Whoo Hoo! We should start a fund to be divied between the good guys!

Thanks, this is good news.

Well…..Finally! Maybe Europe telling Obama that they don’t NEED stimuli because THEY already HAVE social programs in place will help this effort.
I can’t bear healthcare being held hostage by the very “people” who’ve made it virtually impossible to get or use once paid for. Icky business, insurance…. like extortion.

A foot in the door is the best we can do, but in the end it’s all we need and the corporatists know it. Once a public option is in place, and is seen to work, it will force the corps to change their business model, which is to kick anyone with a chance of actually having to make a serious claim off their books. That’s a lot of people, and though there’s bucks to be made in picking cherries, there simply aren’t enough cherries out there to keep those big CEO payments coming in.

The long and short of it is that the stock prices are dependent on aintaining the Big Gouge. The corps understand that better than the Sheeple, and they will fight like hell to hold onto the bi gouge.

We don’t need insurance companies calling the shots. They’ve been given many, many years to get it right. They’ve proven nothing except that they need to be eliminated from the equation altogether.

Are you saying that the majority of the majority party actually has power?

That’s crazy talk!

Everybody knows that real power is find in tiny minorities! That’s what Harry Reid keeps telling us, after all.

Jane, this probably does nothing except betray my massive ignorance, but is there any way to do this piecemeal, such as staring with primary care physicians aka internists. As far as I know, they almost always are the gateway to all other physician services. Then you go one by one through the rest of the specialties?

Senator Kennedy! (I assume).

Finally. It’s about time.

Making money on the misery of others is a morally dodgy business, but making money by accentuating their misery is just plain immoral.

I’m not sure what your question is, Boo.

I did find it quite interesting to hear Sebelius, in her confirmation hearing yesterday, unequivocally state that she supports a “public option” alongside any private health care reform. It’s almost as if that’s the administration’s talking point…

W00t – go McDermott/Saunders!

Thanks for the response.

Physicians are vertically integrated by specialty. Start with a single payer plan just for primary care physicians/internists. Then gradually extend single payer to other specialties, obgyn, psychiatry, general surgery, orthopods, eye/ear/nose throat, dermatologists, podiatry, pediatricians, oncologists, ……

I should have mentioned this above, afaik, primary care physicians are the only specialty to so far endorse single payer plan.

I have a friend who has lived in Japan for 34 years, ever since he got out of the USMC. He does kind of keep up with the US via the internet and one thing we have been discussing is the Japan vs US health care systems. Japan wins, hands down. Same as Europe, they have a single payer. Problem with US system is 2 things 1-health insurance companies and 2-big pharma. That is the problem. I have 2 friends who have diabetes real bad. Both have to use a pump to help control problem. 1 has federal health ins(just like I do) his insurance company can not cancel. HOWEVER, the federal system has lots of people so can spread around risk. Other friend does not have any insurance any more. As soon as he was notified that he had diabetes his insurance dropped him. Possible solution. Allow everyone into the federal HI system. Every Nov I get open season where I can select which insurance I want. I have a PPO type of insurance, I also have never had any problems with my insurance. Laws that allow insurance companies to drop you when you get sick should be forced to keep that person. Our health insurance system is geared towards the insurance companies and big pharma, both for profit organs. All I know is that people die and are burdened with bills they can never pay due to our current system.

OT, did I miss mention in here of what I heard on the BBC, that Chris Dodd is trying to open travel to and from Cuba?
http://news.yahoo.com/s/nm/200…..a_travel_1

There are plenty of models for health care financing that don’t involve our parasitic private insurers. The UK handles it in their government budgeting process, financing the National Health Service. France uses a public/private partnership, essentially making private insurers a publicly regulated utility. In essence, each resident gets a voucher that entitles her to ‘purchase’ health insurance from her preferred provider. Germany tried to partially privatize their system, and seems to be having serious indigestion.

The problem with privatizing without serious regulation (involving defining coverage and capping profits) is adverse selection, also called ‘cherry picking.’ A private insurer does not want to cover someone with a serious chronic condition (e.g., lupus erythematosa, myesthenia gravis, multiple sclerosis, and the list goes on) nor do they want to cover someone at increased risk of serious health problems (e.g., cancer survivors). The reason they don’t want to cover them is simple: profit. To avoid insuring them, the insurance companies set their individual policy rates at astronomical levels, or (if they can) just refuse to cover their condition. It does a lot of good for someone with MS to be told, “Yeah, we’ll cover you for anything unrelated to your pre-existing condition,” when most of their medical problems are related to their condition.

Sometimes a system is so broken that fixing it involves demolition. I’m reading James McPherson’s Battle Cry of Freedom right now. Slavery had so corrupted our body politic that the American Civil War was the only way to settle the issue. I’m wondering now if our health care finance system hasn’t become so corrupt that the only way to fix it is to demolish the existing system and start afresh.

Note that if we do begin anew, things will change. We should focus on preventive care (vaccination, dietary improvement, prenatal care etc) and less on curative measures. Some people won’t like this — there will be a reduction in the number of organ transplants as one consequence. But we won’t have medical indigents, either.

So I guess my answer to your question (not that you asked me) is, no, this doesn’t appear to me to be something that can phased in slowly.

Of course, for this plan to work the centrists have to actually want something to pass in the first place. Generally they stand for nothing so much as maintaining their status as Very Serious Fiscally Responsible Centrist Grownups, so what do they care if a piece of health care legislation fails?

Thanks.

i don’t understand why we’re not fighting for single payer (with the understanding that we are always willing to negotiate). pre-compromising hasn’t worked very well so far (see stimulus bill) and our current situation makes single payer a big winner with the public:

1) right now we just don’t have something like $400 billion/yr to payoff big corporations (primarily big insurance and big pharma).

2) we need the social safety net for perilous economic times.

last week bernie sanders introduced s.703, for single-payer health reform. (more at oxdown)

From the PNHP press release:

Single-payer health reform bill introduced in Senate
Would save $400 billion on bureaucracy, enough to cover all 46 million uninsured Americans

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

i called kennedy’s office and was told (didn’t even have to ask) that they are getting a lot of calls in favor of single payer and are counting calls.

Physicians are vertically integrated by specialty. Start with a single payer plan just for primary care physicians/internists. Then gradually extend single payer to other specialties, obgyn, psychiatry, general surgery, orthopods, eye/ear/nose throat, dermatologists, podiatry, pediatricians, oncologists, ……

Primary care specialities are usually defined as internal medicine (general, not subspecialties), pediatrics, family practice and ob/gyn. But so much of our health care money that is being spent on care goes to secondary and tertiary specialists that we can’t go piecemeal.

In a sense, HMOs do this now: your primary care provider controls your access to specialists. I know some primary care physicians who hate this, they say it turns them into goalkeepers. It’s their job to kick you out of their office and back onto the field of play. Seeing your job that way isn’t a pleasant thing, but that’s how primary care types are rewarded. The HMO looks at their ‘utilization pattern,’ and rewards those who underuse specialists and penalizes those who overuse specialists.

It’s a bastard system, but it’s the one we have.

wOOt … let’s keep calling, folks !

“i called kennedy’s office and was told (didn’t even have to ask) that they are getting a lot of calls in favor of single payer and are counting calls.”

You’re lucky. One of my senators (DiFi) can’t count…well, except for all that campaign contribution and lobbying money, of course.)

for those interested
Dean Baker: Is Another Economic Order Possible?
is upstairs on GRITtv

The only thing that worries me about going single-payer are the inevitable lawsuits from the insurance industry. They’ll claim it amounts to public taking of their ‘private’ property rights.

To that, I can only give the divine Miss M’s answer: “Yeah? What’s it to ya?” Unfortunately I doubt the courts would be willing give that answer, no matter how well-deserved it might be.

One leg of this healthcare caucus, I would hope, should be to demand that all Congresspersons lose their healthcare until/unless ALL Americans, no exceptions, get healthcare just as good.

It (the healthcare system the Congress awards itself) could be used as a very big, embarrassing bludgeon with which to turn the public against any self-serving Congressperson who thinks THEY deserve the best healthcare but no one else does.

i will keep calling. we have an opening now:

AIG was bad enough – no more bailouts of insurance companies.

No company has any “rights” to me in any way. They have no “rights” to be the arbiters of my health, my life, or my death. They have no “rights” to anything about me.

serious question: what is medicare then?

another serious question: would the lawsuits cost more than a couple hundred billion dollars a year? because if not, we’re still ahead.

another serious question: do you really think the industry that’s getting bailed out with taxpayer $$$ (see AIG) is going to sue us over takings?

since you really know this stuff, i hope you will educate the rest of us on these and related issues. thanks!

Question:

Is there any valid reason we can’t have Federal “insurance” that has open enrollment, anyone can sign up, covers the same stuff that Medicare/Medicaid does, and you just pay your premium to the Gov’t (sort of like we do with SCHIP, but make it available to everyone)?

It seems to me that if we did this, and calculated premiums based on covering everyone, we would have a significant reduction in premiums even if we brought in people already enrolled in programs like Medicare/Medicaid at their current costs. It wouldn’t directly eliminate any insurer, it would simply get the government into the competition without the need to make a profit.

Am I seeing this too simplistically?

re difi: my condolences.

why should people even need to enroll? medicare for all.

Going after the immoral “for profit” premise of current American health insurance practices is square one.

Must be square one.

Creation of pilot American Universal Single Payer Secure HealthCare Plan which would be geared to cover bottom 100 million by income/no income Americans would take that current black hole head on.

Beyond this taking place then move upwards in 50 million increments– defined by income–until all Americans have access to AUSPSHC.

Those Americans who opt to not use it or want and can pay for Mercedes Benz/Lexus private healthcare plans can still do so. Those of us who cannot afford several hundred to low thousands monthly healthcare insurance premiums of current system at least can reach first rungs of practical American healthcare outcomes.

I just had some basic tests run and basic doctor visits in follow up and the bill for this was well over $800.00. This was just for basics. Without health insurance this creates a terrible financial load. It is incredibly 19th century in scheme to base American healtcare outcomes on “for profit” premise and “for profit” gatekeeper can or can not have adequate healthcare at peril of financial severe hardship or ruination.

WashingtonDC needs to be pushed and pushed hard to change this for the better. If politicians will not do it then it is time to take away all the benefits they have heaped on themselves.

If low income Americans have to suffer this outrage then WashingtonDC politicians should then as well.

Fix it. Fix it now. The Blue Dogs can go to hell!! Bastards!!

So, what do I think would work? I think we should split the nation up regionally. Some States (California, New York) are large enough to run their very own regional health care systems. Others (New Mexico, the Dakotas, Wyoming and Montana come to mind immediately) will need to be pooled into regions.

Texas is our national laboratory for bad public policy, so I don’t know what to do about it. I don’t trust Texas to make it work, but its so damned big that it would force its solution on anyone it was folded into.

Anyway, each region has its own health care authority that is responsible for administering the single payer system under broad Federal guidelines. Medicare and Medicaid get folded into the Regional Authorities expeditiously. CMS (Center for Medicare and Medicaid Services) becomes a general system monitor. Maybe that’s what we do with Texas, is hand them over to CMS as a demonstration project…

At least we’ve got Boxer. 50% is better than nothing. As for my congressman? A complete idiot, dumber than he is corrupt – or is it the other way around? Calvert of the 44th.

http://en.wikipedia.org/wiki/Ken_Calvert

I agree that that would be ideal, but I’m saying make it optional to use the government’s program (takes away the “government dictates which doctor” nonsense, as well as the argument that you’re forcing people to participate). That leaves the current insurer’s in the game if they wish (they’ll probably opt out, but leave the door open).

What gets me is that we ALL have health that needs care.

And preventative maintenance saves lives and money.

Gee the free competition folks don’t want to compete with the government. I thought free enterprise could do everything cheaper.

thanks for the link to today’s democracy now! they’ve been doing an excellent job of covering the single payer debate (and also the non-debate)

“Put Single-Payer on the Table”

Newly Formed 150,000-Strong Nurses’ Union Pushes for Single-Payer Healthcare

IIRC, Medicare plan billing/payment is divided up regionally, with “Medicare Central” (HCFA? CMS?) soliciting bids for the subcontrator who can process claims for the lowest cost.

For example, CA’s in the Medicare region where the contract plan’s administrator is (I think) Transamerica…

The regional model you describe sounds consistent with (IIRC) Medicare’s current practices.

serious question: what is medicare then?

Medicare has become a hybrid public/private system. Many Medicare recipients (my parents are among them) receive their care through a private insurer who receives a capitated payment from CMS. Often the recipients pay an additional premium for the coverage.

Back in the old days (my grandmother’s time) Medicare was a straight government program. Ronnie Raygun ruined that for us.

Medicaid is also a hybridized program. Here in New Mexico the Department of Human Services contracts with three insurers to provide Medicaid coverage for eligible citizens. The choice is up to the insured’s guardian in most cases (Medicaid is mostly kids, remember) and there is significant competition in our major markets.

So I’m not the least bit sure how Medicare will play out in the lawsuits.

another serious question: would the lawsuits cost more than a couple hundred billion dollars a year? because if not, we’re still ahead.

I’m not concerned about the cost of the lawsuits as much as the delay and FUD (Fear, Uncertainty and Doubt) they would put on the implementation process.

another serious question: do you really think the industry that’s getting bailed out with taxpayer $$$ (see AIG) is going to sue us over takings?

Yep. I do. We’re talking about divvying up 10%+ of GDP and the insurance companies are not going to let go of that tit easily.

since you really know this stuff, i hope you will educate the rest of us on these and related issues. thanks!

I hope this helps.

there are currently three single payer bills in congress. h.r.676 has been the standard we’ve been organizing around for years – do you, or anyone else here, have any analysis on the differences between the three? (s.703 and h.r.1200 as well as h.r.767).

would love to see some oxdown diaries (hint, hint *g*)

And you’re suprised by this exactly why, Mike?

Since the late 19th Century these people have been about privatizing profits and socializing costs. See (for example) Barons, Robber (Railroad).

In case you haven’t noticed I tend to be very facetious.

Sigh. I’ve done bill analysis before, and Mrs Dr CounterTenor is away visiting family. Let me see how big the damned things are.

oh shoot. really hate to miss this discussion, but must go. usda is here to take down my asian longhorned beetle infested maple tree :(

back later to read comments.

Three words: Universal Health Care.

(((selise))) (((maple tree)))

Yeah. I knew you had sarcasm mode on. I should have marked my first smart-ass remark “Tongue firmly planted in cheek.” I was just trying to expand on the history a bit.

Doctors have to stop covering up their mistakes.
And hospitals need to -literally- clean up their acts. No excuse for the horrid rate of hospital acquired infections.

I have no sympathy for doctors in regard to malpractice suits, they don’t police their own.

Here in CO we have the first bill before the state legislature (HB1273)the Colorado Guaranteed Health Care Act that is the start up for single payer. It goes to appropriations committee on Friday. Wish us luck.

You learn something new every day.

I do not know the Medicare financing system as well as I ought to. I was mostly working in the Medicaid side of the system when I was on sabbatical.

So there is infrastructure already present for a regional model. That makes it that much more appealing.

Thanks, Kirk.

LUCK

If you ever understand Medicare, please let me know. I am in Medicare and it’s explanations of things might as well be written some language from outer space.

Germany tried to partially privatize their system, and seems to be having serious indigestion.

What do you refer to with “privatize”?
The “indigestion” is caused by a) the demographic trend (shrinking and aging population) ans b) a certain unstructured bloat of the system.
Remember that the present German health care system is 126 years old, and has grown into a quite byzantine scheme since 1883…

There is a white-coat line that acts to protect physicians.

On the other hand, we have also reached a level of expectation that is unreasonable. Mistakes happen, and people should be compensated when they are the victims of a medical error. But it shouldn’t be a windfall, either. The adversarial system really doesn’t work for us in this regard.

Take vaccination as an example. Some people are going to have adverse reaction to vaccines. They should be compensated for their injury. However, getting them vaccinated is in our joint interest, because of herd immunity effects. Adversarial systems reward these unfortunates with damages often beyond their loss. (I’m not talking about someone paralyzed by the Sabin polio vaccine, or someone whose child died from an anaphylactic reaction here.)

On our part, we need to use the safest effective vaccines. On that basis, we’d not use the Sabin live-virus polio vaccine, because it is extremely dangerous to immune-compromised adults and polio-naive adults. The Salk (killed virus) vaccine is safe and effective, although it will require periodic boosters. Yeah, it’s another shot. BFD.

We have just gotten through eight years of a deliberate attempt to FU everything that the government does.

awesome – thank you! pnhp may be of use to you.

you make good points.

All I know is what I read in the papers … I haven’t seen a comprehensive analysis of the German situation. I read that Schroeder privatized some components of the German system, and I’ve heard complaints from friends who are in the German system.

I personally think hybridized systems run a serious risk of giving us the worst of both worlds, and so I don’t like them. That opinion shaded my interpretation of the complaints I’ve heard.

A 126 year old Byzantine system could definitely cause folks to have high frustration levels.

I agree that some awards are way excessive but there are situations where doctors or hospitals have a history of sloppiness. In these situations the awards should also be punitive.

The New York Times says that “the serious negotiations are being conducted in a secretive process” and no doubt the situation is in flux. Health care lobbyists are discussing a compromise whereby a public plan would be created “only if certain conditions were met — if, for example, private insurers failed to rein in health costs by a certain amount after several years. Such a condition would serve as a strong incentive for insurers to ratchet down payments to doctors and hospitals.”

Although this is largely information free, it suggests that what’s being discussed in a Cheney-like confab is pig lipstick.

I wish you great luck. Please keep us posted on how it goes, will you?

thanks. tree is gone now – they started without me and are moving fast (wasn’t actually the usda, who had been here twice already. was a contractor this time). extra sad because the 2 oak trees were severely damaged in dec’s ice storm (they are what made the hole in my roof) and may not survive. my very tiny yard may go from mostly shade to full sun.

but at least now that all the infested trees have been removed from the area, there is a chance i hope for the uninfested host trees to remain unaffected. we are v close to ground zero for this outbreak.

Nope, nope, nope.

I said the “Medicare financing system”, not Medicare itself. Understanding Medicare requires that you understand which version of Medicare you’re under, first.

But, surveys have shown there is one group of Americans who are basically happy with their health care.

You know who they are? Nope, not Congress. Not Federal employees. Medicare recipients, that’s who.

It is going to be a long day. The committee meets after the legislature adjourns for the day whenever that might be.

I personally think hybridized systems run a serious risk of giving us the worst of both worlds, and so I don’t like them.

my bias is for a system that is shared by all – because then i’d think people’s interests are likely to align to improve the system.

I have a problem with punitive awards. They rarely actually fix anything, and they enhance the windfall effect.

Put out a court order to fix it or be closed down. Notify the Joint Commission about the problem, and tell them to fix it.

As far as individual physicians go, it’s better to get them into a safer practice than to fine them into submission.

JMO, of course.

So is mine, selise, so is mine.

Sorry, misunderstood. Yes, I am happy with Medicare but am always puzzled about how it really works. I rarely ever pay anything.

that’s one of the reasons i’m not so comfortable with the “public option” – where will the interests be in making it run well?

anyway, am very interested in your analysis for the various bills. here in MA we’ve gone through a big reform and i’d hate to see our mistakes go national.

No, Schröder didn’t privatized parts of the system. The law of 2004 created or increased co-pays and reduced coverage in some areas, but it didn’t privatized any part of the system.

If you classify the German Bismarck model as a “hybrid system” (i.e. not-for-profit, universally accessible, but non-government multi payer offering the same coverage), I would tend to think that it actually combines advantages of both systems.

good luck!

Selise, I have read that Ma had some problems. Could you tell me what they are. Am trying to understand all
the stuff we need to avoid nationally. thanks

i should have written at least one diary on the subject by now. my apologies. there are two reports i’ll suggest to you (and if i can get my act together, i’ll write a diary on it – but must run now).

Massachusetts’ plan is the wrong model for the U.S. (scroll down for the link to the report pdf)

Patients’ Experiences Under Massachusetts Health Care Reform

Thanks so much.

Thanks for your info, BC! You learn me. I’m sorry to hear the privateers hybridizers pushed their way into NM’s system. Kinda like killer bees.

I’m still quite optimistic the privateers can be pruned out of Medicare: they’re the low-hanging rot.

They’ve done a good job of hiding, partly ’cause Medicare’s so tangled:

1) The orignal parts of Medicare were

Part A: hospital costs

Part B: Doctors, labs, and medical devices costs

Neither Part A nor Part B pays for all of a covered person’s medical costs. The program contains premiums, deductibles and coinsurance, which the covered individual must pay out-of-pocket. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.

2) So, people bought “Medigap” supplemental insurance. The Medigap plans covered the deductibles and out-of pocket costs (except, of course, for the individual patient’s premium for Part A and Part B). Traditional Medigap plans were highly regulated products that provided seniors with a set of increasingly costly options (A through L) for which services at every level were specified by Federal regulation. The insurers basically could only compete on price, IIRC.

Seniors with Medicare Part A and Part B as well as Medigap have portable health care (they can carry around their care to any doc who accepts Medicare), rather than being trapped in an HMO. The simple fact of this freedom wholly refutes the propaganda that Federally funded and regulated health insurance prevents patients from choosing their doctors.

The plans that actually restrict patients’ choice of doctors are the for-profit health insurers’ “Medicare HMO’s” – which come out of Medicare Plan C.

3) Because making more money than God still wasn’t enough for the “health” insurance ghouls, they bribed their obedient servants in Congress and the Executive Branch to create Medicare Part C, which is basically a far more expensive form of the old highly regulated “Medigap” insurance.

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans.

These Medicare C plans are also commonly called “Medicare HMO’s”: they are the hybrids that capture the individual patients who “sign over” the Medicare Plan A and B benefits to the HMO, which then restricts the patient to care within the HMO cage. [Just to make things confusing, some of the Medicare Part C private plans are “fee for service”, which means seniors with these plans can go to any Meidcare accepting doc they choose.]

Medicare Part C is more expensive for patients because Part C is – you guessed it – less regulated than the traditional Medigap plans! Who could have anticipated?

The private plans are required to offer a benefit “package” that is at least as good as Medicare’s and cover everything Medicare covers, but they do not have to cover every benefit in the same way. Plans that pay less than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits. Private plans use some of the excess payments they receive from the government for each enrollee to offer supplemental benefits. Some plans put a limit on their members’ annual out-of-pocket spending on medical care, providing some insurance against catastrophic costs over $5,000, for example. But many plans use the excess subsidies to offer dental coverage and other services not covered by Medicare and can leave members exposed to high medical bills if they fall seriously ill. Private plan members can end up with unexpectedly high out-of-pocket costs.

4) Medicare Part C is more expensive for the Medicare system (that’s us taxpayers) than were the traditional “Medigap” plans because the “Medicare Advantage” plans siphon Medicare funds out of patient care and into the health insurance megacorps. Yep. Medicare Advantage contains massive subsidies to the insurance serial killers.

In a truly bipartisan show of corporatist bribery, the serial killers known as “health” insurers went back six years later to write themselves a better deal:

Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans.

Medicare Advantage plans simply offer the Medicare HMO crooks another bite of the Treasury. The MA plans give Federal subsidies to the megacorps for doing what they already did quite profitably: sell Medicare C plans (Medicare HMO’s).

In 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.

Because the insurance co’s with billion dollar CEO salaries werent doing well enough already, don’cha know.

5) Medicare Part D – the prescription drug plan – siphons off Medicare funds (that’s our taxpayer dollars) to subsidize BigPharma and, or course, the “health” insurance serial killers. The subsidies come chiefly through forbidding competitive bidding. Because that’s how free markets work, right?

6) Medicare and Medicaid (bare-bones Federal health coverage for the disabled or very poor) payments come from the Medicare Trust Fund: this is the big Federal “entitlement” program at risk of near-term insolvency. (not, of course, Social Security, the shiny object with the trillion dollar prize for Wall Street).

The Medicare Trust Fund was already headed for insolvency, but the Medicare Advantage subsidy scam and the Part D subsidy scam greatly accelerated the Trust Fund’s “burn rate”. The quickest way to free up funds for national health coverage is to take the subsidies for “health” insurance megacorps and Pig Pharma out of Medicare.

7) That’s why I believe the corporate subsidy rot will be cut out of Medicare. We simply can’t afford not to, no matter how much the White House and Congress love their bribes support.

Kirk,

Thanks very much. That’s the best succinct summary of Medicare I’ve ever read.

My parents are in a Medicare C program (Kaiser, in California), and they’re quite happy with it. But they were in Kaiser while Dad was teaching, so it was really no change for them.

Thanks for your info, BC! You learn me. I’m sorry to hear the privateers hybridizers pushed their way into NM’s system. Kinda like killer bees.

Actually, the hybridizers privateers haven’t been all that bad for us, so far. Guiding people through the maze of conventional health insurance can be a daunting task. By allowing BC/BS, Molina and Presbyterian to run the benefits side we were able to reduce per capita costs, extend coverage, and have the first tier of the guidance system put out to the providers. State government still has to handle the appeals and other second-tier support services, but as far as deals with the devil go, this one’s been beneficial.

The tragedy of the commons?

One thing that people are not paying attention to is that single-payer on whatever model is going to bring serious changes in the way we manage health care. I the changes will be beneficial overall and long past due, but people who want to stay hooked to life support indefinitely won’t like them at all.

just want to add my thanks to BC’s. that’s a great summary (should really be a post or at least a diary – hint hint)

Thanks, BC. I’m glad your parents are happy with their care, and I hope it works great for them. I’m also glad to read of the results with the hybridization.

I’m not so glad about my Wiki references re the cost of the Medicare Advatage subsidies to health insurers. Here’s a more detailed Wiki summary (obviously not written by patient advocates – the “advantages” in the bullet points are all about restricting choices/services for seniors!)

Changes to plans

When the Medicare + Choice option was first offered, plans were established by several major health care insurers including Humana, Aetna, and the Blue Cross/Blue Shield plans. These plans were organized along traditional HMO (Health Maintenance Organization) business plans, but patients could freely switch back to traditional Medicare insurance. Some felt that these plans lacked the ability to truly manage care,[7] and some plans did cut back their service areas and stopped enrolling new patients.[8][9]

With the MMA, new Medicare Advantage plans were established with several advantages over the previous Medicare + Choice plans:

* enrollees sign on for a whole year
* care can be restricted to networks of providers
* formularies can be used to restrict prescription drug choices
* prescription coverage can be deferred to the patient or a Medicare Part D prescription plan
* care other than emergency care can be restricted to a particular region
* federal reimbursement can be adjusted according to the health risk of the enrollees

The attraction for health insurers is the large difference between normal healthcare premiums and the federal Medicare premium. Typical health insurance premiums (for someone working or healthy enough to be allowed to enroll) are generally $150 to $350 a month, depending on the level of service desired, health status, and deductibles. For a healthy Medicare-eligible enrollee, the health insurer can receive around $800 a month, more than double the premium for younger citizens. The federal government pays the Medicare Advantage plan more to cover the care of a Medicare patient than the federal government pays through the regular Medicare plan.

i’d like to think there are more people who’s want access to health care while it can really help than who want to stay hooked on life support when it can’t. but with so much of this debate being intentionally hidden from the public, it’s really hard to have those kinds of conversations.

re: hidden, see this post at the agonist, it’s just the most recent in a long line of similar examples.

How will the White House make amends for censoring single payer in its Iowa health care forum “live blog” transcript?

Thanks, selise – and thanks for your tireless focus on this issue and the work you do to keep us all informed.

(as for a post, I think this may be too long and wonky even for my posts.. *g*)

Oh crap – forgot the architecture behind the con. Broadly speaking, Medicare Plan D is a presciption for passing Treasury subsidies to a cartel immune from competition by Federal law.

Sound familiar?

Let’s go back to the simple world of Medicare Parts A/B and Medigap. Medigap plans were allowed to offer prescription drug insurance. Some of the higher tier plans did. We’ll call it “drug coverage”. Medigap plans within a given tier could (IIRC) even compete with one another by offering “better” drug coverage.

The drug coverage “traditional” Medigap plans offered to seniors definitely competed for their premium dollars with the new “Part D” drug coverage insurance plans. In other words, these are simply two different insurance products competing in the market place for seniors’ “drug coverage” premium dollars.

Horrors!

To prevent this outbreak of free market subversion, thisk (the “health” insurance serial killers)’ well-paid servants in Congress and the Bushie Admin whacked the competition for new Part D enrolees. Medigap plans were forbidden to compete for new enrollees by offering drug coverage.

Some Medigap policies sold before January 1, 2006 may include prescription drug coverage, but after that date no new Medigap policies could be sold with drug coverage. This time frame coincides with the introduction of the Medicare Part D benefit.

Medicare beneficiaries who enroll in a Standalone Part D plan may not retain the drug coverage portion of their Medigap policy.

Seniors already enrolled in Medigap with drug coverage could keep it…but they were threatened with a penalty if they ever had to leave their pre-existing Medigap plans and use Part D…

The vast majority of Medicare beneficiaries who hold a Medigap policy with drug coverage and then enroll in a Part D Plan after May 15, 2006 will have to pay a late enrollment penalty.

Yep.

The initial enrollment period took place from November 15, 2005 through May 15, 2006. Potential beneficiaries who did not enroll by the May 15 deadline (or within a given time frame after their initial eligibility date) incurred a late-enrollment penalty of 1% per month based on the average cost of the premium until their enrollment.

Buy now or else.

Seniors already content with their Medigap drug coverage who had the nerve to keep using it after the Part D subsidy train came on the market in 2006 yet later must switch to Part D get mandatory “late fees”.

In the run-up to the May 2006 deadline, thisk used saturation advertising to frighten seniors into dropping their often superior Medigap drug coverage (and sometimes plans) and switching over to Part D.

Thisk’s fear campaign also predictably and sucessfully frightened seniors who didn’t understand the whole mess into dropping “free-choice” Medigap for inferior (yet more profitable to thisk) “Medicare Advantage” simply because many seniors thought that was the only way to avoid the “late enrollment penalty”. No wonder: that’s exactly the product thisk’s scare campaign was selling.

Ain’t crony capitalism grand?

bonus question: How – in one generation – did a nation that spent trillions threatening to blow up the world to “defend free markets” become a nation that willingly gives away trillions to subsidize suited gangsters?

certainly not too long for a diary?

p.s. thanks to you too.

re bonus question. my answer: because the reasons were always the same, it was the justifications that changed.

Jane wrote:

… a compromise whereby a public plan would be created “only if certain conditions were met — if, for example, private insurers failed to rein in health costs by a certain amount after several years.

Bah! That’s just a way to kick it down the road. Justice delayed is no justice and all that.
Hasn’t the health care industry already shown it’s interest in public service by pushing their prices for decades? In a more savage country they’d have already been chained up and beaten.

There appear to be several plans or at least politicians who might produce plans and Sen. Sanders is the first to put one out (showing it doesn’t actually take forever to do it) using a structure others might want to follow. Plans structured similarly are easier to compare & contrast. Which might be the first of those to gain a sufficient majority is anybody’s guess.

As soon as he was notified that he had diabetes his insurance dropped him. Possible solution. … Laws that allow insurance companies to drop you when you get sick should be forced to keep that person.

So, the insurance company has to return his premiums, right? NO? Why not? He didn’t just pay for nothing, did he?

Paying for no return is like dealing with Bernie Madoff.

the inevitable lawsuits from the insurance industry. They’ll claim it amounts to public taking of their ‘private’ property rights

Who gave them the education, training and license to be in the business? If they don’t like our terms, then maybe they should hand back their license(s).

We’re talking about divvying up 10%+ of GDP and the [ health ] insurance companies are not going to let go of that tit easily.

As I understand it the entire healthcare industry is about 16% of GDP, so a program for those without insurance (or even if you wrapped in Medicaid, SCHIP and Medicare) would still probably be no more than 6-8%.

Hopefully new regulations and restrictions will save money too.

I feel awful about calling for so many new regulations on banking and health care, but I didn’t really realize how far Repubs had gone (with some help from Clinton) to deregulate.

I am in Medicare and it’s explanations of things might as well be written some language from outer space.

Intersting. I mostly hear people exclaim it’s goodness. Are you saying it’s more likely we need a simpler system we can wrap Medicare into?

I said the “Medicare financing system”, not Medicare itself.

Oooooh, I see.

Of course, it could be possible the users of Medicare have no complaints because they don’t see the dollars coming out of their own pockets and it seems as close to free as can be.

Questions about it’s performance would probably only be heard in Congress.
How well does it in fact work? I know a lot of doctors are now refusing it.

The subsidies [ for Medicare Part D ] come chiefly through forbidding competitive bidding. Because that’s how free markets work, right?

Bizarre!

bonus question: How – in one generation – did a nation that spent trillions threatening to blow up the world to “defend free markets” become a nation that willingly gives away trillions to subsidize suited gangsters?

Wait, I’m confused. Are you talking about health care insurance providers, bankers or oil companies? It’s so hard to keep up these days.

Health care in the US is running around 15% of GDP currently, and the fraction of GDP has been increasing rapidly. The current rate of increase is obviously not sustainable.

Profit and costs for the insurance companies currently run in the neighborhood of 20% of premiums. (That figure is not based on insurers reports, they regard that information as highly proprietary and don’t share it with anyone that I know of, and certainly not with me. The figure comes from legislation in several states that require health insurers to pay out at least 100f% of their premium income in benefits. Here in New Mexico, f was .8, I’ve seen other State’s figures in that neighborhood. The insurance companies haven’t screamed bloody murder about the requirement, and from that I infer that their processing costs/profits can’t run higher than 20%.

There are some difficult to quantify savings to be made by decreasing the number of medically indigent residents. But I can’t see any realistic circumstances that can reduce total health care expenditures by 1/3 in the short run. So in my view, we are talking about a share of 12-13% of GDP, and the folks who run DenialCare (thanks Tom Batiuk for that name) aren’t going to let go of that very easily.

Yeah, all those parasites like my parents who paid Medicare taxes for 35+ years of their working life. I’ve paid Medicare taxes in every paycheck I’ve received for the last 37 years. You think maybe those parasites have already paid for their health care? And they’re still paying for a share of it with co-pays and premiums for their Medigap or Medicare-C coverage? You think maybe that when I reach 65 I’ve paid something into the system for my health care?

What’s happening for people eligible for Medicare is that health care finance works for them the way it ought to work for everybody. Suppose you’re uninsured and you go into the ER with a back injury, and they tell you, “Gee, we don’t know, the X-rays don’t show anything, but given your array of symptoms you really need to see a neurologist. Tomorrow, honestly. See a neurologist, for sure.” That shouldn’t cause you to ask, “Gee, do I starve myself and the kids for the next three weeks so I can see a neurologist, or do I just ignore the advice?” In a reasonable system, you go see the goddamned neurologist.