Details, with devils in them, from Obama's proposed changes to Medicare/Medicaid
Reading this TNR bit last night giving some details about Obama's planned "small" changes to Medicare made me, well, downright wary -- and gave me such agita I had trouble getting to sleep. I kept trying to figure out how I could incorporate all these ncremental "changes," meaning increases in costs, into my somewhat stringent budget. And I wonder how much hell Democratic politicians will have to pay for these Obama proposals.
The New Republic has this explanation of cost-sharing changes:
Also of note are increases in cost-sharing under some very limited circumstances. This is actually something conservatives should like, at least in theory, since it’s arguably a version of what they call “consumer-directed care,” albeit in a very small dose. In a nutshell, seniors would have to pay slightly higher out-of-pocket costs for home health care and Part B services, plus they’d have to pay a surcharge on their premiums if their Medigap policies have “first-dollar” coverage (in other words, if their Medigap policies don’t have any cost-sharing). The hope is that exposing seniors to incrementally higher out-of-pocket costs would make them a little more wary of using services that might not be necessary. [Who determines whether services "might not be necessary"? Whoa! Experts! See below.]
As with any effort to increase cost-sharing, there’s always a danger that it will penalize people with low incomes or the most serious medical conditions [Ya think???]. But these proposals have the endorsement of many experts [Oh, well that makes it OK then, eh?] – and would protect the sick by, for example, waiving the cost-sharing on home health care if it follows hospitalization. Also, these changes, like the changes to Part B premiums, would start in 2017. Finally, this proposal, like previous ones the president has made, would make it easier to introduce “value based insurance design." VBID, as it's known, is a more elegant way to restructure benefits, so that people pay more or less out-of-pocket based primarily on whether the services and treatments they're getting actually add value. [Again, who determines whether value is added? Ah, yes. Experts.] (My emphasis)
Let's see: By making seniors on limited incomes pay more for any health care, "exposing" them to "incrementally higher out-of-pocket costs," seniors will hopefully be more "wary" of seeking care for themselves. And I'm sure it will. And I'm pretty sure outcomes will become increasingly, well, negative.
LBJ must be rolling over in his grave. And, yes, this is from ostensible Democrats, our Coporatist stealth Republican under the Democratic banner president and his Neolib administration staff.
Sheesh. Who thinks seniors just say, Oh, hey, today I think I'll go doctoring. It's such a fun way to pass the empty hours.... No, they want seniors to self-deny care, just as insurance companies do. People watching their pennies will think many times about getting that somewhat intermittent pain checked out. Some expert might say they'd been frivolous in seeing the doctor and perhaps they'd find out afterwards Medicare wouldn't cover it.... oh, well. Just something related to one's heart. Or cancer....
It may well also make them more "wary" --because they'll have less available income from all these "incremental" increases in the cost of Medicare, cost of supplemental insurance, and cost of who knows what other surprises Obama has in store for them-- of buying, oh, food. Meh, they'll lose weight. Heat. Forget about air conditioning, entertainment, transportation, being able to give gifts to friends and relatives. They'll be lucky duckies if they have a roof over their heads.
This is so close to what Sens. Lieberman and Cornyn were offering last July that I realized my fear that Holy Joe was acting as Obama's stalking horse was, unfortunately, most likely spot on.
Yes, Holy Joe Lieberman, who said the elderly were using too many services, and he wanted to make everyone pay far more up front before ANY Medicare payments would kick in to slow them down on their medical care shopaholicism. By making the elderly pay more for care, Ol' Joe thinks they will use less of it.
Yes, Joe, unfortunately, that's how it works for those with limited income. They will think twice, be "wary" about seeking care. And then...
They hurry up and die...?
Major cost saving, that....
Trudy Lieberman wrote about this in the Columbia Journalism Review this past July: Joe Lieberman and his Medicare Gift.
The plan is deceptively referred to as “Medicare benefit simplification,” says Joe Baker, who heads the Medicare Rights Center, a New York City advocacy group. “What they are proposing is not simplifying the benefit to help consumers but to save the federal government money, and they do that by increasing costs to consumers and providing a disincentive to use medical services.” Lieberman et al want to create a single deductible of $550 for all Medicare services, replacing the separate hospital deductible—this year $1132—and the separate medical deductible of $162. They also want to cap out-of-pocket spending for people with low to middling incomes at $7500.
Those with higher incomes would have to pay more out-of-pocket in a further effort to means-test the program. There’s already some means testing in Medicare, but Lieberman’s proposal would add more. For example, under his plan, people with an income of $85,000 would have to pay $12,500 out-of-pocket, or about 15 percent of their income before collecting benefits. Experts have long feared that as those with higher incomes pay more, they will lose their support for the program and opt out for private market coverage—thus weakening Medicare’s risk pool, which makes it possible to insure sick people in their old age.
Baker says a lower, combined deductible is not a good idea. It would raise out-of-pocket costs for millions of beneficiaries who don’t use hospital services during the year. But nearly all seniors go to the doctor, often several times a year, and Lieberman’s plan would require them to pay a $550 deductible instead of the $162 deductible they pay now for physician services. Under current law, they also pay 20 percent of the bills for doctor services, but Medigap policies, the popular ones at least, cover that amount.
That brings up another goal of Lieberman’s plan—to reduce the amount of coverage Medigap insurance can provide. His plan would forbid Medigap policies, which are owned by some ten million seniors, from paying that deductible. All Medigap policies now cover the hospital deductible, and two of them—Plans F and C—cover the medical deductible. Two-thirds of seniors who have Medigaps buy these plans because they want to reduce their risk of out-of-pocket expenses. Over the last few years, under the guise of consumer choice, Congress has authorized insurers to sell new Medigap plans that cost less but don’t cover as many of the holes. Guess what? Older people don’t seem to buy them. “Seniors are very risk averse,” says Bonnie Burns, a policy specialist with California Health Advocates.
It’s worth noting that Congress also pulled a fast one during the health reform debate. It slipped into the law a provision that will make seniors who buy Plans C and F assume more costs for their medical services. [I did not know about this this stab in the pocketbook and slicing away coverage.] The law calls on the National Association of Insurance Commissioners to draft rules that would make seniors who choose Plans C and F pay a greater percentage of the Part B coinsurance. So, for example, instead of policies paying the entire 20 percent coinsurance as they now do, they may cover only a fraction of it. Campaign Desk has repeatedly noted that the pols haven’t been eager to promote this, but there has been little press interest, too.
Under Lieberman’s bill, Medigap policies could cover only half of a senior’s out-of-pocket costs up to the $7500. In other words, they would have to pay $3750 right off the bat before any insurance would be allowed to kick in. And if they have an existing Medigap plan that does pay those costs, the government would slap them with an excise tax. One couple I know now pays $3720 for two Medigap policies that covers each of them and pays for everything. They would have to pay the tax, drop their policies, and each cough up the first $3750 to pay expenses, plus a premium for the new policy and a higher Medicare premium for Part B, which covers doctor services and hospital outpatient care. Lieberman’s plan would raise that, too. [As does Obama's, per reports.]
Making people pay a lot more is precisely what Lieberman and other pols want. He cites studies showing that when people have to pay more for their care, they will use less of it [D'uh!!!], and claims his proposal will reduce the debt and “save more than $600 billion over 10 years.” In his press release he says: “We can only save Medicare if we change it. Our plan contains some strong medicine but that’s what it will take to keep Medicare alive.”
The devil is in the details....
Do not trust anything Obama says which leaves wiggle room or has weasel terms.
Here's the NYTimes first take on details of changes to Medicare and Medicaid. I imagine there will be many changes within the Committee of the Twelve (Puppet) Caesars, and more details we may not hear about, but, on the whole, looks like Medicare is going to cost quite a bit more and will have less predictability for users of the best selling supplemental plans.
Recipients -- you may want to get anything remotely discretionary or elective done before 2017.
Democratic politicians -- you may want to get a new party or a new presidential candidate for 2012.
Voters -- you may want to be extremely "wary" of the current crop of Democrats. You do deserve a party which represents your needs and goals.