Just a quick hit here, but it’s quite odd to me that 2 things never get mentioned in the Healthcare Reform Debate. Further, I never even see these things questioned.
1. The $177 Billion in Medicare Advantage cuts over 10 years will impact the 11 million Medicare Beneficiaries in Medicare Advantage to a FAR greater extent than it will affect the profits of the insurance companies who offer the plans. You hear on almost a daily basis that MA plans are paid 114% of Traditional Medicare. The basis of this number is the March 2009 Medpac report on Medicare Payments. What’s ironic is THAT VERY SAME REPORT will tell you on Page 260 (you can read this in black and white) that while MA plans are paid $103/member/month more than traditional Medicare, $79/member/month goes to the Medicare Beneficiary (76.7% of the total) mainly in the form of reduced cost sharing. Based on this, if we plan to cut $177 Billion out of Medicare Advantage, $136 Billion will come directly out of the pockets of the 11 million Medicare Beneficiaries on Medicare Advantage. Additionally, even these numbers are wildly skewed by Private Fee for Service which has, for the most part, has been legislated away by MIPPA 2008 (and to a lesser extent the massive overfunding of Puerto Rician MA plans which get 180% of Traditional Medicare, but that’s a whole other story and that’s NOT a typo!).
One could honestly argue that it’s not “fair” that MA members get these additional benefits, but let’s at least be HONEST about who’s going to be paying the vast majority of the $177 Billion in MA cuts to “fund” care for the uninsured–It’s the 11 million (mostly Seniors) on MA plans! I cringe every time I hear “It’s going to the insurance companies and it’s not making anyone healthier.” A more accurate statement is, “It’s going to Medicare Beneficiaries and it’s making them wealthier.”
2. I hear over and over again that we have the “incentives” for Medical Providers misaligned because we pay for “volume of care” and not “quality of care”. The implication is that Doctors order tests and procedures to build their revenues. I have yet to hear mentioned that perhaps the Doctors might be doing this to, not to enrich themselves, but because they are practicing “Defensive Medicine” and fear being sued. It seems to me that EVERYONE is being asked to accept less: Medicare Beneficiaries, Hospitals, Insurance Companies, Physicians, Drug Companies, Medical Equipment Providers, etc., etc., but I’ve yet to hear ANY TALK of trial lawyers having to “accept less”. I’m not saying that tort reform would, in and of itself, solve the Healthcare “Crisis”, however, I’m shocked that it is NEVER EVEN MENTIONED as something we might want to, at least, take a look at.
[...] I’ve blogged about this many times including the fact that the majority of the 14% payment goes back to the Medicare Beneficiary and not to the Insurance Companies (the number is 76.7% of excess payment goes to the 11+ million Seniors in the plans, see my blog post…). [...]
[...] cuts which are being proposed to be used to fund Health Insurance for the uninsured is coming on the backs of Seniors (”poor” Seniors, according to the Inquirer) like those in the IBC plans (see linked [...]
Another big topic that is not often discussed is who the uninsured are and why are they uninsured.
For example, if you go uninsured for a month because you are between jobs, you are counted as uninsured. Most people play the COBRA “game” by not taking COBRA for that month and then signing up if something happens.
Also, how many of those are uninsured by choice and not circumstance? One recent study says that 43% of the uninsured could afford insurance but choose not to take it.
Yes, there are truly people who need insurance and cannot afford it That number is surely smaller than the 40+ million that are technically “uninsured”. Let’s focus on them.
Lastly, the general population seems to think that pre-existing conditions are instituted by the health plans to make them more money. In actuality, they are used to prevent people from going without insurance and then purchasing it when they need it.
The reason tort reform is not in the discussion is that the lawyers have the democratic party in their back pocket!!!
I also am tired of Obama’s continued use of the $177 billion that will be saved from the cuts to med. advantage plans…he also mentions how seniors need more covered preventative services , if he knew anything about MA’s he would realize they cover most preventative services at $0 copay!!!!!!!
Joe,
Excellent point. Obama is clueless on Health care.
Want to know what else isn’t being talked about in the Health Care Reform debate? Prevention and alternative medicine.
The kind of care provided by allopathic physicians (M.D.’s) should be called “Medical Care.” That would distinguish it from Health Care. Medical Care should be looked upon as a subset of Health Care, not as the be all and end all of Health Care. Health Care should include nutrition, pure water, exercise, sunshine, fresh air, whole food supplements, chiropractic care, and perhaps many others. Whereas Medical Care could be looked upon as what you do when the rest of Health Care fails.
But, instead, what we have is total dominance by the Medical Care industry, i.e., prerscription drugs and surgery, to the exclusion of all else. And it’s invasive, it’s often ineffective, and it’s terribly expensive.
Let us begin to think of “Health Care” as being something that we do for ourselves, rather than having things done to us.
Amen!