The Medicare Mess

[shostakovich]

And, now for my last number -------


Medicare works pretty well. It does not need an overhaul. It CERTAINLY does NOT need privatization. It can be run as a non-profit branch of the government. It can NOT be run non-profit by HMOs, which already have a shady reputation. It is quite solvent, and any thoughts that it might be in financial trouble somewhere between 2017 and 2055 (the extremes I've encountered) should be easy to fix now if there is any desire to fix it. The Bush administration clearly has no such desire. Rather, it would sell out Medicare to business interests.

The one failing of current (before the confusing cards) Medicare is that it offers no relief from the cost of prescriptions. The simple solution would be to tack on a prescription benefit, and charge a little more for the service. But the Bush plan (for 2006) 1) requires a person to go to an HMO (i.e., out of traditional Medicare) in order to get prescription cost reduction, 2) forbids Medicare from bargaining for lower prices with pharmaceutical companies as it does with doctors, and 3) makes importation of identical, but cheaper, Canadian drugs illegal. (This 3rd one has nothing to do with Medicare, but simply disallows individual freedom to purchase American drugs from Canada at Canadian prices.)

All these features are designed to benefit HMOs and drug companies far more than the incidental help it will bring to only the most impoverished individuals. Those people would likely already be on Medicaid, getting prescriptions at very low cost anyway. If there is a theme that runs though all of Bush's policies, it's the Inverse Robin Hood motto: Steal from the poor and give to the rich.

There are other parts to the recently passed Medicare plan that I don't have at the tip of my fingers, but none of it bodes well for the public. If Congress were passing a Medicare bill for itself, the Medicare Mess they passed for us wouldn't have been it. Most people are not yet 65, and not looking critically at what Congress passed and is BRAGGING about. When they reach 65 they will not want the horror called Medicare scheduled to begin in 2006.

I'll be gone next week, so take your time commenting if you care to. Enjoy the Olympics.
Shos

[shostakovich]

I paid no attention to Medicare details before I was eligible, so I'm going to assume most of you folks are also in the dark. Here's how it works.

Most doctors are "Participating Physicians in Medicare". That means they do not collect their full charge because of the bargaining Medicare was allowed to do with (I assume) the various physicians' unions. [This is exactly what the miserable Medicare bill does NOT allow Medicare to do about drug charges.]

The doctor's bill: $100
Medicare allows (doc to receive): $60
Medicare pays 80% of that: $48
You owe $12, unless you also have Medigap ins, which pays.

The Medigap also picks up almost half our drug costs (this is totally separate from Medicare), as well as the 20% listed above, but we (my wife and I) are paying over $400/mo for that benefit. Yet, since our medication costs are reduced from about $750/mo to $400/mo (big time arthritis), we come out a little ahead.

As you know, drug costs are skyrocketing. Without some arbiter, such as Medicare, nothing will slow them. The HMOs will not need to because they are not subject to government control. Elected officials pay SOME attention to us once every 4 years, and they have more influence over GOVERNMENT programs, such as TRADITIONAL MEDICARE.

OK, NOW enjoy the Olympics. Honest.
Shos

<small>[ 08-06-2004, 12:56 AM: Message edited by: shostakovich ]</small>

[OperaTenor]

Gee Shos, I don't see why you have such a problem. It's just a matter of converting our system of government to a for-profit business. That being the case, I think HMO's are perfect for the job. Profiteering is what they excel at.

[Selma in Sandy Eggo]

Wow, I missed this. See what happens when you take a vacation?

I don't understand Medicare. So far, not a big problem, because I do understand my HMO. Mind you, I think it's one of the better ones and I had a choice of several, but it's not perfect. Re the drug prescriptions, there are generics ($10 copay), non-generic preferred ($20 copay), non-generic non-preferred ($30 copay), and experimental/cosmetic/homeopathic/alternate-therapy/otherwise-disallowed medications (on your own). I'm pretty sure that, with the premiums they charge, my HMO makes a decent profit off most people, most years.

Yup, they'd like to take over the Medicare market. I'm sure it would work out just fine...

[shostakovich]

Hi Selma. It's encouraging to know you have a good HMO. Are you in a group plan? We got abandoned by our group plan when I retired.

I have a bad feeling about HMOs. A few years ago at least 2 big CT HMOs went belly up. Their clients were suddenly uncovered. Medicare (traditional)can't do that.
Shos

[Selma in Sandy Eggo]

Yes, very big group plan. It's the Plan of Shos & Many Others, via those Infernal Revenoo dollars wrenched away from you each April.

Our coverage has been reduced by political preferences of others, and our copays have been increased, but on the whole we have a decent set of plans. Good to know OPM is good for something.

The philosophy of HMOs is entirely laudable. We have fixed costs and they guarantee treatment for whatever befalls us. In practice, they make a killing on healthy people and lose money on unhealthy folk. This is where things get weasel-y, as the unscrupulous accountants in charge seek to unload or avoud providing care to the very people who need it most; the catastrophic illness/accident, the elderly, those with expensive chronic diseases. Letting HMOs, unsupervised, take over the Medicare accounts sounds like a real bad idea, to me.

[OperaTenor]

When I went to Life/Health insurance school, we were told a simple way to differentiate between an HMO and a PPO: In an HMO, the provider earns more by treating less, in a PPO, the provider earns more the more treatment provided.

Gee, look what we have to look forward to.



I still feel the proponents of dog-eat-dog health care(what we have now, and look forward to) only have that view because they know they'll never have to taste the dogmeat.