AARP takes a position on proposal to cut Medicare and SS

[samclem]

I am curious. What would you propose to these problems. I hear what you think is wrong, but what do you think would be right? How do you think we should handle this medicare problem?

I like much of what I've read about Congressman Ryan's plan, but I don't know the details (e.g. how will the "premium support" payments be calculated for those with medical issues, etc). The details are important, and I don't think they are known yet.

If we're going to have a rational medical care system in this country, it's not clear that the delivery system should be radically different once one turns 65. Maybe the funding changes (since we've made these promises and built up this Medicare "fund"), but if we design a system that controls costs for those under 65 and offers good care, there seems no good reason not to use it for those over 65.

I've typed a word or two about how I think we could cover everyone with affordable medical care, I'd like to see that implemented and the Medicare funds used to help offset premiums for those of qualifying age.

I don't think we'll agree on the proper approach.

Previous Posts:
In a nutshell. Modification: Given the Constitutional issues, we might need to avoid an individual mandate. I think there are ways to avoid/significantly reduce adverse selection without a government individual mandate, though it's a little messy.

http://www.early-retirement.org/for...g-our-healthcare-system-52437.html#post984965

Swiss system as a model

 

[samclem]

Or we could simply compare our hybrid system to any of the dozen or so national systems that achieve per-capita health care spending levels of roughly half what we spend.

Yes, there are good models out there from which we could learn a lot.

 

[GregLee]

And, no, computer systems don't just magically fix that.

Why not? Or, if the complicated billing procedure does actually generate more paper or hand work by humans, then fix it by streamlining the procedure so no extra paper has to be generated, and the computer systems can talk directly to each other to settle things amongst them.

 

[GregLee]

I don't think there is any solution to the problem of cost control, because I don't think rising medical costs are due to inefficiencies or some other systemic artifact. We're older and richer, so we need more health care, and we can pay for more. Costs have risen rationally because the value of the thing has increased, and they will just keep going up -- there's no way to stop it.

 

[samclem]

Costs have risen rationally because the value of the thing has increased, . . .

What determines "the value of the thing"? In 99% of cases in our society, the value of a good or service is decided only by the buyer and the seller by mutual agreement. What's the "value" of a car, of a loaf of bread, of an apartment? With health care we have a more complex situation--the receiver of the service wants the service very much, but in most cases he/she is not the customer (the one who pays for the service). The insurer pays. In most cases the recipient of the services isn't even the entity who pays the insurer. In this light, it's easy to see that the means we determine "value" for everything else (mutual agreement between the seller and the recipient) isn't going to work with medical care as the system is now set up. It shouldn't surprise us that costs keep going up. But, there are ways to restore a balance.

 

[eytonxav]

Seems to me that escalating health care fees decoupled decades ago from the actual costs involved in providing these services, and that such year over year increases will continue to occur because the providers/insurers have more leverage than the consumers (individuals/employers) of these services who seem to simply accept it as inevitable and further the gov't has done nothing to address the cost control issue.

Additionally, I doubt the level of care here in the U.S. is significantly better than in some other countries, but the per capita expenditures are certainly much higher. How can this be acceptable and allowed to continue?

 

[Gone4Good]

I've typed a word or two about how I think we could cover everyone with affordable medical care, I'd like to see that implemented and the Medicare funds used to help offset premiums for those of qualifying age.

I don't think we'll agree on the proper approach.

Previous Posts:
In a nutshell. Modification: Given the Constitutional issues, we might need to avoid an individual mandate. I think there are ways to avoid/significantly reduce adverse selection without a government individual mandate, though it's a little messy.

http://www.early-retirement.org/for...g-our-healthcare-system-52437.html#post984965

Swiss system as a model

I'm still astounded by how similar all of this is to what we actually passed.

I guess I can understand a former Massachusetts Governor trying to pretend that two similar plans are really very different because "farfuf, gertz, shazam", but it's surprising to see ordinary people adopt the same kind of 'double-think.'

But we've had this discussion before, and what it comes down to is this: "The Affordable Care Act is bad because of who signed it into law."

 

[samclem]

I'm still astounded by how similar all of this is to what we actually passed.

Except for the issue of continued employer involvement under the new law. That's not a tiny issue, it's very big--a major cost to our economy due to reduced labor market efficiency. And a major driver of health-care costs due to the further removal of the recipient from the customer from the provider.

There's "hope," of a twisted kind, that the new law will be so expensive that employers will just dump their employees into the exchanges. There are signs companies are already sizing up the cost/benefits and will go this way (at least those companies that aren't among the favored group getting waivers from the administration). Then, if the government will just be content to take only steps needed to provide an efficient market and provide premium supports in accordance with achieving social policy objectives, we might emerge with something good. It is an ugly way to get there.

But we've had this discussion before, and what it comes down to is this: "The Affordable Care Act is bad because of who signed it into law."

Whatever.

 

[Gone4Good]

Except for the issue of continued employer involvement under the new law. That's not a tiny issue, it's very big--a major cost to our economy due to reduced labor market efficiency. And a major driver of health-care costs due to the further removal of the recipient from the customer from the provider.

So what you're saying is that the Affordable Care Act should be expanded to cover more people.

See, we really do agree.

But, at least in your case, arguing simultaneously for expanding it and repealing it does indeed demonstrate 'double think'

 

[ziggy29]

Except for the issue of continued employer involvement under the new law. That's not a tiny issue, it's very big--a major cost to our economy due to reduced labor market efficiency. And a major driver of health-care costs due to the further removal of the recipient from the customer from the provider.

IMO, while I think there are positives out of the recent health care legislation, there are also a few aspects of it I'm quite critical of. One was the lack of cost control measures; to me that *is* the health care problem which drives all other related issues. Get costs and health care inflation under control and the rest is just details; the rest becomes much easier to address.

The other is that it *strengthened* and wrote into law measures which effectively makes health insurance an employer responsibility... when I think good legislation would have worked in the opposite direction, to *sever* the link between health insurance and employment.

I think these are the two worst flaws -- there are some others (and some good things, to be sure) -- in what was passed. Who signed it is irrelevant.

 

[samclem]

So what you're saying is that the Affordable Care Act should be expanded to cover more people.

I don't understand your point. People who will get their insurance through their employers are covered under the Act. How exactly could it be expanded to cover more people? Illegal aliens?

 

[haha]

Additionally, I doubt the level of care here in the U.S. is significantly better than in some other countries, but the per capita expenditures are certainly much higher. How can this be acceptable and allowed to continue?

If you believe that better medical care should increase life expenctancy, or decrease infant mortality, the US is not only no better, but significantly worse than many other countries which spend very much less per capita.

Ha

 

[eytonxav]

If you believe that better medical care should increase life expenctancy, or decrease infant mortality, the US is not only no better, but significantly worse than many other countries which spend very much less per capita.

Ha

Exactly and the powers to be are very skillful in convincing the populous otherwise.

 

[Tadpole]

Health Beat: Medicare Breaks the Inflation Curve
Interesting article and graphic. There must be a place in the conversation for these data.

Today, S&P released data tracking the growth of health care costs which showed that over the year ending March 2011, Medicare spending rose at an annual rate of 2.78%—the lowest rate posted for the Medicare Index in its six-year history....

By contrast, over the same 12 months, health care costs covered by commercial insurers rose by 7.57%.

 

[samclem]

Health Beat: Medicare Breaks the Inflation Curve
Interesting article and graphic. There must be a place in the conversation for these data.

I'm hoping we'll find more trend information about the total cost of care under Medicare vs private plans. The data provided in the chart shows how much the insurers paid out, not the total cost of care. I don't think we can say Medicare is successfully containing medical costs if the reduction in Medicare's payout growth is due to the continued escalation of out-of-pocket cost shares for Medicare recipients and cost shifting to those with private plans.

 

[modhatter]

SamClem. The Private Insurance companies are doing this much more than Medicare. You need to read a few books on the subject. Wendell Potter's book is a good one. Actually Google Wendel Potter, a former insurance exec. for Aetna. He testified before Congress explaining how the insurance companies are currently operating.

See what he says about what the insurance policies are doing today and how they are shifting more and more costs to the policy holder, so most people today purchasing a policy are grossly under insured. It is their main objective to create policies that will shift a much greater percentage of costs to the policy holder.

 

[M Paquette]

SamClem. The Private Insurance companies are doing this much more than Medicare. You need to read a few books on the subject. Wendell Potter's book is a good one. Actually Google Wendel Potter, a former insurance exec. for Aetna. He testified before Congress explaining how the insurance companies are currently operating.

Bill Moyers Journal . Testimony of Wendell Potter | PBS

 

[Surewhitey]

I think its funny that most here say raise taxes & cut spending when the two probably do not affect most on a retirement forum.

Best for the country stuff should involve all parties & age groups, right? I'm not far from getting to the retirement stage in life, so I seek to benefit if nothing changes; I just think of my daughter & the young crowd paying more taxes on recently lowered wages...double whammy for some.

I don't think anyone can defend the spending side of things...except the politicians.

 

[Surewhitey]

We currently have an HSA plan. We DO shop around and ask enough questions of the docs to determine the need of tests based on their opinion and our own research. If more people negotiated / educated themselves, you really can improve your HC costs.

 

[youbet]

Seems to me that escalating health care fees decoupled decades ago from the actual costs involved in providing these services, and that such year over year increases will continue to occur because the providers/insurers have more leverage than the consumers (individuals/employers) of these services who seem to simply accept it as inevitable and further the gov't has done nothing to address the cost control issue.

Additionally, I doubt the level of care here in the U.S. is significantly better than in some other countries, but the per capita expenditures are certainly much higher. How can this be acceptable and allowed to continue?

I'm confused about the point you are trying to make.

First you seem to say that the issue is that health care prices are increasing faster than the costs to provide them. But then you say that the issue is that the gov't has done nothing to address the cost control issue. Which is it? Are you worried about pricing to the consumer or cost to the provider?

 

[SteveL]

If the cost of providing medical care to people increases as they age (I think this is true.), and if the US population on the average is getting older (I think this is also true.), then shouldn't we as a society expect that the % of GDP going to healthcare is going to increase regardless of who pays for it? So, even if you could freeze medicine at the existing level of technology/no new drugs etc., shouldn't we expect the cost of Medicare to increase in the future?

 

[MichaelB]

If the cost of providing medical care to people increases as they age (I think this is true.), and if the US population on the average is getting older (I think this is also true.), then shouldn't we as a society expect that the % of GDP going to healthcare is going to increase regardless of who pays for it? So, even if you could freeze medicine at the existing level of technology/no new drugs etc., shouldn't we expect the cost of Medicare to increase in the future?

European countries are aging at a faster rate, yet their health care costs to GDP ratio is growing at a slower rate.

 

[donheff]

If the cost of providing medical care to people increases as they age (I think this is true.), and if the US population on the average is getting older (I think this is also true.), then shouldn't we as a society expect that the % of GDP going to healthcare is going to increase regardless of who pays for it? So, even if you could freeze medicine at the existing level of technology/no new drugs etc., shouldn't we expect the cost of Medicare to increase in the future?

Yes,

European countries are aging at a faster rate, yet their health care costs to GDP ratio is growing at a slower rate.

and yes.

 

[eytonxav]

I'm confused about the point you are trying to make.

First you seem to say that the issue is that health care prices are increasing faster than the costs to provide them. But then you say that the issue is that the gov't has done nothing to address the cost control issue. Which is it? Are you worried about pricing to the consumer or cost to the provider?

Youbet, what my point is that the prices charged (to you and me) for these services has way outrun the actual cost of providing such services as most consumers willingly accept that they have no choice but to continue paying these escalating health insurance premiums. No question that reducing the year over year increases paid by the insureds is essential to having affordable care. All the Gov't seems to address is how can we fund it, and there has been little to no attempt to address curtailing these year over year increases whether you want to term them costs or charges. Same could be said for education. These inflationary increases are simply not sustainable.

Now I am hearing that drugs are currently in serious short supply because the drug companies no longer want to produce the generics which are less profitable, when does it end

 

[modhatter]

Flash Alert. While reading the most recent comments on this thread, the news was on in the background and got my attention. It stated that legislators are trying to pass new legislation that will prosecute CEO's of companies instead of just fining them as they have been, who defraud medicare.

They said that the majority of fraud in medicare is perpetrated by large companies and it showed some of them and the mega millions they were fined in just one year. One example, our illustrious new governor of Florida Rick Scott. (They also named other major companies)

It appears that fining them doesn't seem to stop them, cause they make much more money with the fraudulent claims then they lose paying the fines. So if fining is not effective, prosecuting the executives with actual jail time, should be much more effective. Here's an example.

In 1987 he helped found the Columbia Hospital Corporation with two business partners; this merged with Hospital Corporation of America in 1989 to form Columbia/HCA and eventually became the largest private for-profit health care company in the U.S. He was forced to resign as Chief Executive of Columbia/HCA in 1997 amid a scandal over the company's business and Medicare billing practices; the company ultimately admitted to fourteen felonies and agreed to pay the federal government over $600 million.[3][4][5][6][7] Scott later became a venture capitalist, and entered into politics in 2010, when he announced his intention to run for Governor of Florida.

Floridians are very sorry for that vote (Because of recent legislative moves, not his past record) Imagine that...