I know Medicare Part B has a 20% coinsurance for most services. The information about it on the Medicare and AARP sites is a little vague, so I am hoping people who have experience using Medicare can fill in a few blanks for me.

1) It says that the 20% includes doctor's fees for services performed in the hospital. So does that mean you pay 20% of the whole cost of a surgery or other procedure, or just the portion of the procedure that comprises the fees for the doctor's time (as opposed to the supplies, facility fee, other personnel, etc.)?

2) Do doctors ever voluntarily disclose the expected cost of a procedure or treatment in advance so you can figure out how much you will have to pay for it?

3) If you request that information beforehand, how difficult is it to get it so you have some idea how much your bill will be?

As some of you know, I am working on a paper arguing against raising the Medicare age for my health policy grad school course. I am trying to decide which alternative solutions to propose, and one that I have seen here and on Kos is to lower the eligibility age to 55 or 60 (proposals to lower it to 0 are outside the scope of my paper, even though philosophically I agree). For those who advocate this, I would appreciate if you could help me understand what you are proposing and how you think it would keep Medicare solvent for longer.

Obviously, lowering the age without either a buy-in or an across-the-board hike in the payroll tax rate would not only not save money, but would worsen Medicare's solvency problem by increasing the number of beneficiaries without increasing the funds to pay for them. So I assume that is not what is being proposed.

I have looked into buy-in, but the problem is, the unsubsidized premium would be over $600 per month, which is less than what my self-employed parents currently pay for health insurance but still too steep for many of the people who would need it. And if you subsidize it, then it costs money rather than saving money (although the subsidies could potentially come from the amount that has been budgeted for subsidies on the exchange). But either way, it costs the govt. more money if the premiums are subsidized. Even if the Medicare buy-in is completely unsubsidized, I still don't see how it would save the Medicare trust fund money unless the premiums were higher than the estimated cost of providing benefits, which would mean making them even higher than $600 per month.

There's also the problem of adverse selection: if the bronze plans on the exchange have lower premiums (and fewer benefits or higher copays), the healthiest people ages 55-64 would be likely to choose a less expensive plan on the exchange, and those in need of more care would be the ones who buy into Medicare. So allowing Medicare buy-in at age 55 would not necessarily make the overall Medicare risk pool healthier, particularly when you consider the fact that some of the people that age who lack employer-sponsored coverage had to retire early because of health problems.

I am not saying that lowering the Medicare age is not good policy (I would lower it to 0 if I were in charge), but as a way to save the Medicare trust fund money I just don't see it.

Am I missing something?

Please do not flame me or accuse me of parroting right wing talking points. I am doing research for a paper on why we should not raise the Medicare retirement age. One of the arguments I make is that doing so would shift the cost to the private sector and hurt the job market by driving up employer costs of health insurance.

One of the alternatives I want to advocate is allowing Medicare to negotiate drug prices. But it occurred to me that there might be a similar problem with that approach: if Medicare pays less for drugs, isn't it likely that rather than just accept a cut in profits, drug companies will charge higher prices to individuals and private insurance to make up for it?

If anyone is aware of any studies that have been done on this, I would really appreciate it.

Again, I am not trying to troll concern or advocate right wing talking points. I just want to make sure my paper is thorough and considers unintended consequences of whatever policies I decide to advocate.

I had this idea while responding to another thread on this forum, and I wanted to throw it out there, because I have not seen it proposed but think it's something liberals and conservatives might be able to live with.

What if we raise the SS retirement age to 70, or even 75, but only for those who continue working and earning a comfortable salary (say, $75,000). Since SS was designed to be a retirement income replacement program, there is really no reason why people who continue working and earning a reasonably comfortable salary need to receive Social Security. Nobody would be forced to work until 70, but those who choose to arguably do not need to start receiving Social Security until they retire. It could be set up in such a way that people could start immediately receiving benefits after sending to the Social Security Administration some sort of proof of termination of employment (whether voluntary or involuntary).

I would also apply the higher eligibility age to those who have high levels of unearned income, but make the threshold higher for unearned income to avoid penalizing those who are forced to draw down their 401(k) when they reach a certain age unless they have a very large 401(k).

I know that currently, you get higher benefits if you wait until 70 to collect. I would leave that in place but would not add additional bonuses for waiting until 75, because SS was designed to provide retirement income replacement and those who are not retired arguably do not need income replacement, especially if they earn a decent salary.

This would also have the effect of incentivizing some older workers to retire and free up jobs for younger people. And it would save the system money without turning it into a welfare program, since everyone would get benefits in proportion to what they paid once they turn 75, and everyone would have the option to retire and collect earlier than that without penalty.

FWIW, I also support raising the cap, but I think this might be an additional proposal worth considering, as it might be more politically palpable than raising or eliminating the cap and it is arguably truer to the purposes of SS.

Thoughts?

http://www.dailykos.com/story/2012/12/22/1173155/-We-Should-Be-Angry-at-the-Republicans



If you like what I wrote in that diary please Rec it here and on Kos if you have an account. I am hoping it can serve as a reminder to progressives who is really responsible for the mess we are in and how we can be most effective at fighting their extremist agenda.

The article is behind the paywall but parts of it are excerpted on Political Wire and since I discovered this morning that my grad school tuition dollars get me free access to WSJ through my school's website, I thought I would post a few more excerpts in keeping with DU policy:



I wish I could post more, but the bottom line is, the president told Boehner he wasn't getting the deal he would have gotten in July of 2011, he refused to budge below $1.2 trillion in revenue, he pointed out to Boehner that he gets $800 billion "for free" if nothing is done before Jan. 1, and he stood firm and got Boehner to drop his demand to raise the Medicare age.

We might not like what he did offer, but if this article is right, the president has been bargaining a lot harder than most of us thought. This also makes me think I was right that the offer the White House leaked might have been made or at least leaked knowing Boehner couldn't get the votes for it.

EDIT: Turns out you can access the whole thing if you go to it through Google. https://www.google.com/search?q=How+'Cliff'+Talks+Hit+the+Wall&sugexp=chrome,mod=6&sourceid=chrome&ie=UTF-8

I normally avoid this forum like the plague because I am so torn about the issue that I usually wind up pissing off both sides. But I saw this post on my friend's Facebook wall and I thought it was worth sharing:

This morning in Jerusalem during my commute I noticed an old Arab man dressed in traditional clothing having difficulty paying for his train ticket. A Jewish Israeli assisted him in putting his card in the right way. The train was crowded and there was a man (also old, with grey hair, a kippah, and a long grey beard) who gave up his seat so that the old Arab man could sit in comfort. What impressed me the most was thinking of the fact that this is not unusual; it happens every day. People get along here. If we can do it on the micro level, there has to be a way we can achieve peace on the macro level too.

That's all I'm gonna say

Please don't attack me, I am just asking. My understanding is that as things stand now, SS will be able to pay out full benefits until 2036, then 86% after that.

Does anyone know what impact chained CPI will have on that calculation? Will it extend the length of time SS can pay out full benefits?

Source: TPM

President Obama is scheduled to make a statement on the administration's path forward on gun control at 11:45 a.m. ET Wednesday in the White House briefing room. Vice President Joe Biden will also attend, according to the White House. Obama is expected to tap Biden to oversee the administration's gun-control efforts in the wake of the Newtown, Conn. shooting.


Read more: http://livewire.talkingpointsmemo.com/entry/obama-to-deliver-gun-control-statement-at-11?ref=fpblg

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More after it happens...