Government run health care

[Edwina's Secretary]

Silly girl, ES! Didn't you read my previous post about what my primary care doc charges me, a Medicare patient, and what he charges a cash paying patient?

I am not exactly what was silly. I was defining the terms. What you describe is the co-pay. What you pay each month for the coverage is the co-insurance.

For example - yesterday I attended a meeting of a volunteer group to which I belong. The woman next to me - retired after 32 years of teaching - is not yet eligible for medicare - nor is her husband who also retired from teaching. They are in good health - she had just completed a 110 mile bicycle trip.

Medical insurance is available to her as a retiree. The co-insurance (what she must pay each month to continue the insurance ) is $2,200 each month.

Not surprisingly - she cannot afford $26,400 a year just to have insurance. I did not ask her what her co-pays would be or her deductible. I would assume fairly good coverage for that price.

So she and her husband - I would guess age 60 or so...have no medical insurance. And it is all she can think about and worries constantly.

But back to your statement. Every medical bill I have ever received shows the "rack rate" the lower rate my insurer has negoitated and my deductible and co-pay. I am not on medicare so I do not know how it operates but I do know how many private insurers operate.

By "cash in hand" do you mean the uninsured or those on private insurance?

One other myth is that those who do not have insurance and pay off their medical bills over time are "paying their own way." What malarkey! The hospital must pay their employees and vendors when due. They cannot tell their employees (nor can the vendors tell their employees) "I will pay you when Johnny pays his bills." So who covers the cost of the money the hospital must have ....yup...those who are insured.

You would think they would at least thank us!

[lizbud]

NO. NEVER.

I never got a check and I did not ask where it was.

Both those statements could be true and you still would have "accepted"
the money. Mine was auto deposited into my checking account. I didn't
"see the check" either.

[pomtzu]

ES - I know the difference between a deductible and a co-pay. Unfortunately, I have had to deal with medical insurance claims and issues, way too much in my lifetime! And when I say "cash-in-hand", I'm referring to the uninsured, whether it be by choice or circumstance.

My beef comes with the government - and what they "allow" providers to charge. That $71 dollars that is given to my doctor because he's "allowed" to charge me what he does, could well be giving folks like you mentioned, some kind of medical assistance. Instead it's paying for that big fancy suite of offices doc just built, with a beautiful, huge salt water aquarium on one whole wall, fancy furniture in reception and a monstrous flat panel t.v. screen on another wall that would rival the downtown cinema! Does that make him a better doctor than old doc who rents a small house in a residential part of town, and has been there for 30 or 40 years, with the worn furniture and cluttered atmosphere, and magazines on the table that seem like they have been there as long as he's been in practice??? I don't think so, and judging from the amount of cars always parked by his office, not many of his patients think so either.

So as long as Uncle Sam keeps lining the pockets of these providers, the system will never be fair or equitable, and there will be people like me who complain about it, but have to take what gets dished out, and other who are deserving of assistance, but just don't "qualify".

[Edwina's Secretary]

I agree with you Pomtzu...I stopped going to a dentist because I resented paying for the granite countertops, flat screen tv and all the other fancy stuff. And I felt I was being "marketed to" every time I went there.

[Puckstop31]

Both those statements could be true and you still would have "accepted"
the money. Mine was auto deposited into my checking account. I didn't
"see the check" either.

Never had it Direct Deposited either Liz.

We pay attention to these things. I work closely with my accountant come tax time to be sure we pay what is owed and use only normal deductions.

We don't need or want other peoples money. We make enough of our own.

I don't blame you if you do not believe me. People often don't believe that I turn down "free money".

[cassiesmom]

I agree with you Pomtzu...I stopped going to a dentist because I resented paying for the granite countertops, flat screen tv and all the other fancy stuff. And I felt I was being "marketed to" every time I went there.

I went to one of those! I found his name on a sedation dentistry Web site. I didn't get the work I needed - instead, I got a major marketing pitch for a fortune's worth of cosmetic work, and a sales pitch for nutraceuticals to give me a healthier mouth. It's going to take a heck of a lot more than nutraceuticals to make my mouth healthy again, because I avoided the dentist for a lot of years. Boo on the flat-screen with direct TV.

Yesterday I attended a meeting of a volunteer group to which I belong. The woman next to me - retired after 32 years of teaching - is not yet eligible for medicare - nor is her husband who also retired from teaching. They are in good health - she had just completed a 110 mile bicycle trip. Medical insurance is available to her as a retiree. The co-insurance (what she must pay each month to continue the insurance) is $2,200 each month.

This makes me steaming mad. That is not right. There has to be a better way for people to get the health insurance they need.

[momoffuzzyfaces]

To make things even more fun, we on Social Security won't be getting even a tiny cost of living raise for the next two years, but we have the honor of paying higher Medicare premiums.

What really makes me mad is Congress will get their big fat yearly raise, they can spend billions for the banks, auto industry, and big businesses AND probably mess all our lives up with the new health care they will force us to have. But give us a teeeny raise? no way!


And if that wasn't bad enough, they want to tax junk food, one of our only remaining affordable comforts. Who will determine what is a junk food? Will we have a junk food tzar? If they tax cookies will they also tax the flour, sugar, and other ingredients so we can't even make them ourselves? Inquiring mind needs to know. I need a cookie!

[pomtzu]

To make things even more fun, we on Social Security won't be getting even a tiny cost of living raise for the next two years, but we have the honor of paying higher Medicare premiums.

I heard that there will be no increase in Medicare premiums in 2010 since there will be no cost of living raise for SS. Where did you hear that there will be an increase? Geeze - I certainly hope not!

[momoffuzzyfaces]

I heard that there will be no increase in Medicare premiums in 2010 since there will be no cost of living raise for SS. Where did you hear that there will be an increase? Geeze - I certainly hope not!

It's been on several of the news channels last night and this morning. Local channels as well as Fox and CNN.

It was also on Yahoo yesterday. The ones of us who pay Medicare premiums will actually have a smaller check because of the increase in premiums.

[Grace]

The rise in Medicare premiums will NOT affect everyone. In an article from the Dallas Morning News, there is this -

Three in four Medicare beneficiaries are protected by a "hold-harmless" provision in the law that ensures that their Medicare premiums won't go up any more than their Social Security benefits, said Kaiser policy analyst Juliette Cubanski.

So next year, if they get the same amount from Social Security, they'll pay Medicare the same $96.40 per month they do today.

That won't be true, however, for the remaining 25 percent of Medicare beneficiaries, Cubanski said. They include:

•Higher-income beneficiaries whose modified adjusted gross income exceeds $85,000 for individuals and $170,000 for couples in 2009.

•New enrollees who didn't collect Social Security benefits or weren't covered under Part B a year earlier.

•Low-income individuals whose Medicare Part B premiums are paid by Medicaid.

Source

[pomtzu]

The rise in Medicare premiums will NOT affect everyone. In an article from the Dallas Morning News, there is this -




Source

I'm safe!! Thanks Gretchen.

[Edwina's Secretary]

If it makes you feel any better (it won’t) it is not just retirees getting the squeeze.

I am beginning the insurance renewal for one of my clients. Right now we are looking at a 12% increase in medical premiums.

Employees share the cost of the premiums.

The current economy has been rough on manufacturing companies and with 0% rise in CPI – 0% will probably be what the raises are this year (as in 60% of companies.)

With the help of our broker we may get the increase down to 9% (I hope.) That will include carve outs – insurance speak for reducing benefits.

So people making $9 - $12/hour will pay more for less coverage.

And the company will either have to lay off more people or if possible, pass the increase along to the customer who pass it along until eventually the consumer – you and me – will pay for it.

We pay for each other's medical care one way or the other. Medicare, private insurance, veterans or the uninsured. There are just a whole lot more hands taking something off the top with our current system.

[lizbud]

The rise in Medicare premiums will NOT affect everyone. In an article from the Dallas Morning News, there is this -

Source

So, am I right in thinking only those with Medicare part D will be affected?
Only those who signed up for the Medicare Drug coverage?

[Grace]

So, am I right in thinking only those with Medicare part D will be affected?
Only those who signed up for the Medicare Drug coverage?

That's the way it sounds to me. But it doesn't definitively say that all will be affected. Guess we need to do more investigating.

One final note for the majority of beneficiaries who may think they've dodged the bullet: The hold-harmless provision doesn't apply to Medicare's prescription drug coverage. So some seniors may still get a smaller Social Security payment next year if their drug premiums increase.

[sasvermont]

What Drop In Benefits?
The Phony Flap Over Social Security COLAs


By Chuck Blahous
Tuesday, August 25, 2009

"Millions of people face shrinking Social Security checks next year," The Post reported Monday, "as officials project that benefits will stay flat for the first time in a generation." The New York Times reported earlier this year that the lack of a Social Security cost-of-living adjustment (COLA) in 2010 "will be a shock to older Americans" and quoted an AARP official lamenting that "Most seniors have never been through a year in which there was no Social Security COLA."

But this controversy is more smoke than fire.

Like other Americans, seniors are suffering through the economic downturn. Unlike other Americans, however, most seniors are benefiting from multiple technical quirks of law that protect their income stream.

First, there is the current Social Security COLA. Automatic COLA increases were established in 1975 in an effort to protect seniors' purchasing power. In January, Social Security began paying its largest COLA since 1982, 5.8 percent. But this adjustment has since surpassed national measures of the cost of living.

The 5.8 percent boost was based on the high price increases of last year, especially in food and fuel. Since then, prices have subsided. According to the Congressional Budget Office, the Consumer Price Index subsequently declined by 4 percent. By law, COLAs can never be negative. So benefit payments are exceeding inflation, and seniors will simply pocket this 4 percent increase in real purchasing power for the indefinite future, until prices once again exceed their 2008 levels and further COLAs resume.

Meanwhile, most seniors stand to benefit from a provision in the Medicare Part B premium formula. Under normal circumstances, the Part B premium is indexed so that one-fourth of program cost increases are passed on to beneficiaries, three-fourths to taxpayers. Part B also has an "income-relating" feature, which requires higher-income seniors to pay more for their benefits.



A "hold harmless" provision, however, ensures that for most beneficiaries (those not subject to income-relating), the dollar amount of their Social Security check (minus the Part B premiums) will not diminish from one year to the next. In a year without a COLA, therefore, the majority of seniors will receive Medicare Part B coverage of increased value, with the larger bill passed on entirely to others.

Third, the February stimulus legislation provided $250 checks to most Social Security recipients. Though some working seniors will need to return these checks because of their interaction with the "Making Work Pay" tax credit, non-working seniors will keep them.

Taken together, these features of law mean that taxpayers are providing substantial additional income protections for most seniors, well beyond inflation.

If our policies for seniors existed in an ideal world, benefits would be adjusted upward when prices go up and downward when prices go down. The intended burden-sharing of Medicare Part B premiums would not shift with price swings in the general economy. Alternatively, the nation's most powerful organization for the elderly would responsibly explain to its members that the deviations from these ideals are largely working in their favor.

But this isn't an ideal world. Accordingly, Congress is being pressured to "do something" about the COLA issue, which would translate into further costs facing taxpayers and increased payments to the seniors benefiting from these technical quirks.

There is nevertheless a potential problem in all of this. Medicare law provides for the premium relief provided to those "held harmless" to be made up by those not so protected. This could result in large unintended premium increases for a minority of seniors, and in more costs shifted to taxpayers through Medicaid.

The Obama administration entered office talking about tough choices and fiscal responsibility. These issues shouldn't be particularly tough. Helping Congress defuse this unnecessary political problem would be a modest threshold test of such responsibility.

The administration should either publicly push back on the misrepresentation of the situation or propose an alternative revenue-neutral distribution of beneficiary premium burdens. Providing this cover -- instead of shifting further costs to taxpayers -- would send a positive signal to lawmakers looking for administration seriousness on bigger fiscal issues, such as the unsustainable growth of entitlement spending generally.

Seniors, like all Americans, are feeling the pain of our economic difficulties. If, after due deliberation, Congress and the administration decide that taxpayers should shoulder still more burdens and seniors less, then so be it. But let's not dress that decision up in the guise of correcting a nonexistent inequity.

Chuck Blahous, a senior fellow at the Hudson Institute, served as deputy director of the National Economic Council from 2007-09 and executive director of the President's Social Security Commission in 2001. His book "Social Security: The Unfinished Work" is due to be published next year.