Tag: Medicare

A threat by the nation’s largest health insurer to pull out of ObamaCare is a sign of the industry’s growing angst about the viability of the federal exchanges, sources close to the industry say.

UnitedHealthcare’s warning sent new shockwaves across the healthcare sector after weeks of mounting anxiety among private insurers whose participation in the exchanges is critical to the viability of the president’s signature law.

In the last month alone, insurers have learned that the Obama administration has significantly lowered its expectations for new customers and will have far fewer federal dollars to help cushion insurer losses.

Source: New ObamaCare angst as top insurer threatens to bail | TheHill

I can just hear all those nay-Sayers  “Here’s proof that Obamacare is a failure!” and in some ways I agree with them. Private insurers are certainly the weakest link in the current system.

I have been on Medicare for about 5 years now and have been paying about $100 a month for that privilege.  It covers 80% of my medical costs so I must either pay  the remainder or get Medigap coverage for the other 20%. I chose a Medigap policy that started out at about $150 a month to cover that last fifth of the costs. Now that policy is up to almost $200 and will climb to over $300 in the coming years.

It doesn’t take a lot of math to figure out that I am paying a private “for profit” insurer ten time more for the same dollar coverage that Medicare provides. Yes, I know that Medicare is paid as a government expense but it has also been widely acknowledged as the most efficient insurance provider in the country. Single payer systems have proven to be the most economical way to provide healthcare to the world’s citizens. We are about the only first world country that refuses recognize that fact.

It seems obvious to this pragmatist that our country and especially our private corporations would be better off if they could shed their healthcare responsibilities and have Medicare as the country’s single payer provider of healthcare costs.  In fact there are many companies that are doing just that. With single payer systems comes economy of scale and also increased leverage over medical manufacturers and such. Aside from a law pushed through by the GOP why do we in this country pay so much more for our prescriptions than anyone else in the world?

As a side note it seems that on a regular basis veteran’s care is attacked by problems of poor implementation. Our veterans are just not getting the quality of care that they deserve under their current system.  Maybe it is time to at least fold it into Medicare instead of trying to stand alone.  Almost half of our citizens are currently on government provided single payer system. When we finally manage to get the rest there like the rest of the world we will all be better off.

Anyone who has read some of my posts know that I am an advocate for universal single-payer healthcare.  After all, it is very efficient and cost containing system used in much of the rest of the world.  Many of our citizens in the U.S. including this one are currently on a single payer system known as Medicare. After being on it for two years now I can attest that I have found it to be much better than the private insurance mode I fought with for so many years prior. Other citizens also on a single-payer system are those on Medicaid and with military healthcare systems. This makes up about 40% of the current population. The other 60% are on various employer or private systems or no insurance at all.

But to those so adamantly against Obamacare, which ended up not even be close to single-payer all of these systems are to be eliminated. Just why they believe that I really don’t know. They say those systems are socialist but why is that a bad thing?  Most of the rest of the world, at least those who no longer have the mammoth healthcare runaway costs implemented single payer systems years ago and statistically most in those countries actually live longer than we do.

When the pollsters show that 52% of the people are against Obamacare what they don’t show is that there is a significant number of those people who are like me and don’t really like Obamacare because it doesn’t go far enough. There are also a large portion in the polls who readily admit that they actually know practically nothing about Obamacare and are only parroting what their favorite talking-head has told them. They are against it because their party is against it.  So much for free-thinkers among the GOP! 🙂  Because Obamacare is such a piecemeal piece of legislation it will have to be pretty greatly changed in the future in order to be cost-effective.

Getting back to the original thoughts for this post, it seems if we are patient enough that we will eventually get to a single payer system. With all us baby boomers retiring and so many others at the other end of the spectrum becoming eligible for Medicaid the population that is in these two systems will continue to grow.  and then of course with our incessant increases in military spending that system will also expand. We might eventually work our way into a single payer system via the back door.

Wouldn’t that be something?

Just a quick note to say I just watched a video of a town hall meeting opposing Obamacare. There was an elderly lady who ranted on and on about it. She was totally convinced that if we allow it to be implemented that it would certainly cause the downfall of the entire country.  She finished with the following statement. “I realize that Obamacare does not directly affect me but I just want to make sure that we keep the government out of my Medicare!!”

They didn’t show if anyone had bothered to tell her that Medicare is a single payer system run exclusively by the government. Of course this just goes to show how so many on the radical right and particularly Fox News have distorted the reality of the Affordable Care Act.

I also reviewed some of the things that happened in 1965 when Medicare was enacted.  It is amazing to see the similarities with today. Most Republicans were, like today, adamantly against that too.

A central reason U.S. health care spending is so high is because hospitals and doctors charge more for their services and there’s little transparency about why. There is no uniformity to the system, in which public and private insurers have separate, unrelated contracts with hospitals and doctors. The result is a tangled, confusing and largely secretive collection of forces driving health care prices higher and higher.

This isn’t possible in many other countries either because governments set prices for health care services or broker negotiations between coalitions of insurers and providers. Known as “all-payer rate setting,” insurers in these systems band together to negotiate as groups. In contrast, U.S. insurers closely guard the secrecy of their contracted prices with health care providers and negotiate individually. This is why a hospital hosting five patients for knee replacements might get paid five different amounts for the surgeries.

Source: Why Our Health Care Lets Prices Run Wild | TIME.com.

There seems to be so many possible solutions to reigning in our ever-increasing healthcare costs if only those in congress would be brave enough to actually try a few. Instead they seem intent on just complaining about the situation. That’s easy, solving it is where the work begins and I am convinced that those yahoos inside the beltway are just too lazy to do the work to actually affect the problem.

After putting in quite a bit of study in this area I have come to believe that the above quote gets to the heart of the problem.  Like everything else in life if something is totally unregulated and uncontrolled it tends to move to an extreme.  I will admit that there are many doctors who are the exception to this statement but overall doctor’s pay is out of control.  When they believe that they are justified in charging me thousands of dollars for an hour of their time they need to be taught otherwise.

The way that hospitals set their rates is simply insanity. It has nothing to do with the actual cost of the service but more to do with getting the most possible. I love the quote above that “the result is a tangled, confusing and largely secretive collection of forces driving health care prices higher and higher”. As long as all of these price setting schemes are held behind closed doors our costs will inevitably grow higher and higher.  Why can’t we understand that simple fact.

Even a simple solution such as allowing Social Security to bargain for lower drug prices has been deemed not allowed by many of the so-called leaders in our government. Until we can finally realize that at some level of regulation is necessary in order to contain our healthcare dollars we will continue to complain about costs but fail to do any real action to contain them. The rest of the world discovered these solutions years ago, when will we ever catch up with them?

But I’m just a simple guy so what do I know…..

A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000…

Source: Hospital Billing Varies Wildly, U.S. Data Shows – NYTimes.com.

I must admit that I have been lazy in regard to studying and reporting on how hospitals are at least partially responsible for the runaway medical costs in our country…..

You might think that just because a hospital charges an amount for a procedure that they actually receive that payment. Fortunately that is not the case for single payer systems like Medicare, Medicaid, and veterans.  The article goes on to say:

Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.

Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.

Now that I have been on Medicare for a couple of years now I have been exposed to these extreme differences.  I recently had an endoscopy for an esophagus problem and when I got the paperwork from Medicare I could see that the medical facility charged about $3,500 for the fifteen minute procedure but Medicare approved less than $700 of which they paid 80% and my Medigap coverage paid the other 20%.  Since I was on Medicare and knew that they paid the same to all facilities I did not shop around for the different costs for the procedure but if I had I probably would have encountered differences like shown in the article above.

If like so many on the radical right seem to wish, I had not had Medicare I’m sure I would have been billed and expected to pay the full amount. The sad fact about it is that those who can afford it the least are the ones who actually are charged the most simply because they have no power behind them.

The rest of the developed world is for the most part on a single payer system similar to Medicare. I know that the most famous doctors tend to migrate to the U.S. because of our extreme compensations but even that fact does not give us superior care to most other countries. In fact even with our ultra-expensive way of doing healthcare many other countries are ahead of us when it come to living longer and healthier. When will we ever learn this very basic fact??

I get the feeling that if lawn mowing services were run by hospital administrators I would be charged  $1,000 for every time they mowed my lawn. Too bad someone can’t come up with DIY pace makers.