News Can Expanding Access to Medicare Really Solve the US Healthcare Crisis?

[airborne18]

I am not into politics, but one issue that has bugged me is the missed opportunity of the last 2 years.

There are very few moments in US history when one party holds the super majority, that precious balance that is veto proof.

I was really looking forward to an overhaul of the US healthcare system, and it was the perfect time in history, and we go nada.

After this coming election we will lose this balance.

Just a gripe thread.

 

[Ivan Seeking]

The Dems have never held a supermajority. In fact, it was the Independents [including Lieberman, in the Senate] who refused to sign on to a more aggressive program - universal health care. If we hadn't compromised, nothing would have passed. Without the two Independents, the Dems had 58 votes, not 60. [recall also that Kennedy died, this required that Senator Snow [R] sign on in addition to the two independents]

The fact is that health care reform was passed after a century of effort. It may not be everything that you wanted, but Rome wasn't built in a day [or a year]. Getting over this first huge hurdle is all that one can reasonably expect. Once everyone realizes that Obama won't be pulling the plug on grandma, or taking the meds from older folks, or taking over the medical industry, more progress will come.

 

[Ivan Seeking]

You need to undestand that the right did everything possible to terrorize people.

For example, it was Senator Grassley [R] who said that Obama wants to pull the plug on grandma. Sarah Palin was then quick to jump on the bandwagon... and Limbaugh, I would assume, and Fox, etc, etc, etc.

All of these fallacies and lies have to be put to rest before more is possible.

 

[Topher925]

All of these fallacies and lies have to be put to rest before more is possible.

OR, people can just stop being so stupid and learn to ignore such propaganda.

 

[turbo]

The right-wing "media" seem to be able to whip idiots into a frenzy, and that made even modest health-care reform difficult at best. Seeing rallies with nuts carrying signs that say things like "no socialized medicine - hands off my Medicare" didn't help much. The intellectual disconnect and unintended irony was lost on them.

 

[Jimmy Snyder]

There are very few moments in US history when one party holds the super majority, that precious balance that is veto proof.

What has veto proof got to do with it? The President is of the same party as the majority. Besides, the majority in the Senate was only 60-40 at best, not enough to override a presidential veto. The requirement for that is 67-33. The value of the 60-40 majority was in the quashing of filibusters, not overriding vetos.

 

[airborne18]

What has veto proof got to do with it? The President is of the same party as the majority. Besides, the majority in the Senate was only 60-40 at best, not enough to override a presidential veto. The requirement for that is 67-33. The value of the 60-40 majority was in the quashing of filibusters, not overriding vetos.

I realize I was wrong, and as someone else pointed out it took independents to fill out that 60-40.

My context for veto proof was that the executive branch would sign it. I realize in a literal context it was a not correct.

This was more of a philisophical point.

I do not participate in the private health care system, the VA medical system is my provider now. And the VA does an outstanding job, since they cleaned it up in the past 10 years, it is excellent care. Yeah it has its irritating qualities, but it is excellent care.

Most people are generally healthy and do not have chronic medical problems. So it is hard to understand the real flaws in our system. They become very apparent when you are faced with chronic medical issues. Your great insurance will quickly disappear. I have been dropped more times from insurance than I care to count.

Just the simple fact that we provide the best care to the oldest citizens, and the youngest can go without. That is why are costs are out of control, and it is because the oldest have the best lobbying group.

In what realm of common sense do we give an old drunken baseball player muliple transplants? Is that why we should donate organs?

ANd why do we even charge for organ transplants? If you are able to donate an organ, you should be able to receive one. You cannot even get on the transplant list if you do not have the money to pay for it.

Just again. me ranting endlessly.

 

[Hurkyl]

Everyone in this thread seems to be operating on the implicit assumption that their pet ideas about health care are better than the status quo -- and that their pet idea is precisely what the democrats would have legislated if they didn't "miss this opportunity".

 

[airborne18]

Everyone in this thread seems to be operating on the implicit assumption that their pet ideas about health care are better than the status quo -- and that their pet idea is precisely what the democrats would have legislated if they didn't "miss this opportunity".

I didn't realize I constituted everyone, but okay. The missed opportunity is that they had a chance to pass what they proposed, and still didn't. Is our system that corruptable that a party with a majority can persuade themselves out of passing their own agenda?

That is what they ran on, and Obama had enough good will and popularity that he could have passed any law he wanted, in his own fashion. The missed opportunity is that his inaction and lack of leadership doomed his own agenda.

And the status quo of healthcare in this country is seriously flawed, and it does not take a phd to realize that fact.

I have no pet ideas, just many examples of how flawed our healthcare system actually is.

The problem is that there is no happy middle ground in our system. Everything is driven by profit. Even something as simple as medical records privacy is compromised by lobbyist, so drug companies know how many scrits each doctor is writing so they can give kickbacks. Read the HIPPA laws, the receptionist in your HR department has better access to your spouse's medical records that you do. And better access to your own medical records.

There is not one aspect of the healthcare system that is not tainted by profit.

And I am actually not for Medicare, because that is golden cash cow of the medical industry.

So don't make assumptions.

 

[mheslep]

I didn't realize I constituted everyone, but okay. The missed opportunity is that they had a chance to pass what they proposed, ...

Which was what exactly, and how would it have been any better than the status quo?

 

[airborne18]

well one thing it would have done is save your state a ton of medicaid money, oh and actually provide coverage for children. Simply fixing medicaid would have saved everyone a lot of money, it is one of the broken cogs in our system that adds to health care premiums.

 

[mheslep]

well one thing it ...

What is it?

 

[DaveC426913]

OR, people can just stop being so stupid and learn to ignore such propaganda.

Funny thing about propaganda, it is not actually labeled as such to distinguish it from truthhood...

 

[turbo]

Funny thing about propaganda, it is not actually labeled as such to distinguish it from truthhood...

or truthiness...

 

[Jack21222]

OR, people can just stop being so stupid and learn to ignore such propaganda.

The Gaussian distribution is a cruel mistress.

Imagine the average American citizen. Have a picture in your head? Good. Now consider the fact that 150 million people are DUMBER than that. Many tens of millions are SIGNIFICANTLY dumber. Over a million will be two standard deviations dumber.

And you know what else? They vote!

 

[SW VandeCarr]

or truthiness...

Then again, it might be truthyness, trutheeness, or truthitude.

 

[CRGreathouse]

I was wondering if anyone participating in this thread would like to make a concrete prediction about how the healthcare system will be (in light of the reforms that were passed) in, say, 2015 or 2020.

 

[airborne18]

By 2020 the system will be redone.

In the short term, unless a new congress can change it, the system will end up exactly as congress wanted it to be: a mess.

Congress created a system setup to fail intentionally, so that in 5 years the country will be begging for nationalized care. Meanwhile the US government will collect tax revenue.

I am all for fixing the system, but to qoute a great philosopher, "this is maddness", (1976, C3-PO).

Small business will happily pay the 750 a year per employee, that is a no-brainer. For the ones who have health plans for the owners, they will just created "managment" companies to hold all of the owners so they don't have to give their employees the plan.

Congress had a choice, expand medicare to cover more, or expand medicaid. They chose poorly. Medicaid is the cause of our systems cost-shifting. ( I know they say it is medicare, but that is a bluff to get medicare rates higher).

Medicaid is also a major reason the states are running budget problems. And these problems will just expand.

The pre-existing conditions issue will drive up private insurance rates, as will the cost shifting.

Instead of 50 million without insurance, there will be 80 million on medicaid who cannot get treatment and more cost shifting to private insurance.

 

[turbo]

We US citizens could have been allowed to opt into Medicare. With lots of younger, healthier clients, Medicare would have had a lot more income and a lower proportion of claims, resulting in a fiscally robust program that is even better that what we have presently.

As someone who spent years in health-care, I can assure you that many doctors would far prefer Medicare reimbursement levels than fighting with a huge spectrum of private carriers, each of whom have their own coding rules. Medical practices lose a LOT of money fighting that crap. I have a friend who is a pediatric ophthalmologist (and my cousin is his office manager) who has a thriving practice serving children from low-income families on Medicaid. The reimbursement rates are low, but his administrative overhead is so low that he and his practice are well-compensated. Medicaid does not kick back claim based on typos and other trivial crap like the private insurers do. He's not the type to splurge on Porsches and ski-getaways in Colorado - just a decent family man who also takes care of his elderly mother.

 

[Gokul43201]

There are very few moments in US history when one party holds the super majority, that precious balance that is veto proof.

Did you mean 'filibuster proof'?

 

[mheslep]

We US citizens could have been allowed to opt into Medicare. With lots of younger, healthier clients, Medicare would have had a lot more income and a lower proportion of claims,

Everyone working pays into Medicare http://en.wikipedia.org/wiki/Federal_Insurance_Contributions_Act_tax" , including the young.

 

[talk2glenn]

We US citizens could have been allowed to opt into Medicare. With lots of younger, healthier clients, Medicare would have had a lot more income and a lower proportion of claims, resulting in a fiscally robust program that is even better that what we have presently.

It is always amusing when people who clearly do not pay taxes tell us how the tax codes ought to work.

American democracy at its finest.

 

[turbo]

It is always amusing when people who clearly do not pay taxes tell us how the tax codes ought to work.

American democracy at its finest.

Perhaps you should explain why you think I pay no taxes. Ad-hom attacks do not advance your cause.

 

[airborne18]

We US citizens could have been allowed to opt into Medicare. With lots of younger, healthier clients, Medicare would have had a lot more income and a lower proportion of claims, resulting in a fiscally robust program that is even better that what we have presently.

As someone who spent years in health-care, I can assure you that many doctors would far prefer Medicare reimbursement levels than fighting with a huge spectrum of private carriers, each of whom have their own coding rules. Medical practices lose a LOT of money fighting that crap. I have a friend who is a pediatric ophthalmologist (and my cousin is his office manager) who has a thriving practice serving children from low-income families on Medicaid. The reimbursement rates are low, but his administrative overhead is so low that he and his practice are well-compensated. Medicaid does not kick back claim based on typos and other trivial crap like the private insurers do. He's not the type to splurge on Porsches and ski-getaways in Colorado - just a decent family man who also takes care of his elderly mother.

This illustrates my point. You hear doctors moaning about Medicare, but really it is their cash cow. Medicare just pays and pays, and never kicks back any claims.

 

[airborne18]

Did you mean 'filibuster proof'?

Well both really. You have a party that has buy in from the White House ensures no veto, so yes. Filibuster proof.


And I pay no taxes. My VA money is tax free.

 

[talk2glenn]

I was wondering if anyone participating in this thread would like to make a concrete prediction about how the healthcare system will be (in light of the reforms that were passed) in, say, 2015 or 2020.

There will be fewer health care providers than there are currently.

http://online.wsj.com/article/SB100....html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsSecond

Premiums will be significantly higher, and there will be fewer choices for coverage.

http://www.mcclatchydc.com/2010/08/23/99550/colleges-say-new-health-law-may.html

http://www.forbes.com/2010/01/16/ob...le-health-health-care-insurance-premiums.html

Taxes and healthcare costs for businesses large and small will be substantially higher, keeping the unemployment rate near current levels.

http://www.bloomberg.com/news/2010-08-18/paychecks-to-shrink-because-of-higher-health-premiums-u-s-companies-say.html

I could go on. Of course, all of this was perfectly predictable (the CBO said as much on several occasions, but the media hijacked the discussion by focusing on "revenue neutrality" and the governmental cost score), and all of this is perfectly avoidable if we manage to scrap this lousy "reform".

 

[talk2glenn]

Perhaps you should explain why you think I pay no taxes. Ad-hom attacks do not advance your cause.

Anybody who has earned income in the United States pays into the Medicare system.

 

[turbo]

Apparently, the right-wingers on this board have not kept up with the health-care debate. Early opt-in for Medicare would bring in younger members who would have to pay higher premiums, BUT they would reduce the experience rate of the program, on average, resulting in cost-savings.

http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-buyingin_18bus.ART0.State.Edition1.4e7fde3.html

 

[mheslep]

Apparently, the right-wingers on this board have not kept up with the health-care debate.

Ad-hom attacks do not advance your cause.

Agreed.

Early opt-in for Medicare would bring in younger members who would have to pay higher premiums, [...]

Then that's Medicare + a whole new rate structure, not just more "US citizens" who "opt into Medicare"

 

[talk2glenn]

Apparently, the right-wingers on this board have not kept up with the health-care debate. Early opt-in for Medicare would bring in younger members who would have to pay higher premiums, BUT they would reduce the experience rate of the program, on average, resulting in cost-savings.

http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-buyingin_18bus.ART0.State.Edition1.4e7fde3.html

Let me make sure I understand your claim correctly.

Currently, working Americans pay into the Medicare system at a rate approximately 3% of their earnings, and they are not eligible to receive any coverage - it is pure subsidy.

Given an average annual income of $45,000 per capita, this means the average household pays approximately $112.50/month and receives $0 in benefits. Medicare uses these earnings to subsidize the cost of insuring the eldest portion of the population.

You propose to increase the number of individuals eligible to receive benefits, presumably at existing subsidized rates, without any corresponding change in the payroll tax structure. How would this maintain program viability?

For perspective, monthly premiums for Medicare coverage are between $250 and $460/month, far below the comparable rates for private insurance plans that cover much lower-risk population segments. These rates are achieves through subsidy and monopoly, and would not be viable as an opt-in program, for obvious reasons (hint: only high-risk individuals would opt in, and program solvency is dependent on a large segment of the population subsidizing coverage for a much smaller segment of the population).

 

[turbo]

Then that's Medicare + a whole new rate structure, not just more "US citizens" who "opt into Medicare"

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums, and who would incur lower health-care costs. Private insurers are dead-set against it, of course.

 

[talk2glenn]

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums, and who would incur lower health-care costs. Private insurers are dead-set against it, of course.

Ok, so now you want to charge younger members higher rates. To be viable, these rates would need to be comparable to equivalent private sector rates for the same coverage with a like risk pool, plus the subsidy, effectively making a Medicare program more expensive than a like private program.

Given that Medicare also restricts provider and treatment access relative to private plans, why would any rational individual "opt in" to paying more for less, unless he was uninsurable in the private sector (and therefore will be consuming more than he pays in, at any conceivable rate premium)?

This kind of structure is only viable as single-payer. Any suggestion that it could work on an opt-in basis is a clear red herring.

 

[turbo]

You propose to increase the number of individuals eligible to receive benefits, presumably at existing subsidized rates, without any corresponding change in the payroll tax structure. How would this maintain program viability?

Are you deliberately mis-stating my position for a reason? Putting words in my mouth doesn't elevate your argument any more than the ad-hom attacks. If you have a cogent, defensible point of view, you shouldn't have to resort to dishonesty.

 

[mheslep]

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums,

Yes, higher premiums

and who would incur lower health-care costs.

Unlikely. Either we'd get rationing or higher costs, as we do with every government run program

Private insurers are dead-set against it, of course.

As are at least 42% of the public, since you are essentially describing a single player plan AKA the public option.
http://www.realclearpolitics.com/horseraceblog/2009/10/the_public_option_in_the_nbc_n.html
http://www.rasmussenreports.com/pub...9/32_favor_single_payer_health_care_57_oppose

 

[turbo]

As are at least 42% of the public, since you are essentially describing a single player plan AKA the public option.

It would be a public program existing alongside the private programs. The reason that so many people are against a public option (option!) is that the right-wing media has been railing against it with end-of-the-world scares, and too many people are gullible enough to buy the scares without being able to think through the consequences of the option. The US public is not very well-informed regarding economics, health-care costs, or insurance plans. As a result, they are easily duped into thinking that health-care reform is a simple good/bad dichotomy, when it is clearly far more complex than that.

 

[airborne18]

It would be a public program existing alongside the private programs. The reason that so many people are against a public option (option!) is that the right-wing media has been railing against it with end-of-the-world scares, and too many people are gullible enough to buy the scares without being able to think through the consequences of the option. The US public is not very well-informed regarding economics, health-care costs, or insurance plans. As a result, they are easily duped into thinking that health-care reform is a simple good/bad dichotomy, when it is clearly far more complex than that.

But we already have two public options, and it is a contrast of the good and the bad with the healthcare profession. But it does illustrate the fundamental issue in our healthcare system: that doctors treat insurance cards and not patients.

I agree it is not a simple issue, but the blame falls directly on the healthcare industry. They over treat one segment of the population, the aging, and they abandon treatment for the young.

The fact that hospitals can have non-profit status is laughable. They set rates, which nobody pays, and then write off what medicare does not pay as donated services. And then they hold health fairs and write that off as donated services. ( at the inflated rates ). Yet they over treat every old person who rolls in an out of the facility on a daily basis and keep racking up write-offs.

We ration care already. But we don't ration care for the oldest, we do it to those on the other public option: medicaid.

Do you know a person is cured and can leave the hospital? When the visit hits the medicare limit.

 

[Proton Soup]

I didn't realize I constituted everyone, but okay. The missed opportunity is that they had a chance to pass what they proposed, and still didn't. Is our system that corruptable that a party with a majority can persuade themselves out of passing their own agenda?

That is what they ran on, and Obama had enough good will and popularity that he could have passed any law he wanted, in his own fashion. The missed opportunity is that his inaction and lack of leadership doomed his own agenda.

And the status quo of healthcare in this country is seriously flawed, and it does not take a phd to realize that fact.

I have no pet ideas, just many examples of how flawed our healthcare system actually is.

The problem is that there is no happy middle ground in our system. Everything is driven by profit. Even something as simple as medical records privacy is compromised by lobbyist, so drug companies know how many scrits each doctor is writing so they can give kickbacks. Read the HIPPA laws, the receptionist in your HR department has better access to your spouse's medical records that you do. And better access to your own medical records.

There is not one aspect of the healthcare system that is not tainted by profit.

And I am actually not for Medicare, because that is golden cash cow of the medical industry.

So don't make assumptions.

yeah, i don't think Obama et al. really ever got much further than slogans, like "change" and "status quo". whatever opportunity they might have had to have a real public debate on the issue was squandered, because in the end, there really is no change. it's government as usual with most deals made in back rooms. talking change is easy, but actually doing it is like herding cats.

i agree with you about the profit motive. the people who come out on top with nationalization are insurance companies. because they will be the ones administering the plan, with a more or less guaranteed percentage.

 

[mheslep]

Some context for predicting whether or not Medicare would reduce costs with everyone under its roof:

Year: Medicare cost ($billions)
1980: 34
1990: 107

2000: 216
2002: 254
2004: 297
2006: 374

2007: 432

2008: 461
2009: 501

2010: 521

www.kff.org/medicare/upload/7731.pdf
www.cbo.gov/budget/factsheets/2009b/medicare.pdf[/URL]

In those latter figures, add another $50-100B/year or so in eventual interest payments as ~half or more of that money is borrowed.

 

[talk2glenn]

Are you deliberately mis-stating my position for a reason? Putting words in my mouth doesn't elevate your argument any more than the ad-hom attacks. If you have a cogent, defensible point of view, you shouldn't have to resort to dishonesty.

You could not charge rates sufficiently high for Medicare to both be competitive relative to private options and simultaneously solvent, as I already said in my response to your later post which linked an article suggesting higher rates could somehow make this idea less insane. There is no mechanism for making this work in fiscal reality. It is a subsidy program. By definition, benefits payments exceed premium collections.

Expanding access to the program would not help anyone except, in the short-run, the individuals given access to the subsidized rates (and they're only helped if the rates they pay are lower than the rates they would have to pay on the open market, obviously). It certainly would not give any conceivable benefit to the healthcare system in the United States, which is already plagued by excessive institutional benefits that offset consumer cost and discourage responsible use of a scarce resource, pushing up prices for everyone.

It would bankrupt Medicare absent a dramatic increase in payroll taxes, increase medical costs, and seriously damage the viability of the private system (moreso than the government already has through ongoing rounds of increasingly onerous and nonsensical regulations). And the individuals who "opt in" to Medicare (love that - you'd have a lot of choice when Aetna goes broke because government deliberately undercuts market rates and covers the losses with public money) would end up with an inferior product that was desgined to cater to the needs of the old and the dieing, not the healthy, the young, and the profitably insurable.

Insane. I never thought I'd see the day.

If single payer, monopolized health care is what you want, at least be intellectually honest and say so. Don't pretend that you can "expand access" to Medicare on an "opt in" basis. This is nonsense, and would never seriously be considered by Dennis Kucinich, let alone the broader Congress, which is why it never gets further than the editorial pages of some obscure Dallas newspaper.