Posts filed under ‘Single Payer’

Looking to Medicare as a Model for Health Care Coverage? Improve Medicare First.

In a September 2017 editorial, the New York Times reviewed proposals to improve health care coverage as efforts to repeal the Affordable Care Act (ACA) are stalled – at least for now. As noted in the editorial, “[t]he Republican campaign to repeal Obamacare, for all its waste of time and energy, has at least gotten people to talk seriously about proposals to improve the health care system.”

When looking to expand access to health care coverage, it’s natural to look to Medicare, the country’s well-tested, flagship health insurance program. Medicare is not only more cost-effective than private insurance, it’s also beloved by beneficiaries, their families, and the general public.  Thus, proposals presented by some would aggregate our current, multi-pronged coverage system into a single-payer model, which some call “Medicare-for-All.” Other proposals would allow people under age 65 to buy-into Medicare.

Considering several of these proposals, a recent article in the New Republic asked: “[i]f the plan is to transition to something like Medicare-for-All, shouldn’t the strategy begin with making Medicare great?”

Yes! We agree, before moving more people into Medicare, it needs to be improved and simplified. With all of its virtues, Medicare also has flaws. There are still significant gaps in coverage – vision, hearing and routine dental, not to mention long-term care.  Traditional Medicare does not include a cap on out-of-pocket expenses or its own prescription drug benefit.  Medicare Advantage adds costs to the system and significantly limits enrollees’ provider choices. Assistance for low-income individuals is limited.  And, all too often, payment and quality measures lead many providers to prematurely terminate, or avoid providing medically necessary care entirely, for people with longer-term, chronic and debilitating conditions.

Traditional Medicare must include the same benefits and the same limits on cost-sharing as private Medicare Advantage. People who choose traditional Medicare ought to have the same cap on out-of-pocket costs and the same “one-stop-shopping” opportunities as people in private Medicare Advantage. Like their counter-parts in Medicare Advantage, people who choose traditional Medicare should be able to obtain prescription drug coverage without having to purchase a separate Part D plan. If supplemental, Medigap insurance continues to be necessary to help with cost-sharing, it should be available and affordable for all people with Medicare, including people with disabilities and pre-existing conditions, which it is not the case in many states.

As health policy discussions (hopefully) turn towards expanding, rather than contracting, health coverage, the Center for Medicare Advocacy will work to improve Medicare for all those it currently serves, and may serve in the future. This is a critical first step before adopting Medicare as a basis for health coverage expansion.

September 18, 2017 at 2:00 pm Leave a comment

Medicare Beneficiary Costs Will Rise if Affordable Care Act is Repealed (And Private Medicare plans will be paid more)

With all the talk about repealing the Affordable Care Act (ACA/Obamacare), many people miss the impact repeal would have on Medicare, older and disabled adults, and their families. ACA added preventive benefits to Medicare, decreased Part D cost-sharing for prescription drugs, and increased the long-term solvency of Medicare by about 11 years.

According to the Kaiser Family Foundation:

” Full repeal would increase spending primarily by restoring higher payments to health care providers and Medicare Advantage plans. The increase in Medicare spending would likely lead to higher Medicare premiums, deductibles, and cost sharing for beneficiaries, and accelerate the insolvency of the Medicare Part A trust fund. Policymakers will confront decisions about the Medicare provisions in the ACA in their efforts to repeal and replace the law.”

Policy-makers and people who rely on Medicare should think twice before supporting legislation that will give windfalls to private insurance companies, while reducing coverage and increasing costs for older and disabled people.

December 13, 2016 at 5:20 pm Leave a comment

Telling It Like It Is: The Ryan Plan Would Kill Medicare

The title of Paul Krugman’s piece in today’s NY Times says it all. The Medicare Killers tells the truth about the Trump/Ryan plan to turn back the clock on Medicare and give it away to the private  insurance industry. A good deal for insurance companies, but a very bad deal for the 60 million older and disabled people who access health care through Medicare. Importantly, as Krugman writes, this is not necessary.  It’s just the latest ploy to privatize Medicare.  Call it what it is.

Help the Center for Medicare Advocacy speak out against false claims and misinformation that could rob older people and people with disabilities of necessary health care – and diminish Medicare for generations to come. Spread the word. Tell the truth about Medicare.

November 18, 2016 at 4:35 pm Leave a comment

Don’t Believe Us? Listen to the George W. Bush CMS Director!

And we quote: Mark McClellan, CMS Administrator in the G. W. Bush Administration:
“If the exchanges’ tech problems are resolved by November, no one will even remember what happened this week,” McClellan said, comparing the Affordable Care Act rollout to when the Medicare Part D prescription drug benefit took effect.
“Millions of seniors in different programs were enrolled into new [private] drug plans, and the computer system fumbled the handoff for tens of thousands of people who really urgently needed their prescriptions,” he said. “By comparison, the frustration of not being able to shop online in the first days of the Obamacare exchanges is small potatoes.”

[From Politico 10/4/2013]

October 4, 2013 at 5:44 pm Leave a comment

Medicare and Jobs: Not Mutually Exclusive!

The more people have health insurance, including  Medicare, the more they stay healthy and are able to work.  If health insurance is provided by Medicare or health care reform or any avenue outside the tired employer-based system, it reduces costs for employers and encourages hiring.  Ask any employer.

Continuing to tie health insurance to employment only continues a system that COSTS jobs. It creates a disincentive for employers to hire.  It creates an incentive for the new employment reality:  Freelance, contract work, part-time, whatever you want to call the newly underemployed who do not have benefits and for whom employers do not pay into Medicare, Social Security, Unemployment, or Workers Comp.  This is a big problem for everyone involved, including individual workers, their families, AND the solvency of important programs that Americans value and that have lifted generations out of poverty and provided fair access to health care. 

Pay attention, people!  We not only can have Medicare and jobs – we will have more jobs if we  increase access to Medicare and health care.  Don’t raid Medicare to pay for jobs.  That will only reduce access to both.

September 13, 2011 at 4:14 pm Leave a comment

Don’t Walk Away From Health Care Reform!

The Center for Medicare Advocacy supports efforts to pass the Senate’s health reform bill.  We reiterate what President Obama asked of Congress in his State of the Union address, “don’t walk away from [health] reform!”  Paul Krugman agreed in his NewYork Times editorial.

Now is not the time to retreat,  or to insist that the perfect defeat the good.  Too many people have no health insurance, too many are denied coverage because of preexisting conditions, too many face bankruptcy because of uncovered medical bills for us to give up.

What would Ted Kennedy do?  He would agree!  He would push forward to pass the Senate health reform bill.  As he writes in his memoir about his efforts to pass reform – in 1977:

“My staff and I worked hard to craft a plan that would be capable of having broad-based support. Specifically, we negotiated long and hard in 1977 to persuade .. the AFL-CIO and … the UAW, to compromise on their strong commitment to a single-payer system, where health care providers would be paid  from a single national fund like Medicare  – and agree instead to support a plan built on our existing system of private insurance provided that coverage was mandatory and universal.  I had personally supported single payer in the past and understood the benefits of it, but I also knew that it would be politically impossible to pass.”  True Compass, p. 359 (2009)

Listen to Teddy!  Pass the Senate health care reform bill as soon as possible – if that’s what can be done, if that’s what’s feasible – do it!

To speak to your members of Congress, call (800)828-0498.

January 22, 2010 at 5:54 pm 2 comments

Thank you! 60 Senators Bring Us One Step Closer to Health Care Reform

True, the bill that passed the Senate is far from perfect. But, can you imagine what the opposition would be saying if the bill met our standards for true health care reform?  As it is, the brave Senators who led this battle have endangered their political careers. This includes Senator Chris Dodd (CT), senior Senator from the Center for Medicare Advocacy’s  home state. 

So we thank Senator Dodd and everyone who worked to get this good bill passed.  Here are some highlight’s from Families USA: Manager’s amendment: Providing more competition and affordable choices for Americans ; Manager’s amendment: Improving quality and controlling costs ; Manager’s amendment: Enhancing affordable choices for small businesses .

Get some rest, all!   Another big push to provide health care equity awaits us after we ring in 2010.

December 24, 2009 at 3:13 pm Leave a comment

Yes, We Still Support Health Care Reform

We’ve decided, we can’t  afford to let the perfect interfere with the possibility of good health reform. There are millions of Americans waiting for insurance coverage and an economy waiting  for businesses to be relieved of health care’s extraordinary costs.  At best the Senate is likely to pass a bill that disappoints but, as of today, we support it.

As economist Paul Krugman says in today’s New York Times, “Pass the Bill, the current health care bill falls a long way short of ideal, but it is better than anything that seemed possible just a few years ago.”

So – today the Center for Medicare Advocacy sent the following letter to Senate health reform leaders:

Dear Senators Reid, Durbin, Dodd, and Baucus:

 The Center for Medicare Advocacy, Inc. is a national, non-profit organization that advocates on behalf of older people and people with disabilities to ensure access to health care.  We thank you for your efforts to enact health insurance reform. 

 The Patient Protection and Affordable Care Act will provide access to health insurance for millions of Americans, provide subsidies to those with limited incomes and resources, improve access to preventive services, and limit discrimination in the offering of health insurance.  Additionally, the bill protects the integrity of the Medicare program by reducing overpayments to Medicare Advantage plans and by promoting delivery system reforms to encourage high quality, coordinated health care.  The bill further assists people with limited means by extending eligibility for Medicaid for the under 65 population.

Overall, the Patient Protection and Affordable Care Act will move this country towards the goal of achieving universal access to health care.  We are pleased to support this legislation. 

Center for Medicare Advocacy, Inc.

December 18, 2009 at 4:17 pm 1 comment

Can We Afford a Private Health Plan Option?

Last week, Congressman Anthony Weiner (D. NY) asked TV commentator (and former Congressman) Joe Scarborough a series of questions about private insurance companies that form the lynchpin of our current health care system and around which health care reform may be based. Congressman Weiner asked:  “Why are we paying profits for insurance companies? Why are we paying overhead for insurance companies? Why are we paying for their TV commercials? What is their value? What are they bringing to the deal?”

Here’s what we know about the role private health insurance companies play in our health care system – and might well play in healthcare “reform”:

1.  Private insurance companies decide which doctors we see.  Most Americans are in network plans that require them to use the doctors who allowed into their network.  Some plans allow members to go to non-network providers, but only if the individual pays more out-of-pocket.  Private insurance supporters argue that people are always free to go to a doctor who isn’t in their insurance plan’s network, but if they do so they have to pay the full cost themselves, something most Americans cannot afford.

2.  Private insurance plans decide who gets insurance.  They reject people who use too much health care, rescind contracts from high health-care users, and deny health insurance and/or coverage to people with pre-existing conditions.  Plans also charge higher premiums for people based on what they determine to be a pre-existing condition or based on the individual’s gender, making health insurance unaffordable for many people.

3.  Private insurance companies decide what health care will be provided and paid for.  They decide what services will be covered in the insurance package they offer.  They establish drug formularies and prior approval requirements for drugs and procedures.  They set the standards for the documentation and proof they require to determine whether a prescribed treatment is medically necessary, and each plan has its own requirements.  Private insurance plans are not bound by what your doctor thinks is best for you, and they may override your doctor’s recommendation, and refuse coverage.

4.  Private insurance companies increase the administrative work load for doctors’ offices.  Staff must submit different health claim forms for different insurance companies and comply with each plan’s own formularies and requirements for submitting medical records to justify claims.  They must spend hours on the phone with insurance companies to verify coverage, cost sharing, and formulary rules.

5.  Private insurance companies encourage people to ration health care.  By developing products with high deductibles and cost-sharing, private health insurance companies encourage enrollees to think twice about getting the care their doctors prescribe.  Unfortunately, such decisions are often based on cost rather than on medical necessity and/or quality of care.  Someone who delays needed care because of a high deductible or high cost-sharing amount may leave a condition untreated, and may end up requiring more costly health care in the future.

6.  Private insurance companies are highly profitable industries, for their investors.  According to insurance industry filings with the federal Securities and Exchange Commission, profits for the 10 largest publically traded health insurance companies rose 428% from 2000 to 2007, from $2.4 billion to $12.9 billion.   During the same time period, the number of uninsured continued to rise, although the economic downturn enabled some individuals to get insurance through state Medicaid programs, many lost their health insurance due to lay-offs.

What do we get from private insurance companies?  A system that decides who gets insurance and who does not; that comes between patients and their doctors – and that makes profits for investors.  Is this the right direction for our country to take in “reforming” the health care system?  Can we afford this?  And who stands to gain?

August 24, 2009 at 6:42 pm Leave a comment

Medicare, We Hardly Know Ya

44 years ago Medicare was enacted into law.  All of today’s dire warnings about a public health option – socialism and government barring the doctor’s door – were made in opposition to Medicare.  Despite such opposition from “conservative,”  leaders, including Senator Bob Dole, Medicare passed. 

Before Medicare, 50% of  everyone 65 or older had NO health insurance. Now, as a result of Medicare, almost all older people are insured.  Medicare, which is national, government-run health insurance, succeeded in insuring older people where private insurance failed.  And, until the Bush Administration privatized Medicare with the extraordinarily subsidized private “Medicare Advantage” and Part D plans, Medicare was remarkably cost-effective too.  It’s private Medicare, not the traditional, public program, that’s bleeding taxpayers of billions of dollars. 

Medicare has been a success, fiscally and morally.  It took on the job of insuring health coverage and care to people that private insurance had abandoned.  Since 2003, on the other hand, private Medicare plans have cost us all tens of billions of dollars that went to support the private insurance industry, not to providing health care.  In addition, private Medicare plans have too often engaged in marketing abuses and restrictive coverage practices. 

As Paul Krugman recognizes in today’s New York Times, people with Medicare love it.  They do not want government to fool around with the traditional program.  Ironically,  these are sometimes the same people who worry that a public health care option will cause long waits for health care and government invasions into their private medical decisions. They, and their family members, (which accounts for pretty much all of us), forget that the traditional Medicare program is a  public health insurance option. 

Hello, America, meet Medicare:  Our 44 year-old public health insurance option that provides care to all its enrollees, anywhere in the country, and that has provided health and economic security for millions of older people, people with disabilities, and their families.

Happy anniversary, Medicare.  Thank you for showing us what a true public insurance program can offer.

July 31, 2009 at 6:38 pm 4 comments

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