Medicare fix ideas- long term

So what is the plan from the democrats?

I don't like the privatization plan either. But the facts are clear, the growth trend is clearly unsustainable in present form. Its going to break the piggy bank big time and most everyone knows it. Google some charts and it is projected to grow way faster than GDP.

So how can it be fixed? I have not heard any solid plans other that "just slap a big tax on the rich" it will fix everything. I wannna hear something else that is sustainable, broad based, and fair.

Any real ideas? Means testing, higher premiums for those able, serious HSAa for over 50s to prepare, Senior orientated gov't subsidized HMOs? Much higher copays, deductables?

Another area not talked about is medicaid nursing homes. They are going to be in bad shape too, and the states have no money.


http://www.kaiserhealthnews.org/Columns ... i.aspx?p=1


http://www.kaiserhealthnews.org/~/media/Images/KHN%20Features/2011/April/18%2022/BobLGRAPH%202%20512.jpg?w=512&h=388&as=1

Not that I consider myself a progressive, but I've read at several places now that Medicare can be fixed for about 75 yrs by raising the Medicare payroll tax by 24%. The tax is now at 2.9% (half paid by employeer), so that would amount to a .7% tax increase for everyone with income (Obamacare will add additional Medicare taxes for those over $200k).

Maybe you could fix it with a much smaller increase if you include means testing? I don't think Medicare should be entirely taken away for anyone, even the very rich. Even with $1 million saved for retirement, a person could still be wiped out with a serious illness. So I'm thinking you might raise the Medicare premiums or increase the deductible for retired people with high income (say $150K or so). If their income later goes down, then they get the standard premium or deductible.

And I don't care for Ryan's voucher plan either. It seems too much to ask for a sick 85 year old to figure out how to use the voucher and find the right policy (and deal with a private insurance company). Plus, why get rid to the system we've had in place for over 40 years? I think the administrative part of Medicare is working pretty well, though improvments are needed in avoiding fraud. It's just the financial model that's screwed up, IMO.

Nor do I understand those who want to get rid of Medicare. Hardly any senior would be able to afford medical insurance at age 80+. Premiums would be huge.

Thanks Pine, really anyone can answer (I edited out progressive, too scary a word for some I guess), I wanted to hear new ideas, not start a bashing contest about Ryan's plan. I had never heard a .7% increase would fix it long term. The growth rate seems too high, along with an increasing ratio of seniors to payroll tax payers. Would you post that link if you can find it again? I think it can probably be fixed too, but it would take a major structural reform to the benefits, a savings model, and some new increased funding source. Also, the health care providers/doctors need to step up and offer some efficiency ideas, other than "just give us more money".

I posted this link before, and I've seen the 24% increase mentioned elsewhere...

http://www.businessweek.com/news/2011-05-13/medicare-social-security-funds-expiring-sooner-u-s-says.html

Medicare, to stay solvent for the next 75 years, would have to immediately raise payroll taxes by 24 percent, or cut current benefit payments by 17 percent, Cori Uccello, a senior health fellow with the American Academy of Actuaries in Washington, said in a phone interview.

Now it was me who assumed that 24% increase applies to the 2.9% Medicare payroll tax (hence the 0.7%). But if it applies to all payroll tax (SS and Medicare) then were are in deep doodoo.

For one thing, medicine and big pharmas. Medicare does not negotiate prices and cannot by law. Just think about the savings on that one.

2Wlady, I am not sure how drug prices work. The part D plan was never funded well, that is for sure. I wouldn't like the idea though of medicare getting drugs below cost and shifting higher prices to everyone else.

Pine, thanks for the link. The details are sketchy, but it sounds like it bases solvency partly on the trust funds which are bogus. There needs to be another revenue stream to re-pay the trust fund money which is really gone, but its talked about as if it is real money.

I figured this topic would get few responses. I guess its just not nasty enough.

Maybe we should start calling each other names. I'll start.
Pine - You center moderate, rational thinking, analytical troublemaker! :VeryScared: There, that should get this going.
LOL

I said nothing about Medicare getting drugs "below cost." I said they should be able to negotiate for a lower cost.

One drug that costs thousands of dollars has now been limited to two injections per month of a certain dose. Those people who need more have to get a different drug and give themselves many, many doses of it to keep the hormone level down. These people on Medicare, who just found out about this in April, are now stuck with $40K-$60K of drug expenses Medicare and their Schedule B or whatever is will now not cover. The difference in price: because it's partially at a state level.

Another thing about this drug: While you are perfectly capable of giving this drug to yourself at home, some insurance companies insist that it be done in a medical facility by a nurse, in which case the cost is much higher. Add to that that most nurses don't know how to prepare and inject the medication and often screw it up, so that the patient does not get the full dose, since the most common mistake leads to the drug solidifying.

As one guy said, the doctor gave me the package and said, "The directions are inside." And the directions are good, there are websites from patients who give even better directions. So, why the medical facility when money could be saved?

Joe wrote: 2Wlady, I am not sure how drug prices work. The part D plan was never funded well, that is for sure. I wouldn't like the idea though of medicare getting drugs below cost and shifting high prices to everyone else.

Everyone else is already subsidizing lower drug costs for Canada......if we are willing to do it for them why not for our own seniors???? Or could it be that drug companies are charging far more than they need to....just because they can. .....nah, they would never do that.

pineinthegrass wrote: Not that I consider myself a progressive, but I've read at several places now that Medicare can be fixed for about 75 yrs by raising the Medicare payroll tax by 24%. The tax is now at 2.9% (half paid by employeer), so that would amount to a .7% tax increase for everyone with income (Obamacare will add additional Medicare taxes for those over $200k).

The problem with that figure is that is presumes a level of return on the "existing trust fund" that is only achievable with the help of the double digit inflation rates we saw in the late 1970's. If indeed we get that level of inflation, which is almost assured if the general government continues to follow the Keynesian economic model, the trust fund itself will be worth the pennies on the dollar that it ended up being worth after the inflation of the 1970's that necessitated the removal of the income cap and a hefty tax increase to boot. When Medicare first started it was a 0.35% from the employee and the employer (0.7% total) on the first $6,600 in wages - a grand total of about $46 as a maximum contribution to the Ponzi. That rose to roughly $1,958 as a maximum contribution on $135K of income by 1993, and since 1994 there has been no maximum that is subject to the tax - and the Ponzi is still in danger of collapsing entirely unless something is done. The Medicare "Trust Fund" only applies to Part A - the hospitalization portion. Parts B and D (physician and prescription) are already stealing nearly 75% of their funds from the general fund - you know, the taxes that are supposed to be going to levee construction and maintenance, highways and bridges, common defense, the federal court system and all of the other "discretionary" roles of the federal government.

2W - I agree, negotiating prices is ok, lower costs is something good. I was talking about fixed or gov't set prices. Drug price variations between countries could be a topic on its own. I really don't understand how it all works like I stated. Maybe someone knowledgeable will post some research and offer real solutions? I'm no fan of the drug cos., they advertise way too much and market a gazillion expensive, feel good drugs that are not real cures, JMO

PrintS - The phantom trust funds give a false sense of the true solvency of these programs, its a cash flow GDP ratio problem. And I think you are right, Pines linked article only addresses Part A medicare.