Archive for Saturday, October 3, 2009

Health care reform could change Medicare in many ways

October 3, 2009


— Businessman Stewart Grill, 75, believes there’s waste in Medicare. He’s just skeptical Congress can find and eliminate it without touching what he likes about his government health care plan.

“The talk of potential savings is a little beyond comprehension,” Grill said. “Why hasn’t it been saved before? It’s virtually impossible to save $500 billion and not do any cutting of benefits.”

The congressional plans for health care overhaul could mean a major restructuring of Medicare. Dozens of changes are being proposed in hopes of transforming the program from one that rewards doctors for each procedure they do into one that improves people’s health and keeps them out of the hospital.

The changes should save money. What many seniors, including Grill, want to know is this: Can lawmakers pull this off without cutting benefits?

Like most seniors, Grill has his Medicare premium deducted from his Social Security check. He sees it as a good deal, but he’s worried about Medicare’s future.

A lifelong independent politically, Grill said he knows that slowing the rate of growth in Medicare can keep it solvent longer. He thinks that’s good for him, and good for his children and grandchildren.

“The figures are so large and so hard to comprehend,” Grill said. “The biggest overall problem I see is nobody wants their own ox gored.”

Here’s a look at the proposals and how they might affect him and other seniors:

• Medicare Advantage

More than 10 million seniors — nearly 1 in 4 — are covered by Medicare Advantage, an alternative that pays for-profit insurance companies to run their own versions of the government program. But the government is spending 14 percent more per patient in Medicare Advantage, so Congress wants to cut some of that — up to

$160 billion over 10 years.

That means seniors covered by the plans may lose extra benefits like hearing aids and health club memberships. Some commercial insurers may pull out of Medicare Advantage, forcing some seniors to switch plans.

“There’s no way to sugarcoat it and say there’s no harm here,” said Dr. Robert Berenson, a Medicare official during the Clinton administration and a senior fellow at the Urban Institute.

• Preventing illness

Free preventive services would be more common in Medicare under the congressional plans. Medicare would pay 100 percent for mammograms, diabetes classes and other preventive services. The Senate bill would include a free annual wellness exam too.

“It starts to change the nature of the relationship from one where you go to the doctor when you’re feeling sick to one that’s more focused on proactive prevention,” said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease.

Paying doctors fairly sharpens the focus on prevention. Democrats in the House and Senate want to delay scheduled decreases in doctors’ fees and provide bonus payments that would make it more lucrative to see Medicare patients.

• Staying out of the hospital

Nearly one in five Medicare patients lands back in the hospital within a month of getting out, costing billions annually.

To attack the problem, social workers in Chicago telephone patients after they leave Rush University Medical Center. The social workers find out what patients need to avoid repeat hospital trips. They help arrange rides to doctors and make sure seniors can afford their medicine.

“It can be one call or 30 calls,” said Robyn Golden, who directs the hospital’s older adult programs. “We call the providers to make sure they’re following through when the patient says they’re not.”

Congress wants more hospitals to think like this.

• Coordinating care

A recent study found the typical primary care doctor must coordinate their Medicare patients’ care with hundreds of other doctors. But rarely does any one doctor take charge of one patient’s care from start to finish of a health problem.

“As it is now, the doctor asks the patient, ‘What did the specialist say?’” said Joseph Baker of the nonprofit Medicare Rights Center.

Proposals in the House and Senate would set up pilot programs to better coordinate care with the goals of saving money and improving quality.

• Filling prescription drug gap

When Congress created the Medicare drug program it left a coverage gap called the “doughnut hole.” More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

Drug companies have promised a 50 percent discount on brand-name prescriptions for people in the doughnut hole. House Democrats want to eliminate the gap entirely by 2023.


Richard Heckler 8 years, 5 months ago

Seniors and Veterans would be far better off under the new Medicare Insurance for All HR 676.

If one would remove: elected officials as shareholders special interest campaign funding the insurance industry recklessly spending health care dollars to bribe votes the news media offering misinformation ( their large advertising revenue is at stake)

The nations consumers could have excellent medicare insurance for all.

Remember it is the most expensive medical insurance in the world that denies care and/or cancels coverage after taking ones money for years and years. Medicare Insurance for All would not allow such arrogance.

Richard Heckler 8 years, 5 months ago

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Medicare Insurance for ALL (HR 676)

Doctors for Single Payer(HR 676)

Unions for HR 676

Organizations and Government Bodies Endorsing HR 676

Health Care In the USA

Consumer Reports On Health Care

National Health Insurance does not remove competition from the actual health care industry. It will be alive and well. Profits will be based on customer service and clinic performance based on the clients experience. This is my perception of competition.

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