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John Smith
06-02-2009, 07:20 AM
If I may, I'd like to make the point that an honest comparing of Medicare to the private sector insurance must consider the age groups each covers.

Obviously, the over 65 group is a less healthy group than the younger crowd.

The private companies, in affect, insure people for the part of their lives when most enjoy the best health, then turn them over to Medicare.

From my experience with my mom, and from my neighbor's experience, Medicare works better than my Blue Cross and whatever insurance my neighbor had prior to Medicare.

Imagine if we put the entire population under Medicare, so they got premium dollars for those who seldom get sick, as well as the seniors.

In doing so, we get health insurance off the backs of the American employers, something I would phase out over several years, so the company sees more money, but still contributes a diminishing amount to the fund for medicare.

This would lead to everyone having health insurance, companies being more competitive, and higher wages for their employees. (perhaps 15% of what the employer saves on healthcare costs could be put to wages)

Medicare spends only a very small percentage of its premium dollars on adminstrative costs, meaning more goes directly to benefits. No huge CEO salaries, no "for profit", no stockholder dividends.

The only people really righting this are the private insurance companies, who are even fighting, and winning, having Medicare as an option for those who might want to choose it.

bob winter
06-02-2009, 07:28 AM
I must admit that I find the US healthcare system very confusing. Just what is medicare? Some friends in Florida tried to explain it to me a couple of years ago but I don't think I grasped it.

George Roberts
06-02-2009, 07:43 AM
"The private companies, in affect, insure people for the part of their lives when most enjoy the best health, then turn them over to Medicare."

That is simply wrong.

John Smith
06-02-2009, 08:44 AM
"The private companies, in affect, insure people for the part of their lives when most enjoy the best health, then turn them over to Medicare."

That is simply wrong.
My neighbor tells me that once he turned 65, and came under Medicare, Medicare is his primary, and his other insurance is a secondary, so I don't think it's wrong.

Generally speaking, arthritis, heart problems, and a variety of other illnesses tend to come with age. How many hip or knee replacements do you know of that went to people under 65? so what part of what I posted was wrong.

Also, another fact of life that many seem to forget, is WE, the people pay for healthcare for whomever has it, as a taxpayer or as a consumer. When I was working for the Postal Service, my healthcare premium, employer part, was reflected in the price of a stamp. When I retired, the taxpayer took over my employer part.

Healthcare being a part of doing business, means higher prices for the product/service.

John Smith
06-02-2009, 08:59 AM
Medicare is the federal program for health insurance, for people over the age of 65. It consists of two parts: one part covers doctors visits, and the other part covers hospitalization. The program generally only covers 80% of the cost, so many people buy supplemental insurance from private companies to cover the remainder. Medicare compensation rates to doctors and hospitals are set by the program itself, and are considered to be lower than what a private insuror would pay, but relatively few doctors refuse Medicare patients.

Medicare is distinct from Medicaid, which is a program to cover health care costs for the indigent. Medicaid is administered by each state, not the Federal government.

Medicare's most significant feature is (believe it or not) efficiency: it runs on an overhead of approximately 4% of expenditures... compared to overheads of nearly 29% for private insurors, after accounting for marketing expenses and profit. This is the primary reason that the idea of extending Medicare into an all-ages program, offered in competition with private insurors, raises so much resistance: insurors naturally don't want to have to compete with a program which has no marketing costs or profit requirements.
Very well put. Thanks.

I can't speak for today, but when my mom was alive and on Medicare, MOST of her doctors just took what Medicare paid.

I believe it is extremely important to realize that Medicare is working with 65 and older. Private insurers, other than those that are supplements to Medicare, are dealing with those 64 and under, where the medical needs on a per capita basis are lower.

Plus, as I said, WE pay, be it as a consumer or as a taxpayer.

cbcc
06-02-2009, 09:24 AM
[QUOTE=John Smith;2215979]Very well put. Thanks.

I can't speak for today, but when my mom was alive and on Medicare, MOST of her doctors just took what Medicare paid.

As a Medicare provider they cannot legally accept more than what Medicare pays.

John Smith
06-02-2009, 09:28 AM
More for Bob Winter:

One of the key problems in US healthcare, Bob, is the fact that we operate our health care as if we were ignoring the life-cycle characteristics.

EVERYONE needs health care... but the young and healthy consume far less of it, than the aging population. As children, we need annual physicals, maybe a visit here and there for the usual childhood illnesses, vaccinations, etc. In our early adult years, for most, health care means an annual physical, perhaps a visit or two for an illness, maybe a prescription for Lipitor if our cholesterol is high, Lisinopril if our blood pressure needs controlling. As senior citizens, the care, and the costs, go higher... there are too many old age illnesses to detail here. At EVERY stage of our lives, there is the possibility for serious injury or illness... emergent or chronic.

But our current system pays little or no attention to this fact... it treats health care is if the life cycle doesn't exist.... until we reach 65, when suddenly, the gov't takes over, simply because private insurance would be impossibly expensive. So, a laid-off middle-ager skips a periodic colonoscopy, because he can't afford it... and waits until he's 65 or older, at which point, any colon cancer requires tens of thousands of dollars for surgery, chemotherapy, and possible death ( I have a particular bug up my ass about colon cancer; my mother skipped getting a colonoscopy, albeit not for financial reasons, and ended up having 2/3rds of her colon removed... thankfully, she's fully cured and reasonably healthy, at age 85).

Any sensible health plan would take the life cycle attributes of medical care into account, meaning that the costs would be distributed across a person's life so that, as they age, and as they need more medical care, this is anticipated. We can't tolerate a system where loss of employment, combined with a pre-existing condition, would mean that health care would be unobtainable, at nearly ANY cost. My wife, for example, was diagnosed with Parkinson's disease a few years back; she's covered by her employee health insurance, but when the disease progresses to the point where she can no longer work, obtaining health care coverage will be essentially impossible.... so not only will she lose her income, she'll have to try to foot the medical bills without that income.

Is that a sensible system?
Great post. Right on the money, and puts a human face on the problem.

We are now, legally, entitled to keep our health insurance if we lose our jobs, but, without a job, we can't possibly pay for it.

Tar Devil
06-02-2009, 09:32 AM
The only draw back to my new job is health insurance. We're a very small company so no group coverage, only individual policies (paid by the company owner). However, since it is governed by individual policy regulations, NOTHING I'm currently being treated for is covered... neither meds or dr visits. And the deductible is five thousand. My wife can't be covered, period, because of her weight.

I'm over ready for the elimination of private sector health insurance.

John Smith
06-02-2009, 09:32 AM
[quote=John Smith;2215979]Very well put. Thanks.

I can't speak for today, but when my mom was alive and on Medicare, MOST of her doctors just took what Medicare paid.

As a Medicare provider they cannot legally accept more than what Medicare pays.
Did you miss the part about he 20% copay? They cannot CHARGE more than Medicare allows, but Medicare pays 80% of most, including wheel chair or other equipment rental.

My mom needed a wheelchair and a hosptial bed. She paid 20% of the rental. Other than her arthritis, she was in good physical health and realized she'd be paying that 20% for quite some time, so we called an asked what it would cost to buy the two pieces of equipment. Allied Health Care Supplies took $500, and she owned them both, and used them both for another 10 years.

John Smith
06-02-2009, 09:38 AM
The only draw back to my new job is health insurance. We're a very small company so no group coverage, only individual policies (paid by the company owner). However, since it is governed by individual policy regulations, NOTHING I'm currently being treated for is covered... neither meds or dr visits. And the deductible is five thousand. My wife can't be covered, period, because of her weight.

I'm over ready for the elimination of private sector health insurance.

I found the most interesting part of "Sicko" to be the speed at which major health insurance horror stories flowed in, and the large number of them that flowed.

And, I remind you the film was NOT about the uninsured, but the insured who where buried by what their insurance didn't cover.

Second part was the lady testifying to Congress that she got paid more if she found ways to deny more claims.

I know I've said this before, but the best way I know to get this changed is to go to www.congress.org (http://www.congress.org) and write your congressperson, your senators, and the president. You can write the letter and send it to them all with one click.

If the American people would get off their butts and take the time to contact their representatives, they might change the course this takes. At least, they'll have greater standing to complain.

Tar Devil
06-02-2009, 09:42 AM
Surely it has to be cheaper than individual policies....


No, it isn't. My brother sells group policies and I asked him about submitting a proposal - he said he couldn't offer a group policy that wasn't significantly higher.

George Roberts
06-02-2009, 01:56 PM
My neighbor tells me that once he turned 65, and came under Medicare, Medicare is his primary, and his other insurance is a secondary, so I don't think it's wrong.

Generally speaking, arthritis, heart problems, and a variety of other illnesses tend to come with age. How many hip or knee replacements do you know of that went to people under 65? so what part of what I posted was wrong.

Also, another fact of life that many seem to forget, is WE, the people pay for healthcare for whomever has it, as a taxpayer or as a consumer. When I was working for the Postal Service, my healthcare premium, employer part, was reflected in the price of a stamp. When I retired, the taxpayer took over my employer part.

Healthcare being a part of doing business, means higher prices for the product/service.

The wrong part was in stating that insurers turn old people over to medicare.

Poor people depend on medicare. People who don't care about their health care depend on medicare.

We have had several friends who have had private insurance in their old age until they died. 24 hour nursing care in their home. 6 figure annual health expense - paid for by insurance. Much better than medicare.

Even I and my wife have $8 million (or is it still $3 million I forget what we decided on) each in health insurance. This year our tax situation changed - we are about $600 better off with health insurance than without.

---

I do agree that there is a life cycle to most health care costs. But a lot of young people have very high costs.

Insurance is about paying someone to assume your risk. All individual policies are based on risk - which adjusts for age.

But too many people want a group policy that treats everyone as if they were about to consume huge amounts of health care.

paladin
06-02-2009, 02:40 PM
George...I gotta tell you....I have 3 bullet holes in my body....another from a big knife...and a poke from a bayonet......NO MILITARY insurance coverage...I carried my own......and in the last 4 years I have gone WAAAAAY past the $3 million mark...the first two weeks after getting rear ended was over 250K at Washingtomn Hospital......then two weeks in an induced coma after the heart attack and heart surgery etc etc......If I had to rely on medicare/medicaid I'd be dead......I have some pills on my desk that are available from one source only....$1000 a dozen...my basic meds are about $800 a month, plus all the associated stuff......and yup...they tried to get me to convert to AARP insurance after taking my premiums for 40 years.

Dan McCosh
06-02-2009, 05:19 PM
"The private companies, in affect, insure people for the part of their lives when most enjoy the best health, then turn them over to Medicare."

That is simply wrong.

It may be wrong, but that is what is happening.

John Smith
06-03-2009, 08:24 AM
The wrong part was in stating that insurers turn old people over to medicare.

Poor people depend on medicare. People who don't care about their health care depend on medicare.

We have had several friends who have had private insurance in their old age until they died. 24 hour nursing care in their home. 6 figure annual health expense - paid for by insurance. Much better than medicare.

Even I and my wife have $8 million (or is it still $3 million I forget what we decided on) each in health insurance. This year our tax situation changed - we are about $600 better off with health insurance than without.

---

I do agree that there is a life cycle to most health care costs. But a lot of young people have very high costs.

Insurance is about paying someone to assume your risk. All individual policies are based on risk - which adjusts for age.

But too many people want a group policy that treats everyone as if they were about to consume huge amounts of health care.
What percentage of people over 65 do you believe are able to afford private insurance? Pretty small number I'd wager.

Most people are in Medicare and if they can, they get a private supplement.

It's not the "poor" who rely on Medicare, it is the wealthy who are able to buy private insurance for all their needs.

John Smith
06-03-2009, 08:33 AM
It may be wrong, but that is what is happening.
It sure is, and Medicare is covering the age group that has the most ailments.

People are living longer, but they are doing so in perfect, or even good, health.

George Roberts
06-03-2009, 09:22 AM
What percentage of people over 65 do you believe are able to afford private insurance? Pretty small number I'd wager.

You are about to confuse several different issues:

How many can afford private health insurance?
How many purchase private health insurance?
How many desire private health insurance?

I can afford it. I have it. I don't want it. (I am in this situation because I am in a better financial situation by buying health insurance even if I never wish to use it.)

But as to your question ...

All the old people I have personal knowledge of have chosen to live modest lives. They all can afford private health insurance. But I suspect most are happy with Medicare.

I should point out that many older people I know or knew chose to give their assets away and let the government provide for their health care.

---

I am not sure of the point of your question. Economics argue that for every person with health care expenses large enough to be a financial burden there must be a large number with only minor health care costs. For any health care program to be viable one needs to have most people have minor lifetime health care costs and only a few with large lifetime health care costs.

John Smith
06-03-2009, 10:44 AM
You are about to confuse several different issues:

How many can afford private health insurance?
How many purchase private health insurance?
How many desire private health insurance?

I can afford it. I have it. I don't want it. (I am in this situation because I am in a better financial situation by buying health insurance even if I never wish to use it.)

But as to your question ...

All the old people I have personal knowledge of have chosen to live modest lives. They all can afford private health insurance. But I suspect most are happy with Medicare.

I should point out that many older people I know or knew chose to give their assets away and let the government provide for their health care.

---

I am not sure of the point of your question. Economics argue that for every person with health care expenses large enough to be a financial burden there must be a large number with only minor health care costs. For any health care program to be viable one needs to have most people have minor lifetime health care costs and only a few with large lifetime health care costs.


My point is simple. From an actuary's point of view, Medicare insures the most expensive sector of our population to insure.

It covers them from 65 until death, and it's pretty obvious that most people get ill before they die, no?

You must lead a very priveleged life. The great bulk of the people in this country, at age 65, cannot afford private insurance on their own. Most people of working age, if they lose their job, cannot afford health insurance.

Obama's plan is to let everyone keep what they have, enter into the Federal employee health benefit plan, which is what congress has (and I have), and add a public insurance (Medicare or similar) the the option list.

Howard Dean was on last night explaining how the private insurance companies are fighting us having this option, because, as he puts it, "It will keep them honest." Not having to make a profit, not having to pay huge CEO salaries, cuts down on overhead, so the public plan can provide more coverage for the same premium dollar.

The fact that the private health insurers don't want me to have this option kind of says it all, no?

How many people, who've used their private health insurance, are happy with it? Every year my premium goes up, and my coverage goes down.

"Sicko" wasn't about the uninsured, but the insured who are being buried by what is not covered, and the various ways the insurance companies try to get out of paying claims.

George Roberts
06-03-2009, 12:34 PM
John Smith ---


You are about to confuse several different issues:

How many can afford private health insurance?
How many purchase private health insurance?
How many desire private health insurance?I
I made a statement that you would confuse several issues. You did.

Despite your claim that the uneducated have worthy views, it appears an education would have benefited you. Perhaps something is economics.

John Smith
06-03-2009, 02:58 PM
The American system is a for profit health care system. It's primary goal is to make money, not provide health care. Health care is a secondary desire.... hence 43 million people without healthcare, and a system ranked 37th in the world, despite the highest per capita health care costs in the world.

True. This stystem stinks.

And, watch how hard it will be to change it.