Before we begin – The Tony Award Show is serving as background noise as I write this. The Dallas / Miami game may be on, but not in my home. I want the Mavs to win, or more importantly, I want the Heat to lose. I don’t want to invest two hours of my life cheering for someone to fail. That negativity isn’t healthy. For that matter, investing all of your energy praying for the other political party to fail is not only unhealthy for you, it can be devastating for the country.
It is only fair to warn you, dear reader, that this is another post about Medicare. Click. I just lost half of my readers. Medicare is boring and about old people. Since most of my readers are under 65, most don’t care about a program designed to provide health care to senior citizens and the permanently disabled. The average American has a notoriously short attention span. We need good guys and bad guys, winners and losers. There is little interest in nuance and detail.
The path to a true solution is built with patience, compromise, and lots and lots of detail.
Medicare was created in 1965. The business of health care has changed significantly in the last forty-six years. We are living longer, getting lots more treatments, many of which didn’t even exist in the mid-60’s, and we are taking an incredible amount of medications.
Senior citizens, in 1965, were thankful that the U.S. Government was coming to their rescue. Medicare filled a need. That need was very real. Today we take Medicare for granted and whine about copays and deductibles. Medicare is the ultimate entitlement program. Ask everyone on Medicare. They will tell you that they are entitled to all the medical care they could possibly need or want.
How do we pay for this? How do we control costs? Can we limit care without being accused of creating death panels? How much should the U.S. Government pay a doctor, a lab, a hospital? Does a doctor in Akron, Ohio really get paid the same amount as a doctor in Manhattan? Can a government really make all of these decisions, and thousands of others, efficiently?
The answer – Maybe.
The citizens of most of the developed world depend on their governments to make those decisions. We, emphatically, do not. We want choices. We want to feel like we are in control. We just want someone else to pick up the tab.
If Medicare is to survive, the government will need to get control of the cost of care. The insurance companies have had some success in this area. Medicare has not. The government will have to get control of fraud and abuse. The insurance companies have had some success in this area. Medicare has not. As long as the doctors have lobbyists, the hospitals have lobbyists, the labs have lobbyists, and the pharmaceutical companies have Congressmen, meaningful change will not happen easily.
There are almost 50 million Americans on Medicare. The influx of baby boomers with our growing life expectancy means that more and more people will be dependent upon a government that is unprepared and unwilling to change until forced.
Representative Paul Ryan’s plan is to pass the buck. Instead of controlling medical costs or even working with the medical providers and insurers, Representative Ryan would send you a check and tell you that you are on your own. If you view his plan as simply a starting point to a long discussion, then it has some (small) merit. If you view this as the ultimate answer, you might need new glasses. Dumping all of the decisions and problems on to the backs of our senior citizens is not the answer.
So how do we move forward? It will take a Presidential Commission comprised of serious, well-known and well-respected Democrats and Republicans. We desperately need to remove the politics from this if we are to have any chance of success. Some of the questions are:
* Medicare begins at what age?
* How much does it cost?
* Will the price be adjusted by age or assets (means testing)?
* How do we control medical expenses?
* Is every test a doctor orders necessary?
This is a partial list. It will take a fair amount of courage to answer those questions. It will take a historic effort to implement the final recommendations.
And when that time comes, when a bi-partisan group has created a workable framework to save and preserve Medicare, it will be our job to cheer for their success. Because their success will be our success. And their failure would be devastating.
I just snuck a peek. Five minutes are left and Dallas is up by 7!
Did I see the following bumper sticker on your car?
Other questions that come to mind:
How much is the Presidential Commission?
Is means testing mean?
Can one attend two parties at the same time?
Can Dave Cunix be Chairman of the Process?
No Names Please
I have had Medicare since about 1999/2000. Medicare pays 80% of what they consider is resolnabae cost. Believe me that isn’t much. For example: Suppose I have a bill of $1000. Medicare determines that resolnabae cost is $400; they pay 80% of that. And even though I have a private insurance which supplements Medicare, Medicare still sets the resolnabae cost which means in my example that my private insurance will pay 20% of $400. Whoever performed the service (doctor, hospital, whoever) is out $600. When my doctor retired about five years ago I called four places which wouldn’t take me on as a patient because I have Medicare.Even though private insurance companies are in it for profit, because they charge much higher premiums than the government does for Medicare, they can afford to pay more out because of those higher premiums. It’s truly a case of you getting what you pay for.Because I don’t work, Medicare is primary and my Blue Cross/Blue Shield is secondary so Medicare sets the reimbursement rate. Secondary insurers REQUIRE that a person be entitled to Medicare if they are eligible to cut down on the costs of the secondary insurance.If I didn’t have Medicare and I wasn’t eligible for it, my Blue Cross/Blue Shield would be reimbursing my doctors and hospitals at a much higher rate than what Medicare does.Now why doesn’t everyone in the United States have Medicare? The insurance companies wouldn’t stand for it and the medical community would be backing them up. Our representatives and senators wouldn’t dare extend Medicare to all Americans!Frankly I think Medicare should be extended to everyone with increased premium rates and higher payments to providers of services and it could be administered through the private companies. But who am I?