How the newly named Medicare Pt. E differs from "old" Medicare and Single-payer

[clear eye]

In a nutshell "Medicare Pt E" is a renaming of the House's proposed "public" option.

No one not meeting current elegibility standards for Medicare would be permitted into "old" Medicare plans. What is happening is that the already proposed "public" option is being renamed Medicare pt. E. It is not a gov't run plan, unlike the main Medicare, and it won't even include a gov't run plan to compete w/ the privately administered plans. Since there will be as many provider payers as there are private administrators of plans, it doesn't remotely resemble single-payer. It is not being subsidized by payroll taxes or by raising the income taxes of the top bracket. There is no premium cap, and no mandated payment rates to providers as Medicare has. The only subsidies will be for people earning just over what would qualify them for Medicaid, and there will be a small tax rebate for many more people, but that will likely be eaten up by inflated premiums.

The major differences from current private health insurance will be that it will be available to all outside of the workplace, it won't have pre-existing condition exclusions, and there will be some required minimum coverage in the listed plans. The downside is that it will be mandated with a tax penalty for not enrolling no matter what it ends up costing, and no matter if your kid just started an expensive college or you have any other unavoidable heavy expense that year. The captive market and lack of premium cap will lead to inevitably inflated premiums, as has happened in states like MA which mandate private insurance.

It is favored by "centrists" of both parties because there is the possibility that in the future elements of this model might more easily find their way into the Medicare offered to the elderly, degrading it, and opening it up to higher cost private plans.

[peacebird]

1. Absolutely unacceptable. It would be another massive sop to the insurance industry

:grr:

Talk about your Trojan Horses - name is "Medicare" part E so folks will assume it is a govt run plan. Absolutely unacceptable.
I bet Mark "Never Saw a Corporation I didn't Love to give breaks to" Warner is all over this option.

[Peace Patriot]

2. Jeez. Thanks for the heads up! Profiting off a medical care is a sin. nt

[Autumn]

3. Okay, so what the

fuck? Where did this come from. Jesus H so we are getting excited over this? I hope you are wrong.

[clear eye]

4. Please don't take my word for it.

You can talk to a your Representative's staff person dealing w/ the issue. I'm sure there are details that I'm not aware of, but since it is acknowledged to be the "public" option defined in the House bill renamed, I'm going by that.

[Autumn]

6. I will call tomorrow,

but it seems like we are being fucking played. Thank you.

[slay]

15. I have looked into this and you are correct

it is NOT a government run plan - at least as it stands now. This has been the biggest failing in the health care debate in my opinion - the Dems do not fully explain any of this. No wonder people are confused/mad/whatever. Calling it Medicare or even "public option" are both very misleading to the American people. :(

[MarjorieG]

5. Current Medicare premium private policies cause us money problems. With different incentives and

regulation hope better, but hard to regulate when we can't see the books and loopholes. No magic answer, here, and we'll always need a watchdog to bring for profit, even non-profit, into fairness.

[liberal N proud]

7. The GOP must love it...

It is their beloved end to Medicare. With no one new allowed into Medicare, the end is in sight for them.

They have fought long and hard to get here. And the people will think they suddenly became bipartisan.


:grr:

[clear eye]

9. Wait! I didn't catch that!!

Did the article say that when Pt E goes into effect (2013), the original Medicare pts A & B come to an end?!!

Readers, I didn't say that, and I don't know if it's true.

[inna]

11. I don't think it's true, but....

... could someone please confirm?


KR+6, btw.

[clear eye]

14. I think it was a misinterpretation of my poorly worded first sentence.

I edited it to make it clearer.

Whew! Had me going for a minute.

[liberal N proud]

19. I was concluding that Medicare would end by attrition

No new members + time = no members. That translates into no need for the program.

Killed without legislation explicitly doing so.

[Sebastian Doyle]

8. So the House Bill is useless too?

I like Thom Hartmann's idea a lot better. In Medicare Part E, the E should mean "Everybody".

[clear eye]

10. It does mean "everybody". Hitch is what exactly is for everybody.

Everybody will get a plan (by law), but not the plan the elderly get.

[Sebastian Doyle]

13. If it's anything like that RomneyCare shit in Massachusetts, they can shove it up their ass

That shit must not be allowed to pass in any capacity. :grr:

[pnwmom]

18. There isn't a single House bill yet. n/t

[slipslidingaway]

12. knr - a new name for the public option - no more. Some good points..

made here as well...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8709524&mesg_id=8709655

"Medicare was open from day one to all of the elderly 65 and above exactly the population it was designed for. It wasn't limited to a small percentage of those 65 and over too broke to buy private ins. It did not subsidize private insurance in direct competition with it nor did it require the program to be self sustaining with no government subsidies.

Today we have a public option which is supposed to be designed to be a government option to private insurance for anyone. What we get is enrollment limited to approx 10 million after 10 years, no subsidies and direct cutthroat competition form private insurers.

And now they have the balls to lie and call it medicare part e to somehow fool the dlc to vote for it. People believe this crap? ..."

[slipslidingaway]

16. A short history of Medicare - open to Everyone, 93% enrollment in first year...

compared to a public option that Obama says will have an enrollment of just over 3% in 10 years, must compete with private plans on a level playing field and we'll give subsidies to buy a private plan.

The Democrats are making a big mistake if they try and re-frame this PO as Medicare for everyone.

http://www.politifact.com/truth-o-meter/statements/2009/sep/16/tom-price/medicares-history-public-option/

He started with the administration's proposal to cover hospital services for the elderly, now known as Medicare Part A. He also included a proposal promoted by the committee's senior Republican member, John Byrnes of Wisconsin, who wanted coverage for physicians' services, now Medicare Part B. Finally, Mills included coverage for poor elderly Americans, which is today's Medicaid...

...Here's how an April 8, 1965, report in the New York Time s described the plan:

"As revised, the bill provides the basic hospitalization and nursing care benefits originally proposed by the administration while covering major doctor bills and many other medical expenses under a supplementary insurance program in which participation would be voluntary.

"The basic benefits, financed by increases in the Social Security payroll tax, would be automatically available to persons over 65. The additional coverage would be available to those over 65 who enrolled in the voluntary plan and paid premiums of $3 a month. Half of the voluntary plan's cost would be financed by federal subsidies of about $600 million a year from general tax revenues."

Johnson signed the Medicare law on July 30, 1965, and the program's aministrators began an intensive recruitment drive. At the end of the first year, participation was up to 93 percent of the elderly, according to The Politics of Medicare , a history by Theodore Marmor.


As we reviewed the history of Medicare, we noticed that legislators and policymakers drafting the legislation seemed to assume that Medicare participation would be very high. We could find nothing implying that Medicare coverage would compete with private insurers in paying for coverage...

This is markedly different from today's debate and discussion about the public option. Obama has said the public option would be one among many insurance proposals from which people could choose, and that it would be a backstop to keep private insurers honest. He also said it should not be subsidized by other tax revenues but pay for itself with customer premiums..."

[clear eye]

34. Now they're calling proposed programs w/o any gov't plan at all

a "public" option. This makes it very confusing since the House version lets everyone join, in fact mandates it, but not into a gov't plan. So you can't compare it to Obama's proposal letting 3% into a public option defined as a gov't plan.

[slipslidingaway]

41. They can call it anything they like, but wait until people find out...

the truth.

Obama cited the CBO score where just over 3% will be enrolled in 10 years, quite a difference.

Thanks for the thread.

:(

[pnwmom]

17. The House hasn't worked out the details of a single public option, so I don't

know where you're getting your facts. For example, if it isn't a government run plan, then who is running it? And why do you say there will be no mandated payment rates -- when the articles I've read today say it will use Medicare rates plus 5%?

I think what you're posing here is the worst case scenario.

[ipaint]

21. I'm getting my facts from the fact that I have been told over and over here

that the final public option will be a conservative combination emerging from the senate of all 5 plans. There are no public options in any of the plans that come close to a "medicare for all or some" option.

I wish people would just quit with the "nothing is written in stone yet" baloney. There is no more liberal, more progressive more inclusive real public option hiding in the wings that will dive down and save us all at the last minute. What we will end up with is a much more conservative plan than the most liberal public option put forth by the progressive caucus. The progressive caucus public option falls way short of medicare.

[pnwmom]

26. I see. You're getting the "facts" from the most pessimistic faction of DUers.

That's fine, as long as you make it clear where you're coming from.

Here's another point of view, suggesting your "facts" are wrong.

http://thehill.com/homenews/house/64029-medicare-for-everyone

SNIP

The plan, called the “robust” option or “Medicare Plus 5” in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November

SNIP

The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi has flatly stated that the House bill will include a public option.

In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn’t advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.

In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.

People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal “Medicare Part E.”

SNIP

[ipaint]

33. My facts aren't wrong. There is no robust medicare for all public option

in any of the bills. Where is it going to come from?

[pnwmom]

44. You're saying that Kennedy's bill didn't include a robust option?

And none of the several House bills?

[clear eye]

32. According to the article on PNHP that I read,

there will be multiple "administrators" who have to have the qualifications of insurers and be not-for-profit--outfits like Blue Cross/Blue Shield. Sort of like other privatized gov't services except that instead of being paid for w/ progressively raised taxes, we would have to pay for it directly w/ a little help from tax exemptions. It may be possible for a state if they wanted to, to have the agency administering Medicaid w/i the state, be designated the administrator for the state. I believe that most if not all states are presently too cash-strapped to want to hire more people and take it on.

It actually isn't the absolute worst case scenario. By uncoupling health insurance from employment, as employers take advantage of the availability of private insurance for their employees to stop paying insurance premiums, our economy may be stimulated. Of course the mandated premiums will hit the middle class like a ton of bricks curbing their buying power, so who knows what the net effect will be.

The mandated payment rates (which were only a recommendation in the article I read) must be a new development. I'll call my representative's health reform staff member to find out more, tomorrow.

[stray cat]

20. better to not change anything at all - and keep the insurance in charge and uninsured

without health care!

[stray cat]

22. I deserve a free house and I want you or someone else to pay for it!

Unlikely to get that kind of deal from taxpayers - probably not going to get someone else to pay for my health care either.

[ipaint]

24. Oh don't worry, this all will come to pass. You'll get your premium rate cut

on the backs of the 34 million that will be left uninsured.

Best we can do for you.

[clear eye]

29. Unlike the freeloading Europeans w/ their crummy old single payer

paid for by very progressive income tax structures.

[BrklynLiberal]

23. Kick

[bertman]

25. Damn!! I hope this is premature. I'll be waiting for more info to verify your information, clear eye

But, if some Democrats are putting this out as "Medicare E" which is what it is hyped to be, this is total bullshit.

It pisses me to have to say this, but I am not the least bit surprised that some conciliator in the Democratic party would try to mis-label this to win public support.

I will be contacting my Rep and Senator about this if it pans out to be a Trojan horse.

[pnwmom]

27. The OP told me that s/he was getting the "facts" from people on DU.

S/he doesn't have any particular knowledge about the bill -- which hasn't even been released yet, by the way.

Here's another point of view:


http://thehill.com/homenews/house/64029-medicare-for-ev...

SNIP

The plan, called the “robust” option or “Medicare Plus 5” in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November

SNIP

The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi has flatly stated that the House bill will include a public option.

In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn’t advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.

In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.

People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal “Medicare Part E.”

SNIP

[bertman]

42. Thanks for the info, Pnwmom.

[clear eye]

28. Please post any new info you find, bertman

It's hard to read the legalize in the bill, so if your Representative's staff person can give you more info, I'd be grateful to read it.

[bertman]

43. I will, but the next few days are very busy work days. Just so you'll know.

[Faryn Balyncd]

30. If this is true, we should not allow such a thing to be associated with & corrupt Medicare.

[Faryn Balyncd]

31. K and R

[Kermitt Gribble]

35. K&R for getting the truth out.

People need to start reading more than headlines.

[Roland99]

36. If they really want Medicare Part E (Medicare for Everyone), there's a VERY easy way to do it.....

H.R. 676!!!

[glitch]

37. No kidding. But then they'd have to give credit to Kucinich, and the centrists won't allow THAT. nt

[change_notfinetuning]

38. So how much did the consultants get paid to come up with this BS? Vote

YES on NO! Up is usually down.

What do you get when you cross Republicans and Democrats?

Just look around. Now bend over!

[change_notfinetuning]

39. So how much did the consultants get paid to come up with this BS? Vote

YES on NO! Up is usually down.

What do you get when you cross Republicans and Democrats?

Just look around. Now bend over!

[slipslidingaway]

40. HR 3200’s “public option” will not resemble Medicare - by Kip Sullivan

http://pnhp.org/blog/2009/09/13/sullivan-publicoptionin3200unlikemedicare/

Other links in the original thread as well...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6540952&mesg_id=6540952

[clear eye]

45. A few specifics from the bill

When the public option takes effect, no other individual insurance will be permitted to be issued. Existing plans grandfathered in have to limit new enrollees and keep the benefits, deductibles and copays the same as they have been.

The price for the basic benefits package which H.R. 3200 calls a "QHBP" (qualified health benefits package), is on the one hand supposed to by set by determining the acturial costs (a sort of average) of what is provided to the holder and requiring that the premiums set so that 75% of them must be used for costs, but on the other hand

shall be set at the highest level med
12 ical loss ratio possible that is designed to ensure adequate
13 participation by QHBP offering entities, competition in the
14 health insurance market in and out of the Health Insurance
15 Exchange, and value for consumers so that their premiums
16 are used for services.

So the premiums have to be high enough to get a fair # of health insurers biting. How this is balanced against consumer value is not specified. The premiums will be adjusted yearly.

Only people who do not have access to insurance through their employers or are not in some way self-covered will be permitted to purchase insurance from the exchange. If a family's income is less than a certain level above the poverty line (in a high cost state like NY, the upper limit would be $80K) they will be elegible for a sliding scale subsidy dependent on income. There is provision for a "public health insurance option" which is underwritten by the federal gov't, but unlike Medicare, will be administered by a private not-for-profit entity like Blue Cross/Blue Shield. It is required to set its premiums for each level of coverage to be equal to whatever amount is previously worked out for the private insurers participating in the exchange.

I verified with an expert Congressional staffer that in H.R. 3200 there is an individual mandate for all uninsured to purchase insurance in the exchange. The mandatory basic plan includes prescription drug coverage, and the gov't may not negotiate drug prices to lower costs.

Everything I have written so far refers to H.R. 3200. At this time the legislators are reviewing the provisions and negotiating changes amongst themselves, so no one knows exactly what the final bill will be. The person I spoke with did not believe removing the individual mandate was "on the table".

There will be an outside unpaid committee to be made up of representatives of all the stakeholders in such a proportion that no one group dominates deciding on what changes are necessary in the provisions and premiums of the program each year and reporting to the health commissioner who may only accept or deny the entire package. The commissioner can send the package back to the committee for revision, but if it doesn't deliver something acceptable to the commissioner by that year's deadline, their recommendations become final. Congress is not to be consulted.


Edited to add: Both of the main Senate health reform bills, the Finance committee bill, and the HELP committee bill, contain the individual mandate. Only the HELP committee bill also contains an employer mandate.