'I'm referring to the Social Security Reform Act of 1983, which followed the recommendations of a commission led by Alan Greenspan. Its key provision was an increase in the payroll tax that pays for Social Security and Medicare hospital insurance'.
Then Clinton came on boards saying we have to cut Medicare to save it. Clinton did to Medicare what Bush/Obama are doing to our Federal public K-university funding-----sending what are hundreds of billions in public school funding to build global neo-liberal education corporations. Clinton cut Medicare forcing two things------first, it destabilized our public hospitals and public clinics no longer getting what they needed to treat seniors. second, it created that GAP in what Medicare paid opening the door to private MEDICARE ADVANTAGE/MEDIGAP. Obama and Affordable Care Act simply ends public Medicare and sends it into state private health systems.
Clinton dismantled oversight and accountability to allow massive health industry frauds of our Medicare and Medicaid with a goal of growing what were local hospitals, local insurance businesses into national consolidated health systems. Here in Baltimore those frauds built a global Johns Hopkins and a national MEDSTAR hospital chain. This is why our Medicare Trust cannot pay full costs for all seniors----as it was designed to do. The cut in Medicare and tying to inflation created what was called THE DOC FIX. Because health industry costs were soaring from all the fraud and profiteering----and because the tie to inflation limited Medicare payments----doctors/hospitals were forced to losses and those DISHONEST DOCTORS AND HOSPITALS TURNED TO BILLING CODE FRAUD. All of this was simply DEREGULATING a system known around the world as best----
'Here's Clinton speaking to the American Association of Retired Persons in October that year: "Today, Medicaid and Medicare are going up at three times the rate of inflation. We propose to let it go up at two times the rate of inflation." Given that prices were expected to climb 3 percent a year, Clinton meant 6 percent growth for Medicare.
"That is not a Medicare or Medicaid cut," he reassured seniors. "So when you hear all this business about cuts, let me caution you that that is not what is going on. We are going to have increases in Medicare and Medicaid, and a reduction in the rate of growth."'
Honest doctors and public hospitals lost or were pushed to being dishonest -----while those corrupt doctors and hospitals doing the billing code frauds et al scored twice----committed fraud AND received this Congressional Doc FIX annually. This was done for global BIG AG as well at the same time.
Good Riddance To One Of Congress’ Dumbest Rituals: The ‘Doc Fix’
04/14/2015 09:52 pm ET | Updated Apr 15, 2015
Jeffrey Young Health Care Reporter, The Huffington Post
AP Photo/Susan Walsh
WASHINGTON — It’s been called “dumb,” “bad policy” and “common-sense-defying.” And that’s by the people in charge of it. It’s also called the “doc fix,” and it’s finally letting out its death rattle.
At long last, Congress on Tuesday killed off a policy with no defenders that has served as an excuse for crisis-motivated legislating for years.
Over the past decade and change, the term “doc fix” became shorthand for a nearly annual process by which Congress, facing a big, unintended cut to how much Medicare pays physicians, would scramble to find some way to stop it, as doctors issued loud, mostly empty threats to stop treating Medicare patients. This happened 17 times between 2003 and 2014. Seventeen times.
Rather than actually addressing the policy requiring these cuts and coming up with a new way to pay doctors that actually worked as intended, Congress continually dug itself into a deeper hole, making a permanent doc fix costlier. It’s like putting off repairing that leaky faucet in the bathroom and instead putting a sponge under the drip so they don’t have to hear the splashing sound.
This embarrassing legislative ritual could be seen a precursor to the fiscal brinksmanship and dysfunctional governance that has become more the rule than the exception in Washington. But this year, somehow, Republican and Democratic lawmakers came together, led by House Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.), with the full-throated support of President Barack Obama, to overwhelmingly pass a $141 billion bill that fixes the doc fix, and it’s is headed to the White House.
Amazing as it is that Congress passed bipartisan legislation that makes substantive policy in the current political climate, what’s even more amazing is it took a dozen years to get it done, despite virtually universal hatred of the old doctor-payment policy.
During those years, Congress dithered and lobbyists lobbied until these cuts in physicians’ fees were mere days or even hours away — and in a few cases, actually took effect, at least briefly — until the emergency scared lawmakers enough to do something. That usually amounted to a pay freeze or a small raise for physicians, along with cuts for other medical providers. The fix would be temporary, guaranteeing that Congress would have to revisit the issue within a few months or maybe a year or two, creating the same spectacle all over again.
“That is a lot of bad policy all around. The fact that there’s not a Medicare freight train every year is probably better for humanity,” said Tom Scully, who was administrator of the Centers for Medicare and Medicaid Services in 2002, the first time a doctor pay cut kicked in.
Pretty much the only winners in the doc fix economy were the lobbyists paid to influence it and the health care reporters paid to cover it, two camps that profited from this mess and don’t deserve your sympathy.
Lately, there’s been some strange, advance nostalgia for the doc fix. Defenders say it’s been good for the federal budget because it’s kept physician payments lower than they would’ve been under the system the preceded it, and because Congress usually made other spending reductions to pay for blocking the cuts required by the “sustainable growth rate,” or SGR, a complex formula to calculate annual pay adjustments for doctors treating Medicare beneficiaries.
But garbage policy that reduces the budget deficit is still garbage policy. If Congress wanted to reduce the deficit, Congress could have passed deficit-reduction bills.
Chip Kahn, CEO of the Federation of American Hospitals, put it more tactfully. “It’s wrongheaded policy-making. If you’re going to cut people and let it go to deficit reduction, then let’s do that. If you’re going to cut people so that something else doesn’t happen, I can’t believe that’s good policy,” he said.
This year, Boehner and Pelosi decided to rip off the Band-Aid, and the Senate went along with it despite some squawking by deficit scolds. The House leaders pieced together a package that’s not really paid for and adds to the deficit, and told their respective caucuses to take it or leave it. And it worked! Some Senate Democrats complained a bit because they didn’t get to put their fingerprints on it, and some Senate Republicans protested about the legislation’s effect on the budget. But once Obama enthusiastically endorsed the Boehner-Pelosi deal, they began to quiet down. The House passed the measure 392-37 last month, and the Senate approved it 92-8 Tuesday evening.
The legislation on its way to Obama’s desk would give doctors a small fee increase over the next few years, then link how much they get paid to how well they treat their patients.
All this was necessary because of a policy enacted in 1997 that pretty much everybody knew was bad only a few years in. Back in the ‘90s, Congress wanted to curb rising Medicare spending on physician services, and concocted the “sustainable growth rate“ policy. Turns out, only the third word in the name was true.
“The doctor policy here was never intended to reduce doctor payment as much as it did,” said Kahn, who helped create the maligned physician-payment system as a House Republican aide back in the 1990s.
This problem first reared its head in 2002, when the SGR cut Medicare payments to doctors by 4.8 percent. Nobody wanted this, but Congress let it happen anyway. That was the last time they did.
“The docs really got angry,” said Scully, now a health care lobbyist and investor. The docs stayed that way.
Virtually everyone agreed that the SGR policy didn’t work, and had to be replaced with some other method of restraining physician payments. But the usual intra- and inter-party squabbling, a ton of lobbying and a rising price tag made a permanent replacement harder and harder to achieve.
“There’s no fun way around it,” Scully said. “There have been a lot of efforts to try to fix it, but they were always painful.”
During the intervening years, the formula kept calling for lower payments and Congress kept stepping in to stop them, usually by taking money from hospitals and other health care providers to pay for it.
“There was a constant sense of crisis,” Kahn said. “From a provider’s standpoint, it was an annual or semi-annual nightmare because it meant that you were spending all your time not worrying about big-picture policy, but worrying about how your rates might be cut in some way so that Congress could get through the next six months or year,” Kahn said.
To make these interventions seem cheaper, Congress started pretending that one year’s cuts would simply be delayed and added to the next year’s cuts. Then they’d block that one, too, and so on. That’s why the reduction that was slated to take effect this spring was more than 20 percent.
So does the end of the doc fix mean the end of legislative brinksmanship and the beginning of a new era of bipartisan cooperation in which lawmakers will actually manage the federal government like they’re supposed to? Hardly. The same week the House passed the Medicare bill, Republican senators were trying to repeal Obamacare again.
But does doing away with the farcical doc fix process at least mean Congress has solved the problem of how Medicare should pay physicians? Once again, hardly. The “sustainable growth rate” system was considered reform in 1997, and look what happened. Obama hasn’t even signed the new bill and critics are already predicting the new policy will fail based on rosy assumptions about its effectiveness … meaning someday, we may need a doc fix fix fix.
With these few decades of DOC FIX killing all our public hospitals, public clinics, building national for-profit predatory health industry structures in insurance and private managed care systems----why was it Obama's task to end DOC FIX? Affordable CAre Act privatized Medicare to private state health systems, totally deregulated how these funds are distributed----once every citizen received the same regulated care because it is a Federal public health savings plan for all------ACA broke all that equal protection and now global health system corporations decide who, what, where, when, and how seniors get THEIR PERSONAL HEALTH SAVINGS ACCOUNTS----VIA PRIVATIZED MEDICARE. So, since ACA privatized Medicare it becomes OK to return to full-funding of Medicare with those hundreds of billions once lost to fraud and profiteering simply moved directly to these criminal health chains.
OUR MEDICARE AND MEDICAID TRUSTS ARE NOW THOSE HUGE GLOBAL CORPORATE HOSPITAL COMPLEXES BEING BUILT IN US CITIES DEEMED FOREIGN ECONOMIC ZONES. WANT TREATMENT? ROLL AROUND ON THAT NEW JOHNS HOPKINS ARTIFICIAL TURF!
Obama signs $200 billion 'doc fix' bill
By Jordan Fabian - 04/16/15 05:52 PM EDT
President Obama on Thursday signed a $200 billion Medicare reform package, hailing it as a “significant bipartisan achievement.”
The so-called “doc fix” measure is one of the biggest achievements for the new Republican Congress. It permanently ends automatic Medicare payment cuts to doctors that lawmakers have been forced to address every year for almost two decades.
In a rare outdoor signing ceremony in the Rose Garden, Obama congratulated Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) who brokered the deal.
“Not only does this legislation permanently fix payments to doctors but it also improves it,” he told reporters. “It encourages us to continue to make the healthcare system smarter, without denying service.”
The bill was an uncommon example of bipartisan cooperation. The measure passed the House with an overwhelming majority and on Tuesday, it cleared the Senate with just eight "no" votes.
“This was a bipartisan effort, Republicans and Democrats coming together to do something that's smart and common-sense, and my hope is it becomes a habit,” the president said.
Obama said he would congratulate lawmakers for passing the doc fix at a White House ceremony in the next two weeks.
This is when I stopped listening to National Public Radio-----American Public Media as in 2009 after the economic crash it was privatized to global CHAMBER OF COMMERCE---MARKETPLACE MONEY.
What NPR would be telling us if it was not right-wing global Wall Street is this-----all of that Medicare fraud and profiteering from Clinton era through Bush fleeced the entire Trust. Obama came on board knowing that and gave us his famous I SEE NO FRAUD. So, our Social Security AND Medicare Trusts are not depleted----they are simply all those national and global health corporations and we need to claw this back. Simply return these too big to exist because they are becoming MONOPOLIES----to being those public hospitals and public clinics---and public nursing/retirement facilities----WELL FUNDED AND MAINTAINED!
All of these pols and the national media KNOW this was the goal of CLINTON/BUSH/OBAMA----they knew this was what was happening. So too did AARP-----our national labor union leaders, our national civil rights leaders, our national women's rights leaders. All those NATIONAL NON-PROFITS headed by appointed CLINTON 1% WALL STREET GLOBAL CORPORATE NEO-LIBERAL 5% TO THE 1%!
WHEN WE KNOW WHAT CAUSED THE PROBLEM---WE UNDERSTAND THE SOLUTIONS AND GET RID OF THESE ROBBER BARON POLS AND THEIR FARM TEAMS.
Can you imagine the amount of payroll taxes paid especially by that large cohort BABY BOOMERS over 50 years and then right when they need it-----we are told it is DEPLETED.
Trustees: Medicare Funds Will Be Depleted By 2017
May 13, 20096:00 AM ET
Heard on Morning EditionJulie Rovner
The Obama administration announced Tuesday that the Medicare program is running out of money faster than projected. Health and Human Services Secretary Kathleen Sebelius said that news should make lawmakers redouble their efforts on a full health system overhaul. On Capitol Hill, senators are struggling to come up with ways to pay for that overhaul.
STEVE INSKEEP, host:
It's MORNING EDITION from NPR News. Renee Montagne is in on assignment today. I'm Steve Inskeep.
Even in a time of trillion dollar bailouts, it can be hard to get your brain around the costs we have coming. President Obama's administration says the Medicare program is running out of money faster than expected. So is Social Security. Neither program is taking in money quickly enough to handle all the baby boomers heading their way. And in a moment, we'll get a diagnosis from David Wessel. We began with the plan to add even more expenses to overhaul health care for the rest of us.
NPR's Julie Rovner reports.
JULIE ROVNER: About the only person who was upbeat about health care yesterday was the president himself. Here's what he said at a photo op after meeting with a group of business leaders to talk about how they've managed to cut their worker's health care costs.
President BARACK OBAMA: We're doing some stuff on health care because I think the country is geared up. Businesses are geared up. Families are geared up to go ahead and start solving some of our extraordinary health care system problems.
ROVNER: Down the block, Treasury Secretary Timothy Geithner was far more somber as he delivered the bad news about the state of Medicare's finances.
Secretary TIMOTHY GEITHNER (Department of Treasury): Medicare's Hospital Insurance Trust Fund is projected to become exhausted in 2017, two years earlier than projected in last year's report.
ROVNER: Health and Human Services Secretary Kathleen Sebelius said the news about Medicare should make lawmakers redouble their efforts on a full health system overhaul.
Secretary KATHLEEN SEBELIUS (Department of Health and Human Services): The only way to truly slow Medicare spending is to slow overall health care spending to comprehensive and carefully crafted legislation.
ROVER: Over at the Senate, that's pretty much what the Finance Committee was trying to do at the last of three public sessions prior to writing an actual health care bill. First, however, advocates of a single payer government-financed health system disrupted the proceedings for the second week in a row.
Unidentified Woman: …Americans for 30 years.
Senator MAX BAUCUS (Democrat, Montana; Chairman, Senate Finance Committee): Here we are. You know, standard recess until the police can restore order.
Unidentified Woman: We want single payer at this table.
ROVNER: And for the second week in a row got themselves arrested at the direction of Committee Chairman Max Baucus of Montana. Baucus, however, insisted he wasn't purposely excluding those who back a single payer plan.
Sen. BAUCUS: It's a long haul process. And so those of you in the audience who are not panelists and wish to be heard, I urge you just to contact my office. We'll figure out a way to talk to you. I'll figure out a way to listen to you. I'll be there personally.
ROVNER: But when the protest died down, senators took on and even more contentious issue: how to finance what could be a $1.5 trillion price tag for the health bill they're about to write. Several of the experts summoned to advise the senators had the same suggestion. This came from health economist Gail Wilensky, who advised for Republican presidential candidate John McCain.
Dr. GAIL WILENSKY (Health Economist): The first one is to go after the tax treatment of employer sponsored insurance. It's regressive, it's inefficient and it's a lot of money.
ROVNER: She's referring to the fact that workers don't pay tax on the value of health insurance provided by their employers. McCain campaigned to eliminate that tax break last year, so it's not surprising Wilensky would be for it. But here it was also being endorsed by MIT political scientist Jonathan Gruber, considered far more of a liberal.
Professor JONATHAN GRUBER (Political Scientist, MIT): This is a large amount of dollars we're talking about. It's about $250 billion as of a year two ago, making it the second largest federal health care program in America.
ROVNER: Now Chairman Baucus was quick to make clear he wasn't going to go as far as Senator McCain did last year and suggests getting rid of the tax exclusion entirely.
Sen. BAUCUS: To be honest, I don't think we're going to repeal the exclusion. That's just not going to happen.
ROVNER: But he left he door wide open for possible changes that stopped short of getting rid of the exclusion. For example, one possibility, said John Shields of the number-crunching Lewin Group, would be to make people pay taxes on only the most expensive health care policies.
Mr. JOHN SHIELDS (The Lewin Group): The tax exclusion for health benefits, if we were to cap that at, say, the average amount per worker right now, you'd raise about $700 billion in revenues over 10 years.
ROVNER: Meanwhile, back at the White House, officials continued to stress that the president doesn't like the idea of potentially taxing health insurance benefits. But they also said that redoing the health care system, including Medicare, is a long process, and this is just the beginning.
Julie Rovner, NPR News, Washington.
If we look at the winners in this massive health industry fraud------here is Maryland the only state given AN EXEMPTION from MEDICARE-----for what was the entire period of Clinton's terms. This is why Hopkins has that jump on global health systems-----it is why we have a national MedStar----global HCA-----it is why we have global investment firms buying all our senior care facilities----
It is this structure built by Hopkins that infuses the Affordable Care Act. Maryland was allowed to block grant Medicare and Medicaid basically creating a pool of health funds to be distributed and spent anyway private health systems in the state deemed profit-maximizing.
As with Clinton claiming to SLOW HOSPITAL COSTS----we all know these few decades had the US with the most costly health system costs with the worst of patient outcomes right----so too does this Maryland structure and we can believe data coming from this as much as we do from Medicare fraud investigations.
This health care pool of money became a slush fund as with all Maryland trusts and it funded expansions overseas and nationally-----while unconstitutionally denying Maryland seniors equal protection in receiving Medicare benefits just as every other citizen around the nation.
The health disparities are huge in Maryland as it is set to become for all US citizens as they MOVE FORWARD to only the global 1% and their 2% travelling with global health tourism for what was ordinary health care all Americans received---AND PRE-PAID AS HEALTH SAVINGS ACCOUNTS.
It was never legal to allow this one state exemption by executive order----given by Clinton and Obama----
Maryland’s Medicare waiver now front and center
May 4, 2012, 6:00am EDT
Ben Fischer Staff Reporter Washington Business JournalMaryland hospitals reluctantly swallowed a near freeze on rates May 2, but the state’s health care industry will now turn to an all-hands-on-deck attempt to save the unique system that allows strict government regulation of hospital rates in the first place.
The state’s authority comes from a 35-year-old exemption from standard Medicare rules, but the waiver comes with an important condition: Hospital costs must grow more slowly in Maryland than in the rest of the country, or the exemption goes away.
Notice this use of 2020 ------for the same reasons----with this coming economic crash from global US Treasury and municipal bond market fraud with all that sovereign debt----all those municipal bankruptcies---all those smaller local hospitals unable to compete with a global Hopkins for example---1% Wall Street staged the wipe-out of our entire public health care structure and fast-tracked health industry consolidations with these managed care state health systems already global. This is when we will see our long-term hospitals like Sinai----GBMC----close because they cannot compete-----our remaining quasi-corporate UMMS and its branches left unfunded being enfolded into larger global health systems-----probably one consolidated Johns Hopkins/global Bloomberg hospital system.
This was the goal of Obama and Affordable Care Act---they needed to get that consolidated health system and deregulation in place before the coming economic crash and load other hospitals with corporate debt to fast-track monopoly health systems.
Now, guess what happens to SOCIAL BENEFIT SUBSIDIES----with all this for-profit maximization? All health subsidies will go away----our once best in the world MEDICARE will simply become SINGLE PAYER MEDICAID FOR ALL------the same preventative health structures being built in all Foreign Economic Zones globally. Private health insurance rates will soar----the upper-middle class may hold on through this first decade but watch out----the goal is to end health care access for all Americans outside of clinic care and preventative care.
HUMAN CAPITAL HAS NO VALUE WHEN IT BECOMES WEAKENED WITH AGE----MAY AS WELL KICK THE BUCKET!
Boy, does this article make our once #1 ranked public health care system sound abysmal? Isn't that what outsourcing, deregulating, defunding is supposed to do?
Why one-third of hospitals will close by 2020
David Houle and Jonathan Fleece | Policy | March 14, 2012
For centuries, hospitals have served as a cornerstone of the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to die. Across the nation, hospitals have become embedded into the sacred fabric of communities.
According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions. More than 1 in 10 Americans were admitted to a hospital last year.
Hospitals make a substantial imprint on local economies. In many communities, hospitals represent one of the largest employers and economic drivers. Of the total annual American health care dollars spent, hospitals are responsible for more than $750 billion.
Despite a history of strength and stature in America, the hospital institution is in the midst of massive and disruptive change. Such change will be so transformational that by 2020, one in three hospitals will close or reorganize into an entirely different type of health care service provider. Several significant forces and factors are driving this inevitable and historical shift.
First, America must bring down its crippling health care costs. The average American worker costs their employer $12,000 annually for health care benefits, and this figure is increasing more than 10 percent every year. U.S. businesses cannot compete in a globally competitive marketplace at this level of spending. Federal and state budgets are getting crushed by the costs of health care entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are vulnerable as they are generally regarded as the most expensive part of the delivery system for health care in America.
Second, statistically speaking hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000. The Journal of the American Medical Association reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group, 80,000 die from hospital acquired infections, many of which can be prevented. Given the above number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to medical errors. So hospitals are very dangerous places.
It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths. Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The airlines would stand before the nation and the world in disgrace. Currently in our non-transparent health care delivery system, Americans have no way of knowing which hospitals are the most dangerous. We simply take uninformed chances with our lives at stake.
Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.
Fourth, health care reform will make connectivity, electronic medical records, and transparency commonplace in health care. This means that in several years, and certainly before 2020, any American considering a hospital stay will simply go on-line to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics. Isn’t this what we do in America, comparison shop? Our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare roofers or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost — all of which will be necessary to compete.
What hospitals are about to enter is the place Americans, particularly conservative Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers.
A third of hospitals now in existence in the United States will not cross the 2020 finish line as winners.
David Houle is a futurist, advisor and speaker and Jonathan Fleece is a health care attorney, advisor, and speaker. They are the authors of The New Health Age: The Future of Health Care in America.
It is INSULTING to have to listen to these criminal Robber Baron pols go from being the ones who deregulated, defunded, dismantled all oversight and accountability---who privatized all public health and allowed widespread disparity in access now ROLLING OUT THE MODEL TO A PUBLIC OPTION MEDICARE. This is crazy stuff.
CLINTON/BUSH created all that deregulated structure of MEDICARE A ---MEDICARE B----MEDICARE C----MEDICARE D----MEDIGAP----that was deregulating our public Medicare. Maryland went further and became completely exempt from regulations requiring equal coverage and protection. Now these same pols who installed all this breakdown in our public health are calling to end all that complexity to create ONE MEDICARE. Now, what would a privatized set rate of $3,400 out-of-pocket get us in hyper-inflation global health care? It would attach WE THE PEOPLE to telemedicine computer consumer service with someone they call a doctor telling us-----ITS TIME TO THINK HOSPICE.
THAT IS THE GOAL OF HOPKINS/KAISER BROUGHT TO US AS USUAL BY FAR-RIGHT 1% WALL STREET GLOBAL CORPORATE CLINTON NEO-LIBERAL---O'MALLEY
'What the researchers propose then is sort of a no-brainer: eliminate the need for multiple sources of coverage by creating one plan administered by Medicare. Medicare Essential would replace the Part A, B, and D deductibles that together cost at least $1,454 with a single $250 deductible, and would set a maximum of $3,400 per year in out-of-pocket costs. If coverage that combines multiple Medicare benefits into one plan with limited out-of-pocket costs reminds you of something, you’re not wrong: in many ways, it’s basically a public option for Medicare Advantage'.
'However, recently more and more employers have been eliminating health coverage for retirees. The Kaiser Family Foundation found that the share of large employers (those with 200+ employees) offering retiree health coverage dropped from 66 percent in 1988 to just 23 percent in 2015. Five national surveys produced different estimates of the decline among all Medicare beneficiaries, but as the Kaiser report puts it, “Any way you slice it, this coverage is eroding.”'
O’Malley is out; his Medicare plan shouldn’t be
The candidate struggled to get voters to buy into his vision, but his Medicare plan should be an easy sell ... even to a GOP Congress
- By Rob Cullen
- medicareresources.org Contributor
- May 26, 2016
Still it might not have helped. O’Malley had some really smart ideas for health reform, but even when he had a chance to talk, he wasn’t great at explaining them in a way that resonated with voters. Granted, the centerpiece of his plan – which he calls “comprehensive payment reform” – is a wonky subject that’s difficult to make interesting (although if you’re curious, I gave it a shot here). But his Medicare plan, which he rarely talked about, should have been an easy sell.
Originally proposed by researchers from John Hopkins University and the Commonwealth Fund, “Medicare Essential” could make Medicare simpler for enrollees, lower their premiums and out-of-pocket costs, and improve the quality of their care. It’s an idea that could strengthen Clinton’s “Medicare for More” plan or serve as a step toward Sanders’ “Medicare for All.” On top of that, it would cost the federal government nothing, making it hard for even a Republican Congress to vote no.
So what is Medicare Essential?
As O’Malley explained on his website, Medicare Essential is actually pretty simple: it would combine hospital, physician, prescription drug, and supplemental coverage into one opt-in Medicare plan. What he fails to really explain is why this is such a good idea.
People on Medicare report being much happier with their coverage than working-age people with private plans, so it’s easy to miss the fact that some beneficiaries can face enormous out-of-pocket costs. Thanks to the Affordable Care Act there’s an annual limit on out-of-pocket costs for private plans – $6,850 for an individual or $13,700 for family coverage – but there’s no such limit on traditional Medicare. Richard Mayhew, an insurance expert who blogs at the website Balloon Juice, recently showed how in a worst-case scenario Medicare’s daily hospital costs and coinsurance for doctors and prescription drugs could leave an enrollee on the hook for over $400,000 in a single year.
Traditional Medicare also has some hefty deductibles: $1,288 for Part A’s hospital coverage, $166 for Part B’s physician coverage, plus up to $360 for a drug plan, for a total of $1,454 to $1,814. That’s comparable to many private plans for working-age people, but could be unaffordable for seniors on limited incomes.
One reason we don’t hear more stories about seniors going bankrupt due to medical bills (although there are plenty) is that the vast majority of Medicare recipients have some kind of supplemental coverage. That could mean a Medigap plan, Medicare Advantage, retiree health benefits from a former employer, Medicaid, or some combination of any of those.
86 percent of Medicare beneficiaries have supplemental coverage.
These supplemental plans are a huge help for seniors, but with so many different private payers, that help is pricier than it could be. For one, it’s inefficient. The authors of the John Hopkins/Commonwealth study point out that administrative costs for employer-based retiree plans range from 10 to 15 percent, and for Medigap plans they average around 20 percent; for traditional Medicare, administrative costs are just 2 percent.
Also, the most popular Medigap plans provide “first-dollar coverage,” meaning they kick in as soon as any medical service is used, so enrollees pay almost nothing out-of-pocket. While unaffordable deductibles and coinsurance can be a burden for Medicare enrollees, having no out-of-pocket costs means they use far more services – both necessary and unnecessary – than they otherwise would. Of course we shouldn’t discourage them from seeking necessary care, but as the Hopkins/Commonwealth researchers explain, having multiple sources of coverage “makes it difficult for Medicare to … provide incentives to seek high-value care.”
What the researchers propose then is sort of a no-brainer: eliminate the need for multiple sources of coverage by creating one plan administered by Medicare. Medicare Essential would replace the Part A, B, and D deductibles that together cost at least $1,454 with a single $250 deductible, and would set a maximum of $3,400 per year in out-of-pocket costs. If coverage that combines multiple Medicare benefits into one plan with limited out-of-pocket costs reminds you of something, you’re not wrong: in many ways, it’s basically a public option for Medicare Advantage.
Help for businesses, local governments and seniors
The researchers estimate that this new plan would reduce national health spending by $180 billion over ten years. Private employers would save $90 billion on retiree plans by buying into Medicare Essential instead, thanks to its reduced administrative costs; state and local governments would save $27 billion.
However, recently more and more employers have been eliminating health coverage for retirees. The Kaiser Family Foundation found that the share of large employers (those with 200+ employees) offering retiree health coverage dropped from 66 percent in 1988 to just 23 percent in 2015. Five national surveys produced different estimates of the decline among all Medicare beneficiaries, but as the Kaiser report puts it, “Any way you slice it, this coverage is eroding.”
In response, many seniors have turned to Medigap plans, and a Medicare Essential would save them money as well. The typical Medicare beneficiary with a Medicare Part D drug plan and a Medigap supplemental plan spends $427 per month on premiums and out-of-pocket costs. Beneficiaries with Medicare Essential would spend $354 per month on average – a 17 percent savings. And that’s just the start. The plan also provides incentives for beneficiaries to seek care from preferred providers, like patient-centered medical homes, which reduce costs by coordinating services, a particular help to patients with multiple chronic conditions. Beneficiaries who opt for these “high-value providers” would spend even less: just $254 per month on average, a savings of 40 percent. Added up, the savings to households receiving Medicare benefits would total $63 billion over the next decade.
Other politicians should look into itO’Malley may be out of the presidential race, but his Medicare Essential idea is something that both of his Democratic opponents should consider borrowing.
Hillary Clinton hasn’t released many details about her proposal to allow people “55 or 50 and up” to buy into Medicare, but if it’s traditional Medicare coverage, they’d be looking at those same enormous out-of-pocket costs in the event of serious illness. Medicare Essential could provide a much more attractive buy-in option without the need to purchase a separate supplemental plan.
Meanwhile, Sanders calls his plan “Medicare for All,” but it would eliminate all of traditional Medicare’s cost-sharing, which is one reason analysts say it would cost much more than Sanders estimates. A Medicare Essential benefit structure – with its modest cost-sharing and incentives to seek high-value care that both reduces costs and improves health – would bring down spending in his plan, making it easier to pay for. Also, if he couldn’t get his single-payer plan through a Democratic Congress all at once, better benefits for seniors combined with a buy-in option for younger Americans might be a more doable first step.
Medicare Essential moves in the other direction from Republicans’ recent proposals to replace traditional Medicare with vouchers for private coverage, but that doesn’t necessarily mean it would be dead on arrival in a Republican-controlled Congress. It would be hard for moderate Republicans to explain why they oppose a bill that saves businesses and seniors $180 billion, yet doesn’t cost the federal government anything. (The plan is designed to be budget neutral over its first ten years, but beyond that it could actually save the federal government money as health spending slowed).
Martin O’Malley has an idea that saves American businesses and households billions, improves health, and doesn’t cost taxpayers a dime – and despite our current hyper-partisan politics, it actually could stand a chance of passing. It’s about time that we noticed.