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Old Yesterday, 07:41 AM
 
Location: Tennessee
24,090 posts, read 17,916,630 times
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Quote:
Originally Posted by athena53 View Post
This is my concern. As states find it harder and harder to pay for LTC for all the elderly who don't have funds, care will deteriorate and eligibility requirements will be tightened. And the rest of us will be taxed more to pay for it.
Something has to give somewhere.

Many, many facilities would close if everything was paid at the Medicare level. Small town and rural hospitals are often cashflow negative as it is. Many patients at these hospitals have no insurance and simply show up at the ED. Nursing homes chock full of patients on Medicaid provide bare minimum services, but they're also operating on string and duct tape themselves.

In my local area, the hospital system is making changes to some of the rural hospitals, and the public is raising absolute hell over it. The fact of the matter is that there are three hospitals in Wise County, VA, a declining community of less than 40,000 in the coal country part of Virginia. You don't need three hospitals there. One ED has been averaging less than four patients daily for over a year. That's huge overhead for a facility that is serving relatively few people.
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Old Yesterday, 07:58 AM
 
14,291 posts, read 7,638,884 times
Reputation: 26145
Quote:
Originally Posted by Serious Conversation View Post
Something has to give somewhere.

Many, many facilities would close if everything was paid at the Medicare level. Small town and rural hospitals are often cashflow negative as it is. Many patients at these hospitals have no insurance and simply show up at the ED. Nursing homes chock full of patients on Medicaid provide bare minimum services, but they're also operating on string and duct tape themselves.

In my local area, the hospital system is making changes to some of the rural hospitals, and the public is raising absolute hell over it. The fact of the matter is that there are three hospitals in Wise County, VA, a declining community of less than 40,000 in the coal country part of Virginia. You don't need three hospitals there. One ED has been averaging less than four patients daily for over a year. That's huge overhead for a facility that is serving relatively few people.

You really don't know what you're talking about.


Medicare pays just fine. It's Medicaid that doesn't, particularly in the southern red states. It's worse in the ACA opt-out states because the hospitals get stiffed by all the uninsured poor people. Rural and poor region hospitals are closing because they don't have enough private insurance and Medicare patients to come remotely close to breaking even. The hospital holding companies that own these hospitals are getting slaughtered. Look at the financial report for Community Health Systems (Franklin, TN) which runs a huge number of rural/poor region hospitals. They've shrunk their hospital count in half (well north of 200 to 105) and are still losing millions. It would be really surprising if they still exist in 2021.
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Old Yesterday, 09:01 AM
 
Location: SW Florida
9,843 posts, read 7,141,358 times
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Originally Posted by NewbieHere View Post
I believe they get SSI, itís for people who never contribute to SS.
Wouldn't they have to come up with a disability to do that?
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Old Yesterday, 09:12 AM
 
Location: SW Florida
9,843 posts, read 7,141,358 times
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Quote:
Originally Posted by GeoffD View Post
You really don't know what you're talking about.


Medicare pays just fine. It's Medicaid that doesn't, particularly in the southern red states. It's worse in the ACA opt-out states because the hospitals get stiffed by all the uninsured poor people. Rural and poor region hospitals are closing because they don't have enough private insurance and Medicare patients to come remotely close to breaking even. The hospital holding companies that own these hospitals are getting slaughtered. Look at the financial report for Community Health Systems (Franklin, TN) which runs a huge number of rural/poor region hospitals. They've shrunk their hospital count in half (well north of 200 to 105) and are still losing millions. It would be really surprising if they still exist in 2021.

Actually, Medicare reimburses poorly (according to the records I see) for services, at least in this neck of the woods. I've seen reimbursement abounts ranging from about 1/10 to 1/3 of amounts billed for services. Not that Medicaid pays any better (anywhere) than Medicare, I've no doubt it pays less. When those reimbursements don't even cover the providers' overhead, (and not just in red states, despite your thinly disquised attempts at a partisan dig) no wonder so many providers opt out of either one.
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Old Yesterday, 09:30 AM
 
Location: Tennessee
24,090 posts, read 17,916,630 times
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Quote:
Originally Posted by Travelassie View Post
Actually, Medicare reimburses poorly (according to the records I see) for services, at least in this neck of the woods. I've seen reimbursement abounts ranging from about 1/10 to 1/3 of amounts billed for services. Not that Medicaid pays any better (anywhere) than Medicare, I've no doubt it pays less. When those reimbursements don't even cover the providers' overhead, (and not just in red states, despite your thinly disquised attempts at a partisan dig) no wonder so many providers opt out of either one.
Absolutely. Any executive with insight into this at any hospital system will give you this answer. Medicare reimbursement rates are a challenge for revenue generation. There are plenty of other challenges as well.

In another thread, I posted about how there are three hospitals in Wise County, VA. This is a county of about 40,000, with its biggest city close to an hour away from the nearest "real hospital." One of the EDs has been averaging less than a half dozen patients per day for over a year now. A hospital requires a lot of fairly well paid people to run. Just the overhead in terms of utilities and such is enormous.

This is a county with a lot of older and poorer residents who are on Medicare, Medicaid, or are completely uninsured. The hospital system is being paid at relatively low rates for many patients and not getting paid at all with the relatively high rate of uninsured patients. With low patient volumes, declining numbers of admissions, and a poor makeup of payors, the revenue environment is challenging.
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Old Yesterday, 10:23 AM
 
2,378 posts, read 833,613 times
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Quote:
Originally Posted by Travelassie View Post
Actually, Medicare reimburses poorly (according to the records I see) for services, at least in this neck of the woods. I've seen reimbursement amounts ranging from about 1/10 to 1/3 of amounts billed for services. Not that Medicaid pays any better (anywhere) than Medicare, I've no doubt it pays less. When those reimbursements don't even cover the providers' overhead, (and not just in red states, despite your thinly disquised attempts at a partisan dig) no wonder so many providers opt out of either one.
The BBC did a podcast on rural hospitals closing. The CEO of the hospital said that they just about broke even on MediCARE patients, lost money on MedicAID patients and the "gravy" came from private health insurers. I've also read that nursing home stake Medicaid patients because they're required to have a specific % of Medicaid beds in order to get the more lucrative Medicare rehab business. (Medicare rehab is very narrowly-defined; you have to have been discharged from a hospital after having stayed there X days as a patient, and the number of days they cover is limited. A typical patient might be recovering from knee replacement surgery and not have anyone at home to take care of them.)
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Old Yesterday, 10:34 AM
 
234 posts, read 68,780 times
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Quote:
Originally Posted by TMSRetired View Post
Well the breakdown is that 32% of boomers have less than $10K saved.

Also..did you see the methodology for that survey at the bottom of the article ?
They surveyed individuals and asked for their best estimate on how much they have saved.
What if they have cushy pensions ? That was not asked.

You've got better studies coming from the likes of Fidelity and the Federal Government.


Any late Baby Boomer starting their career after 1980 most likely does not have a "cushy pension" to fall back on. That's about when every employer was switching to 401K plans.


What these studies do not take into account is how much a person is getting in inheritance or where the person has worked/lived for the last 10 years of their life.


Its a lot easier to retire if you have the means and inclination to relocate to a cheaper area. But what about the life long city dweller, retiring to BF nowhere isn't really an enjoyable retirement!
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Old Yesterday, 10:46 AM
 
1,540 posts, read 301,945 times
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Quote:
Originally Posted by TexasRoadkill View Post
Any late Baby Boomer starting their career after 1980 most likely does not have a "cushy pension" to fall back on. That's about when every employer was switching to 401K plans.


What these studies do not take into account is how much a person is getting in inheritance or where the person has worked/lived for the last 10 years of their life.


Its a lot easier to retire if you have the means and inclination to relocate to a cheaper area. But what about the life long city dweller, retiring to BF nowhere isn't really an enjoyable retirement!
Public Service still has pensions. I have both a pension and 401K..started at that company in 1988.
Pension was later phased out around 2001-2002 for new hires.
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Old Yesterday, 10:50 AM
 
273 posts, read 60,178 times
Reputation: 394
Quote:
Originally Posted by TexasRoadkill View Post
Any late Baby Boomer starting their career after 1980 most likely does not have a "cushy pension" to fall back on. That's about when every employer was switching to 401K plans.


What these studies do not take into account is how much a person is getting in inheritance or where the person has worked/lived for the last 10 years of their life.


Its a lot easier to retire if you have the means and inclination to relocate to a cheaper area. But what about the life long city dweller, retiring to BF nowhere isn't really an enjoyable retirement!
As a late baby boomer joining the workforce after college in 1986, I can attest to that. Private sector had no pensions. The federal government switched to FERS over the standard CSRS pension. So, there is a little bit of pension there still, but not sure it amounts to much such as a traditional pension.
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Old Yesterday, 11:14 AM
 
Location: Tennessee
24,090 posts, read 17,916,630 times
Reputation: 28255
Quote:
Originally Posted by TexasRoadkill View Post
Any late Baby Boomer starting their career after 1980 most likely does not have a "cushy pension" to fall back on. That's about when every employer was switching to 401K plans.

What these studies do not take into account is how much a person is getting in inheritance or where the person has worked/lived for the last 10 years of their life.

Its a lot easier to retire if you have the means and inclination to relocate to a cheaper area. But what about the life long city dweller, retiring to BF nowhere isn't really an enjoyable retirement!
I can't think of anyone in my social circle who has a substantial private sector pension. Most private sector worker retirements will basically be DIY.

Most of the folks in my circle were born after 1955. I can't think of anyone I know well personally who has worked at the same place for a career. I know very few people who are working at the same place they did in 2000. My office is full of people 50+, and while there are some lifers here for a few decades, most have been here less than ten years.

If you weren't a "lifer," you're going to have a reduced pension benefit, if you have one at all. I don't believe I know anyone right now who is currently working at a private sector employer that offers a pension of any kind.

If you're living in urban CA, metro Boston, DC, etc., one of the superstar cities, it's easy to cash out the home equity and go buy in podunk nowhere with the equity and still have hundreds of thousands of cash from the equity leftover. For people IN podunk nowhere, there's nowhere to bail out TO.
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