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Old Yesterday, 05:10 PM
 
Location: Ohio
20,097 posts, read 14,337,142 times
Reputation: 16277

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Quote:
Originally Posted by RationalExpectations View Post
Medicare spent 3.6% of gross domestic product in 2016, more than six times the share it consumed in 1967, the first full year it was implemented.
You do like your propaganda nonsense.

In a word: "Technology"

If you actually bothered to study the issue instead of perusing asinine websites you'd understand.

Annual healthcare costs are driven by technology (up to 65%) and consumer demand for healthcare (up to 36%).

Source: United States Government General Accounting Office GAO-13-281 PPACA and the Long-Term Fiscal Outlook, January 2013 pp 31-36

That's a fact, Jack.

Quote:
Originally Posted by RationalExpectations View Post
The share of GDP consumed by Medicare will rise to at least 9% within 75 years — and that’s the best-case scenario. Other plausible forecasts show that Medicare could spend more than twice that.
Yes, because of new technology and increased demand for healthcare services.

There is no Economy of Scale in healthcare technology.

Economy of Scale is what allows things to be sold cheaply. A Bentley is expensive because one man builds the car and they don't produce a whole lot of them. On the other hand, Ford mass produces cars on an assembly and can achieve Economy of Scale to sell the cars far cheaper than a Bentley.

Healthcare technology is like a Bentley.

There is no "Medical Best Buy" where you go to a showroom and shop for MRIs or PET scanners or CAT scanners and such and you cannot order them on-line. It's not like you can buy them on Amazon or E-Bay.

MRIs are built to order and assembled by one person or a team of 3-5 people.

If you built MRIs on an assembly line and marketed and sold them to the 127 Million US households you'd have Economy of Scale and they'd only cost about $15,000 instead of $3 Million.

There's only ~5,000 hospitals and not everyone has or wants an MRI and they certainly don't buy one every year for fun.

Quote:
Originally Posted by RationalExpectations View Post
Back in 1967, the average 65-year-old American was expected to live 14.8 more years. In 2016, 65-year-olds live 19.3 more years on average—a roughly 30% jump while the government has not adjusted the age required for benefits.
That's a great example of disinformation.

The author tries to wow people with "30% jump."

Where's the correlation between longevity and Medicare costs?

It's non-existent, which is why they author never mentions it, because it would doom the argument for the agenda he's pushing.

Quote:
Originally Posted by RationalExpectations View Post
The solution is to raise Medicare’s eligibility age incrementally so it once again provides for about 14.8 years of benefits on average.
Another disingenuous claim.

He fails to mention the HI (Medicare) tax rate has only increased 1.1% in 35 years.

That's because he doesn't understand 6th Grade Math. Social Security and Medicare use the same formula:

Revenues = #Workers * Tax Rate * Wages

Like the FICA tax, the HI tax has not been properly adjusted to account for population.

Quote:
Originally Posted by RationalExpectations View Post
Second, there has been a fourfold increase since "the disabled" among working-age adults. We need to restore the original disability standard—which has become lax—so that people qualify for benefits only when they are “unable to work any job in the economy.”
More disinformation. He applies the standard for Supplemental Security Income (SSI) a State program to Social Security Disability, which has a standard of "substantial gainful activity."

The definition is not some nebulous idea that is arbitrarily applied. There is a four-prong test and each prong of the test must be met to qualify.

Additionally, depending on the initial assessment, there's a CDR (Continuing Disability Review). Some people's medical records are reviewed every 18 months, for others it's every 3 years and for others its every 5 years.

In any event, the author has failed or refused to show any correlation between disability and Medicare and those receiving Social Security Disability are not eligible for Medicare until they have received benefits for at least 2 years.

Quote:
Originally Posted by RationalExpectations View Post
Third, we need to raise deductibles and coinsurance premiums. The average beneficiary today consumes six times more medical services than in the previous generation, even without counting the drug benefit introduced in 2006.
Medicare Part D -- the, um, "drug benefit" -- has nothing to do with Medicare Part A.

Medicare Part B has nothing to do with Medicare Part A, either.

Medicare Part A is strictly hospitalization. It does not involve itself with doctor office visits.

The author rails against people on disability, but if people on disability are being hospitalized that suggests they merit disability.


Again, he tries to wow people with "six times more medical services" but shows no evidence that those medical services are being paid through Medicare Part A.
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Old Yesterday, 05:23 PM
 
920 posts, read 538,261 times
Reputation: 3766
For Medicare to be sustainable there will come a point in time when restrictions will have to happen.

For about the past 25 years I have had a front row seat to the amount and type of care your typical Medicare patient receives. With medical advancements life spans have increased, and Medicare has become essentially a healthcare free-for-all.

It's like that game whack-a-mole. Every problem that comes up there is a surgery, procedure, or medicine to "fix" it, and there are no restrictions. Doctors encourage this too even if the patient's quality of life won't improve overall and age has no limits. I have watched my parents and multiple aunts and uncles have hip and knee replacements, heart stents, rotator cuff surgeries, sleep tests, apnea machines, eye lifts (yes, this is a new one Medicare is covering for droopy lids!) and the list goes on and on. My 70 year old uncle's psoriasis meds cost $1500 a month (he of course doesn't pay that). There are no requirements for weight either, even though that poses great complications. My aunt who has advanced COPD (and still chain smokes in between stints on oxygen) shopped around and found a doctor to do total knee replacement. She isn't expected to live for long yet she got her new knee anyway. I can only imagine how much that cost Medicare.

My other aunt was visiting us the other day. She's 83 and has fallen twice by her pool. First time was a broken hip which required a replacement. Second time was her knee. She doesn't do well with anesthesia so surgeries mean extensive rehab. The other day she showed me her hammer toe and related how she wanted to get surgery for that. I asked her does it hurt you to walk? Answer was no, as long as she wore correct shoes she was fine but it bugged her that she couldn't wear certain sandals. Yet she planned on pushing for toe surgery anyway.

My point to all of this is that Medicare was never designed for the times we have today, where expensive medical advancements can prolong life well beyond what it was back in the day. While pondering my own family I did an analysis and figured out that the average take out from Medicare per relative was $900,000 each (when you include all the surgeries and rehab plus meds). There is no way this can continue.
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Old Yesterday, 06:41 PM
 
1,776 posts, read 621,513 times
Reputation: 3315
Quote:
Originally Posted by ocnjgirl View Post
I don’t think Vermont’s a whole lot cheaper!

Edited to add, I think those laws may effect what companies offer health insurance there? I just went back to ehealthinsurance and this time put in the zip code for New Rochelle, NY. I did get cheaper plans, but there was only one company, some insurer called "Oscar". I never heard of that. I have Blue Cross now. Maybe they had to get their own state plan because insurers wanted to be able to raise rates on older people and would rather not even sell there if not?
Yes, New York has always been considered an "unfriendly" state for insurance companies to do business; not just health but other kinds of insurance too. There are requirements and regulations up the wazoo and that does affect the number of companies that choose to sell here.

ehealthinsurance is not showing all of the ACA plans available in NY. I just went to the NY State Plans web site, plugged in a New Rochelle zip code and got plans from three insurers: Oscar, Fidelis Care, and MVP.

Out of curiosity I then plugged in my zip code here on Long Island. The results were Oscar, Fidelis Care, and HealthFirst.

Perhaps the ehealthinsurance web site only shows insurance companies who pay that web site a commission for referrals?

The state web site is here (for ACA plans):

https://nystateofhealth.ny.gov/individual?lang=en

Of course ACA is for pre-Medicare customers. There are 13 different insurers offering various Medicare Supplement plans in NY State currently. The premiums depend on your region of residence. Not all of the 'letter plans' are offered in all regions. For example the current rates for a Plan F which is the most comprehensive available (and thus also the most expensive) are:

Lowest rate = Empire HealthChoiceAssurance at $230/mo if you live in the Albany or Mid-Hudson region. If you live in the NYC Proper, Long Island, or Westchester regions the same policy costs $290/mo.

Nine other companies also sell Medigap Plan F in Westchester which includes New Rochelle. Other than the $290 one mentioned, the other premiums are $250 (from United/AARP), $351, $375, $399, $423, $483, $492, $530, and $621 -- depending on the insurance company.
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Old Yesterday, 06:57 PM
 
1,776 posts, read 621,513 times
Reputation: 3315
Quote:
Originally Posted by mathjak107 View Post
We pay a whole lot more for being community rated and not age based here in ny .....our F plans are very very high day one , so we likely end up paying more then age based states in the long run...
Yes but IMHO the Guaranteed Issue is a huge advantage and worth paying more here. Here in NY we can add and drop at will. We are one of only three states in the country to have total guaranteed issue year round with no restrictions. The other two are Connecticut and Washington state. That is why when I briefly considered moving out of state the only one I was seriously interested in (after learning the ins and outs of senior-age insurance!) was CT. No interest in moving out west!

Other than NY, CT, and WA there are only four other Guaranteed Issue states at all: California, Oregon, Missouri and Maine. But all of those have restrictions that NY/CT/WA does not have:

For example, in California and Oregon you can switch at any time BUT the guaranteed issue (no medical underwriting) only applies to a 30-day window after your birthday each year. If you want to buy or change a policy at any other time, they can use medical underwriting. In Missouri you can change plans without medical underwriting only when the plan is up for renewal, and at no other time.

Theoretically if I suspected I might have a serious health problem but have not yet consulted a doctor for it, I could buy a Medigap policy in NY tomorrow, to be effective on Sept 1st, keep it for a few months until I know whether or not I will "need" it, and then drop it if I discover that I don't. Under the current rules I could do that numerous times if I wanted to. There's no rule in NY against doing that.
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Old Yesterday, 07:13 PM
 
Location: DFW - Coppell / Las Colinas
32,301 posts, read 36,884,146 times
Reputation: 39077
Without getting too Political, Medicares going broke and certain Politicians want to eliminate all private insurance and expand Medicare for all? Even illegals who cross the border everyday? Come to the US and get free Medicare without ever contributing a dime.

Sounds like a recipe to take a bad situation and make it a disaster. I can just imagine the tax increases to pay for such an expansion and free coverage.
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Old Yesterday, 07:13 PM
 
Location: Haiku
4,387 posts, read 2,655,772 times
Reputation: 6452
Quote:
Originally Posted by Coloradomom22 View Post
My point to all of this is that Medicare was never designed for the times we have today, where expensive medical advancements can prolong life well beyond what it was back in the day. While pondering my own family I did an analysis and figured out that the average take out from Medicare per relative was $900,000 each (when you include all the surgeries and rehab plus meds). There is no way this can continue.
I imagine I am going to get boo'ed off the Retirement forum for saying this, but my feeling is Medicare part A should end at age 80. If you want coverage after 80 or so, buy private insurance but it seems crazy to have a system that gives unlimited, expensive care to a segment of the population that can soak up all that unlimited care. Take the money saved and use it push the age of eligibility down to 55.

I am 68 and I am on Medicare so I would be affected by this in short order, but I still think it makes more economic sense than what we're doing.
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Old Yesterday, 07:40 PM
 
734 posts, read 372,273 times
Reputation: 2200
Quote:
Originally Posted by TwoByFour View Post
I imagine I am going to get boo'ed off the Retirement forum for saying this, but my feeling is Medicare part A should end at age 80. If you want coverage after 80 or so, buy private insurance but it seems crazy to have a system that gives unlimited, expensive care to a segment of the population that can soak up all that unlimited care. Take the money saved and use it push the age of eligibility down to 55.

I am 68 and I am on Medicare so I would be affected by this in short order, but I still think it makes more economic sense than what we're doing.
Buy private insurance at age 80? The Medicare law was created by the insurance lobby and pushed through Congress because they didn’t want to insure people past the age of 64. The private health insurance industry doesn’t want you as a customer past that age because nobody outside the wealthy could afford the premiums.
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Old Yesterday, 08:49 PM
 
20,983 posts, read 16,829,324 times
Reputation: 39326
Quote:
Originally Posted by BBCjunkie View Post
Yes, New York has always been considered an "unfriendly" state for insurance companies to do business; not just health but other kinds of insurance too. There are requirements and regulations up the wazoo and that does affect the number of companies that choose to sell here.

ehealthinsurance is not showing all of the ACA plans available in NY. I just went to the NY State Plans web site, plugged in a New Rochelle zip code and got plans from three insurers: Oscar, Fidelis Care, and MVP.

Out of curiosity I then plugged in my zip code here on Long Island. The results were Oscar, Fidelis Care, and HealthFirst.

Perhaps the ehealthinsurance web site only shows insurance companies who pay that web site a commission for referrals?

The state web site is here (for ACA plans):

https://nystateofhealth.ny.gov/individual?lang=en

Of course ACA is for pre-Medicare customers. There are 13 different insurers offering various Medicare Supplement plans in NY State currently. The premiums depend on your region of residence. Not all of the 'letter plans' are offered in all regions. For example the current rates for a Plan F which is the most comprehensive available (and thus also the most expensive) are:

Lowest rate = Empire HealthChoiceAssurance at $230/mo if you live in the Albany or Mid-Hudson region. If you live in the NYC Proper, Long Island, or Westchester regions the same policy costs $290/mo.

Nine other companies also sell Medigap Plan F in Westchester which includes New Rochelle. Other than the $290 one mentioned, the other premiums are $250 (from United/AARP), $351, $375, $399, $423, $483, $492, $530, and $621 -- depending on the insurance company.
I never looked on the ACA marketplace because I know I do t qualify for discounts or subsidies. Can people get cheaper plans there even so?
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Old Today, 08:26 AM
 
1,776 posts, read 621,513 times
Reputation: 3315
Quote:
Originally Posted by ocnjgirl View Post
I never looked on the ACA marketplace because I know I do t qualify for discounts or subsidies. Can people get cheaper plans there even so?
Depends on your definition of "cheaper." Certainly not any cheaper than Medicare is. Whether it is cheaper than the combination of regular Medicare + a drug plan + a Medigap (so that all bases are covered) is another question.

For example, looking at the ACA plans available in my state for the New Rochelle zipcode, the bronze plans are all between $420 and $464 per month. Silver plans are all between $590 and $655.

So let's say the average Silver plan in New Rochelle is $610 just for comparison's sake (with no subsidies.)

Someone on Medicare in New Rochelle would pay $135 for part B and then if they wanted full coverage via a Supplement plan, they could get one for $351 (assuming they don't go the AARP route). So that's $486 for the two. How much their Part D plan premium would be, would depend on their drug coverage needs. If they only want a bare-bones one like mine, figure another $20 per month for that. Round it up and say $500 per month for Medicare/Supplement/Drug coverage versus $600 for a Silver/No-subsidies ACA plan.

Granted that the ACA plan would doubtless cover some things that the Medicare combo would not (such as hearing aids and orthotics) but the deductibles and co-pays would also doubtless be larger. So the out of pocket costs each year would be heavily dependent on actual usage.
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Old Today, 08:30 AM
 
Location: SoCal
13,713 posts, read 6,516,267 times
Reputation: 10240
Quote:
Originally Posted by TwoByFour View Post
I imagine I am going to get boo'ed off the Retirement forum for saying this, but my feeling is Medicare part A should end at age 80. If you want coverage after 80 or so, buy private insurance but it seems crazy to have a system that gives unlimited, expensive care to a segment of the population that can soak up all that unlimited care. Take the money saved and use it push the age of eligibility down to 55.

I am 68 and I am on Medicare so I would be affected by this in short order, but I still think it makes more economic sense than what we're doing.
It’s a crazy idea. 80 is when you can’t work and need the insurance the most. The 55 crowd can still work.
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