View Full Version : OK then.....Medicare.....What IS the answer?
gimmethesimplelife
8-18-12, 11:56am
I have been thinking the past day or so off and on about my post re: wanting to leave the US with the state of US health care being a big reason. I understand though, that many if not most will stay - so for them I wonder - what is the answer for US Medicare then?
It seems so lose/lose to me. On the one hand if we keep burrowing money as we have we will eventually reach a point where this can not continue. (One of Paul Ryan's points and on this I do agree). However, say we means test Medicare - that is going to mean less disposable income for seniors leading to less money spent leading to more low paying service jobs drying up. And also if Medicare is subject to means testing, I would not be surprised if folks in the mid thirties onward started saving more money due to terror of health care costs in the future. So that might mean less spending there too, with yet less economic activity as result - not good in a country where 70% of economic activity is based on consumer spending.
My point is that either way things seem very lose/lose. What do you'all think, anyone see a way out of this mess? I personally don't, which is another reason I want out. I'm just glad my mom had her spine surgery this year before any cuts went into effect.....Rob
SteveinMN
8-18-12, 12:40pm
I have been thinking the past day or so off and on about my post re: wanting to leave the US with the state of US health care being a big reason. I understand though, that many if not most will stay - so for them I wonder - what is the answer for US Medicare then?
As I wrote in another thread here, just whacking at recipients will not do the job. We need to reform the legal system so that human doctors making an educated guess are not punished unduly by sympathetic juries. Sure, every doctor should get everything right. But it's not possible or even reasonable to require it. And both the large awards in malpractice suits and the belts-and-suspenders treatment protocols used to avoid them cost us patients much more than we realize. The other part of the reform is to go single-payer. Of course, Medicare already is, but part of the problem with our health system is that it's easy for health providers to choose to not accept Medicare patients because Medicare reimbursements are lower than providers would like and they'd rather treat other patients with different insurance. If everyone were on the same insurance plan, that insurer (be it Uncle Sam, UHC, BCBS, whoever) could demand volume discounts and drive what is "reasonable and customary" to pay for a medical procedure. That doesn't happen now. There will need to be some vigilance so that medical suppliers don't achieve the status of military contractors, where the sheer size of the projects and relative individuality of the product guarantee surprising levels of profit. But it's unlikely adhesive bandages will get to that category, I think.
I think the issue is endemic with healthcare in general. Not so long ago, options for treating people were very limited - which also limited cost. Now there is an incredible amount of options - and the cost that goes with all that. At some point it just becomes too expensive to do everything possible. Death panels are coming.
Eventually the way we approach it will have to be more like we approach other consumables - you can't afford it, you go without. And those with the fortunes will have more access - although since they also have more access to government, it would not surprise me if they come up with government entitlements that will help someone with millions but do little for those without.
iris lily
8-18-12, 12:49pm
I think the issue is endemic with healthcare in general. Not so long ago, options for treating people were very limited - which also limited cost. Now there is an incredible amount of options - and the cost that goes with all that. At some point it just becomes too expensive to do everything possible. Death panels are coming.
Eventually the way we approach it will have to be more like we approach other consumables - you can't afford it, you go without. And those with the fortunes will have more access - although since they also have more access to government, it would not surprise me if they come up with government entitlements that will help someone with millions but do little for those without.
woah! I completely agree with this. It ain't a pretty picture. Creaker for President.
Put me down for single-payer, as well. As soon as we let insurance companies and investment bankers in the door, affordable care went out the window. That we over-treat, over-diagnose, and over-medicate to a dizzying degree doesn't help matters.
Put me down for single-payer, as well. As soon as we let insurance companies and investment bankers in the door, affordable care went out the window. That we over-treat, over-diagnose, and over-medicate to a dizzying degree doesn't help matters.
While this goes against my most basic tenant which is to not grow the Federal government and give them more control over more chit, once the gooberment gets spending under control (ha ha ha bloody unlikely) I might support single payer plan as long as there is an allowance for Harley Street type treatment to continue for those who have personal funds for it. In other words, I would want an official government sanction of a multi-tied medical treatment system for haves and have-nots.
I will not ever agree to a system like Canada where everyone gets the same thing and anything else isn't allowed by law. Sorry.
But JAne, please understand that before I stand with you in solidarity on this, the Feds must control spending and bring it down to not exceed that which we take in. That's pretty much not going to happen.
Put me down for single-payer, as well. As soon as we let insurance companies and investment bankers in the door, affordable care went out the window. That we over-treat, over-diagnose, and over-medicate to a dizzying degree doesn't help matters.
I agree with this totally. Germany has universal healthcare but if you make over X Euros per year you can buy private insurance. We have too many profit centers in health care insurance companies, lawyers, corporate hospital chains, too many physician specialist and too few family doctors who get paid the least. We all pay for these profit centers including the government through Medicare.
Put me down for single-payer, as well. As soon as we let insurance companies and investment bankers in the door, affordable care went out the window. That we over-treat, over-diagnose, and over-medicate to a dizzying degree doesn't help matters.
I agree with this - I don't think it's any more onerous than the government providing police or fire or highways or the kazillion other things they do. Medicare has a good record for efficiency, at least as far as % in administrative costs. I just think you'll hit a ceiling in terms of how far that can go which will fall short of what is medically treatable. Especially if you're including later life/end of life care in that. Somewhere sometime someone is going have to draw some lines.
As long as we can afford our Department of War and continuing BUsh's tax cuts to the wealthy, we can afford healthcare and medicare. Single payor run like medicare would have admin costs of 1-2%. Private insurance has admin/overhead/profit costs of 30-40%. Put us all on single payor and reallocate 28-38% of the insurance overhead (i.e. half dozen people in every doctors office processing claims to many insurance companies, insurance company profits include CEO salaries, etc) to healthcare for the 40 million in this people that don't have healthcare.
I also believe, as the baby boomers age, there will be an allocation of resources....maybe more "death with dignity" states or maybe less spent in the last few months of life since we read that is where the majority of health care dollars are spent.
While this goes against my most basic tenant which is to not grow the Federal government and give them more control over more chit, once the gooberment gets spending under control (ha ha ha bloody unlikely) I might support single payer plan as long as there is an allowance for Harley Street type treatment to continue for those who have personal funds for it. In other words, I would want an official government sanction of a multi-tied medical treatment system for haves and have-nots.
I will not ever agree to a system like Canada where everyone gets the same thing and anything else isn't allowed by law. Sorry.
But JAne, please understand that before I stand with you in solidarity on this, the Feds must control spending and bring it down to not exceed that which we take in. That's pretty much not going to happen.
I've never have a problem with a gradual trimming of programs (they can start with our Department of Foreign Invasion, aka Defense)--gradual, to keep thousands from being unemployed all at once. We can also do away with corporate subsidies and streamline the tax code to eliminate loopholes as much as possible, raise rates to at least Clinton-era levels, eliminate the FICA cap, reinstitute tariffs, and bring jobs home. The one best thing we can do to achieve fiscal stability is to foster a robust economy and living-wage jobs here in this country.
I would be perfectly happy with fee-for-service outside a single-payer plan--for those who want exceptional care. I'm surprised Canada doesn't have that.
ApatheticNoMore
8-18-12, 3:01pm
also if Medicare is subject to means testing, I would not be surprised if folks in the mid thirties onward started saving more money due to terror of health care costs in the future.
I rather doubt it. It seems to me one reasonable way to deal with means testing is to end up one of the poor ones who gets the benefits - ie DON'T SAVE!! (you're probably not going to end up fantabolously rich and ending up in the middle in a mean tested world where only the poor get benefits and only the rich can really afford is just the worst place to be - not saving seems to me in many ways the more sensible answer unless you are super risk adverse - um like the Japanese who save, not like most Americans.).
We have too many profit centers in health care insurance companies, lawyers, corporate hospital chains, too many physician specialist and too few family doctors who get paid the least.
+1 And I really find it hard to believe it's mostly the trial lawyers when the hospitals are always adding a new wing ... hospitals and universities = two things always under construction (and yet education and health care become increasingly unavailable and unaffordable).
Is entitlement spending a problem? Sure but it's really really hard to take it seriously as *the* problem, when the Federal reserve funnels trillions into banks all over the world, when there's wars a plenty and all Romney and Obama want is 4 more wars (or at least two - and sure the wars may have certain economic benefits but was choosing this direction as a country ever really debated?), when tax cuts are here to stay and only added to all the time (really cutting the payroll tax?), when the department of homeland security is fully funded but what a BS department. So discussion of entitelment spending just becomes well yes if we were looking at the big picture it would be one thing to look at but since the big picture isn't discussed, I can hardly bother caring. It's like being unemployed, hemoraging thousands of dollars a month on housing payments on an underwater house which you could save by getting out of it and saying: "daily lattes, that's what we REALLY NEED to discuss". I mean yes daily lattes while unemployed and going broke not good ... but ... but .... It is the only thing that is permissable to be changed though, so entitlement programs are going to get butchered. By the way socialized medicine could have been a possible way to save them, since the overall costs may be less.
All means testing does is create another group of peons the ruling class (and their wannabes) can look down on, and the only reason tort expenses even register is that insurance companies use them as an excuse to charge sky-high premiums. IMO, of course. And I agree the Department of Homeland Security is a dangerous boondoggle.
We need to reform the legal system
Bingo.
We need to reform the legal system so that human doctors making an educated guess are not punished unduly by sympathetic juries. Sure, every doctor should get everything right. But it's not possible or even reasonable to require it. And both the large awards in malpractice suits and the belts-and-suspenders treatment protocols used to avoid them cost us patients much more than we realize.
I'd agree with your premise if insurance companies were going broke paying out all those malpractice settlements. We both know they ain't. They're making profits so fast they don't know what to do with it all. Maybe some regulations could be place upon the insurance companies instead limiting rate at which premiums can be increased on the policyholders on an annual basis, thereby restricting the obscene level of profits these corporations make every year? Just throwing it out there.
No, we do not need to restrict the ability of the little guy who has been shafted by the big guy to appeal to the court system for recompense. Doctors who flagrantly and commit malpractice on ignorant patients who are at there mercy must be held accountable.
Aside from what I think are significant questions regarding how much more expensive healthcare is in an overly litigious environment there is one other question that comes to mind. Why do we need the insurance industry to have any part of healthcare in the first place?
That's been my constant refrain. People could pay out of pocket for health care in my far-away youth, including hospitalizations. Then the insurance grifters came along and ran their scam on us, et voila'. All they do is add layers of expense and drive up costs. They're a scourge.
awakenedsoul
8-18-12, 8:00pm
Aside from what I think are significant questions regarding how much more expensive healthcare is in an overly litigious environment there is one other question that comes to mind. Why do we need the insurance industry to have any part of healthcare in the first place?
Very good point. There's so much overspending on people when they're dying. A friend of mine had AIDS. They knew he was near the end, but they gave him a blood transfusion. For what? Money. They could bill the insurance.
My mother has been addicted to prescription drugs since she was 21. She's in her 70's now. The doctors constantly schedule her for surgery after surgery, and she drinks wine with her 23 prescriptions. They put her on life support after she fell and broke her pelvis. There are many other people like her. They are addicted to drugs/medications, alcoholic, and chronically ill and injured. We pay for it. It's horrendously expensive. They don't get better.They get worse.
They are keeping the elderly alive for as long as possible now. It's barely an existence, and it's a money machine. I think addiction is the root of a lot of these problems. Self care, a healthy diet, enjoyable exercise, and compatible relationships go a long way. We are so doctor oriented in our society. People have lost touch with the simple pleasures in life. There are many wonderful self healing methods available. They take self discipline and consistency. The body really does tell you what it wants.
SteveinMN
8-18-12, 11:04pm
I'd agree with your premise if insurance companies were going broke paying out all those malpractice settlements. We both know they ain't. They're making profits so fast they don't know what to do with it all. Maybe some regulations could be place upon the insurance companies instead limiting rate at which premiums can be increased on the policyholders on an annual basis, thereby restricting the obscene level of profits these corporations make every year? Just throwing it out there.
Fair enough. But one reason they're not going broke is that they charge a boatload for malpractice insurance. Take away the huge payouts and there's less fiduciary reason to charge huge premiums. There also is the profitability factor. I'm not quite sure what people would be willing to do about limiting profits. If we could find a way, it would be worth applying to petroleum companies, too.
No, we do not need to restrict the ability of the little guy who has been shafted by the big guy to appeal to the court system for recompense. Doctors who flagrantly and commit malpractice on ignorant patients who are at there mercy must be held accountable.
Totally agree. The trouble is that, anymore, any less-than-desirable outcome is worth hauling a doctor into court. Most people don't haul their mechanics or plumbers into court if what the mechanic said would fix the car doesn't fix the car. Why do we insist on a more perfect outcome from doctors? Flagrant incompetence? Repeat offenders? Absolutely get those people into another line of work. A really touchy baby delivery? Gimme a break.
flowerseverywhere
8-18-12, 11:45pm
I think that there is some confusion here. If a malpractice suit is filed, it is not against the insurance company that provides insurance to consumers. Seperate insurance companies collect malpractice premiums and then defend and pay for judgements in malpractice cases. Some specialties, such as Obstetricians pay huge premiums for the privilege.
I am not defending insurance companies, quite the contrary. One day I was in a city and we saw a huge shiny building full of people with the name of a major insurance company. All I could think of was a portion of every persons health care premium that had that insurance was paying for it. Money that could go towards paying for care.
Part of the reason we are in a quandry is money.
Physicians graduate from medical school with hundreds of thousands of dollars in school loans.
Drug companies come to their offices and give them samples and try to establish a rapport so they will prescribe their drugs.
Patients come in, and physicians decide what to do based on their insurance coverage and whether or not they will face a lawsuit. If your company pays for testing, most physicians will err on the side of ordering unnecessary tests if they have good insurance.
Due to the huge loans, many physicians just can't afford to have a practice of medicare patients.
Insurance companies have this huge structure of buildings, equipment and people to pay for.
The really crazy thing is Michelle Obama has the right idea. She has pushed exercise and healthy eating since she walked through the front door of the white house. Since the re-election push has begun that has been swept under the rug. It must not be popular in the eyes of the groomers/re-election team. But in reality that is what we all have to do. Eat right. Exercise. Stop smoking. drink in moderation. Manage stress. Manage your weight. And most importantly, when it is your time to die accept it with dignity.
ApatheticNoMore
8-19-12, 1:22am
Totally agree. The trouble is that, anymore, any less-than-desirable outcome is worth hauling a doctor into court. Most people don't haul their mechanics or plumbers into court if what the mechanic said would fix the car doesn't fix the car. Why do we insist on a more perfect outcome from doctors?
Well it being a life and death and quality of life issue tends to make it more emotional and important than a car ever will be. But also I think there is a kind of cultural myth about how advanced the state of medical practice and even medical science really is. It's really not that advanced. Do antibiotics work? Can surgery save your life? Yes. But when presenting to a doctor with symptoms the myth goes "and then the doctor gives you a diagnosis and prescribes a medicine (or surgery) for you and you get better", like presto chango advanced medical knowledge. But what really seems to happen is half the time the doctor doesn't have a clue what's really wrong. And even tests don't show it, etc.. And this is remarkably common. The whole state of medical practice is not what it could be in my view (high standards? I think so much more is possible). But even if practice could be better even at the level of science the unknowns can swamp the knowns. But this slams you head first into the cultural myth of the ominpotent doctor, House, every hospital drama, etc.. The belief that medical science and practice is so advanced in our modern world, when really it's not, though it has progressed from leeches. :)
I'm loath to limit the right to sue. I think the right to sue provides very basic protections for the individual in this society, and yes indeed to the little guy, those types of protections are important in a world where power is plenty unbalanced, very hesitant to give it up. Especially if I'm not convinced it's really the main reason medicine is unaffordable.
SteveinMN
8-19-12, 10:30am
I'm loath to limit the right to sue. I think the right to sue provides very basic protections for the individual in this society, and yes indeed to the little guy, those types of protections are important in a world where power is plenty unbalanced, very hesitant to give it up. Especially if I'm not convinced it's really the main reason medicine is unaffordable.
In pretty much every comment I've made on health care in this forum, I've contended that there are many reasons why health care in this country is the way it is, and that attempting to "fix" health care by addressing just an element or two is bound to fail.
To say it as clearly as I can, I do not believe we should take away the right of people to sue in obvious cases of malpractice (amputated the wrong leg, left the rails down on the bed so non-ambulatory patient could fall out, didn't take enough X-rays and biopsies to catch all the cancer present). I'm saying there should be some restrictions on awards. And there should be some consideration that courses of treatment don't always work out as hoped (the myth to which you referred) -- to my mind, that is not malpractice, and providers should not risk being sued for that. Nor should they have to request all kinds of tests which are not medically but are deemed legally necessary. Those are costs we all pay. I'm talking tort reform, not elimination.
There are plenty of other variables in the equation of health care costs. The cost of college tuition/fees is rising way faster than the cost of living. That's a different topic, but it is salient in that it means that even new doctors likely graduate with six figures of debt which has to be paid off. Part of what we pay for name-brand drugs goes to incessant advertising -- to the providers, but also to patients. Why should I be the one who asks my doctor about Nexium? Shouldn't (s)he be versed in it? I'm sure the pharma rep has visited and sung its praises. Why pre-sell us lay folks? And on and on.
If we were willing to step back from the myth that U.S. health care is the best in the world, maybe we could set out toward making that true. Right now so much of it is posturing.
In pretty much every comment I've made on health care in this forum, I've contended that there are many reasons why health care in this country is the way it is, and that attempting to "fix" health care by addressing just an element or two is bound to fail.
To say it as clearly as I can, I do not believe we should take away the right of people to sue in obvious cases of malpractice (amputated the wrong leg, left the rails down on the bed so non-ambulatory patient could fall out, didn't take enough X-rays and biopsies to catch all the cancer present). I'm saying there should be some restrictions on awards. And there should be some consideration that courses of treatment don't always work out as hoped (the myth to which you referred) -- to my mind, that is not malpractice, and providers should not risk being sued for that. Nor should they have to request all kinds of tests which are not medically but are deemed legally necessary. Those are costs we all pay. I'm talking tort reform, not elimination.
There are plenty of other variables in the equation of health care costs. The cost of college tuition/fees is rising way faster than the cost of living. That's a different topic, but it is salient in that it means that even new doctors likely graduate with six figures of debt which has to be paid off. Part of what we pay for name-brand drugs goes to incessant advertising -- to the providers, but also to patients. Why should I be the one who asks my doctor about Nexium? Shouldn't (s)he be versed in it? I'm sure the pharma rep has visited and sung its praises. Why pre-sell us lay folks? And on and on.
If we were willing to step back from the myth that U.S. health care is the best in the world, maybe we could set out toward making that true. Right now so much of it is posturing.
+1
We also need to look hard at medical school. Right now, they have designed it to run like the diamond trade, keep supplies low to keep prices high. It's hard to get into medical school and then the cost is so ridiculously high, that weeds out even more. Consequently we have shortages of doctors and more and more of our doctors in small towns and remote areas are from India, or elsewhere. Why aren't we staffing these places with American doctors? I"m not saying I am against immigrants, but isn't' it kind of ridiculous that all these smaller hospitals need to go out of the country to staff? And these are doctors who have received a lot of their, if not all of their training in a much cheaper market. In trying to keep the profession exclusive, we have priced ourselves literally out of the market! But, instead of saying ok, maybe this guys service (surgeon) is only worth $5,000 an hour and we have 3 to choose from, we (and I mean the medical establishment) says no, you only have one who can do this and he is $15,000 and hour. I think most would agree the first is a rather good return on investment/time, but the second is simply greedy.
I still think it makes sense that healthcare expenses should be spent primarily on caring for someone's health. Yes, there has to be a certain level of administration and other overhead, but it is all at obscene levels right now and most of that, as far as I can see, has some basis in the insurance industry (including Medicare).
awakenedsoul
8-19-12, 3:46pm
Americans, in general, are very unhealthy. Most have a lot of bad habits. I read Michelle Obama's book. It was excellent. She is extremely fit and toned. She's doing a lot of preventive work, as another poster mentioned. It's too bad that we, as a nation, don't see the value in that. There are many methods of self healing that could help a lot of people who run to the doctor every time they have an ache or a pain. I have to spend two hours a day maintaining my body: exercise, yoga, relaxation, physical therapy, etc...but it's worth it to me. I avoid traditional medicine if at all possible.
Powered by vBulletin® Version 4.2.5 Copyright © 2025 vBulletin Solutions Inc. All rights reserved.