View Full Version : The Hard Decade Ahead for Hospitals
dado potato
3-15-19, 5:51pm
Trigger Alert: This post could be depressing.
Morgan Stanley recently commented that 18% of American hospitals are at risk of closure.
Moody's recently predicted that 8% (about 480) of the 6,000 hospitals they reviewed are "apt to close". I understand that Moody's would only be reviewing those hospitals that pay Moody's the fee to form an opinion of their credit-worthiness.
Any time I care to read about a hospital in dire straits, I will read Becker's Hospital Review on-line. It is usually a rural hospital with declining admissions, or a hospital that cannot cope with reductions in Medicare reimbursement.
The coming 10 years will be hard on hospitals, because
A. There currently are about 53,500,000 Americans over 65. Except for those who are incarcerated, virtually all are enrolled in some form of Medicare for their hospitalization insurance.
B. According to the Census Bureau, over the coming 10 years, approximately 10,000 Americans will turn 65 every day, and I believe they will be eager to enroll in Medicare.
C. Some Medicare beneficiaries certainly will die every day too. But the actuaries seem to all agree that the number of beneficiaries will go up continually, to approximately 83,000,000 by 2050.
D. (This is the most depressing part.) Notwithstanding the promises he stated during the election campaign, President Trump's budget proposal for fiscal year 2020 is to CUT Medicare spending by $800 billion over the coming 10 years. Although some mystery surrounds the details, it seems obvious that the President is urging that Medicare reimbursements to hospitals be cut.
As hospitals consolidate (the more solvent hospitals acquiring their weaker sisters) or escape their creditors by filing Chapter 11 bankruptcy, it seems inevitable there will be job loss, and facility closures... More Americans may have no alternative other than to travel further for hospital care. It could be good for hotels located adjacent to the campuses of the hospitals that survive, because families of patients (or their drivers) may need overnight accommodation until the patient is discharged.
Also poised to benefit are CVS and WalMart. I believe CVS plans to scale up their walk-in/urgent care capacity. And WalMart's new "Town Center" concept includes healthcare services in WalMart parking lots.
Virtual doctor's visits should also increase.
Teacher Terry
3-15-19, 6:12pm
Hopefully Trump will be stopped from making any cuts to Medicare, SS, etc.
iris lilies
3-15-19, 6:16pm
Our little publicly funded hospital in Hermann is always front page news for their finances. The finances are not healthy. There is constant turnover of staff at all levels. Too bad, because it is a senior citizen Mecca and that hospital is a matter of blocks from my house.
I think the growth of IDNs (Integrated Delivery Networks) will help redefine the traditional hospital. There are so many changing dynamics in healthcare that it will be an adjustment period for sure. IDNs have more outpatient services; some healthcare systems are merging with specialty pharmacies--some of these types of new profit centers may help to support traditional inpatient care.
But. you're right: cutting Medicare is not the answer.
Working on the inside and in leadership for 27y now and having been Director for a privately owned facility for 8y amidst my hospital career parts: YES! All you state is true and so much more.
I'm VERY concerned for healthcare in our country. No facility can survive on Medicare reimbursement. Our costs are astronomical hence YOUR costs are ridiculous.
Becker is a good barometer of our reality so good for you for going there Dado.
Rural Nevada:
https://www.reviewjournal.com/local/local-nevada/tonopah-hospital-closes-leaving-medical-care-100-miles-away/
And then there is senseless shit like this: https://www.nytimes.com/2019/03/09/well/oregon-child-tetanus-vaccine.html
Unlikely insured. This causes outrage amongst us as we are trying hard to save $1 here and $5 there.
Family demanding we rush 99yo Grandma to the OR to save her. She dies minutes after we get her to the ICU. Another $30k spent! Why?
My sister and I cared for Mom at home the final 7w of life. Final bill? $2876 fully paid by Medicare. The cost of 24h in the hospital back in 2009. but no, people don't want to take care of Mom or Dad at home. So the hospital it is.
I could go on and on and on......but I won't!
IDN's are not nearly as helpful as you might think they are Catherine.
Yes, the next 10y in healthcare are going to suck the life and the money out of all of us:(
I agree that cutting Medicare overall is not the answer; however, I do agree with a lifetime cap on benefits for those 65+. I know that makes me sound mean and uncaring, but the numbers aren't sustainable. I think people have to be educated on natural death and supported in that by doctors willing and able to provide pain management during end of life. I don't think that relatives or guardians can simply demand "do everything" and then leave the bill to the taxpayers.
I'm thinking of extraordinary and expensive procedures like bone marrow transplants for 80 year olds. If you want one at that age and can afford it, then have it. Perhaps a review of how they do these things in Great Britain would be a start.
Gardnr, we cross-posted but are thinking along the same lines.
catherine
3-15-19, 11:49pm
IDN's are not nearly as helpful as you might think they are Catherine.
Do you think they have to potential to evolve into a profitable business model? It boggles my mind that we have the highest per capita medical costs in the world, but we don't have the healthiest people, and we don't have financially healthy medical institutions either?? What gives? I think it's more than more people on Medicare.
The profit model for hospitals is not going to be able to work for small cities and rural areas over much of our country. Hospitals are not distributed by actual need but by the ability to make a profit. Medicare is not enough.
In our big city, we seem to be in a construction boom for hospitals. They have small urgent care stand alone clinics and now small stand alone mini hospitals. We have everything within a walk from me from the newly rebuilt VA hospital, a huge cancer hospital, Riley hospital for Kids, Eskinazl semi public hospital, and Methodist Hospital which is replacing buildings. They are all huge. This does not count Community South, East, and North, St. Francis with new buildings, Johnson County Hospital, various heart specialty Hospitals, Women's Hospital, etc.
I dont know what the answer is. Single payer has its own unique issues and would have unintended consequences.
In this country, people make demands and have immediate gratification expectations. It is no different in healthcare. Examples:
My brother severely injured/fractured his foot in a farming accident about 15y ago. His doc was able to fix all the bones and skin graft his foot. 4 trips to the OR. 5d in the hospital. Brother was furious the final bill was $40k. I said "well, you have your foot and all that surgery and care and anesthesia and medications cost money. They could have cut it off and sent you home for about $7k." You don't get Mercedes healthcare for a Volkswagen price.
I had a knee replacement in June and was home 14h after I left. People think they should be at the hospital for several nights. For what? You can take pain pills at home. AND the bonus is you get to sleep! Why not go home? Savings? About $5k.
My Mom's end of life care noted above was under $3k for 7wks. Hubby's Grandma was 5d in the hospital for over $50k (their age difference was 2y). Cat scan after cat scan to monitor changing conditions from a stroke until she died.
Do I believe in restricting care as we approach end of life? Yes I do. And I mean at ANY age. TONS of money is spent attempting to save preemies, trauma victims as well as that 99yo Grandma I spoke of earlier.
80% of healthcare dollars are spent in the final 30d of life-regardless of age.
Medical Ethics committees are faced with this every day in hospitals. But then we have the USA overpopulation of ambulance-chasing Lawyers who are constantly advertising to "victiims". TORT reform is badly needed in this country. You have no idea how big legal teams have become in hospitals in this country. It doesn't matter if there was no wrongdoing...we spend a ton of $ defending ourselves.
It's all going to get much worse before it gets better. People want what they want. They want it now. They want it perfect. They don't care if it's safe or not.
Another example: high blood glucose seriously inhibits tissue healing. A patient with a 385 glucose gets cancelled. He is outraged. He demands to have this elective surgery because it is inconvenient to wait. He yells at everyone. Stupid nurses. Stupid doctors. And NO, we did not do his procedure. Now you know he has told 10 of his friends what a crappy place we are and how stupid we are.
Can't win for losing. I could go on and on about what I've seen in my 38y career....but I'll stop for now.
dado potato
7-22-19, 10:13am
This morning I read about two more hospital bankruptcies.
In Philadelphia, Hahnemann Hospital, 496 beds, founded 1842, a teaching hospital affiliated with Drexel University, will close in September 2019. Approximately 570 medical students must be wondering where they will go to complete their education. The emergency room treats 150 patients per day. Hahnemann has been losing money every year since 2004. As an urban hospital, the challenge is to attract enough patients with high-paying private insurance. Medicaid typically pays about 70% of the cost of treatment.
The Springfield Hospital (non-profit, community based, in Vermont), intends to remain open, under contract management supplied by consulting firm Quorum Health Resources. Under the former CEO and CFO the hospital became unable to pay its bills, and the State of VT Agency of Human Services made an loan of $800,000 (an "advance against future Medicaid payments"). The hospital's insolvency has been attributed to high levels of charity care and bad debt expense, inadequate reimbursement by Medicare and Medicaid, and increasingly fewer patients covered by private insurance. In 2018 the hospital had an operating loss of $7 million. Under the new management the birthing center was closed, staffing was reviewed (resulting in 27 layoffs, 6% of the hospital employees). Wages and salaries were cut 4% for hourly employees and 10% for salaried employees. Now operating as a tight ship, the hospital limits admissions some days. During the expected 12-months period in Chapter 11 bankruptcy, consolidation with a stronger sister, such as Dartmouth-Hitchcock Medical Center, will be discussed.
This morning I read about two more hospital bankruptcies.
I wish I could say I'm surprised Dado.....but I'm not. In my experience Medicaid/Medicare pay about 34%, nowhere near the 70% you site. Did that data come from the facility? I've never seen 70% reimbursement from them.
In my experience, it takes a full payment for every MC/MC payment to break even. So add in a 5-12% no pay population on top of that and then figure out how many additional full payment patients you need to see in order to remain solvent.
Since 1998 my wage was frozen 13 years over time. I should be about $40k higher than I am for my peer group. That's healthcare in the not-for-profit sector. The joy of being an above-average employee in a shrinking-reimbursement world.
No more after Friday's shift:cool:
catherine
7-22-19, 11:30am
This morning I read about two more hospital bankruptcies.
In Philadelphia, Hahnemann Hospital, 496 beds, founded 1842, a teaching hospital affiliated with Drexel University, will close in September 2019. Approximately 570 medical students must be wondering where they will go to complete their education. The emergency room treats 150 patients per day. Hahnemann has been losing money every year since 2004. As an urban hospital, the challenge is to attract enough patients with high-paying private insurance. Medicaid typically pays about 70% of the cost of treatment.
Wow. Thanks for this information. Over the past year, DH has been under the care of a Hahnemann specialist, and we just recently got a letter that they are closing their practice, but I had no idea this was the reason.
What will it be like when Bernie and his Democratic Socialist followers demand Medicare for all be the only option for everyone?
catherine
7-22-19, 11:47am
What will it be like when Bernie and his Democratic Socialist followers demand Medicare for all be the only option for everyone?
I knew someone was going to say that. Once we tax appropriately, get the middlemen out of the picture (the managed care executives and pharmacy benefit managers), reduce corporate profiteering and demand transparency in cost, it should all work out just fine.
Here's a summary of the excellent cover piece Time ran on why hospital costs are so high: https://patriciadubrava.com/?p=187
“Put simply, the bills tell us that this is not about interfering in a free market. It’s about facing the reality that our largest consumer product by far—one-fifth of our economy—does not operate in a free market.”
I knew someone was going to say that. Once we tax appropriately, get the middlemen out of the picture (the managed care executives and pharmacy benefit managers), reduce corporate profiteering and demand transparency in cost, it should all work out just fine.
We would still have middlepersons. They would just be on the government payroll. Unless we decide to nationalize health care entirely and not just health insurance.
catherine
7-22-19, 11:56am
We would still have middlepersons. They would just be on the government payroll. Unless we decide to nationalize health care entirely and not just health insurance.
Read the article. Medicare is actually a very efficient middleman between the government and the consumer.
ETA: As you know, my job is to interview healthcare providers and healthcare payers. I have been told by payers how fearful they are of proposed legislative cuts (by the current Republican administration I might add) to restrict cost incentives like rebates offered by manufacturers to favor access to them. They are freaked out about it because if you take away their cost incentives, it unravels their revenue stream.
Happily for them, those proposals were withdrawn just last week (https://medcitynews.com/2019/07/trump-administration-ends-key-drug-pricing-proposal/). So pharmacy benefit managers can rest easy that their profits are safe.
I wonder how every other civilized country in the world does it. But oh yeah--American exceptionalism. >:(
I wonder how every other civilized country in the world does it.
Typically by highly regressive VAT, Social Security and Payroll Taxes on top of higher income tax rates, along with stiff co-payments and deductibles at every income level.
Highly regressive VAT, Social Security and Payroll Taxes on top of higher income tax rates, along with stiff co-payments and deductibles.
My Scottish relative was unfortunately involved in an accident that made him a paraplegic. The UK gave him an income and even a disability-friendly HOUSE.
I just did research in Japan on gene therapy. I had a whole section on affordability and access and the local market research director told me those questions aren't relevant because Japan provides 100% healthcare.
I don't see the UK and Japanese economies crumbling.
Would I up my taxes for peace of mind against unfortunate and unforeseen circumstances? You bet.
I don't see the UK and Japanese economies crumbling.
I don't think anyone suggested economies would crumble, only that those promises of free healthcare actually carry hefty individual costs.
Would I up my taxes for peace of mind against unfortunate and unforeseen circumstances? You bet. Good, because that's exactly what it takes to achieve the goal, not just for you but for everyone, especially that 45 to 50% of citizens who currently pay little or none.
I don't think anyone suggested economies would crumble, only that those promises of free healthcare actually carry hefty individual costs.
And what's the individual cost of not being able to afford healthcare? Or the cost of being a slave to the "golden handcuffs" of employer-based insurance programs. That doesn't sound free to me; nor does it sound like a Republican value. If Republicans truly wanted to encourage entrepreneurship, high insurance premiums is certainly not the way to do it.
And what's the individual cost of not being able to afford healthcare? Or the cost of being a slave to the "golden handcuffs" of employer-based insurance programs. That doesn't sound free to me; nor does it sound like a Republican value. If Republicans truly wanted to encourage entrepreneurship, high insurance premiums is certainly not the way to do it.I think Republican values are neutral regarding healthcare. They're more about limiting government control so I guess in that sense high insurance premiums would be preferable to high taxation as the cost to the consumer would almost certainly remain the same for most.
dado potato
7-22-19, 2:32pm
@ Gardnr
I appreciate your skeptical comment about "70%" reimbursement by Medicaid. I don't have the article in front of me any more, but that is what it stated. I wonder if 70% was specific to Pennsylvania, or was a pure inaccuracy carried in the story?
Clearly, the level of reimbursement was a major factor in both hospitals reaching a point of insolvency. I have no doubt that both hospitals were administered by well-educated, ethical managers. (There was a forensic audit of the Springfield hospital, and it found no malfeasance on the part of the former CEO and CFO.)
Typically by highly regressive VAT, Social Security and Payroll Taxes on top of higher income tax rates, along with stiff co-payments and deductibles at every income level.
I have lived in Canada and have many relatives there. The deductibles and copayments are miniscule, not stiff.
I suppose the boomers will put a strain on the mortuary businesses.
Public radio features outrageous medical bills once a month. Today they had a feature today about a couple in Montana. She worked at a hospital they were insured through the employer's private insurance. Husband in his early 50's was diagnosed with kidney failure requiring either dialysis or transplant if possible. He began dialysis, but there were apparently no treatment centers near-by in the insurance network. They were charged over $10,000 per treatment. Had he been on medicare, they would only allow a couple hundred dollars for each treatment. Although they negotiated down parts of their total bill, it still came to over $200,000. They anticipated declaring bankruptcy. A difference in private insurance vs. government provided medicare? I think that's a fair summary although there were other relevant details.
https://www.npr.org/sections/health-shots/2019/07/22/743180947/first-came-kidney-failure-then-there-was-the-540-842-bill-for-dialysis
I suppose the boomers will put a strain on the mortuary businesses.
Public radio features outrageous medical bills once a month. Today they had a feature today about a couple in Montana. She worked at a hospital they were insured through the employer's private insurance. Husband in his early 50's was diagnosed with kidney failure requiring either dialysis or transplant if possible. He began dialysis, but there were apparently no treatment centers near-by in the insurance network. They were charged over $10,000 per treatment. Had he been on medicare, they would only allow a couple hundred dollars for each treatment. Although they negotiated down parts of their total bill, it still came to over $200,000. They anticipated declaring bankruptcy. A difference in private insurance vs. government provided medicare? I think that's a fair summary although there were other relevant details.
https://www.npr.org/sections/health-shots/2019/07/22/743180947/first-came-kidney-failure-then-there-was-the-540-842-bill-for-dialysis
That's not likely to sway the conservatives, because they feel, like Scrooge, that if they are to die,"they had better do it, and decrease the surplus population" (The unborn is the exception, whether or not the mother has the means for health insurance, which, of course, is not the conservative's problem). Social Darwinism is the name of the game. If you wind up between employers, or if you have the wrong insurance, you deserve to die or become impoverished. The conservatives don't realize that "There but for the grace of God go I." So, the difference between living and dying is picking the right employer and the right insurance plan. Seems like a really existential rationale.
Ultralight
7-22-19, 6:59pm
Public radio features outrageous medical bills once a month. Today they had a feature today about a couple in Montana. She worked at a hospital they were insured through the employer's private insurance. Husband in his early 50's was diagnosed with kidney failure requiring either dialysis or transplant if possible. He began dialysis, but there were apparently no treatment centers near-by in the insurance network. They were charged over $10,000 per treatment. Had he been on medicare, they would only allow a couple hundred dollars for each treatment. Although they negotiated down parts of their total bill, it still came to over $200,000. They anticipated declaring bankruptcy. A difference in private insurance vs. government provided medicare? I think that's a fair summary although there were other relevant details.
https://www.npr.org/sections/health-shots/2019/07/22/743180947/first-came-kidney-failure-then-there-was-the-540-842-bill-for-dialysis
A small price to pay for freedom, right Alan and LDAHL?!
Ultralight
7-22-19, 7:00pm
I have lived in Canada and have many relatives there. The deductibles and copayments are miniscule, not stiff.
They won't believe you.
Ultralight
7-22-19, 7:05pm
Canadians have been taxed into poverty to pay for their healthcare! All their millionaires fled the country! They have no freedom and no jobs, only socialist breadlines! And their lifespans are considerably shorter than Americans!
TRUMP 2020! Yee-haw!
A small price to pay for freedom, right Alan and LDAHL?!
Did you read the article? My take on it was that the service provider cannot operate on Medicare level reimbursements (much like the hospitals mentioned in Dado Potato's several posts), resulting in the service provider overcharging private insurance companies.
What we should be asking ourselves is once we eliminate private insurance and force Medicare on everyone, who will provide service? That may be the true price we impose on freedom lovers.
Couple it with free higher education and student loan forgiveness and doctors and other medical professionals can work for less. After all, isn't it better to have those saving people's lives have their loans forgiven versus public sector fundraising telemarketers?
Ultralight
7-22-19, 7:48pm
Couple it with free higher education and student loan forgiveness and doctors and other medical professionals can work for less. After all, isn't it better to have those saving people's lives have their loans forgiven versus public sector telemarketers?
LOL! Here we go.
Couple it with free higher education and student loan forgiveness and doctors and other medical professionals can work for less.Of course every American will pay more for the privilege of professionals working for less. That seems more regressive than progressive, don't you think?
LOL! Here we go.You added your own text to Yppej's post without taking credit for it. You should fix that!
France is an interesting healthcare model. I watched a documentary on them several years ago. What struck me most There is an MD on every ambulance. Admission to hospitals was reduced by 90% the first year. Read this for the pros/cons:
https://vittana.org/17-france-healthcare-system-pros-and-cons
Comparison of USA vs France:
http://www.brightonyourhealth.com/difference-france-and-america-health-insurance/
Of course every American will pay more for the privilege of professionals working for less. That seems more regressive than progressive, don't you think?
You spread the costs over everyone instead of blaming sick people for their illnesses and making them in some cases go bankrupt as punishment. If instead of health care being a common good and a right we want to make it a reward for innocence or virtuous behavior we could make a revenue neutral system where we cover everything for babies since they are innocent but don't cover things like lung cancer treatment for smokers.
80% of money is spent on the final 30 days of life was the statistic reported early this century. Age doesn't matter.
The best data is truly available for Medicare as it is the single best snapshot of an age demographic since virtually all 65yo and up are participating in it.
https://www.kff.org/report-section/medicare-spending-at-the-end-of-life-findings/
Comparative end-of-life spending, article July 17: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0174
I continue to believe 1 of our many problems in US healthcare is the demand for every damn test and right now! MRIs are overused and under-accurate. Not every complaint requires an MRI. Colds do not go away because of antibiotics...they go away with "tincture of time", my favorite prescription.
My surgeon insisted on an MRI and it showed very little pathology. After 6 more miserable months, I asked for a knee arthroscopy to look. HUGE hole in my femoral condyle. I waited another 15months before having my replacement. So: xrays, steroid pack, steroid injection, MRI, knee arthroscopy, more x-rays, then finally the replacement. What is the right answer? This is the recommended course of treatment for my complaint.
The use and abuse of healthcare is most definitely my soapbox having been on the inside for 38+ years.
You spread the costs over everyone instead of blaming sick people for their illnesses and making them in some cases go bankrupt as punishment. If instead of health care being a common good and a right we want to make it a reward for innocence or virtuous behavior we could make a revenue neutral system where we cover everything for babies since they are innocent but don't cover things like lung cancer treatment for smokers.I would agree that health care should be considered a common good, but not that it is a right. Health care is a service that is provided at a cost, one which we hope everyone can afford, and we could use a robust safety net in place to help those who cannot.
The problem, as I see it, comes when we use the power of government to place limits on individuals in order to enhance others ability to pay for services or limit the earning potential of highly skilled professionals in the business of providing a service. And we really need to stop referring to "free" things, such as education or healthcare when the reality is that every single one of us will be expected to pay for the benefits enjoyed by others.
Tuition inflation is a contributing factor to medical inflation. So is greed, such as pharmaceutical companies jacking up prescription drug prices by thousands of percentages because our current system is not competitive, but dominated by special interests, a few large insurance companies, and with the end user often having no idea what care really costs. It's a broken system that keeps getting worse and given the outsize role of special interest money in our political system it is not going to get better. We have to scrap it, start over, and Keep It Simple Stupid. Medicare for all sort of does that (though you still have all the Medicare letters of the alphabet handled by private insurers). A government catastrophic insurance you go on once you hit say $1 million in lifetime spending for your care would be another way to go. A third would be Hotel California public option - you can go on the public plan but you have to stay on it forever, no cycling off when you are healthy and on when you are sick. You can check out (die) but you can never leave the plan.
Medicare is most likely here to stay and the problems will only get bigger as the boomers file into the system. One thing that seems in line with the discussion is that Medicare compensation is not proving professionals with what they consider compensation to allow for a "reasonable" profit. I have know people who transition from private insurance to Medicare and find their doctor(s) don't take Medicare patients, and have trouble finding a good doctor who does. And then the example of private or uninsured people being billing outrageous amounts to compensate for Medicare shortcomings. Without an entirely new system, the only way I see to fix problems is taxation and regulation to help the Medicare system. An exchange of one freedom for another.
Ultralight
7-23-19, 8:16am
Medicare is most likely here to stay and the problems will only get bigger as the boomers file into the system.
The answer to these problems is more freedom! Senior citizens are oppressed by Medicare and must be liberated. I suggest abolishing Medicare, or at least privatizing it. I am sure the vast majority of seniors -- including the boomers -- would agree!
You should’ve added something about putting old people on ice floes. That would really sell it.
I’m not a strict libertarian. I think government should have some role in helping the helpless. But we seem to keep defining helplessness down and inventing new classes of victim only a powerful centralized government can save. I think there is a price to be paid for that in the long term.
The answer to these problems is more freedom! Senior citizens are oppressed by Medicare and must be liberated. I suggest abolishing Medicare, or at least privatizing it. I am sure the vast majority of seniors -- including the boomers -- would agree!
Ha, ha. Might work in a society where there is no retirement and you work 'til you can't. But wait...that's the millennials.
ApatheticNoMore
7-23-19, 10:50am
Ha, ha. Might work in a society where there is no retirement and you work 'til you can't. But wait...that's the millennials.
no it would NEVER work in such a society. If anyone imagines employers want to bring on 65+ year olds (when they would already rather not) and offer them full benefits including medical and pay that cost. No that would never happen.
Meanwhile as it is, how many millenials, still youngish are forced to work jobs and gigs without benefits, and how many 50+ can hardly get hired at a job with benefits to save their life (because employers do know the benefit costs are more for the older crowd and they aren't even covering 65+).
ApatheticNoMore
7-23-19, 11:42am
The answer to these problems is more freedom! Senior citizens are oppressed by Medicare and must be liberated. I suggest abolishing Medicare
the financials of the entire existing system would not hold together if this was done.
Ultralight
7-23-19, 1:50pm
no it would NEVER work in such a society. If anyone imagines employers want to bring on 65+ year olds (when they would already rather not) and offer them full benefits including medical and pay that cost. No that would never happen.
Meanwhile as it is, how many millenials, still youngish are forced to work jobs and gigs without benefits, and how many 50+ can hardly get hired at a job with benefits to save their life (because employers do know the benefit costs are more for the older crowd and they aren't even covering 65+).
Someday, when you decide to work hard and smart you will be very wealthyand own your own businesses. And then you will appreciate the freedom you have to not hire old people that cost so much!
Besides, these old people should innovate -- start their own businesses! Stop sticking your hands out to Nanny G. and expecting everyone to support your lazy bums!
Ultralight
7-23-19, 1:52pm
the financials of the entire existing system would not hold together if this was done.
That is the whole point!
gimmethesimplelife
9-5-19, 12:52pm
I predict medical tourism will increase. I know of a wonderful hospital in Mexicali to which I went in 2012 for an ultrasound of my gallbladder. Walking in off the street what did I pay with no appointment arranged? Ready? $57.50 USD. Can an American hospital compete with this price point if indeed Trump takes the machete to Medicare? Thailand and Malaysia and Chile are great medical tourism places, and India in particular is good for heart surgery with US trained doctors but bargain basement and very same and humane costs. I'm thinking airline CEO's will be cheering this trend. Rob
Teacher Terry
9-5-19, 1:31pm
I am not worried about Medicare. Seniors are a big voting block. That’s political suicide.
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