Yes, I agree raising the Medicare payroll tax would mainly help Part A. Parts B and D are unfunded, or funded from the general fund.
And one big problem with fixing Part A is that there are some very unrealistic assumptions made. The main one I've seen has to do with the so-called "doctor fix". Every year Congress keeps delaying this "fix" in which doctors are supposed to be paid less and less to help keep Medicare afloat. I'm pretty sure the 0.7% increase I talked about assumes the doctor fix is finally implemented. But if it is, it will reduce payments to doctors by 29%.
Right now Medicare pays about 80% of what private insurance pays to doctors. If the doctor fix is ever implemented, then Medicare would just pay 60%. How may doctors will accept this, especially if it means treating patients at a loss? And don't forget Obamacare is supposed to cut another $500 billion from Medicare on top of that.
I had a New York Time link about this the other day, but can't find it right now. So I guess Fox News will have to do for now. The numbers seem the same as I recall...
Yep, the doc fix law allows for bogus optimistic CBO budget numbers, And doctors are already refusing new medicare patients, soon to get worse not better.
If you want to be, press one. If you want not to be, press 2
Republicans are red, democrats are blue, neither of them, gives a flip about you.
I wonder what they are using for comparison, the payments to my doctors by Medicare seem to be about the same as what BC BS paid them before I switched, within a couple bucks anyway.
edited to add......I went back through my bills during the change to medicare, it seems to depend on what doctors and what procedures are being paid for. for some there is quite a significant difference, and for others not too much. Specialists get the short end of the stick when it comes to medicare reimbursement, but then they charge more than double what a family doctor charges for a 15 minute appt.
As the article says, what happens when the part B reimbursement is insufficient for a doctor to accept the "insurance", are you then going to pass a law that states they must? How many physicians already refuse Medicaid for this very reason? What happens when the hospitals decide not to accept the insurance either due to the low "benefits" that can be recovered when it treats someone who has that insurance?
Medicare started out as a reimbursement to the person, not the hospital, not the doctor. It was the principle that the money first had to be paid out of the individuals pocket that kept prices low. The same goes for insurance in general. When the person has to pay the money, they care how much of their money they are spending. When they are spending other people's money instead of their own, however, they are less concerned with cost, especially when the benefits derived from the spending of the money are personal in nature.
The best Medicare fix is to return to the original manner in which it was employed - a reimbursement amount to the person who received the care, not the caregiver. When you do that the charges for the care will once again be tied to the ability of the person to pay for it. The reason the prices of care, hospitalization and prescription drugs have skyrocketed is that we are no longer paying for it out of our own hard earned money. We don't pay the daily room charge for the hospital, heck, we don't even care what it is. We pay the $200 copay to be admitted and we're done caring after that. That's the problem that has led to the cost of care rising, which has led to the cost of insurance rising. Only by fixing the root of the problem can the problem be solved.
the flaw in that scenario is having the patient come up with the big bucks for some procedures and then wait for reimbursement.....what if they don't have the money? Some chemo can run $10,000/month or more....how many seniors can pay that amount then wait for reimbursement from medicare? It gets worse if you have surgery or need to go to the hospital for any reason. Or were you only talking about part B?
I don't disagree with your premis that costs would be lower, or at least people would shop around for lower costs, if they had to pay out of pocket. But the truth is they would probably not get life saving procedures if the cost was more than they could pay.
this is anecdotal, so take it for what it's worth. I switched to medicare last december, right in the middle of treatment....I notified all my doctors about the change and asked them if that was going to change my care, or if I would need a different doctor. My oncologist was pretty honest.....she said, yeah....I will get paid less but I will also get paid sooner. Medicare pays within the month, BC/BS pays when they get around to it, sometime months down the road. So she was not concerned about the change.
PrintSmith wrote:
Medicare started out as a reimbursement to the person, not the hospital, not the doctor. It was the principle that the money first had to be paid out of the individuals pocket that kept prices low. The same goes for insurance in general. When the person has to pay the money, they care how much of their money they are spending. When they are spending other people's money instead of their own, however, they are less concerned with cost, especially when the benefits derived from the spending of the money are personal in nature.
The best Medicare fix is to return to the original manner in which it was employed - a reimbursement amount to the person who received the care, not the caregiver.
Printsmith - that is how traditional "indemnity fee for service" insurance works. Except you don't really have to pay out of pocket first, as long as the insurance company processes your claim in a reasonable time. Its the way homeowners and car insurance works. I had 2 claims both over $5K and state farm sent me checks first, and I paid for the work with my own check after I received the money." All they required was quotes from 2 roofing contractors, and the body shop estimate.
Todays health care plans are really not true insurance anymore. They have morphed into pre-paid managed care, PPO, HMO, all inclusive managed care with a desire for lowest possible out of pocket costs, high premiums. The providers like it better if they know they will get paid by a big company, not an individual's bounced check. Customers don't want to deal with the paper work, and like you say they don't pay any attention to prices after the copay.
I still have not heard the Democrat plans for long term solvency, other than negotiate drug prices.
If you want to be, press one. If you want not to be, press 2
Republicans are red, democrats are blue, neither of them, gives a flip about you.
They're not buying it. Most Americans say they don't believe Medicare has to be cut to balance the federal budget, and ditto for Social Security, a new poll shows.
The Associated Press-GfK poll suggests that arguments for overhauling the massive benefit programs to pare government debt have failed to sway the public. The debate is unlikely to be resolved before next year's elections for president and Congress.
Americans worry about the future of the retirement safety net, the poll found, and 3 out of 5 say the two programs are vital to their basic financial security as they age. That helps explain why the Republican Medicare privatization plan flopped, and why President Barack Obama's Medicare cuts to finance his health care law contributed to Democrats losing control of the House in last year's elections.
Medicare seems to be turning into the new third rail of politics.
"I'm pretty confident Medicare will be there, because there would be a rebellion among voters," said Nicholas Read, 67, a retired teacher who lives near Buffalo, N.Y. "Republicans only got a hint of that this year. They got burned. They touched the hot stove."
Combined, Social Security and Medicare account for about a third of government spending, a share that will only grow. Economic experts say the cost of retirement programs for an aging society is the most serious budget problem facing the nation. The trustees who oversee Social Security and Medicare recently warned the programs are "not sustainable" over the long run under current financing.
Nearly every solution for Social Security is politically toxic, because the choices involve cutting benefits or raising taxes. Medicare is even harder to fix because the cost of modern medicine is going up faster than the overall cost of living, outpacing economic growth as well as tax revenues.
"Medicare is an incredibly complex area," said former Sen. Judd Gregg, R-N.H., who used to chair the Budget Committee. "It's a matrix that is almost incomprehensible. Unlike Social Security, which has four or five moving parts, Medicare has hundreds of thousands. There is no single approach to Medicare, whereas with Social Security everyone knows where the problem is."
In the poll, 54 percent said it's possible to balance the budget without cutting spending for Medicare, and 59 percent said the same about Social Security.
Taking both programs together, 48 percent said the government could balance the budget without cutting either one. Democrats and political independents were far more likely than Republicans to say that neither program will have to be cut.
The recession cost millions their jobs and sent retirement savings accounts into a nosedive. It may also have underscored the value of government programs. Social Security kept sending monthly benefits to 55 million recipients, like clockwork; Medicare went on paying for everything from wheelchairs to heart operations.
Overall, 70 percent in the poll said Social Security is "extremely" or "very" important to their financial security in retirement, and 72 percent said so for Medicare. Sixty-two percent said that both programs are extremely or very important.
Since this is really congress, let's have them on Medicare. See how they like it and actually find out what the process is. These folks have no true idea of what is going on with Medicare.
archer wrote: the flaw in that scenario is having the patient come up with the big bucks for some procedures and then wait for reimbursement.....what if they don't have the money? Some chemo can run $10,000/month or more....how many seniors can pay that amount then wait for reimbursement from medicare? It gets worse if you have surgery or need to go to the hospital for any reason. Or were you only talking about part B?
I don't disagree with your premis that costs would be lower, or at least people would shop around for lower costs, if they had to pay out of pocket. But the truth is they would probably not get life saving procedures if the cost was more than they could pay.
this is anecdotal, so take it for what it's worth. I switched to medicare last december, right in the middle of treatment....I notified all my doctors about the change and asked them if that was going to change my care, or if I would need a different doctor. My oncologist was pretty honest.....she said, yeah....I will get paid less but I will also get paid sooner. Medicare pays within the month, BC/BS pays when they get around to it, sometime months down the road. So she was not concerned about the change.
The point I was attempting to make, which it sounds like you are in agreement with, is that the chemo wouldn't cost $10K a month under such a scenario because most people couldn't afford to pay that much. If no one is purchasing the product or service because the cost is too high, the cost comes down to a point where it will be purchased. That is simply the way that a free market works. You would likely realize far greater reductions in cost via this process than you ever could by having a group of bureaucrats selected by the current group of "Ins" in Washington D.C. set a standard rate for reimbursement that applies across the board based upon the procedure.
And IMNTBHO, it gets even better when you have this domestic concern addressed by the state rather than the general government. The Medicare system in Washington D.C. has no sense of the different needs of an elderly patient in Grand Junction and one in NYC - so it treats both the same. In Colorado, for instance, we might be able to fund a state program similar in nature to the current Medicare for a smaller tax than the citizens of Colorado are currently paying. We might even be willing to pay a higher tax to ensure that our own elderly citizens are properly cared for. We might even be able to attract more industry to the state and have a larger tax base based upon where we set that tax or the level of benefits that this state decides to extend compared to others.
We all agree that the need for care generally increases with age, and we agree that a civilized society doesn't abandon its elderly in their increased need. The crux of the conflict lies in whether or not we think the general government is the proper place for the program to exist given that when it is so far removed from local control the likelihood of waste and fraud is greatly increased. There is not a single government, entity or person who is capable of doing everything and doing it exceptionally well. Why do we ignore this most basic understanding and seek to make the general government responsible for every aspect of our governance? It not only defies every principle of reason, it defies even rudimentary common sense.
We want the best governance we can obtain, don't we? Why then do we expect a single government to be capable of something that is evidenced nowhere else in society or nature? We know that a single doctor can't be the best orthopedic, brain surgeon, gynecologist and family physician all at the same time. We know that a single printer can't be the best in signs, books, brochures, direct mail and business cards. We know that a single automobile manufacturer can't put out the best compact, full sized, light duty truck and heavy hauler. We know that a single teacher can't provide the best education from elementary through doctorate level. It makes absolutely no sense then to expect that if we consolidate all power of governance into one entity that we will have the best government, does it?
Unless some big changes are made I would not want to see medicare become a state program.....one of my biggest complaints about health insurance is it is often state specific. Going from one state to another can wreak havoc with your coverage. A plan may cover emergencies, but not a doctor's visit. Going to a hospital out of state may not be covered even if the doctor you want to see is a specialist in what you need. When I had an individual plan (I was self employed and bought my own) it was difficult to find a plan that worked in both AZ and CO......I had to change companies to get one. Fortunately this was before I had any health problems, or I would not have been able to change.
The ease of using medicare in any state in the country is one of it's big advantages.
