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Medicare for all who want it?

Health Care Medicare 2010

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#1 JadziaDax

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Posted 30 March 2010 - 04:47 AM

My insomnia is keeping me up like nothing else, and I managed to run across this in my research on this new health care reform. I'm surprised the media hasn't taken a hold of this simple 4 page bill and run with it like the world is gonna end tomorrow:

Senator Grayson wants to let people buy into Medicare at any age

Quote

Congressman Alan Grayson, (D-Orlando), today introduced a bill (H.R. 4789) which would give the option to buy into Medicare to every citizen of the United States. The “Public Option Act,” also known as the “Medicare You Can Buy Into Act,” would open up the Medicare network to anyone who can pay for it. ...

The bill would require the Secretary of Health and Human Services to establish enrollment periods, coverage guidelines, and premiums for the program. Because premiums would be equal to cost, the program would pay for itself.

I think this could be a viable public option, if it ever gets out of committee, but of course, the keywords here are anyone who can pay for it. Since obviously, it would not change the current system, just expand it, you wouldn't be able to have the government help you out with the premiums.

However, it would allow a public option to drive costs down with the stupid mandate. Which should make the free-market people happy, since it only adds competition, and make the public option people happy, since it's the closest thing we've got to a single-payer.
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#2 QueenTiye

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Posted 30 March 2010 - 08:31 AM

It was always the best idea out there, but insurance companies would, I think, have a cow.  I keep thinking of how cool it would be if you could buy into Medicare - how the program could solve a lot of medicare's problems, and how your premiums would simply go down to whatever seniors pay (do they pay?) when you become a senior. I was also thinking that wealthy seniors should have their premiums go down, but not as much.  Simple solution.  But the insurance companies would surely goad people into hollaring "SOCIALISM!" at the top of their lungs.

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#3 Palisades

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Posted 30 March 2010 - 10:25 AM

I would be against Medicare-for-All if it underpaid providers like Medicare does since this results in the providers engaging in cost shifting to make people with private insurance pick up the tab. I don't remember what Sen. Grayson's bill did regarding provider payment rates. IIRC, Grayson's bill had the votes to pass or it was close enough that it would have had the votes if someone tried to whip for it. However, IIRC the Democrats' leadership killed Grayson's bill because Obama had promised the special interests that there wouldn't be a public option.
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#4 Nick

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Posted 30 March 2010 - 10:43 AM

I have little hope this will get out of committee but has the bill been truly killed yet?

#5 Palisades

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Posted 30 March 2010 - 10:56 AM

View PostNick, on Mar 30 2010, 09:43 AM, said:

I have little hope this will get out of committee but has the bill been truly killed yet?

I see the distinction you're making, but if the Democrats were going to move on it, I'd think they'd have stuck it in the reconciliation bill.

Edited by Palisade, 30 March 2010 - 10:57 AM.

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#6 Themis

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Posted 30 March 2010 - 10:59 AM

Yes, seniors pay - $90+ this year for part A (hospital), more for Parts B (drs/office visits) and Part whatever - prescriptions.  Or something else entirely for Medicare Advantage Plans that wrap it all into one, through insurance companies.  I'll be looking into everything more in a couple of months.  Insurance guy said to wait and see what legislation does to all the programs...
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#7 Nick

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Posted 30 March 2010 - 11:22 AM

View PostPalisade, on Mar 30 2010, 11:25 AM, said:

I would be against Medicare-for-All if it underpaid providers like Medicare does since this results in the providers engaging in cost shifting to make people with private insurance pick up the tab. I don't remember what Sen. Grayson's bill did regarding provider payment rates. IIRC, Grayson's bill had the votes to pass or it was close enough that it would have had the votes if someone tried to whip for it. However, IIRC the Democrats' leadership killed Grayson's bill because Obama had promised the special interests that there wouldn't be a public option.

I'm not convinced there's all that much in the way of cost-shifting from Medicare to private payers.  Here's a more detailed argument against the idea:

http://www.thehealth...fting-myth.html

I don't see how the economics works out.  If a provider charges private individuals more to recoup losses on care underfunded by Medicare, they'll lose market share, will they not?

Either way, I've heard conflicting information on the actual prevalance of cost shifting between Medicare and private payers.  I'd like to find something sourced with hard numbers.

I recently learned of one provision of the bill that passed that could go a long way to resolving this question once and for all (and bring down overall healthcare costs to boot).  There's a provision for Comparative Effectiveness Research that will gather data on the relative costs and benefits of medical procedures.  A large database of real-world pricing and results could be tremendously useful in identifying the specific areas to target and prove conclusively if Medicare is consistently reimbursing providers much less than private payers and their insurers.

View PostPalisade, on Mar 30 2010, 11:56 AM, said:

View PostNick, on Mar 30 2010, 09:43 AM, said:

I have little hope this will get out of committee but has the bill been truly killed yet?

I see the distinction you're making, but if the Democrats were going to move on it, I'd think they'd have stuck it in the reconciliation bill.

Even if this bill had the full-throated support of the caucus, I highly doubt they'd be willing to risk the reconciliation bill's passage by inserting a provision the Senate has thus far seemed to be adamantly opposed to.  Medicare For All stands on its own, and I do hope it comes up for a vote (if only to force opponents to go on record voting against it).  The bill itself probably meets the criteria for reconciliation in the Senate on its own, but I don't see Democrats even having the votes for that.  It has a snowball's chance in hell of clearing the house, and none at all of clearing the Senate, imo.

Edited by Nick, 30 March 2010 - 11:23 AM.


#8 JadziaDax

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Posted 30 March 2010 - 11:23 AM

View PostPalisade, on Mar 30 2010, 09:25 AM, said:

I would be against Medicare-for-All if it underpaid providers like Medicare does since this results in the providers engaging in cost shifting to make people with private insurance pick up the tab. I don't remember what Sen. Grayson's bill did regarding provider payment rates.
I don't think there was anything in the bill about provider payments. It was only about opening it to everyone, I think. Improving payments to providers is a tax issue, and IMO Medicare is underfunded, but as we all know, we wouldn't dare increase taxes over something like this (or SS-but that's another thread).


View PostPalisade, on Mar 30 2010, 09:56 AM, said:

View PostNick, on Mar 30 2010, 09:43 AM, said:

I have little hope this will get out of committee but has the bill been truly killed yet?

I see the distinction you're making, but if the Democrats were going to move on it, I'd think they'd have stuck it in the reconciliation bill.
Everyone in congress was, IMNSHO, bought out by big insurance and big pharma in order to get this bill to pass (since it was a giant gift to them with a pretty pink..er..blue bow attached to it), any public option would probably have to be in a separate bill to stand a snowball's chance in hell. And as much as I'd like to see a national public option (which I firmly believe is needed in order to prevent insurance companies from doing whatever the hell they want), it will probably wind up being state based, which is the direction single payer seems to be going. I understand that CA has tried twice to pass it, but Gov Schwarzenegger vetoed it. I think Pennsylvania is also trying for one right now too.

But I agree, I don't think this will ever make it out of committee :(. But it does have 81 cosponsers, how many does it need to force it way out of committee and into a vote?

View PostThemis, on Mar 30 2010, 09:59 AM, said:

Yes, seniors pay - $90+ this year for part A (hospital), more for Parts B (drs/office visits) and Part whatever - prescriptions.  Or something else entirely for Medicare Advantage Plans that wrap it all into one, through insurance companies.  I'll be looking into everything more in a couple of months.  Insurance guy said to wait and see what legislation does to all the programs...
I thought that premiums seniors pay depended on how much they've worked in the 10 previous years. I honestly don't know much about Medicare, but only because I'll likely never get use it. All this part A, B, D-alphabet soup confuses me. So is the claim that Medicare needs to be privatized, or is already privatized....

Pretty much all I know is I pay a fairly small tax into it, and it doesn't pay doctors well, so they limit the number of people they see on Medicare/aid, but a lot of people love it.....
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#9 Palisades

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Posted 30 March 2010 - 11:46 AM

View PostNick, on Mar 30 2010, 10:22 AM, said:

View PostPalisade, on Mar 30 2010, 11:25 AM, said:

I would be against Medicare-for-All if it underpaid providers like Medicare does since this results in the providers engaging in cost shifting to make people with private insurance pick up the tab. I don't remember what Sen. Grayson's bill did regarding provider payment rates. IIRC, Grayson's bill had the votes to pass or it was close enough that it would have had the votes if someone tried to whip for it. However, IIRC the Democrats' leadership killed Grayson's bill because Obama had promised the special interests that there wouldn't be a public option.

I'm not convinced there's all that much in the way of cost-shifting from Medicare to private payers.  Here's a more detailed argument against the idea:

http://www.thehealth...fting-myth.html

I don't see how the economics works out.  If a provider charges private individuals more to recoup losses on care underfunded by Medicare, they'll lose market share, will they not?

Why would they? Do you check the price various doctors or hospitals will charge you before you go in for the doctor's visit or medical procedure? Do you even know what the price will be before you get the bill? Personally, IIRC, my price for a doctor's visit is $10 and the insurance company pays the rest of the bill, whatever it is.

Normal economic theory doesn't work so well for health care the way our system is set up since customers don't know what the price is until after they make the purchase, don't know what the competitors charge, and the customer pays only a small portion of the cost with the insurer paying the rest. (Actually, mainstream economics has identified that last factor has a reason medical prices are higher than they would otherwise be.)
"When the Fed is the bartender everybody drinks until they fall down." —Paul McCulley

"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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#10 Nick

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Posted 30 March 2010 - 12:10 PM

^In any event the "real prices" are often hidden from patients, which is why I'm optimistic about the benefits of the comparative effectiveness research.  I have a PPO that covers 90% after copay, and I have to cover the remaining 10%, which doesn't make me completely cost-insensitive.  It sounds like you have either an especially good PPO plan or are on an HMO.

The more hard data we have to zero in on the true cost drivers of healthcare, the better, imo.

#11 QueenTiye

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Posted 30 March 2010 - 12:31 PM

They are saying there will be a second reconciliation bill, and that's why Grayson is trying to put this forward.  At least, that's what I understood.

QT

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