AARP takes a position on proposal to cut Medicare and SS

[Bestwifeever]

Several posts have been removed for political content. Please do not repost them.

 

[GregLee]

In this campaign they are saying 1) Medicare and SS should be preserved in their current states and implying 2) the remaining liabilities and spending in Washington are not related to seniors.

Would you please give a reference for where they say these things?

 

[MichaelB]

Would you please give a reference for where they say these things?

1) Medicare and SS should be preserved in their current states

We can cut wasteful spending without cutting the benefits you’ve earned

2) the remaining liabilities and spending in Washington are not related to seniors.

so Washington can pay its bills

Your benefits, its bills convey the meanings that I used above.

The Medicare benefit is not just for seniors that are current beneficiaries. Everyone that pays has an interest. There are more people with vested interests that are not current recipients.

BTW, Washington's biggest bill's are ... Medicare and SS.

When politicians use this language, they are accused of creating or exploiting partisan differences. If it's not appropriate for politicians, AARP should not use it either.

 

[eytonxav]

While I don't disagree with AARP taking this stance for its constituency, I have a hard time separating some of their past positions which sometimes seemed pretty self serving (considering the insurance products they hawk).

That said, one thing I would like to see is finding a solution to stop the massive $s expended due to fraud in all these gov't programs, not just healthcare related ones.

 

[GregLee]

1) Medicare and SS should be preserved in their current states

We can cut wasteful spending without cutting the benefits you've earned

This quote does not imply that Medicare and SS should be preserved in their current states. An increase of eligibility age, for instance, deferred so it does not affect the "you" of the quote, or an increase in the SS/Medicare taxes, or even making Medicare cheaper to administer would all change the systems without cutting already earned benefits. But even if someone were to agree with you about the implications of what the AARP did say, they didn't say what you attribute to them.

 

[Gone4Good]

I noticed some typos in the AARP copy. A corrected version below:

You’ve [-]worked hard your entire life, paid your dues, raised a family[/-] voted repeatedly for higher government spending, and lower taxes. You’ve [-]earned some[/-] enjoyed the peace of mind knowing that the money borrowed to fund the government programs you've long enjoyed will be repaid by someone else. Now, some in Congress want to make [-]harmful cuts to[/-] Medicare and Social Security live within their means. Cutting [-]your[/-] the benefits we promised ourselves without ever saving a dime to fund them so Washington can pay the other [-]its[/-] bills we ran up. AARP believes the country can [-]do better[/-] bend over. We can cut [-]wasteful spending[/-] other people's benefits without cutting our own [-]the benefits you’ve earned[/-]. Join us. Tell Congress to stop [-]the harmful cuts to Medicare and Social Security[/-] messing with an entitled class. We vote. Our kids don't.

 

[Geoffrey]

I disagree with AARP . . . I wouldn't like it, but I'd accept a cut in my social security and medicare benefits if it was part of a fair and balanced plan to bring back some finanical sanity to the U.S. budget.

As an aside, I've deferred collecting SS for a couple of years, but I feel I've already reaped a substantial benefit in that my folks have lived on little more than SS for MANY years and, but for SS and medicare, I would have had to pony up a LOT of money for their support. Thus, if I never collect a dime, I've still received a significant benefit from both programs.

 

[Gone4Good]

I feel I've already reaped a substantial benefit in that my folks have lived on little more than SS for MANY years and, but for SS and medicare, I would have had to pony up a LOT of money for their support. Thus, if I never collect a dime, I've still received a significant benefit from both programs.

A very good point. One that should be more widely appreciated, I think.

 

[Bestwifeever]

Geoffrey, good point.

 

[rocks911]

The claim that AARP's postion is unpatriotic is ridiculous. Money follows priorities and apparently the priorities of this country and it's politicians has been war, the war machine, proping up dictators, and proping up Wall Street crooks.
AARP is doing what it was designed to do, politicians are selling this nations citizens down the river.
I dont care much for the term "entitlement" what is corporate welfare but entitlements of the monied class?
The amount of money required to mount a political campaign requires that our politicians be in the back pocket of corporations, and until that changes us citizens will always come second.
Stand your ground AARP!

 

[jdw_fire]

...
I dont care much for the term "entitlement" what is corporate welfare but entitlements of the monied class?
...

a total aside:

SS and medicare are "entitlements" because the american people were told/promised that because they paid (separate taxes) into these "systems" they were entitled to collect from them, which to me is totally reasonable and should be fulfilled! welfare, corporate bailouts, subsidies, etc are not "entitlements" since the recipiants are not entitled to them. instead they get them as a gift. it is a shame that the word "entitlement" has gotten a bad name.

 

[eytonxav]

a total aside:

SS and medicare are "entitlements" because the american people were told/promised that because they paid (separate taxes) into these "systems" they were entitled to collect from them, which to me is totally reasonable and should be fulfilled! welfare, corporate bailouts, subsidies, etc are not "entitlements" since the recipiants are not entitled to them. instead they get them as a gift. it is a shame that the word "entitlement" has gotten a bad name.

Very good point that should not be forgotten!!!

 

[samclem]

The courts have ruled that we have no contractual right to SS. The annual statements from SS have made it pretty clear that, unless something changes, the money won't be there to pay the full amount of benefits that recipients receive today.
If an individual fights to amend the SS program or Medicare program so that future generations of workers pay far higher taxes than he ever had to pay, is he really fighting for fairness?

 

[ziggy29]

I disagree with AARP . . . I wouldn't like it, but I'd accept a cut in my social security and medicare benefits if it was part of a fair and balanced plan to bring back some finanical sanity to the U.S. budget.

I guess where I part with AARP is that many times their position is that sacrifices shouldn't be shared, but rather they should all be made by younger generations. And to that end, I think those who simply bash AARP as selfish and greedy are taking the wrong tack, just encouraging defensiveness and retrenching into their positions that they "earned the right" to everything they get and that others need to do all the sacrificing.

I think more to the point, show them what impact their position is having on their kids and grandkids. We're living in a society where today's AARP generations probably have it better (on average) than their kids, and their kids on average will have it better than their grandkids. Show clearly the holes that AARP's opposition to shared sacrifice will have on the financial future of their kids and grandkids. They pay lip service to it in terms of PR, and with things like "keep SS and Medicare solvent for our grandchildren" and what not, but the problem is that their policy recommendations will keep these programs alive but make them an increasingly bad deal for future generations. Do they really want to see their grandkids have their SS and Medicare taxes jacked up substantially for the right to receive worse (and possibly heavily means-tested) benefits decades down the road? Do they really "love" their grandkids like that?

At the very least, if AARP expects younger generations to take a big hit to preserve their current deal, they should ask the more affluent among their membership to share in the sacrifice. It seems like every age-based entitlement has the same proposed solution: stiff younger folks so the older ones can keep their deal. IMO, these younger folks have good reason to oppose this when they are expected to bear all the burden of fixing these things. Share the sacrifice across ALL generations and we'll talk.

 

[SteveL]

Suppose Mr Ryan's $14k voucher plan became law, what would happen when folks reached 65 or whatever age deemed eligible? SS spent $14000 per recipient in 2004, and costs have risen dramatically since then, so seniors would have to make up the difference. However, that isn't the main problem. I predict that no for-profit insurance company would willingly write health insurance for those over the age of eligibility. That is one of the main reasons Medicare was created in 1967. Old people couldn't buy coverage at any price.

There is a reason for Govt. flood insurance, Govt. Windstorm pools in Florida and other states, Govt. run assigned risk plans for auto insurance, etc. etc. etc. The private sector doesn't want to write coverage for sectors of the market they know to be losers.

So, any solution that involves doing away with Medicare will mean that you have to force the private sector to provide the coverage. This will then create cross subsidies as other participants have to subsidize us old folks just as they do today for Medicare, which currently doesn't pay the full cost of treating seniors. And, the private sector costs 8% more than SS just for admin costs.

So, I suspect that if there is a solution, it will mean more means testing so that those of us that can afford it pay a greater share of the cost. And, it may mean that some things provided by the current program are cut back.

I would encourage people to read the following for another element of the solution:

McAllen, Texas and the high cost of health care : The New Yorker

If I were to criticize AARP it would be for not offering some practical suggestions rather than just saying no.

 

[samclem]

Suppose Mr Ryan's $14k voucher plan became law, what would happen when folks reached 65 or whatever age deemed eligible? SS spent $14000 per recipient in 2004, and costs have risen dramatically since then, so seniors would have to make up the difference.

You're doing static analysis. A prime reason medical costs are rising is because Medicare keeps dumping money into that system (more dollars chasing the same basket of goods= higher prices). Medicare pays per procedure, so more procedures = more money for health care providers (which is sometimes the only way they can make up for low per-procedure reimbursement rates for some items--perform other procedures with higher reimbursement rates). There are better models for providing health care services, and private insurers will use them when they've gort an incentive to do so.

However, that isn't the main problem. I predict that no for-profit insurance company would willingly write health insurance for those over the age of eligibility. That is one of the main reasons Medicare was created in 1967. Old people couldn't buy coverage at any price.

Private insurers now cover government employees of all ages, this is no different.
If the premium support payments prove to be insufficient to provide the quality of care we (collectively) decide is right, then Congress can amend the law to provide higher payments (just as they do now every year for Medicare). This is not some type of unalterabe autopilot. The difference is that we'll have competition in the provision of health care, and I trust that mechanism to do a much better job of controlling costs than any top-down centralized price-control system.

Remember that the present health care reform law already calls for big cuts to Medicare. Let's try something (competition) that works throughout the rest of the economy rather than keep doing the same dumb thing.

 

[GregLee]

A prime reason medical costs are rising is because Medicare keeps dumping money into that system (more dollars chasing the same basket of goods= higher prices).

That makes sense to me, but of course just because something makes sense, that doesn't make it true. The "dumping money" description suggests that a Medicare paid for procedure is less carefully monitored and more freely approved than it would be if the insurer were private. I don't know this to be true. I kept an eye on my mother's expenses when she was on Medicare, and last summer when I went from private health insurance to Medicare, I haven't noticed any special laxity developing. For instance, last Fall I had a colonoscopy which was given after an interval of less than 5 years from my preceding colonoscopy, so Medicare refused to pay. Well, I was able to straighten that out, because the procedure was not just for screening, but was given for medical diagnostic reasons. But the point is, someone was watching, trying to make sure the rules were observed.

 

[samclem]

The "dumping money" description suggests that a Medicare paid for procedure is less carefully monitored and more freely approved than it would be if the insurer were private.

Since we both lack data (for now), let's back up a step and look at incentives as a means to discern likely impacts on costs.

Present Medicare: The providers make more money if they supply more services. Some have a higher "markup" than others. They have incentives to render more services overall, and especially ones that yield more profit. To try to reign this in, Medicare imposes various rules/limits/etc (as you found out--limits on colonoscopy screenings. As your provider found out: call it a "diagnostic procedure" and not a "screening" and Medicare will still pay). To cut costs (as required under present law) there will be more rules/hurdles/required parameters to be met (and documented--OMG),

What if: 5 years from now, GregLee can use his "voucher" to buy medical care from MayoClinicMedical, Inc. They don't get paid by the procedure--they get paid to keep you healthy. The "must cover" items are spelled out in the policy you buy. They can offer you all kinds of incentives if you'll come in for vaccinations, screenings, etc because it will save them money. Quit smoking, lose weight, etc and maybe there's something in it for you (reduced copays?). The healthier you stay, the more profit they make. That sounds like the incentives are right.

Now, we can argue that under this plan MayoClinicMedical has incentives to deny you expensive care, and there are fixes for that. But at least the incentives to control costs would be in place: providers aren't under pressure to order more procedures to make more money.

Not all private insurance would need to work like this--some might still be fee for service. The marketplace will decide the winner.

 

[GregLee]

As your provider found out: call it a "diagnostic procedure" and not a "screening" and Medicare will still pay).

Just to keep straight about the anecdote, it was actually a diagnostic procedure. Characterizing it as a screening was just a staff error. Previously, a radiologist interpreting my CT scan had reported an apparent thickening of the bowel wall and had explicitly recommended an endoscopic examination. There was a specific medical rationale for the colonoscopy, so it should not have been characterized as "screening".

While I understand the suspicion that providers of health care might be tempted to work the system to maximize their incomes, I don't think a sort of free-floating paranoia should lead us to the conclusion that it's actually happening, absent actual evidence.

 

[samclem]

. . . I don't think a sort of free-floating paranoia should lead us to the conclusion that it's actually happening, absent actual evidence.

Paranoia? That may be a bit over the top. It's easy enough to compare costs of fee-for-service approaches to capitation approaches. Or HMO vs PPO. These give indications of the results produced by different incentives. This is an exercise left to the reader.

 

[Webzter]

You're doing static analysis. A prime reason medical costs are rising is because Medicare keeps dumping money into that system (more dollars chasing the same basket of goods= higher prices).

It's an interesting idea, and I know you're just positing it, but I'm not sure I agree with it completely (as in, it's all Medicare's fault).

However, expanding that train of thought a bit... I wonder if health care would be cheaper if insurance were divorced from employment. Many people purchase group health care through their employer and, as a result, are often ignorant to the true cost of the plan. At megacorp, I just went with a PPO for $130 a month for two and I knew my employer was on the hook for another $9k a year. We could see any specialist we wanted for anything we wanted. Cost was irrelevant.

So, more dollars chasing the same basket of goods, but on the private side as well.

Now we get to the anecdotal part of the post just based on my personal experiences

I've also noticed that, if the answer to a problem for a doctor is "I don't know", the default is to send you on to a specialist for more tests. If that specialist doesn't know, then the default is to send you on for more tests. I'm not blaming this on threat of lawsuits. After all, I'd rather find out and prevent something bad than not.

However, if I were on the hook for more of my medical cost, then I imagine I'd have more talks with my doctor where I decide not to go in for more tests if we both assume the risk is low enough to wait and see.

Now that we have a high deductible plan (individual insurance), we're less likely to go to a doctor and we're more likely to take a wait and see approach on many minor things to see if a trip to the doctor is warranted. For example, my wife likely broke her toe or at least jammed it on Tuesday. Rather than running off to urgent care as we would have on the PPO plan, she assessed the pain and swelling herself and decided, based on it subsiding by Thursday, that she wasn't going to bother.

I'm not saying this is a smart move over the long run, but, for the issue at hand (health care cost) it is having a pronounced effect.

 

[Webzter]

While I understand the suspicion that providers of health care might be tempted to work the system to maximize their incomes, I don't think a sort of free-floating paranoia should lead us to the conclusion that it's actually happening, absent actual evidence.

I doubt most doctors are working the system (always a few bad apples in any bunch). I doubt most providers are working the system (again, bad apples).

One thing that is interesting, to me, is the amount of waste in the system. I'm not sure if one can trace this waste to any single cause... but it's there.

Our doctor bills through a provider. The provider then bills our insurance company even though we both know the claim will be rejected. When the claim comes back rejected, we then pay the provider's negotiated rate for service. This negotiated rate is significantly lower across the board than if I had just paid directly at the doctor's office.

Additionally, that provider (at least the one I helped out in writing a billing system for) assumes, by insurance carrier, a certain amount of write-off that they'll never be paid for. That is, your regional hospital assumes it might not see, say, 20% of the money it bills to UHG or Aetna. These rules were actually built into the system we wrote, which means it's just part of the standard way of doing business.

My wife went to see her doctor this winter to see if she had pneumonia or bronchitis or something else. Four months later, we're still getting bills related to the visit. There were two different lab bills (apparently the techs that took the xray were billed through a different company than the radiologist who interpreted the xray), a bill from the doctor, and some other bill. Think of the overhead for that. Four different companies employing staff just to ensure payment for a single visit. High touch in paperwork is never good.

In this regard, a single payor system may (may) reduce cost and overhead. I'm not sure. On the other hand, I'm not seeing a lot of efficiency now and I doubt that introducing a government program would enable that.

 

[modhatter]

The GOP just wants to get rid of the problem. They are not interested in fixing it. How on earth can anyone actually believe the insurance would be cheaper with private insurers for seniors?

Yes, I agree there is waste and inefficiency in health care in both private and government insurers. There are so many things that could be fixed to lessen costs. I'm on medicare and recently at a visit to my GP office, the nurse I know was saying that the doctor regretted his decision to move his location. I asked her why and she said the seniors were getting to him. So I asked him about it and he said he just gets too many seniors coming in multiple times when there is nothing wrong with them. I said "there should be some kind of office visit co-pay for office visits maybe on a sliding scale, and he agreed whole heatedly and said if there was even a $25 co-pay this would stop 80% of the unnecessary visits." So I agree there needs to incentives as well as decentives for all parties involved.

Health care for profit is absurd, but private insurance for seniors (under whatever new name the GOP packages it) is insane. However, rational people (even liberals like me) have to be realistic and understand that we need to really overhaull the system and do everything we can to control costs. (In addition to cutting other areas and raising revenues at the same time)

People who shout "hands off my medicare" and in the same breath, say but do not raise my taxes, or weaken our military presence, or change social security in any way", are living in a dream world. But changes can be made and belts tightened without throwing grandma off the cliff and dumping the seriously disabled out on the street.

It is a time for re-evaluating priorities, and lots of fixing. If we could just stop fighting each other, we could actually effect change.

 

[GregLee]

Think of the overhead for that. Four different companies employing staff just to ensure payment for a single visit. High touch in paperwork is never good.

I'm thinking, thinking. Where exactly is the overhead? Everyone has to have staff to handle billing, anyway. Everyone has to pay Webzter for the computer software, anyway. If staff actually had to understand and work through the details of this arcane system that has evolved, I can see that we'd be in big trouble. But since Webzter's software handles the details, why should we care about the complications? We'll just let your programs figure it all out for us.

 

[Tadpole]

The GOP just wants to get rid of the problem. They are not interested in fixing it. How on earth can anyone actually believe the insurance would be cheaper with private insurers for seniors?

Yes, I agree there is waste and inefficiency in health care in both private and government insurers. There are so many things that could be fixed to lessen costs. I'm on medicare and recently at a visit to my GP office, the nurse I know was saying that the doctor regretted his decision to move his location. I asked her why and she said the seniors were getting to him. So I asked him about it and he said he just gets too many seniors coming in multiple times when there is nothing wrong with them. I said "there should be some kind of office visit co-pay for office visits maybe on a sliding scale, and he agreed whole heatedly and said if there was even a $25 co-pay this would stop 80% of the unnecessary visits." So I agree there needs to incentives as well as decentives for all parties involved.

Health care for profit is absurd, but private insurance for seniors (under whatever new name the GOP packages it) is insane. However, rational people (even liberals like me) have to be realistic and understand that we need to really overhaull the system and do everything we can to control costs. (In addition to cutting other areas and raising revenues at the same time)

People who shout "hands off my medicare" and in the same breath, say but do not raise my taxes, or weaken our military presence, or change social security in any way", are living in a dream world. But changes can be made and belts tightened without throwing grandma off the cliff and dumping the seriously disabled out on the street.

It is a time for re-evaluating priorities, and lots of fixing. If we could just stop fighting each other, we could actually effect change.

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