Health insurance premiums going up, thanks to new legislation

[Pine Barrens Mafia]

So happy in fact, that millions have to enroll in a Medicare Advantage plan to cover many of their basic medical needs, because original Medicare doesn't cover enough for them

 

Which, under this "reform" plan, is going the way of the dinosaurs. The BILLION$ being heisted from the MA program is going to severely impact the bottom end of the MA market, where most seniors go fleeing to when they learn how much it costs to have a supplement. Less choice? Check! Thanks, big gumbint!

[birdog1960]

Oh yes, they're very happy with Medicare. So happy in fact, that millions have to enroll in a Medicare Advantage plan to cover many of their basic medical needs, because original Medicare doesn't cover enough for them. And who are these Medicare Advantage plans run by? Egats! It's private insurance companies. Ever look at the reimbursment rates that Medicare gives these private companies? They'd be shockingly high to you, and Medicare sets the rates.

 

Why are administrative costs as a percentage of total costs lower? Another shocking answer, because these are passed off to the private insurance company running the Medicare Advantage programs. Medicare can hide the $ amount in the reimbursment payment.

a sizable majority of the elderly remain in traditional medicare (as of 2008-80%). private insurers had a great and loyal friend in bush who approved ridiculous subsidies for the MA programs (which are now being decreased. many enrollees have been unhappy with these and returned to traditional medicare. i hear complaints all the time. the basic medicare coverage is better than a great many private plans and will be improved by covering wellness visits starting jan. 1. the percentage of administrative cost for medicare would be much lower as compared to private insurers if the low risk lives in the population were included in the national risk pool. private insurers cost more administratively despite cherry picking the best patients and dumping the worst on the government. think of what the numbers would look like on an even playing field. traditional medicare (even under the competitive disadvantages mentioned above) still has significantly lower administrative costs than it's private "competitors".

Edited September 24, 2010 by birdog1960

[Pine Barrens Mafia]

many enrollees have been unhappy with these and returned to traditional medicare.

 

While this is true, partially, for some people traditional medicare is not an answer. Unless you can afford a supplement, it is HIGHLY inadvisable to leave granny in original medicare due to the unlimited 20% liability.

[birdog1960]

While this is true, partially, for some people traditional medicare is not an answer. Unless you can afford a supplement, it is HIGHLY inadvisable to leave granny in original medicare due to the unlimited 20% liability.

i'm confused...don't most of you free marketers argue that people don't appreciate the true cost of care (and i agree). doesn't that 20% ensure that they do and that they have some skin in the game? medicaid becomes a secondary insurance when you spend down far enough so it wouldn't be forced denial of care just forced use of savings. it might change some decisions about futile care if the 20% was an issue more frequently.

[jjamie12]

Is Medicare, essentially, going bankrupt?

 

Is there a 'Yes' or 'No' to that question?

[birdog1960]

Is Medicare, essentially, going bankrupt?

 

Is there a 'Yes' or 'No' to that question?

predicted solvency til 2029 (assuming health reform bill allowed to play out)...12 year improvement in prediction since passage of health reform bill.

[BB27]

predicted solvency til 2029 (assuming health reform bill allowed to play out)...12 year improvement in prediction since passage of health reform bill.

 

Is this supported by actual facts? Or is this just some opinion?

[Magox]

Is this supported by actual facts? Or is this just some opinion?

Actually it's a bit of accounting trickery, and it is being dubbed as "double counting". The Obama administration along with the rest of them were being disingenous when they claimed that the Bill would REDUCE the DEFICIT AND extend the life of MEDICARE. I'm sure Birdog didn't know this, but they are double counting, on one hand they use the "savings" (which are taxes) to pay down the debt, then on the other with the same revenues that they are purporting to reduce the deficit, they are using to also extend the life of Medicare. It has to be one or the other, not the both of them.

 

Or as the CBO says:

 

 

The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund. Unified budget accounting shows that the majority of the HI trust fund savings would be used to pay for other spending under the PPACA and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits. To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position.

 

What say you Birdog?

[OCinBuffalo]

Hell, I predicted those outcomes, and my understanding of economics doesn't go much beyond college-level macro.

 

The laws of supply and demand aren't exactly subtle.

Anybody with some junior college could have predicted these outcomes....

 

So why the F didn't these Ph.D's and college professors get it? Ah, that's right: when you are defending an indefensible ideology, that has been proven stupid everywhere in the world for the last 40 years, it is bound to keep kicking your ass.

 

The problem here is that ideology '= solutions. This is doubly true when we are talking about leftist ideology, because by definition, it is doomed to fail.

 

The point is Tom: while you may not know economics that well, you do know history. Apply your historical knowledge to this health care abortion and you end up with the same conclusions as Magox.

[/dev/null]

The point is Tom: while you may not know economics that well

 

Aw snap, telling Tom that he doesn't know something well is setting him to punk your ass down as hard as he makes conner his b*tch.

[OCinBuffalo]

Aw snap, telling Tom that he doesn't know something well is setting him to punk your ass down as hard as he makes conner his b*tch.

But, Tom knows better than to get up in my business.

[birdog1960]

Actually it's a bit of accounting trickery, and it is being dubbed as "double counting". The Obama administration along with the rest of them were being disingenous when they claimed that the Bill would REDUCE the DEFICIT AND extend the life of MEDICARE. I'm sure Birdog didn't know this, but they are double counting, on one hand they use the "savings" (which are taxes) to pay down the debt, then on the other with the same revenues that they are purporting to reduce the deficit, they are using to also extend the life of Medicare. It has to be one or the other, not the both of them.

 

Or as the CBO says:

 

 

 

 

What say you Birdog?

i say: are you channeling bill o'reilly? bad choice.

i say "overstate the improvement (which implies that some improvement will result)" and "indeed improves" from the cbo coupled with the actual medicare trustees report probably places what will actually happen somewhere in the middle (which is often the case). either way, both opine that the bill IMPROVES the fiscal problems, not worsens them as some contend. either way, more has to be done so that 20 somethings paying in to medicare get some benefit. this is going to mean rationing eg: a national formulary, cost benefit analyses on therapeutic and diagnostic procedures and screenings, an open discussion and agreement on end of life care etc,etc. thus my contention that this is a work in progress...baby steps....we will have to see much bigger and more radical changes in order to keep medicare solvent for the next generation and the next after that. both parties understand this. you're seeing the dems approach, although the end game is still vague. you saw the repubs approach with the medicare advantage programs which was the first step towards privatizing medicare and handing it over to the big private insurers who will then do the rationing.

Edited September 26, 2010 by birdog1960

[Doc]

i say: are you channeling bill o'reilly? bad choice.

i say "overstate the improvement (which implies that some improvement will result)" and "indeed improves" from the cbo coupled with the actual medicare trustees report probably places what will actually happen somewhere in the middle (which is often the case). either way, both opine that the bill IMPROVES the fiscal problems, not worsens them as some contend. either way, more has to be done so that 20 somethings paying in to medicare get some benefit. this is going to mean rationing eg: a national formulary, cost benefit analyses on therapeutic and diagnostic procedures and screenings, an open discussion and agreement on end of life care etc,etc. thus my contention that this is a work in progress...baby steps....we will have to see much bigger and more radical changes in order to keep medicare solvent for the next generation and the next after that. both parties understand this. you're seeing the dems approach, although the end game is still vague. you saw the repubs approach with the medicare advantage programs which was the first step towards privatizing medicare and handing it over to the big private insurers who will then do the rationing.

At the time Medicare was created (1965), by 1990 it was projected to cost $12B. It actually cost $110B. Medicaid was only supposed to be temporary program. Projections are always off by several-fold (and in the case of Medicare, akin to Obamacare, it was over 9-fold!).

Edited September 26, 2010 by Doc

[birdog1960]

At the time Medicare was created (1965), by 1990 it was projected to cost $12B. It actually cost $110B. Medicaid was only supposed to be temporary program. Projections are always off by several-fold (and in the case of Medicare, akin to Obamacare, it was over 9-fold!).

ah. so your solution is to throw our hands up int the air and all say "whatever" in unison. good thinking!

[Magox]

i say: are you channeling bill o'reilly? bad choice.

i say "overstate the improvement (which implies that some improvement will result)" and "indeed improves" from the cbo coupled with the actual medicare trustees report probably places what will actually happen somewhere in the middle (which is often the case). either way, both opine that the bill IMPROVES the fiscal problems, not worsens them as some contend. either way, more has to be done so that 20 somethings paying in to medicare get some benefit. this is going to mean rationing eg: a national formulary, cost benefit analyses on therapeutic and diagnostic procedures and screenings, an open discussion and agreement on end of life care etc,etc. thus my contention that this is a work in progress...baby steps....we will have to see much bigger and more radical changes in order to keep medicare solvent for the next generation and the next after that. both parties understand this. you're seeing the dems approach, although the end game is still vague. you saw the repubs approach with the medicare advantage programs which was the first step towards privatizing medicare and handing it over to the big private insurers who will then do the rationing.

In other words, you got nothin....

 

Ok, just making sure

[Doc]

ah. so your solution is to throw our hands up int the air and all say "whatever" in unison. good thinking!

 

This is like trying to put out a fire with what you think is water, but turns out to be gasoline. Sure it's "doing something" and you thought it was going to help, but it only made things worse. And it's becoming abundantly clear that the Dems rushed-into this poorly-planned effort because they saw they had a majority in Congress that was being threated. But first they had to make sure they made their special deals with Big Pharma, the AMA, AARP, hospitals, lawyers I'm sure...

 

Again, you are laboring under the delusion that the promises made to you by politicians will materialize this time. That's your first mistake. And while you seem to be claiming that this is in everyone's best interest, you're more looking out for what you perceive to be your best interest, i.e. primary care getting better reimbursements.

[Alaska Darin]

In other words, you got nothin....

 

Ok, just making sure

It's more like: we've got hope, magic, and are sprinkling in a little Enron accounting to reach our end goal of single payer.

[birdog1960]

This is like trying to put out a fire with what you think is water, but turns out to be gasoline. Sure it's "doing something" and you thought it was going to help, but it only made things worse. And it's becoming abundantly clear that the Dems rushed-into this poorly-planned effort because they saw they had a majority in Congress that was being threated. But first they had to make sure they made their special deals with Big Pharma, the AMA, AARP, hospitals, lawyers I'm sure...

 

Again, you are laboring under the delusion that the promises made to you by politicians will materialize this time. That's your first mistake. And while you seem to be claiming that this is in everyone's best interest, you're more looking out for what you perceive to be your best interest, i.e. primary care getting better reimbursements.

it IS making things better from a budgetary stand point. even if one accepts your nihilistic view of the budgeting process, the reform model is still better in a relative sense to what we had from a fiscal perspective. more emphasis on primary care benefits me but it also benefits society as a whole. the systems that produce the best results at the lowest cost worldwide are those that rely heavily on primary care. consider the example of the 20% copay for medicare advanced above. then consider the case of an elderly patient mulling knee replacement. if he's faced with $10k+ of the cost he's more likely to come to me first for joint injections and medical treatment than to jump into an expensive surgery frought with possible complications with marginally better outcomes. thats a win- win.

Edited September 26, 2010 by birdog1960

[kegtapr]

then consider the case of an elderly patient mulling knee replacement. if he's faced with $10k+ of the cost he's more likely to come to me first for joint injections and medical treatment than to jump into an expensive surgery frought with possible complications with marginally better outcomes. thats a win- win.

 

And then when your injections don't work and he's left with no choice, he's already out the 20% he's paid to you plus another 20% for the replacement. Who's it a win-win for? Better evaluation of the best course of treatment from the start would help. You think Mr. Senior wants knee surgery if there are other options? Unfortunately, hospitals can act more like a business offering upsells then a place for care. You're looking for reform in the wrong place.

Edited September 26, 2010 by kegtapr

[birdog1960]

And then when your injections don't work and he's left with no choice, he's already out the 20% he's paid to you plus another 20% for the replacement. Who's it a win-win for? Better evaluation of the best course of treatment from the start would help. You think Mr. Senior wants knee surgery if there are other options? Unfortunately, hospitals can act more like a business offering upsells then a place for care. You're looking for reform in the wrong place.

there is always a choice. that's why it's called ELECTIVE surgery. despite what you may have been led to believe, there are conditions and situations where doing less is the correct decision and there are things that can't be fixed. despite what americans want to believe, medicine can't keep anyone alive and functioning well forever. even artificial joints have finite lifespans (much shorter than the ones we're born with). I frequently hear pts say they wish they never had x,y,z elective surgery. they are sold on the possibility of extended youth even when, at times, the odds of improvement over conservative care are not good. injections are a small fraction of the cost of surgery. the most prudent course of action in many cases (doctors also being mortals, without the ability to divine the future) is conservative treatment in elective cases with surgery only considered when all other options have been extinguished and even then, not offered to poor candidates. "upselling" could be mitigated by adherence to best practice guidelines (based on outcomes data) being instituted and followed. so how is this concept "looking for reform in the wrong place"?