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Wed Jan 2, 2013, 03:58 PM

Medicare Reform / Medicaid Reform

Is the issue that Medicare/Medicaid are very good programs without any real issues, or is the issue that we can't trust the people we would be negotiating with to fix the problem, and shouldn't try.

For the same reason you wouldn't want a sociopathic person who hates you performing first aid on you.

Bryant
2 votes, 0 passes | Time left: Unlimited
Medicare is a very good program and we can't trust the current political climate with it.
1 (50%)
Medicare has some problems, but we can't trust the current political climate to fix it.
1 (50%)
Medicare is a very good program, but if it had problems, we could fix them in the current political climate.
0 (0%)
Medicare has some problems; we should let our elected representatives try to fix it.
0 (0%)
No political climate could fix this bullshit poll.
0 (0%)
I like to vote!
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7 replies, 610 views

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Replies to this discussion thread
Arrow 7 replies Author Time Post
Reply Medicare Reform / Medicaid Reform (Original post)
el_bryanto Jan 2013 OP
democrattotheend Jan 2013 #1
exboyfil Jan 2013 #3
democrattotheend Jan 2013 #5
nenagh Jan 2013 #6
exboyfil Jan 2013 #7
PETRUS Jan 2013 #4
lovuian Jan 2013 #2

Response to el_bryanto (Original post)

Wed Jan 2, 2013, 04:21 PM

1. I'm doing a paper on Medicare for my health policy class

And contrary to what many on here would like to believe, there are problems that need to be fixed. The program as it is is not sustainable long term, as the costs of health care continue to rise and the number of beneficiaries grows and they live for longer than when the system was created.

The gist of my paper is about why we should not raise the eligibility age, but other than allowing Medicare to negotiate drug prices, which would help but would not solve the problem indefinitely, I am having trouble coming up with alternative solutions. Further cuts to providers are a bad idea because they would drive doctors away from accepting Medicare.

Some people say lower the eligibility age, but I can't figure out how that saves the system money. Even if it lowers the average cost per beneficiary, it still results in more beneficiaries without more revenue to support them. And buy-in is problematic because at cost, the premiums would be over $600/mo for people ages 55-64, which many people could not afford. And if you charge premiums at cost, it doesn't save any money, and if you subsidize it it costs more money rather than saving Medicare any money. Maybe it would be slightly less expensive to provide care to beneficiaries over 65 if they had Medicare for 10 years prior and otherwise would not have had insurance, but there's no way those savings are significant enough to offset the costs of covering more people.

What are some other progressive solutions to ensure Medicare's long-term solvency that I should be exploring?

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Response to democrattotheend (Reply #1)

Wed Jan 2, 2013, 04:41 PM

3. Single payer system financed by 15% tax on all income

7.5%/7.5% for those working. 7.5% for those not working (retirement income). Medicaid LTC takes almost all retirement income (just like currently). Copay brackets dependent on income levels (Medicaid level $5 copay for example) going up to $25/visit for highest income.

Up supply of U.S. doctors by 20%. Greater involvement by feds in paying for the education of doctors as well as offering liability insurance and weeding out poor doctors (those with liability exposure).


If you stay in the current framework, you do not have a solution.

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Response to exboyfil (Reply #3)

Wed Jan 2, 2013, 04:45 PM

5. In theory I like some of your solutions

But it's too ambitious for what I am writing, not to mention in terms of what could ever pass Congress.

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Response to democrattotheend (Reply #5)

Wed Jan 2, 2013, 05:30 PM

6. I live in Ontario. In Canada Health Care is under provincial jurisdiction...

Here the Ontario Govt specifies if a medication will be covered by Ontario Drug Benefit..ie the Rx plan for Seniors.

It specifies the cost price it will pay for that medication...and if it will pay only for the generic drug.

There are rules: a maximum of 100 days supply of meds is allowed to be dispensed for a Senior at one time.

If the medication is new to the patient: a 30 day supply only can be dispensed after which, if the patient is to continue on the medication..a 100 day supply can be dispensed. (prevents paying the govt paying for 100 days of meds, if a patient does not tolerate the med within the first 30 days & the Dr stops the med.)

Here in Ontario, there is a $100.00 deductible each higher income Senior must pay per year..towards the Ont Govt Drug Program.

All this accounting etc is automatically carried out at the Ontario Drug Benefit HQ and is transmitted online to the Pharmacy computer at the time of dispensing.

This may be like rules for Medicare Rx's, I don't know.

However, in addition to controlling the amount of $$ the govt will repay for meds...there are also restrictions on medical procedures.

eg...I had cancer in 2008 & received rituxin as part of the therapy. My daughter, who works in Health Care tells me that rituxin is not being covered by the govt, now... You must have a private insurance plan for coverage of some more costly cancer therapies...

In addition...certain medical procedures will be paid for by the Ont govt...depending on the clinical diagnosis..

Eg, my Oncologist explained that, for my type of cancer, the Govt would pay for a bone marrow transplant up until the finish of my 65th year.. after that, other therapies would be available, but not the bone marrow transplant.

Oh yes, in addition, many especially small hospitals operate on a formulary system...

Sometimes , a Senior will bring into hospital medications from home, which they have had dispensed from a Pharmacy..
because, essentially, the govt has paid once for the meds...and perhaps some of the meds are not on the Hospital formulary..

So ultimately, there are ways of reducing Medicare costs...not all are palatable perhaps to all who provide health care...and every govt is squeezing every $$$ as far as it can go.....





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Response to democrattotheend (Reply #5)

Wed Jan 2, 2013, 05:55 PM

7. Good luck to you on your paper

It is an interesting area to study. I think the Canadian in another part of this thread had some good observations. Anything that is ultimately done will involve DEATH PANELS!!! (sarcasm alert) - would any politician dare discuss it even in a roundtable discussion?

Your observations about how extending Medicare to younger people is a non-starter without additional revenue/shifting around the current spend. I just don't see a long-term solution in the current framework.

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Response to democrattotheend (Reply #1)

Wed Jan 2, 2013, 04:43 PM

4. This might be a fun thing for your paper

From the CEPR - http://www.cepr.net/index.php/publications/reports/free-trade-health-care/

Free Trade in Health Care: The Gains from Globalized Medicare and Medicaid

The huge gap between the cost of health care in the United States and the cost in other countries with comparable health care outcomes suggests the potential for substantial gains from trade. This paper describes one mechanism for taking advantage of these gains – through a globalization of the country’s Medicare and Medicaid programs. The projections in this paper suggest that the country’s long-term budget situation would be substantially improved if beneficiaries of these two programs over the age of 65 were allowed to take advantage of the lower-cost health care available in other countries (that also have higher life expectancies than the U.S.). This could also allow them to enjoy much higher retirement incomes than they would otherwise receive.

Full report as a PDF here: http://www.cepr.net/documents/publications/free-trade-hc-2009-09.pdf

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Response to el_bryanto (Original post)

Wed Jan 2, 2013, 04:32 PM

2. Healthcare costs and Insurances and Pharmaceuticals are the reason for

skyrocketing healthcare

and it will eventually go to Universal Health

the inflation of costs
is destroying the nation


It will be military or healthcare....and healthcare will go Universal

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