September will be the most difficult month regarding healthcare reform for the Obama administration and the advocates of comprehensive health reform. They knew that it would be a tough month but knowing it and going through it is two different things. This administration and advocates are going through it.
Lawmakers are returning from a break and the President is returning from his vacation. Healthcare reform is not an easy task and has been a tough fight.
On top of everything else, Ted Kennedy – the Lion of the Senate – has now passed away.
Senator Kennedy had served for over 45 years and was a guiding light for lawmakers that were on both sides of the aisle. He was able to explain his point of view tactfully and respectfully so that even those who didn’t agree would still at least listen – and some of them actually heard him and adjusted their thinking on whatever subject was at hand. Of course, there were those times when he could be quite forceful and absolutely nobody missed the point.
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Now that lawmakers and the President are getting back to action, we will see what happens with these bills. One of the important issues when it comes to health insurance reform is the changes to Medicare.
We have been told that seniors and individuals with disabilities will not lose their benefits; however, there is a lot of spirited debate debating regarding their Medicare coverage.
One approach would be decrease the cost of reform as well as lessening its scope and spend around $600 billion to around $800 billion during the next ten years instead of over $1 trillion which has been proposed as a possibility. Doing this would make it easier on the finances of the federal government, but would be more difficult to actually put into place than doing a comprehensive overhaul of the whole system. Using the lesser figures would actually create a kind of hodge podge of a fix and would not fix two essential issues with the system we have now. There are two many people without health insurance and too many others are getting to the point where, not only can they not afford it, but it is not taking care of their needs at the prices they are paying now.
If there becomes a situation where reform cuts out subsidizing employers regarding health insurance, many people could not afford it anymore. They would be obligated to purchase insurance on their own. If they did not, there is a possibility that they would be fined.
Coverage could be offered to various groups depending on the situation, and hopefully, in time, other groups could be added. The hard part would be who would get this coverage. It is obvious that Medicaid is essential to individuals at or close to the poverty level. Having that program stay solid and be offered to all at that level would be an expensive proposition – around $40 billion in the next ten years. Yet going without it would cause extra problems – people at the poverty level who could not receive Medicaid could end up at the ER for things that could have cost the government hundred or thousands of dollars less had they been covered by Medicaid and allowed to simply see a doctor or a clinic. Essentially, if people in this position are not covered by Medicaid, they still get sick and the bills for those ER visits and other medical services for those who are not covered by Medicaid are partially absorbed by the hospitals as a loss and, you guessed it, paid by the government, thus affecting our taxes.
Medicare is another program that is essential to save. As Boomers are becoming retirement age they will be ready to enroll in hordes, so they will need to be able to have this coverage. Most Boomers are a little more prepared for retirement than the last generation, so there may be a little breathing room as they transition, however, Medicare must be fixed and saved, and the President has promised not to cut this program, rather to save it and make it work.
The challenge now is for congress to find a way to make sure the uninsured are insured, find the money to pay for comprehensive healthcare reform and save these two programs – Medicare and Medicaid – while working to make all this affordable while moving into the future.
For now, we are all waiting to see what congress comes up with.
As the saying goes, stuff rolls down hill. In the situation with all the budget constraints on the federal government, comes constraints on the state and local government. Healthcare is definietly no exception. Lawmakers in Washington are looking at some very deep cuts when it comes to many programs and trying to figure out how to keep them from being deeper than they already are.
One of the programs that is being looked at piece by piece and line by line is Medicare. There will definitely be cuts to that program, period. As a result, as things roll down hill, Medicaid, which is a state program but bolstered by federal dollars, is taking a big hit, too.
Not only are some Medicaid benefits being cut way back, but getting into the program, which is already on the difficult side, has become much tougher indeed. It seems as though unless you are in the most dire straits getting approved for Medicaid is extremely difficult. Even if you are in dire straits and the rope you are hanging onto is beginning to fray - a lot - it is still difficult to get approved.
Consider the case of a 60 year old woman who was disabled in an accident. Her doctors took her off work indefinitely and she has no income except for $200 of assistance money which will run out very soon because of the new cuts from 18 months down to 12. She has no money to go to the doctor and has applied for Medicaid. She suffered injuries in the accident - which happened at work - but Worker's Comp is fighting against paying because she had some pre-existing conditions. Of course, what 60 year old man or woman doesn't? Meanwhile, she is in constant pain, in need of surgery and walking around on crutches or a cane with a fractured hip and two badly injured knees just for starters. She has high blood pressure (which has sent her to the ER 6 times in 3 months because it was at stroke level or higher), osteoporosis, arthritis, degenerative disc disease and possibly diabetes. She has doctor's letters, medical records and more that were sent to Medicaid. She applied for Medicaid and was turned down.
This individual did everything by the book and is having to go through hoops all over again trying to get help. This is before the new budget cuts that are on the way.
This is not to say that Medicaid is unfair or that it is a bad program. It is a good program and was designed for people like this 60 year old lady who has fallen through the cracks - badly. Each state deals with their own Medicaid program so it can be a little easier or a little harder depending on the state a person is in. Even if you have all your ducks, doctor's notes and medical information in a row, it can be tough to get Medicaid.
Do not give up, re-apply, call and talk to your worker and do whatever is necessary to give them the information so that you will get approved. Eventually, most people do get approved. It is simply a tedious road sometimes to getting the coverage you need.
I saw this article while reading The Seattle Times. I read papers around the nation regularly to see what people have to say about the healthcare situation we are in as a nation. There are as many millions of opinions as there are people and lawmakers are playing tug of war with the situation. The problem with that -at least the biggest problem - is that they have the best healthcare in the world.
If they get a hang nail, a hernia or a heart attack their healthcare will cover it. The rest of us who are not covered like that or not covered at all can be having a stroke going into the hospital and being questioned as to whether we have insurance or not while we can't hold our head up in a wheelchair. This happened to my friend just before she fell out of the wheelchair, had an aneurysm, went into a coma and died a month later. She was 42 years old.
Here is the story from The Seattle Times:
Then there are the common people like us. Some of us have no healthcare because we make just a couple of dollars too much for Medicaid. OK. If that is so, than let us pay the two
Richard H. Cooper wrote in The Seattle Times about the need to fix Medicare before letting government undertake another program.
I agree with all his points about improvements needed to this program. However, I believe there is a way to fix it and do health-care reform at the same time.
There's already House Bill 676, the new-and-improved Medicare Act. This bill will put everybody in Medicare, and as we know, the bigger the pool, the less the cost.
By having only one nonprofit financing mechanism for our health care, we can save huge amounts of money. Imagine all the premiums now going to for-profit insurance companies whose goal is to make as much money as possible, not make our population healthier.
Also by having one financing mechanism, we can save huge amounts of money for practitioner's by reducing administration and overhead costs.
Secure public coverage for all will also mean a lot of people will retire that now just work for health benefits, and some will start businesses and provide more jobs because the burden of health-care coverage is lessened.
We already have a mechanism for employers and employees to pay a Medicare tax, so it can easily be adjusted to cover all and substitute for paying premiums. And with a tax, one pays according to income as opposed to with a premium. It's a fair and simple way of reforming our health-care system.
But most important of all, this system gives us the most bang for the buck, and I do not want my tax dollars to subsidize for-profit health care.
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
On Sunday, March 29, the Star-Ledger ran "book-end" op-eds on healthcare reform. They quibble about the cost and benefits of Obama's plan. Neither addresses a superior plan that is already before Congress but is being kept "off the table" in most discussions of healthcare reform.
President Obama insists that some consumers like their current health insurance. Most are probably unaware that illness and medical debt are the single biggest cause of personal bankruptcy in the United States, or that three out of four of those households had health insurance when illness or injury first struck. They do not realize that they will not be able to keep their plans if they lose their jobs.
In the United States, most young adults get their health insurance from their employer. If they lose their job, they have to buy health insurance, a huge expense when their income has vanished. What's worse, the high cost of health insurance has been chasing jobs away. Health insurance companies have been making money on employers of all kinds in the United States. Unlike Medicare, which has an overhead of only 3%, the insurance companies skim about 30% off the top, to pay for executive salaries and bonuses, shareholders' profits, and the cost of a wasteful bureaucracy. Many employers can't afford this, especially if they are competing with foreign companies that have efficient national health insurance. So employers from large industries to small businesses to nonprofits like your child's school have to make the nearly impossible choice between cut benefits or cutting staff.
Many citizens feel that the obvious solution is to expand and improve Medicare to cover everything for everyone: 100% of all medically necessary care, including prescription drugs and long-term care. By cutting out the private insurance companies, we could cover everyone at a reasonable cost: 90% of American families would end up paying less than they are paying now.
The United States National Health Care Act or the Expanded and Improved Medicare for All Act (H.R. 676) would be funded by a payroll tax: 4.5 percent from employers and 3.3 percent from employees. There would also be a one third of one percent tax on stock transactions and a small increase in income tax for the top income earners. So most unemployed and retired people won't have to pay a cent.
If Medicare for All is enacted, most Americans will never see another medical bill or pay for another prescription drug. They won't have to sell their home to buy long-term care for a disabled family member. All we need to do is get the House of Representatives to pass H.R. 676, and the Senate to pass the companion bill S. 703, and the President to sign it.
"But it will never pass," people say, "because Congress is in the pockets of the health insurance industry." The truth is that we can get this legislation passed. Pollsters report that most people want a "single-payer" plan like H.R. 676. Strong majorities of doctors and nurses support it. Most employers, from big manufacturers to small businesses to your children's school or your church, would save money on health insurance, while providing better health coverage to their employees. Medicare for All will help make American businesses competitive again. If patients, doctors and nurses, and most employers want this bill to pass, who can stand in its way? And why -unless you are a lobbyist for an insurance company - would you want to?
Nevertheless, getting Medicare for All will be an uphill struggle. The single-payer option is being swept "off the table" by the likes of Max Baucus, Senate Finance Committee Chair and recipient of over $2 million in campaign contributions from the insurance and healthcare industries in the last election. Fortunately, members of the House of Representatives face reelection every two years. If your Representative doesn't support H.R. 676, find someone who will and get that person elected in 2010. Senators serve longer terms, but the principle is the same. Ask Senators Lautenberg and Menendez to cosponsor S.703.
To get involved, connect with groups like Physicians for a National Health Program (www.pnhp.org) or Healthcare-Now! (www.healthcare- now.org). Beware of groups that are really fronts for the insurance companies. Learn the facts of healthcare reform options. Talk to your friends, relatives, coworkers and neighbors. Get organized, and get active. Together, we can do it!
Some quotes and material from Geoff Thomas at oped.com The views expressed in this article are the sole responsibility of the author, Geoff Thomas, and do not necessarily reflect those of this website or its editors.
Washington is trying to fix heath care and Medicare. Mark McClellan, a well respected think tank guru, said recently "It's a lot harder to come up with ways to implement reforms than it is to come up with ideas for reform," he said.
McClellan, 45, is an Austin native from a strongly political family. Brother Scott was President George W. Bush's press secretary. Their mother, former Texas Comptroller Carole Keeton Strayhorn, ran for governor in 2006.
Mark McClellan was a major policy figure in health care during the Bush administration. While most of his former colleagues are now in the political wilderness, McClellan is using his post at Washington's Brookings Institution to keep moving in the circle of implementers who want to "bend the curve" of rising health care costs.
Along with several other health care experts, McClellan is trying to persuade President Barack Obama's reform team and Congress to pay hospitals and doctors more if they can show they're improving treatment for Medicare patients while lowering costs.
McClellan argues that sharing savings could keep Medicare viable without bankrupting the federal government. "Right now, we are getting what we pay for – high-volume, high-intensity health care," he said. "Often, there's no support for preventive care."
White House Budget Director Peter Orszag says McClellan's approach is extremely closely aligned with the Obama administration's views on the need to change payment incentives.
"We have the same basic philosophy," Orszag said. "There are huge variations in health care costs across different regions of the country that can't be explained other than because of the intensity of care. ... We need to change the incentives so we get better care, not more care."
Medicare accounts for 20 percent of health care spending, pays providers on a fee-for-service model. Each visit, each test, each procedure a doctor performs pays a certain amount. The system creates an incentive to see lots of patients, lots of times.
For many years, reformers have argued in favor of payment systems based on performance rather than volume. Pay-for-performance advocates argue their approach gets patients the most effective type of care rather than an uncoordinated cascade of diagnostic tests, prescriptions and treatments.
Dr. Elliott Fisher of Dartmouth's Institute for Health Policy and Clinical Practice developed a pay-for-performance approach called Accountable Care Organizations that McClellan is now backing in Washington.
Fisher came to his model after sifting data that shows Medicare pays twice or even three times as much per patient in different parts of the country. The average enrollee in Medicare in Dallas, for example, consumes $10,103 a year in medical treatments, while Medicare enrollees in Salem, Ore., get by on half as much.
Fisher argues the regional cost disparities can be bent toward lower costs if physicians group together around hospital networks where each Medicare patient's care is coordinated and each treatment is evaluated for quality and effectiveness.
If the network can demonstrate its care regimen reduces average spending by 2 percent or more a year, the doctors and hospital would get bonuses amounting to 80 percent of the savings. If the network fails to meet either its quality or savings targets, its compensation would be penalized. "We need some big changes to address quality and regional disparities," McClellan said.
Len Nichols, a health care economist who worked on the Clinton administration's failed reform effort, said the reform emphasis now was less about ideas like pay-for-performance than ways to implement them. "None of these are new ideas," he said. "What we have is a sense of economic urgency driven both by the fiscal realities of our Medicare program and, obviously, the economic situation we're in right now. "We really shouldn't dither any longer about doing serious reconstructive surgery on our health system...We should start this afternoon. The longer we wait, the greater the costs."
This need to implement change is where Nichols and others see McClellan playing a role in the current debate. John Goodman, president of the Dallas-based, conservative National Center for Policy Analysis, said McClellan is "the single-most respected person in health care policy. He's both a medical doctor [Harvard Medical School] and a Ph.D. in economics [Massachusetts Institute of Technology]," Goodman said. "Most people in this debate are neither."
The health care debate is just getting started, and how much success McClellan will have is uncertain. For now, though, he's a busy man, shuttling between the White House, Congress and federal health care agencies. His phone directory includes the heads of major health centers across the nation, including Parkland and Baylor.
During the past few years, Medicare Advantage has become a more integral part of seniors’ health planning. Using basic Medicare and adding Medicare Advantage has been helpful to many Medicare beneficiaries including giving them some perks, such as gym memberships which could otherwise cost thousands of dollars. The added benefit to both seniors and Medicare is that the extras, such as gym membership encourages healthy living and can help prevent illness.
It is important that individuals who are thinking of enrolling in Medicare Advantage compare rates and coverage carefully. Since Medicare Advantage is private insurance and is not offered through Medicare, there can be issues that arise. Instead of paying your claims directly, the government pays private companies to do this through the Medicare Advantage plans.
Over 10 million seniors are enrolled in Medicare Advantage. Experts advise that especially during these difficult financial times seniors should look beyond some of the perks offered and compare private coverage to their traditional Medicare coverage.
There are various problems that seniors run into when they have left traditional Medicare for private coverage. One of the most common problems is that many physicians don’t accept Medicare Advantage; therefore many seniors are finding that they are in a position where they have to change doctors. For many, this can be traumatic for many reasons. Finding a new doctor who doesn’t know you (and who you don’t know) can be quite an ordeal. It has taken some people several months to either find a new doctor or go back to their old Medicare plan. Some individuals have had to go without medication during that period of time.
Many individuals are happy with Medicare Advantage. It is important, however, to determine what the plusses and minuses would be for you. Just because the agent tells you that you can continue with your old doctor, does not mean that it will be possible for your doctor to continue seeing you. Also, some individuals are finding that some medications and other out of pocket expenses are not covered as well as they were by their old Medicare policy, therefore costing them more money.
Before you change your coverage make sure you research to determine what will happen to your benefits in advance.
There have been many debates recently as to how to handle the situation of healthcare for individuals who are living in the United States but are not U.S. citizens. With elections around the corner, this issue has become an intense topic for discussion on all sides of the aisle.
There are many varied opinions regarding healthcare for these individuals and families. Studies have shown that the money they generate in the economy and sometimes in taxes offsets most or all of the medical expenses they incur. Other studies say the opposite.
With Medicare and Medicaid budgets and services struggling financially there have been questions raised as to how these individuals receive medical care and what it costs the system.
In Ohio, the Columbus Dispatch Newspaper stated in an article that the poor and/or undocumented in central Ohio, line up at the free health clinic near Ohio State University. The lines begin to form hours before the clinic – which is staffed by volunteer doctors and nurses - opens for services.
There is now a proposed bill requiring Clinica Latina and other clinics that serve undocumented residents to check for immigration status and turn away any individuals who do not have documentation. The bill states that the reason is that part of the funds for this particular clinic and some others come from Ohio State University. If the clinic were to receive funds only from private sources, they could continue treating these individuals without checking their status.
The issue that this leaves could have a huge financial impact on Medicare, Medicaid and the healthcare system because it would leave undocumented citizens with only the hospital emergency room for treatment. Unlike clinics, federal law states that hospitals cannot deny services to individuals based on various issues, including immigration status. As a result, seeing a doctor at the free clinic and receiving a $5 prescription for blood pressure or diabetes medication could now cost hundreds of dollars at the emergency room, and Medicare, Medicaid and taxpayers would have to absorb those costs.
The issue of undocumented residents in this country is not a simple one, nor will it be solved simply or quickly, however, it is important for lawmakers and administrators to look at the big picture and the overall costs before eliminating programs that could save an already struggling system money just to prove a point.
If you receive Medicaid, there have probably been some times that you wanted to go to a community health center but ended up having to go to the emergency room waiting for hours to get care. If you feel you have missed out on other services, such as education and non-emergency assistance, help is on the way.
A $50 million grant through the Centers for Medicare and Medicaid Services has been granted to be used by 20 states to provide alternative healthcare services and programs, such as establishing new community healthcare clinics, extend the hours of many existing clinics, create new services and provide electronic (computerized) sharing of information and more.
All of these are important improvements, and electronic sharing of information is critical because in the event that you live in a particular town – especially in a rural town – and a specialist in a large city 500 miles away can help you if he or she has your current information and tests, being able to share this information online could very well save you a 500 mile drive and save your life, as well. In fact, there are more and more reports of procedures – and even surgeries – have been done with electronic assistance.
It is important to note that this will not diminish or eliminate the benefits that you already have. The funding will help improve services and add additional ones.
They will also help individuals receiving services get the best services they can locally at a healthcare office instead of having to go to the hospital or having to go hours away.
