Why seniors would be health reform winners, not losers

[question everything]

Why seniors would be health reform winners, not losers

HOWARD GLECKMAN

September 3rd, 2009

Opponents of health reform have targeted seniors with a blunt message: You will be big losers if “Obama-care” is enacted. In the words of Republican National Committee Chairman Michael Steele: “Senior citizens will pay a steeper price and will have their treatment options reduced or rationed.” Scary words. But, in truth, seniors are likely to be big winners if responsible health reform passes and prime victims if it fails. The casualties will not only be today’s elders, but the Baby Boomers, who are the next generation of seniors. They will all pay the price if the existing health system is allowed to fester. It is true that, today, seniors have a pretty good deal. Nearly all those over 65 already have insurance through Medicare — a government program. Seniors and younger people with disabilities who are both very poor and unable to care for themselves are also eligible for long-term care benefits through Medicaid, which is run jointly by the federal government and the states.

So if seniors already have coverage, don’t they have everything to lose from change? Isn’t cost control just a fancy euphemism for cutting benefits? And what about those bureaucrats deciding who gets care and who doesn’t? These claims are both irresponsible and wrong. But their biggest flaw is that they ignore the real problem: Without fundamental changes, Medicare and Medicaid are unsustainable. Like a poorly built house that has gone too long without repairs, they will soon collapse without major renovations. And seniors will face both massive tax hikes and huge increases in their monthly insurance premiums.

To understand why, remember that Medicaid and Medicare Part A hospital insurance are funded with tax revenues. Medicare Part B coverage for doctor visits and Part D drug coverage are financed through a combination of taxes and premiums. Many seniors also pay extra for Medicare Supplement (Medigap) insurance. In just 10 years, according to the Medicare trustees, Part B premiums are expected to increase from about $96 a month to more than $130, while Part D premiums will rise to $50. Add a few hundred dollars more each month for Medigap coverage and many seniors will be spending $5,000 annually on Medicare. Higher-income seniors will pay far more — as much as $420 a month for Part B alone. That is the future seniors face if we do nothing.

(snip)

As for rationing, Medicare already decides what to cover. Nobody seriously expects it to pay for any treatment patients want. It also rations by deciding how it pays physicians and hospitals. For instance, doctors are paid more for tests than office visits, so patients get more MRIs and less face time with physicians. Health reform is not about choosing between rationing or not. Rather, it is about whether we will continue to spend health dollars in the crazy way we do now or find a better way. Done right, it can mean less treatment but better health.

One example: Critics of reform call “comparative effectiveness research” a backdoor trick to deny care for the frail elderly. They are wrong. Done well, it can improve care at less cost. Today we know very little about how medications affect seniors. So they often get too many drugs that can make them ill, or even kill them. Wouldn’t it be nice to have a research program to tell us what drugs work best for the elderly? How about Medicaid? Today, because the program is required to pay only for nursing home care, beneficiaries are more likely to get their assistance in a facility than at home. Health reform could give consumers more choice. Instead of a government bureaucrat saying you must move into a nursing home to get benefits, seniors would have more opportunity to decide where they want to live. It is hard to see how that makes them worse off.

(snip)

Howard Gleckman, a senior research associate at the Urban Institute, is author of “Caring for Our Parents” and a frequent writer and speaker on long-term care issues. He wrote this for the McClatchy-Tribune News Service.



http://www.thenewstribune.com/opinion/othervoices/story/865886.html

[question everything]

1. Kick (nt)

[raccoon]

2. kick. nt

[Bluenorthwest]

3. Pretty good piece

However, even this expert does not get all the facts correct. First off, people with disabilities who are under 65 and not very poor. The author makes it sound like Medicaid is the only program for disabled people, and that is not correct. One third of Medicare beneficiaries.
Also, he states some things such as Part D as having set prices. He says 'it is going up to $50" but Part D is many plans, with many prices, and I bet I could find one today that already charges 50.
But at least he is trying and gets closer than most. I read far too many posts on DU that lack information, and suggest that Seniors be told that they get 'free health care' and when they say they pay for it, tell them they don't pay enough. Folks on DU are sure all people pay $90 and no more for Medicare, when some pay over 400 for part B alone. Folks here say that those who make 900 and pay 96 are paying a 'nominal' deduction. 10% is nominal. They don't seem to know that those on classic Medicare also pay deductibles, co-pays, and face gaps in coverage where they are paying all out of pocket. Those who buy Supplements, as the author says, pay more premiums to make up for the holes in coverage. Telling such people they get free care is never going to be a winning argument. That which costs a large percentage of one's income is simply not free. And saying that it is does not make it so, it just makes the speaker seem mean, as well as stupid.
Seniors and the disabled who have income pay income taxes as well. So this 'young workers pay for your free care' routine is a joke as well. Many retired people pay more taxes than many younger workers. Yep. Social Security benefits themselves are taxed, by Fed and by most States. Pensions are taxed, and of course any other income is taxed.
So telling a 66 year old who pays 800 a month in premiums and thousands a year in taxes that they get free care paid for by other people's taxes is just not true. And they will rightly reject as uninformed anyone who tries to tell them such lies.
The most important fact for anyone to know about Medicare, is that the excesses and fraud are 100% on the provider end. That is the medical industry over tests and over bills. It is virtually impossible for a person who has Medicare to defraud the system in any way. Providers however can and do, but to defraud Medicare, they also have to defraud and use the beneficiaries. Getting that problem solved would save everybody money. Some geographic areas of the country do much better with that than others. That is, if you wanted to be an over billing provider, some States are better than others to practice in.

[question everything]

6. Thank you for a detailed reply

Obviously, he was limited on how much he could have gone. But, as you say, he points out that we have to make some changes.

And, yes, too many DUers want a single payer health care or a universal access to health care and are not willing to consider how we pay for it. If we still have insurance - everyone has to have one so that, yes, the young and the healthy subsidize the old and the sick... until they get old and sick.

Or, we have to pay taxes for it. This is how universal health care are being supported in other countries. And shouting that "the rich have to pay first," or that we have to get out of Iraq and Afghanistan first will not help, either.

[mikekohr]

4. Thanks for the info! nt

[JPZenger]

5. kick