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Debates Forum

  1. Subscriber no1marauder
    It's Nice to Be Nice
    19 Aug '12 14:04
    Good article in the New Yorker pointing out why radical reform of Medicare is unnecessary and may be counterproductive:

    1. Traditional Medicare works better, and more cheaply, than most private-insurance plans. With tens of millions of enrollees, Medicare can exploit its bargaining power to pay health-care providers less than private insurers do: that is the great advantage of a single-payer system. Typically, doctors and hospitals receive twenty or thirty per cent less from Medicare for a given procedure than they do from private insurers. They don’t like it, but they need the business.
    2. Medicare’s big challenge is demographics, not cost inflation. We’ve all seen the projections: if nothing is done to constrain it, spending on retiree health care will virtually swallow the federal budget. But what’s driving that spending is the growing number of enrollees—another million and a half Baby Boomers every year—rather than rising spending per person. “[W]hen it comes to what health-care costs per person, Medicare’s growth rate is remarkably low,” Feder pointed out—about three per cent a year over the next decade, according to the latest projections, which is considerably less than the cost inflation in the private-insurance sector.
    3. In the health-care industry, competition hasn’t produced the savings that economists expected, and it has led to other problems, such as gaps in coverage. Remember the rise of H.M.O.s, another idea promoted by Enthoven that was supposed to revolutionize health care and drive down costs? Part of the problem is the advance of costly treatments. But a bigger problem is that private insurers, rather than haggling with doctors and hospitals, try to make money by limiting the procedures they cover and by aggressively managing their risk pools—that is, taking on fewer sick people. This problem can be addressed through vigorous oversight, but that’s not an easy thing to implement, especially when half of Congress is controlled by a party that breaks out in hives at the very idea of government regulation.
    4. Significant measures have already been taken to reduce the future growth of Medicare spending. Under the Affordable Care Act of 2010—“Obamacare”—the formula that governs payments to health-care providers was altered to reduce outlays significantly—about five hundred billion dollars over ten years. Assuming that these measures go into effect, their impact will be very noticeable. Citing numbers from the Congressional Budget Office, Feder wrote that “Medicare premiums, currently estimated to be 11 percent lower than private insurance premiums for the same benefit package, will be about 30 percent lower by the end of the next decade.” (This change in the growth in outlays accounts for much of what Romney has been referring to as money taken away from seniors.)
    5. Retirees can already make choices about what sort of health-care coverage they want. Although Medicare is often regarded as a monolithic system, it has actually changed quite a bit. Aaron noted: “The sort of competitive system that voucher advocates say they want to create already exists. The average Medicare enrollee today may choose among an average of 24 plans, in addition to traditional Medicare, including 10 health maintenance organizations.”
    6. For many elderly patients, choice isn’t necessarily a good thing. Back to Aaron: “The Medicare population contains many people with mental disabilities and early or advanced mental decline. The recently announced Wyden-Ryan plan promises to provide voucher recipients with ‘clear and easy to understand information’ on various plans. Has any of you actually read the clear and easy to understand (!) information that Medicare and private insurers now distribute to enrollees? To think that providing ‘clear and easy to understand information’ equips those with mental disabilities or early-state dementia to deal with competing insurers is delusional.”

    http://www.newyorker.com/online/blogs/johncassidy/2012/08/privatizing-medicare-a-supporter-recants.html
  2. 19 Aug '12 16:17 / 1 edit
    Medicare in its current form is clearly unsustainable. This isn't rocket science—just arithmetic.

    A typical couple retiring last year will, on average, pay $150,000 in Medicare taxes over their lifetime, but receive more than $350,000 in benefits. As a result, the program ran a combined deficit of more than $288 billion last year. Going forward, the most optimistic scenario puts Medicare's future unfunded liabilities at more than $35 trillion. More realistic estimates suggest that the shortfall could actually exceed $90 trillion.

    The question, therefore, isn't whether to reform Medicare, but how.

    President Barack Obama would reform it from the top down, empowering a 15-member board of unelected bureaucrats, the Independent Payment Advisory Board to cut reimbursements to doctors and hospitals. Whether or not such cuts are successful in reducing long-term Medicare costs, they will make it more difficult for seniors to see their doctor. In fact, Medicare's own actuaries predict that as many as 15 percent of hospitals could close, and some estimates suggest that up to 40 percent of doctors will stop seeing Medicare patients.

    In contrast, Paul Ryan would reform Medicare from the bottom up by increasing competition and consumer cost-sharing. If anything, in fact, his plan is probably too timid since it makes no changes to the system for anyone age 55 or older. Even those under age 55 would still have the option to remain in conventional Medicare if they wish to do so. However, the growth in spending under traditional Medicare would be capped at roughly the same growth rate as proposed by Obama.

    Those who wished another option, however, could choose instead to receive a voucher or premium support payment based on bids by private insurers in their area. Seniors who choose a lower-cost plan can keep the difference, while those who choose to enroll in a more expensive plan will have to pay the difference between the government payment and the premium.

    Does that mean that, over time, many seniors will have to pay more to receive the same level of benefits as today's seniors? Probably. But as noted above, Medicare simply cannot continue to provide that level of benefits in the future without bankrupting the country.

    Ryan's plan puts the decision over how to balance paying more or getting less in the hands of each individual consumer. In contrast, Obama would simply impose that decision on every senior from above.

    By increasing competition and forcing healthcare consumers to make value-based decision, the Ryan plan holds the prospect of finally restraining the growth of Medicare costs. And it does so by trusting and empowering consumers rather than government bureaucrats. It may not be perfect, but it's a big step in the right direction.

    Medicare Needs the Ryan Plan's Cost Controls



    Medicare Needs the Ryan Plan's Cost Controls
    U.S. News & World Report‎ - 2 days ago
  3. Subscriber no1marauder
    It's Nice to Be Nice
    19 Aug '12 16:23
    Originally posted by utherpendragon
    [b]Medicare in its current form is clearly unsustainable. This isn't rocket science—just arithmetic.

    A typical couple retiring last year will, on average, pay $150,000 in Medicare taxes over their lifetime, but receive more than $350,000 in benefits. As a result, the program ran a combined deficit of more than $288 billion last year. Going for ...[text shortened]... icare Needs the Ryan Plan's Cost Controls
    U.S. News & World Report‎ - 2 days ago[/b]
    How's that leaving up to the private sector to control health care costs doing so far?

    Ryan's plan will leave seniors with far less coverage at a higher cost.
  4. 19 Aug '12 16:31
    Originally posted by no1marauder
    How's that leaving up to the private sector to control health care costs doing so far?

    Ryan's plan will leave seniors with far less coverage at a higher cost.
    Current beneficiaries and those age 55 and older would see no changes in the way the program works for them.
  5. 19 Aug '12 16:34
    medicare pays for almost nothing I had under my own insurance for Multiple sclerosis... that doesn't mean Ryans plan would either,, just saying.. example inject able copaxone, taken 1x daily is a 1400.00 monthly co-payment...
    you on it?
  6. 19 Aug '12 16:38 / 1 edit
    I have been on it for several years now, after the 2 year wait....... cobra started at 1100.00 a month for my family of 4,, then jumped to 1800.00. That's when I had to bail
    all in all medical coverage sucks... literally..a loud swooshing sound coming from your bank account. I would highly recommend those that can afford it, to buy both short and long term disability coverage...
  7. Subscriber no1marauder
    It's Nice to Be Nice
    19 Aug '12 16:39
    Originally posted by utherpendragon
    Current beneficiaries and those age 55 and older would see no changes in the way the program works for them.
    I'm aware of that. But in the end seniors will get screwed once Ryan's abolition plan goes into effect.
  8. 19 Aug '12 16:40
    Originally posted by no1marauder
    I'm aware of that. But in the end seniors will get screwed once Ryan's abolition plan goes into effect.
    hard to say that really, the picture isn't clear... I am taking it in the shorts now..
  9. 19 Aug '12 16:45
    Originally posted by Hugh Glass
    I have been on it for several years now, after the 2 year wait....... cobra started at 1100.00 a month for my family of 4,, then jumped to 1800.00. That's when I had to bail
    all in all medical coverage sucks... literally..a loud swooshing sound coming from your bank account. I would highly recommend those that can afford it, to buy both short and long term disability coverage...
    So you would recommend nationalizing health care then?
  10. 19 Aug '12 16:54
    Originally posted by KazetNagorra
    So you would recommend nationalizing health care then?
    I would have to see the facts,, how is it paid for, nothing is free..Do I want my children burdened by me..no.
  11. 19 Aug '12 16:58
    Originally posted by no1marauder
    I'm aware of that. But in the end seniors will get screwed once Ryan's abolition plan goes into effect.
    If you are talking about future seniors ,Gen Xers and beyond, they are really gonna get screwed under the currnt system because there won't be any medicare by then. We will be totally bankrupt.
  12. 19 Aug '12 17:05
    Originally posted by no1marauder
    Good article in the New Yorker pointing out why radical reform of Medicare is unnecessary and may be counterproductive:

    1. Traditional Medicare works better, and more cheaply, than most private-insurance plans. With tens of millions of enrollees, Medicare can exploit its bargaining power to pay health-care providers less than private insurers do: that ...[text shortened]... www.newyorker.com/online/blogs/johncassidy/2012/08/privatizing-medicare-a-supporter-recants.html
    "1. Traditional Medicare works better, and more cheaply, than most private-insurance plans."

    This is a baseless assertion believed by uninformed people. Medicare in its very first year of operation had cost exceeding estimates by 10x. Any private insurance company with that poor actuarial estimates would have gone bust immediately. And in fact Medicare's own actuaries predict its failure.

    "Medicare can exploit its bargaining power to pay health-care providers less than private insurers do: that is the great advantage of a single-payer system."

    Again a myth not supported by any actual evidence. What we know, is that Medicare has a record of being abused by fraudulent providers, and bureaucratic ineptness increases its costs.

    Do I really need to go further and rip the whole piece to sheds?

    What's really wrong with American health care, and escalating costs? HMOs were the creation of Ted Kennedy, as the best thing since sliced bread to revamp the "failing health care" system. Instead they made the situation worse.

    The real culprit, is attempting to insure what are not insurable interests, or events. Ask an underwriter what insurable means. Predictable expenses are never insurable. Insurability is based on a relatively rare but costly event, where the costs can be shared by the majority who will not experience the event.

    The predictable result of insuring the uninsurable is adverse selection, where people who know an expense is coming rush to buy a policy to cover it. The understanding of most people is that insurance companies or the government has a sugar daddy with an unlimited money source to cover any and all risks. Commonly people think that if they pay X in premiums, they ought to get X in benefits. That isn't how it works. The reality is that 100 or 1000 people pay in, to cover the big loss of one, and to cover the administration of the company and its employees, and make a profit for the stockholders or policy holders in the case of a mutual company.

    The health care insurance industry has tried to avoid the basics, mostly because of the force of government. Insurance and market in general don't work well with government dictating the rules.
  13. 19 Aug '12 17:14
    Originally posted by Hugh Glass
    I would have to see the facts,, how is it paid for, nothing is free..Do I want my children burdened by me..no.
    http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
  14. Subscriber no1marauder
    It's Nice to Be Nice
    19 Aug '12 17:24
    Originally posted by normbenign
    "1. Traditional Medicare works better, and more cheaply, than most private-insurance plans."

    This is a baseless assertion believed by uninformed people. Medicare in its very first year of operation had cost exceeding estimates by 10x. Any private insurance company with that poor actuarial estimates would have gone bust immediately. And in fact Medic ...[text shortened]... Insurance and market in general don't work well with government dictating the rules.
    LMAO! You think by making a bunch of baseless assertions you are "ripping anything to shreds"? The article gives SPECIFIC figures which refute your religion based claims (the religion of laissez faire naturally).

    Health care costs are certainly insurable and are insured the world over. According to your "analysis", life insurance shouldn't work either because death is a predictable event.
  15. Subscriber no1marauder
    It's Nice to Be Nice
    19 Aug '12 17:28
    Originally posted by utherpendragon
    If you are talking about future seniors ,Gen Xers and beyond, they are really gonna get screwed under the currnt system because there won't be any medicare by then. We will be totally bankrupt.
    Then we'll either have to control costs or raise additional revenues. Insuring the elderly shouldn't be that hard; every other wealthy country (and many non-wealthy ones) have health insurance for everybody.