill, and in urgent need of care.

Certainly there must be some 2% pocket change lying around in those cushions?


Aaah, what other "corporate interests" are making a quick-buck on our unavoidable old-age conditions?

Well I remember some hot debates, on how Health Insurers typically plot plan to increase their profit margin, often at the expense and/or disregard of our own individual health outcomes.

A big part of the Affordable Care Act was designed to deal with and cap that discrepancy.  


Does Obamacare Limit Profits for Health Insurance Companies in Your State?

by Jason Shafrin, thehealthcareblog.com

[...] The ACA imposes a minimum medical loss ratio (MLR) on all insurers. The MLR is the amount of money spent on covered person medical care divided by the total revenue received through premiums. [...]

The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs. The corresponding figure for large groups is 85 percent. [...]

Even though the MLR is a national law, it may not apply in your state.
Why? Because many States are petitioning for a waiver. HHS is currently reviewing applications from six states: Florida, Kansas, Michigan, Texas, Oklahoma and North Carolina.


SO, another out of control driver for profit -- Insurance Providers -- just might a contributing factor to the outsized growth in the cost of Health Care. It's not like we can "shop around" for the best price, when we are ill, and in urgent need of care.

There might be 2% cost-benefit reward ratio -- just waiting to be implemented around that MLR ratio, eh?

Insurers improve your outcomes -- and earn a 2% MLR bonus. Fail to deliver, then lose it.


Of course many Progressives would argue:  Why in a humane world, should there even be a 15% PROFIT MARGIN, on anything as basic and universal as providing caring for human illness.


Single Payer System Cost?

June, 1991 General Accounting Office

“If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” (“Canadian Health Insurance: Lessons for the United States,” 90 pgs, ref no: T-HRD-91-90.

December, 1993 Congressional Budget Office

S491 (Senator Paul Wellstone’s single payer bill) would raise national health expenditures above baseline by 4.8 percent in the first year after implementation. However, in subsequent years, improved cost containment and the slower growth in spending associated with the new system would reduce the gap between expenditures in the new system and the baseline. By year five (and in subsequent years) the new system would cost less than baseline. (“S.491, American Health Security Act of 1993”)

March/April 2012

Gerald Friedman, Professor of economics, University of Massachusetts-Amherst

“While providing superior health care,” the Expanded and Improved Medicare for All Act (HR 676), “would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single payer system would also make health-care financing dramatically more progressive by replacing fixed, income-invariant health-care expenditures with progressive taxes.”

Friedman estimated that, in 2013, single payer would save $215 billion on administrative costs to providers, $23 billion on government administration, and $153 billion on private health insurance administration. It would also save $178 billion on drugs, medical equipment, and hospital care by reducing their market power, for a total of $570 billion. Of that, single payer would spend $110 billion extending coverage to all, $142 billion on eliminating co-pays and increasing utilization, especially home health care and dental, and $74 billion to raise Medicaid payment rates to providers, for a net savings of $244 billion.


Why don't we charge people a 15% surcharge to eat? Well the "supermarket concept" with its intense competition, tends to shake out those excesses.

Perhaps the ACA's soon-to-be implemented version of the "supermarket concept" -- health insurance exchanges -- perhaps it will deliver the same market efficiencies in the long run. Perhaps not.


It would seem a lot more likely IF, one of the choices on the menu, were a Public Option -- you know, give us the option to choose Health Care, which has only a 2-3% profit/administrative margin built into its fees.

A NON-PROFIT CHOICE THAT WE STILL DO NOT HAVE.


If Americans had that choice, that 2% spare change problem could be "solved" in no time.

15% - 3% equals 12%  of "found money" that could be plowed back in to the public wellness system, to reduce the price of cost-effective quality care.


Heck they might even be able to LOWER the "Eligibility Age for Medicare" if we had a cost-effective, non-profit-driven choice like that. A choice that forgoes the Corporate Middlemen ... see ya, wouldn't want to be ya!

A choice that focuses on outcomes -- NOT incomes.  Our outcomes, not their incomes.



Kind of hard to fit all that into a 15-second sound bite, on the agenda-setting Sunday Shows, I guess. Assuming at least some of this was what David Axelrod was thinking.

Originally posted to Digging up those Facts ... for over 8 years. on Sun Jan 20, 2013 at 04:06 PM PST.

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Comment Preferences

  •  If they say we're the problem, (9+ / 0-)

    we're the problem.    Case closed.   You must have us confused with a representative democracy.

    What we need is a Democrat in the White House.

    by dkmich on Sun Jan 20, 2013 at 11:19:58 AM PST

  •  My progressive solution (10+ / 0-)

    is to kick out of office anyone who dares support cutting Medicare benefits.  

  •  There are so many--even I know these: (13+ / 0-)

    Pay primary care physicians to keep patients well.

    Negotiate drug prices along with the Vet.

    Allow 55 year olds to by into Medicare (to prevent putting off needed medical care.)

    Make even more basic screenings for common illnesses (like the PSA) free.

    Reward good health behaviors with lower deductibles.

    Get rid of even more waste and abuse. (No, you can't have a company's pet doctor write your prescription for an electric wheelchair you don't need.)

    Make care in the home as financially practical as a (Carlisle Group-owned) nursing home.

    •  thanks, MsTribble! (2+ / 0-)
      Recommended by:
      3goldens, Lujane


      good list,

      very insightful.  and dare I say, very progressive.


      Here's how the game is really Rigged.

      by jamess on Sun Jan 20, 2013 at 11:48:37 AM PST

      [ Parent ]

      •  Not every reform is bad (7+ / 0-)

        I read ranters on this site that think every effort to reform medicare is bad. Most of what I wrote actually benefits patients. (I'm a little uncomfortable with forcing generics on folks, but it is manageable.)

        Another example: At one point HHS suggested limiting the number of hugely-expensive machines like PET and MRI in a region. THe manufacturers went haywire. Now in this community there's about one on every block, and they are only open 8 hours a day.

        And another; Force insurers to use the same coding. Right now physicians' groups have to hire many staff members just to learn and manage thousands of codes. (Of course, even better is Medicare for all aka a public option. Once the codes are the same, it's a step in that direction.)

        Our local specialist was laughing that their group got an incentive for putting all records on mutually-accessible computer systems to avoid doctor hopping and needless duplication. He said: "They are paying us to do what we should have done years ago!" Whatever it takes!

        •  it sounds like you work as a Care-provider (5+ / 0-)

          thanks again for the insightful cost-saving items.


          I think what most are ranting against (myself included),

          is the blind austerity knife, being aimed at

          cutting our earned benefits,  

          in terms of increased barriers of eligibility

          or diminished payments of through CPI tricks, etc.


          The cost of living doesn't go down,
          so why should our mean of support do so?

          FICA deductions in my paycheck never go away.
          That's the deal.  That's the "social contract"

          We paid for a lifetime, now you need to take care of us.

          as our lives fade to black.


          Here's how the game is really Rigged.

          by jamess on Sun Jan 20, 2013 at 12:23:35 PM PST

          [ Parent ]

  •  The solvency issues are related to (5+ / 0-)

    payments for services.  We need price controls.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sun Jan 20, 2013 at 11:45:30 AM PST

    •  price controls on what? (2+ / 0-)
      Recommended by:
      3goldens, Chi

      didn't Nixon try that,

      which ultimately didn't cap them for long.


      It seems allowing the Govt (ie Medicare) negotiate
      for bulk purchases on drug, etc,

      would be more doable, and would still allow "the market to work."


      Here's how the game is really Rigged.

      by jamess on Sun Jan 20, 2013 at 11:51:34 AM PST

      [ Parent ]

    •  zenb - we have a fundamental supply demand (1+ / 0-)
      Recommended by:
      coffeetalk

      issue. We don't have enough primary care physicians and nurses. If we reduce what the gov't will pay, fewer of them will provide service. We have seen that already with Medicaid and it is gaining momentum within Medicare. The solution is more physicians and nurses in primary care, but that will take a big investment by the federal government and at least ten years to show a difference.

      "let's talk about that"

      by VClib on Sun Jan 20, 2013 at 07:14:57 PM PST

      [ Parent ]

  •  of course (2+ / 0-)
    Recommended by:
    3goldens, Lujane

    the real Budget Problem,

    is largely a problem of framing its context:


    Say hello to the Big Bait and Switch
    by jamess -- Jan 19, 2013


    ... something most of the media is very reluctant to do

    -- assigning Real Blame, for our Real Debts,

    and to those who blithely put them on the books.


    Here's how the game is really Rigged.

    by jamess on Sun Jan 20, 2013 at 11:46:47 AM PST

  •  The is clearly a long-term problem with Medicare (5+ / 0-)
    Recommended by:
    jamess, Jon Says, VClib, Lujane, Cedwyn

    People need to read the Medicare Trustees Report for 2012.

    It says that even if you assume the most favorable outcomes under the ACA with respect to reducing spending,

    Total Medicare expenditures were $549 billion in 2011. The Board projects that, under current law, expenditures will increase in future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP,  they will increase from 3.7 percent in 2011 to 6.7 percent by 2086 (based on the Trustees’ intermediate set of assumptions). If lawmakers continue to override the statutory decreases in physician  fees, and if the reduced price increases for other health services under  Medicare are not sustained and do not take full effect in the long  range, then Medicare spending would instead represent roughly  10.4 percent of GDP in 2086. Growth of this magnitude, if realized,  would substantially increase the strain on the nation’s workers, the  economy, Medicare beneficiaries, and the federal budget.
    That means that if we do the doc fix every year (which we just did again), Medicare will grow to 10% of GDP -- not 10% of the budget, 10% of GDP.  And that's assuming the most favorable outcome with respect to the ACA being able to reduce costs -- they say the lilkely outcome may well be much worse.  Read that report.

    We can't have a situation where 1 out of every dollar generated by every single person in this country goes to Medicare (not counting Medicaid, and SS, and all other government spending).  Right now, we only take in about 15% of GDP in government revenues.  We HOPE to get up to 18% of GDP -- which means that Medicare alone (not counting Medicaid, interest on the debt, Defense) will take up over half of every dollar the federal government takes in.  

    Yes, this is a LONG TERM outlook.  We probably have 10 - 15 years before the situation begins to be really problematic (right now, Medicare is projected to be solvent for 10 years or so).  But that doesn't mean we can wait 10 years to do something.  We can't wait ten years, and then tell people who are 65, ok, we're changing things for you.  If things are going to change for someone who is now 45, we need to start talking about that now so that 45 year old will know what he/she can count on and what he/she can't count on.  People don't wait until they are five or ten years away from retirement to start making SOME kind of plan, and so neither should Congress.  

    I completely agree that Ryan's premium support program is a political non-starter.  But I DO want to hear the Democratic plan for a long-term solution.

    I believe it is the obligation of our elected officials to tell us what they envision as the long-term solution for the unsustainable path for Medicare.  And I applaud anyone who asks the question of our elected officials.  It is irresponsible for an elected official to say, "I'll think about that when it happens."  

    •  so coffeetalk (2+ / 0-)
      Recommended by:
      3goldens, Lujane

      where do you stand on the Public Option?

      seems there's an automatic 12% cost-cut right there,

      mostly taken larger from Insurance Exec salaries and bonuses,

      and those other Wendell Potter -type perks.


      Here's how the game is really Rigged.

      by jamess on Sun Jan 20, 2013 at 12:06:23 PM PST

      [ Parent ]

      •  I'd have to see the specifics of a proposal (2+ / 0-)
        Recommended by:
        jamess, Lujane

        Any proposal is going to have some positives and some negatives, and those have to be weighed.  

        In a way, a government-run system for health care such as that Krugman proposed makes some sense.  But on the other hand, I have some concern that it would become a health care system for the poor, with anybody who is able to afford it opting to go into the private sector.  And with reimbursement rates for providers so low that only those who have no other choice agree to practice in it.  Perhaps I am jaded by my experience with the public school system in New Orleans growing up, where pretty much  anybody in the middle class -- of any race and/or religion -- opted to send their kids to the private schools, most often the Catholic schools, which provided an affordable option for many middle-class families and became the dominant high-school system here.  The public schools (except for  few magnet schools like Ben Franklin) became a "holding ground" for those families who didn't have the resources to get their children out.  And because the middle class largely didn't use the public school system, the middle class largely didn't support the public school system, and didn't want to pay for the public school system.  

        In other words, give me some specifics:  how would it be run, how would it be paid for, how do we guarantee it doesn't become a second class system for the poor and really really sick, and what would it mean for the long-term projections for Medicare?.

        But as Krugman says, that's a political non-starter.  And that's the crux of the problem.  There needs to be SOMETHING the Congressional Democrats are for -- something the Democratic leaders will support.  We know they DON'T support the Ryan plan.  Fine.  What do they support?  I'd be happy if they put forth some kind of Medicare public option -- because that would be, at the very least, an acknowledgement that there is a problem that we need to address, and it would force us to have the discussion.  

        •  That only shows how effed up (3+ / 0-)
          Recommended by:
          jamess, Lujane, Chi

          LA is. Public schools here are generally better than any of the private ones. But we spend money on it and it is important. We don't do young earth or creationism or any of that other bullshit.

          Also I'd have to say that state medicine is far better than the private practice experiences I had. Like not even close. Our health departments are unbelievable and staffed with friendly knowledgeable people who like to answer questions.

          •  It's not all of Louisiana (1+ / 0-)
            Recommended by:
            jamess

            I'm giving you my experience growing up in New Orleans, which in a lot of ways is not representative of al of Louisiana.  

            And the Krugman suggestion of a universal system like the VA health care system will bother some people.  The reports of the quality of the VA hospitals have been mixed at best, and problems have often been reported in the papers.  See, for example, here  and here and here.  Some people are happy with the VA system, certainly, but there are many people whose only knowledge of the quality of the system comes from those stories in the papers.

    •  There's a long-run problem with health care (2+ / 0-)
      Recommended by:
      Chi, Cedwyn

      costs in general, not with Medicare.

      We can't wait ten years, and then tell people who are 65, ok, we're changing things for you. If things are going to change for someone who is now 45, we need to start talking about that now so that 45 year old will know what he/she can count on and what he/she can't count on.
      It sounds as though you're assuming the solution is going to involve cutting benefits or otherwise providing less care to patients. I don't assume that at all. We know it's possible to provide care for far less money because every other country is already doing it.

      We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

      by denise b on Sun Jan 20, 2013 at 08:18:04 PM PST

      [ Parent ]

  •  Improved Medicare for All! (8+ / 0-)

    (i.e. Single Payer)

    It's such a no brainer.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Sun Jan 20, 2013 at 04:33:06 PM PST

  •  Not in the real world (5+ / 0-)
    Such a move would also have a positive impact on general tax revenues as more 65 and 66 year olds would remain in the work force in the effort to protect their company-provided healthcare benefits or, if they are self-employed, continue earning enough money to pay for their private health insurance premiums for an additional two years.
     In the real world, where 45+ year-olds are already being broomed out of jobs for the sin of being "too old", the notion that very many 65 year-olds (who are not among those in privileged positions) could actually "choose" to continue working in a job where they even get any healthcare benefits is laughable.

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Sun Jan 20, 2013 at 04:34:05 PM PST

  •  require every person receiving Medicare (4+ / 0-)
    Recommended by:
    jamess, Gooserock, reflectionsv37, Cedwyn

    to complete a medical directive form which specifies what medical interventions they desire and which they do not.  A lot of money is spent during the last 12 months of life, and I'm guessing much of those medical procedures would be opted out of by patients if they were forced to think about it beforehand and discuss it with their family.

    Oregon: Sure...it's cold. But it's a damp cold.

    by Keith930 on Sun Jan 20, 2013 at 04:39:38 PM PST

    •  interesting idea Keith930 (0+ / 0-)

      hadn't heard of that one before.


      Here's how the game is really Rigged.

      by jamess on Sun Jan 20, 2013 at 04:43:08 PM PST

      [ Parent ]

      •  some...perhaps most, would say "I want it all" (1+ / 0-)
        Recommended by:
        jamess

        BUt I'll bet a not insignificant number would actually give it some thought.  Either way, most people choose not to deal with those questions until it's too late, and the system ends up taking over and making the decisions for them...and then it's all about medical CYA and running up the bill.

        Oregon: Sure...it's cold. But it's a damp cold.

        by Keith930 on Sun Jan 20, 2013 at 04:57:43 PM PST

        [ Parent ]

        •  well I still think (1+ / 0-)
          Recommended by:
          3goldens

          merit compensation based on wellness outcomes,

          not on the number of tests etc,

          has significant incentives to drive costs down, in the long run.

          ie. pay doctors a bonus, when their patients, DON'T need any tests or treatments.


          Here's how the game is really Rigged.

          by jamess on Sun Jan 20, 2013 at 05:01:54 PM PST

          [ Parent ]

          •  Is that like paying teachers (1+ / 0-)
            Recommended by:
            jamess

            according to how well their students do on tests?

            Doctors don't completely control outcomes, just as teachers don't. They can't control how their patients will respond to treatment or how sick their patients are or how well they comply with instructions or the other factors in their lives that affect their health.

            And maybe you want your doctor to have a financial incentive to deny you tests - I don't. I've already seen in HMOs what happens when the insurance company has an incentive to deny them: diagnosis and treatment get delayed for non-medical reasons, and people suffer.

            Creating financial conflicts of interest between doctors and patients is just as bad - or worse - as giving doctors incentives to overtreat. And I certainly don't want to give them an incentive to turn away sicker patients. The answer has to lie elsewhere.

            We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

            by denise b on Sun Jan 20, 2013 at 09:03:51 PM PST

            [ Parent ]

            •  yes but (1+ / 0-)
              Recommended by:
              Chi

              tests for the sake of tests

              does not usually result in long-term learning.


              Learning is a process, much more than memorization;

              but you raise some good points about HMO's and denial of care ... for dollars, in my "merit system."


              Obviously for a bonus based on wellness to work.

              Wellness would have to be more than an arbitrary pronouncement.  Made by the provider.


              Here's how the game is really Rigged.

              by jamess on Sun Jan 20, 2013 at 11:34:26 PM PST

              [ Parent ]

        •  I started to write an advance directive (1+ / 0-)
          Recommended by:
          Chi

          a year ago, along with two of my friends. It's harder than we thought. I have not been able to complete mine yet.

          One of us already had a disease that she knew would kill her when we started the process, most likely within five years, although she was still doing quite well at the time. Her illness was the impetus for the three of us, all in our 60s, to do this. She has since died. She went downhill very abruptly one day and spent the next month in and out of the ICU, then in hospice for a month. She rescinded her original advance directive and did not complete another until she left for hospice, because, as I said, it's hard to say exactly what you will want before you're faced with concrete choices.

          It bothers me a lot that anyone would suggest that the money spent on her hospital care was wasted because she died anyway. Yes, she had a terminal disease, but no one knew when she would die. Her doctors didn't know exactly what caused her to get worse - whether it was the progression of her disease or a treatable infection. They might have been able to get her well again to live for an indeterminate amount of time, so of course they treated her. I would never want her or anyone else deprived of care in a situation like that. When her doctors determined that they could not get her better, then and only then did they stop treating her. It would have been tantamount to murder to do otherwise.

          And though she did not want her life prolonged if she was in a coma or on a breathing machine, she definitely wanted to live the last weeks or months she had left. I think almost anyone in her situation would have.

          We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

          by denise b on Sun Jan 20, 2013 at 08:50:27 PM PST

          [ Parent ]

    •  Back in the 70's They Were Saying That Most (1+ / 0-)
      Recommended by:
      jamess

      of your lifetime spending occurs in the last year, as I recall.

      We lived in WA state which has a lengthy, detailed advanced directive questionnaire. When we brought mom out to live with us she went through the whole thing very carefully. She was afraid of being kept alive in limbo in possible pain so she made the choices that would spare her those conditions and so much spending. Her Dr. just changed her status to end stage alzheimers, and honoring the directive he ended all of her therapeutic meds. Comfort meds only. This is saving Medicare and her insurance plan money, and she has a DNR directive so if there's a heart attack, stroke etc. she'll receive only comfort care.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Sun Jan 20, 2013 at 05:04:39 PM PST

      [ Parent ]

  •  Here are some specifics that we must address, (2+ / 0-)
    Recommended by:
    jamess, Chi

    we must simplify the health care delivery for seniors.  The whole system is way to complicated for most seniors and families to navigate.  Seniors are receiving too much health care and it killing them, they are overmedicated and underserved.  Lack of coordinated health care(read this too many specialists) and not enough doctors that understand the health needs of the elderly.  I know of several cases where the lack of communication almost killed a couple of wealthy seniors, their money did not protect them from malpractice.  Anyone that spends any time with our health care system knows that too much of our style of "healthcare" will kill you or make you sicker than you were before they started treating you.

  •  If companies paid (6+ / 0-)

    their workers a decent wage instead of stinting on employee pay while paying the CEO millions that go untaxed above $100k, we'd have a lot more money being contributed into FICA.

  •  Look for the excess profits not at the costs (4+ / 0-)
    Recommended by:
    jamess, Brown Thrasher, ladywithafan, Chi

    If you just look at costs, the easy answer is to deny care.

    I'd focus on who is making too much money.  Healthcare should not be unduly profitable.  Yeah, we need some incentive for research and for producing providers but when the incentives are wrong (and you'll find the wrong incentives when you find the excess profits) then the wrong kind of care is provided.  We need more incentives for primary care providers who are trained to treat the elderly and fewer incentives for procedure mills.

  •  Medicare Advantage needs to go!!! (5+ / 0-)
    Recommended by:
    jamess, Araguato, ladywithafan, Chi, Cedwyn

    About 25% of us on Medicare have signed up for Medicare Advantage programs.  Most of us pay nothing for this, and get some benefits.  The biggest is a stop lose at $5200 a year.

    To get this free benefit, the insurance companies are paid to administer Medicare instead of the government.  I still have regular Medicare A and B  which I do pay $105 a month for.

    But the profits the companies are making off of this are huge, and could be easily eliminatd

    "We borrow this Earth from our Grandchildren."

    by Arizona Mike on Sun Jan 20, 2013 at 06:39:01 PM PST

    •  Agree ^^^^^ (2+ / 0-)
      Recommended by:
      jamess, ladywithafan

      My husband is newly on Medicare and this was the first year we had to fight our way through the unbelievably complex choices every single senior has to make.

      Where one plan before 65 did everything, we wound up with four different sets of benefits (Parts A and B from Medicare, mandatory Part D (drug plan selection) and a supplemental policy (Medigap Insurance). As it happened the first year we chose the supp. from the insurer that had covered him before he turned 65, so it basically was the same insurance, only now with four, not mutually coordinated, parts.

      This fall we struggled mightily with the drug plan choice which not only requires you to estimate (in advance) what you  wish (or can even afford) to pay, but also what drugs you now take, may take, might have to take if things change, but even which pharmacy chain to choose.  The variables, though helpfully laid out in an interactive website are enough to drive one mad.

      No wonder so many people fall for the Medicare Advantage plans  - only one decision to make.  Though I know of one person who actually died because they believed that traditional Medicare was no longer possible and chose an Advantage Plan. And that plan controlled access to treatment that would have saved his life had he been "allowed" to chose another facility.

      When people say "Medicare For All" (as I once did) I now mutter to myself, "Be careful what you wish for."

      The other technical argument against raising the entry age for Medicare is that most health insurers won't offer insurance after the month you turn 65 - they are only too eager to dump customers onto the public program.  We wouldn't have made the change without their demand.  It had ramifications for me, too, as I was suddenly in limbo as the too-young- for-Medicare dependent on the policy of a person being involuntarily switched. We made some adjustjments and it worked out but it was hair-raising for a few weeks.

      From the insurers' points of view shot-gunning the newly-65 into Medicare pre-emptively saves them money as older people tend to use more services, in the aggregate.  But keeping those same older people in the under-65 insurance market only shifts those costs to younger workers' plans and their employers.

      The Part D plan also has a built-in pitfall. By keeping the drug plans separate from Medicare (and the Medigap insurers if one chooses such a plan) there is an economic dis-incentive for drug plan companies to pay for more-expensive drugs that sometimes would result in cheaper overall care, as long as the care is being paid for by someone else.  

      Case in point: My husband takes an old-fashioned blood thinner, so generic and cheap, it's practically free.  There are newer and vastly more expensive  ($600+/mo) blood thinners available.  Most Part D drug plans that we priced which covered them cost much more in premiums and still only covered a small share.

      The thing to know about this is that the newer drugs are reputed (they're new so who really knows the truth here) to do a better job, with less side effects, fewer restrictions, and with better outcomes at what you're taking them for than the old, cheap,  stand-by. Since you take blood-thinners to prevent very serious (and very expensive to treat) disease-related complications  and the old drug has a significant risk of serious (and expensive to treat) drug side-effects, one would think that everyone in the system would be clamoring for the over-all cheapest course of action: the new drugs.

      Nope. Using the old drug means Medicare will get saddled with paying for any possibly-avoidable poorer-outcome costs AND any drug-related complications, while the private Part D insurer is still making money on the newer drug by limiting access, jacking up premiums and skimping on reimbursements for it. Who negotiated this foolish state?

      I know, I know, one more thing to chalk up to Shrub.

      A

  •  I would not be opposed (1+ / 0-)
    Recommended by:
    jamess

    to paying a higher premium for those of us who could afford it. This would be much more acceptable to me than raising the age for Medicare.

    Shop Liberally this holiday season at Kos Katalog

    by JamieG from Md on Mon Jan 21, 2013 at 07:50:06 AM PST

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