Posts tagged 'Medicare costs'
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.
Copyright © 2009 The Seattle Times Company
This seems to be a week for special stories that need to be told and need to be heard. There are many stories about problems with Medicare, just as there have been many successes with Medicare, as well. The fact that Medicare is in trouble in various ways is not news. We have been hearing this for decades, yet, it has taken until now - where Medicare is in a crisis - for lawmakers to sit down and really pull up their sleeves and put in the work to try to stabilize not only Medicare, but Social Security and the entire healthcare system.
It doesn't matter who is to blame or how many presidents back contibuted to the mess rather than fix it. For years it has been known that if a pet project needs funding all congress has to do is tap into Medicare or Social Security funds. Lawmakers know it and the public knows it. Just the charges alone for a pill or a pillow show that there should be more control over the system and more regulations between Medicare and the pharmaceutical companies as well as other vendors. Now we are all dealing with the results.
Below is a story I read that shows the results of a system that has been poorly managed - and, at times, not managed at all. I am leaving the story as written, as it speaks for itself. This is why we have to fix the system. There is no alternative.
My Medicare Experience
by jboettner
05/19/2009 01:02:14 PM EST
My father passed away last July 2008. Even though he is gone, I thought people should know about a couple major issues we encountered with Medicare.
First of all, my father was in rehab recovering first from hip replacement surgery, then from revision surgery. When Dad was a few weeks from discharge, he fell down and broke the same injured leg, and extended his recovery time indefinitely.
The problem is under Medicare patients only have 100 days to utilize rehab facilities, once 100 days were exhausted, my father's care immediately jumped to $200/day.
In addition, I found a source of VA medical supplies from a friend who died; we thought we'd ease the burden on Medicare with the second hand supplies.
I was very impressed with the quality of the VA equipment. But Dad's nurse determined that he needed a special pillow for his wheelchair, and the only way he could get the special pillow was to get a Medicare supplied wheelchair. As we found the Medicare wheelchair was not only inferior to the VA wheelchair, but as far as the "special pillow," about the only thing special was the $500 cost!
As we get ready to launch this major effort to reform healthcare, I just thought you should be aware that private industry seems to have also co-opted Medicare.
Apparently there is a 60 day period between medical events required to qualify for another 100 day rehab period. This would have been nice to know, but even if we did I doubt the outcome would've been different.
When we can approve $500 for a pillow when the patient can get it for free, plus deny a free wheelchair from the VA - in better shape and better quality than the one being provided by the facility through Medicare and forced on the patient - this shows why Medicare is in the mess it is in. This hapens thousands of times over. It is time for it to stop
Medicare fraud is not a new thing. It has, unfortunately, been going on for years. The problem is that years ago the amount of money at stake was not nearly as high and the Medicare system was not in nearly as much trouble financially. When you put those two factors together in today’s system, fraud is hitting Medicare harder during its most difficult time in the last 60 years.
For one thing, Medicare fraud has become a multi-billion dollar business. There are people making multiple millions of dollars defrauding Medicare every year. With Medicare funding being cut and with lawmakers trying to keep payments to doctors and healthcare professionals competitive enough so that they can afford to continue treating Medicare patients, just eliminating part of the fraud could provide the funding for the shortfall.
CMS, the Centers for Medicare and Medicaid Services, has been looking into the situation for quite some time now and is in the process of enhancing its anti-fraud efforts. They have announced that they will be implementing some aggressive new steps in cracking down on fraud.
Some of the changes CMS will be making include enlisting program integrity contractors who will study billing trends throughout the Medicare system. In doing so, when it finds providers whose billing is higher than or otherwise out of sync with the majority of other providers in their region, these providers will be audited. Since it is impossible for Medicare to look behind every claim, this is a cost effective way to look at any red flags that are going up.
In addition, another way that CMS will fight fraud will be to actually contact beneficiaries to be sure that they received the equipment or supplies that Medicare is being billed for and that these were the right equipment and were in good condition. Billing will be reviewed before and after payment and physicians who order an unusually high number of the same or related item(s) will be audited and/or reviewed as well.
These ideas alone, when implemented, should save Medicare millions of dollars. They should also discourage some individuals from engaging in fraud, as the penalties will be quite stiff and will be handled by local, state and federal law enforcement agencies, including the FBI if necessary. With this new program and the strength of law enforcement, hopefully fraud will decrease and the money saved by Medicare will be used to help the beneficiaries who need it.
Mike Leavitt, head of Health and Human Services wrote to lawmakers a few days ago asking for their help in healing Medicare. In the position he is in, he should know what some of the essential issues are that face Medicare and he has some straightforward ideas as to how to address these issues and begin fixing them.
Leavitt started out by stating that Medicare has done a great deal of good over the years, and this is important for all of us to remember. Medicare in and of itself is a good program, but the world, the United States, and the economy today is far different than it was 43 years ago when Medicare first began. In addition, medical costs have skyrocketed for many reasons including new treatments for diseases such as cancer, heart disease, diabetes and others. Many incredible medical discoveries have been made, however, the costs of caring for individuals with ongoing medical issues – especially critical issues – is much more prohibitive than in the past.
Today’s Medicare has more beneficiaries and fewer workers to fund the program. In addition, the costs of the funding will fall to our children and grandchildren, and if lawmakers – on both sides of the aisle – are not moved to fix the problems inherent in the system sooner, rather than later, the burden on the next generations will be overwhelming.
Leavitt states that in 1970 the cost per Medicare beneficiary was about $2,000 and now, in 2008, it is about $10,000. To make matters worse, there are over double the amount of Medicare beneficiaries now as there were before. Add to this the fact that health care costs have doubled but Medicare costs have quadrupled and baby boomers haven’t yet retired, and this is a recipe for disaster.
It is estimated that in the next 20 years the U.S. will be spending more on Medicare each year than on national defense. Families who are now spending about 23% of their wages on medical care will be spending over 40% of their wages on medical care, and Medicare will account for about 23% of that price tag. Add to that the fact that in 1970, about 4 workers paid for each Medicare beneficiary, and currently, less than 4 workers pay for each beneficiary. Then, looking 20 years ahead, only 2 to 2 and 1/2 workers will pay for each beneficiary, which means that workers will carry a heavy burden and the Medicare system may not be able to handle the toll of paying claims for all the beneficiaries enrolled in it.
Mr. Leavitt is urging Congress to consider these critical issues carefully and act on them in a bipartisan effort to fix as much of the problem as possible before it is too late. After all, it is our children and grandchildren, as well as their children and grandchildren who will be forced to deal with the problem if it is not dealt with now.
