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Member since: Wed Jan 30, 2008, 03:33 PM
Number of posts: 10,157

About Me

I'm a lawyer representing workers and consumers and a longtime Democratic activist. Nothing I say on here, including any comments about legal topics, should be construed as legal advice or creating an attorney-client relationship.

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Questions for those on Medicare (or who have experience with it)

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?
Posted by democrattotheend | Wed Jan 9, 2013, 09:04 PM (73 replies)

How would lowering the Medicare age save the system money?

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?
Posted by democrattotheend | Mon Jan 7, 2013, 08:21 PM (42 replies)

Would allowing Medicare to negotiate drug prices shift the cost to individuals/private insurance?

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.
Posted by democrattotheend | Thu Jan 3, 2013, 09:11 PM (15 replies)
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