Why expanding medicare should be off the table...

I hear a lot of cries for expansion of medicare benefits to create universal coverage. I'd like to propose that it would be better to start from scratch than to expand a program that is broken on many levels. To be clear, I'm still advocating for universal coverage, but not with medicare.

1. Medicare is a nightmare of regulatory complexity. In order for hospitals or providers to be paid the small sum that medicare is willing to cough up, it requires a level of hoop-jumping unheard of in other countries with universal health coverage (including Canada, the UK and Germany).

2. Medicare is inflexible. It is a large, centralized program run by the national government and therefore is cumbersome and out-of-touch with the needs of communities and individuals.

3. Medicare part A pays for inpatient and skilled nursing care at no additional fee. Part B, which covers doctors bills, medical supplies and services (like a trip in an ambulance) is not included in the cost of the social security that you have been paying in. It requires an additional monthly premium that may or may not be affordable to people depending on their financial circumstances and the increase in costs that might be seen if more people enroll and need coverage...particularly if it isn't mandatory and the healthy people who aren't using the services aren't paying premiums. Part D? So confusing that you need to speek to an actual medicare specialist to decipher....and I'm sure it is intentionally done like this!

4. Medicare doesn't currently cover routine care, dental care, foot care, eyeglasses, most prescriptions (see Part D if you dare), and experimental treatments. That might not seem like a big deal unless you have a raging infection and your specialist wants to try an off-label use for a drug or a chemotherapy for cancer that is not yet past the experimental stages in America. It won't matter that the treatment is being used successfully in Europe, for example.

5. Medicare isn't all-encompassing healthcare...it has both fee-for service and HMO coverage plans. Your choice affects how much you pay. Again...there are a lot of people who will think it is unfair that they can't afford the care their neighbor is getting.

6. Many people with medicare also carry additional insurance coverage called supplemental coverage. There is a reason for that. ;)


I just want to add a little bit more texture to the medicare conversation. I feel like I'm reading "expand medicare or nothing". Perhaps we need to be really thinking through each individual issue and how to implement a national plan. I suspect that this is what Obama is doing and it is why he isn't rushing to endorse one specific plan. He is getting all of the information right now.

happen.


Even in countries with single payer systems, like France, considered by some to be the best in Europe, a significant percent get supplemental insurance.

Most of us without insurance would be happy to simply see a doctor with all of the problems that you outline.

pay off the pharmacies and drug companies. As soon as that went into effect the drug companies upped the costs of certain drugs.

My mother in law used to have no problem with getting prescriptions, but when they made seniors get prescription coverage, it's been a mess! It took us some time to figure out the best plan, and a longer time figure out how it all worked. She pays a premium, has a deductible, then has a "doughnut" hole where they don't pay, then if she is lucky before the year ends, they start paying again! It's as yo said, nothing more than Bush paying off the drug companies!

Medicare isn't the problem. It is the dirty lobbyists for big pharma and the health insurance industry who exploit the program - thanks to our politicians.

Separate out what isn't working and why. Let's not throw out the baby with the bath water.

medicare part D. Now I have been hearing - as you stated somewhat - that part D is a mess because private insurance got their claws into it. Just makes me more angry about the whole situation. Even though I will be able to enjoy medicare, I am still pushing for single payer for the rest of you all and my family. I have been screwed by private insurance and have watched it screw up this whole country.

and then again once it did pass. This was a bon mot to the pharma people who loved George Bush, and who lovingly supported him. It was made deliberately confusing, so that people would get ripped off right and left, and never knew for sure, what was covered:grr:

1. Medicare is a nightmare of regulatory complexity. In order for hospitals or providers to be paid the small sum that medicare is willing to cough up, it requires a level of hoop-jumping unheard of in other countries with universal health coverage (including Canada, the UK and Germany).

Actually Medicare is simpler to deal with than hundreds of different insurance companies each with their own protocols. That is one of the primary reasons so many physicians prefer a Medicare type system or single-payer system for all - doctors will be able to spend more time treating patients than haggling with insurance companies.


2. Medicare is inflexible. It is a large, centralized program run by the national government and therefore is cumbersome and out-of-touch with the needs of communities and individuals.

Single-payer like Medicare will just make the payments. You can still go to your own health provider. It is up to you to decide if your doctor is out-of-touch with your needs or those of your community. If so find another doctor.

Currently over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.

The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.

It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $300 billion annually.


3. Medicare part A pays for inpatient and skilled nursing care at no additional fee. Part B, which covers doctors bills, medical supplies and services (like a trip in an ambulance) is not included in the cost of the social security that you have been paying in. It requires an additional monthly premium that may or may not be affordable to people depending on their financial circumstances and the increase in costs that might be seen if more people enroll and need coverage...particularly if it isn't mandatory and the healthy people who aren't using the services aren't paying premiums. Part D? So confusing that you need to speek to an actual medicare specialist to decipher....and I'm sure it is intentionally done like this!

Single Payer will be modeled up Medicare, however it will greatly improve upon it.

All medically necessary care would be funded through the single payer, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. We also advocate a sharp increase in public health funding.


4. Medicare doesn't currently cover routine care, dental care, foot care, eyeglasses, most prescriptions (see Part D if you dare), and experimental treatments. That might not seem like a big deal unless you have a raging infection and your specialist wants to try an off-label use for a drug or a chemotherapy for cancer that is not yet past the experimental stages in America. It won't matter that the treatment is being used successfully in Europe, for example.

Once again All medically necessary care would be funded through the single payer, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. We also advocate a sharp increase in public health funding.


5. Medicare isn't all-encompassing healthcare...it has both fee-for service and HMO coverage plans. Your choice affects how much you pay. Again...there are a lot of people who will think it is unfair that they can't afford the care their neighbor is getting.

All medically necessary care would be funded through the single payer.

Of course, the biggest change would be that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance so full of gaps like co-payments, deductibles and uncovered services that it would be almost worthless if they were to have a serious illness.

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.


6. Many people with medicare also carry additional insurance coverage called supplemental coverage. There is a reason for that.

See response to #5 above. Thanks to Physicians for a National Health Plan for their FAQs. http://www.pnhp.org/facts/singlepayer_faq.php#raise_taxes

The public insurance would be subsidized and the supplemental would have all risk removed for expensive coverage

Of course, other aspect of this ham stringed system could be cleaned up. It may be better to start from scratch. But I think the concept people are arguing for is essentially single-payer rather than the exact details of the current medicare system (which they may or may not be familiar with). Canada's medicare for all isn't constrained like the current system, and that is more what people are advocating for.

is with all of the things that you guys have mentioned that have gone wrong thanks to the interference of congress, the republicans and big business.

I see THIS as the greater problem here. Basically, no public plan can move forward without first ridding ourselves of the noose that big pharma and big industry have on the policy-making process. So even though we think that we are going to stream-line this to get the best of everything, I see it as being highly unlikely that we will get the change we are looking for in that regard.

It also does not change the inefficiency of our government's system of chart review and payments and I wonder how we change that.

Basically, what we are talking about here is not expanding medicare but a complete overhaul of the public system...which are two different beasts!

i got scrips yesterday for two meds, each a 90 day supply.

one, my insurance won't honor because while 1 every 3 months is ok, 3 all at once for 3 months is not, even though that's the way they said the scrip should be written.

they will approve 6 doses every 6 days, but not 72 doses for 90 days, not even 24 for 30 days. i literally have to go back to the pharmacy every 6 days.

they jerk us around with stupid hurldes like this because they have a profit motive to make things difficult for people who generate claims. so they CREATE difficulties.

i need to get my doctor to write a "letter or medical necessity" stating that, uh, he meant exactly what he wrote in the scrip. then i have to wait for them to deny it anyway, then i have to appeal. eventually they'll cave, but they've delayed things and that's good for them. it's all crap and there's no basis for it other than that the more delays the more money they save, and the more migraines i have to suffer through without medication.

It's the County Medical Services Program, and it's offered to low income people who don't qualify for medi-cal (mostly people younger then the medi-cal age limit). There is a limited to what doctor you can see and procedures you can get, but you can always see a doctor in a timely fashion, even specialists, and access to prescriptions isn't a problem either, and there's no huge wait for needed surgeries or treatments.

It's not a perfect system, but it's low to no cost medical coverage that millions of americans could really benefit from.

http://www.cmspcounties.org/index.html