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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.

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a little night musing's picture
Submitted by a little night ... on

Yeah, right after he said " It's just like your mother writing you and saying she wants $20, and I'd always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. " he followed up with "... unless, of course, she wanted it for a trip to the doctor."* < / snark >

Incentives to use treatments that actually work - sounds like a good thing, but why am I suspicious that isn't how it will turn out. Cynical me.

* unsnarkiness: had he actually followed it up with something like this, he would have then probably said, "In which case I'd make it $200." For real: go read his actual words.

Submitted by jawbone on

the patient thinks he or she can't afford. That's what Lieberman, Obama et al, want Americans on Medicare to do. And the devil in that detail is probably lives lived not as healthy as people could be.

Neat, huh?

One particular area that may strongly affect outcomes is physical therapy, for whatever reasons -- after surgery, joint replacement or repair surgery, heart surgery, strokes, etc. It's very expensive when paying a co-payment 3 or more times a week, and usually one "session" of 4 or 6 weeks does not do enough to bring the patient to his or her fullest potential for recovery, for return to normal life.

A friend of my family had quadruple by-pass surgery, had to recuperate in a nursing home, and had only one go-round of PT. She ended up unable to stand up straight and spent the remainer of her life in discomfort. She'd been told she didn't need more than one session of PT, when she probably needed at least two, maybe three or four. She'd been a very active older woman, was a former ballroom dancer competing in pro-am contests. It was so sad to see her with her chest area kind of concave, from the tightening of the muscles as they healed (I think, based on what I've learned from my burns and graft surgery recovery).

Now, I know she had good supplemental insurance with her Medicare, but she was from a generation which didn't question authority, alas. And she'd been told she didn't need any more PT.

Good to go....downhill.

The point is that PT is frequent, the 20% co-pay is not unsubstantial, and many more Medicare patients will be trying to save money by avoiding the expense of additional, albeit medically necessary, care.

Submitted by jawbone on

From Market Watch, How Debt Reduction Plan Hits Your Taxes and Medicare.

Luscombe [Mark Luscombe, a principal analyst with CCH, a Wolters Kluwer business] said there are proposed increases in Medicare income-related premiums under Medicare Parts B and D. Under Obama’s plan, an additional $25 will be added to the Part B deductible for new enrollees in 2017, 2019 and 2021. And, Part B and Part D income-related premiums will increase by 15% until 25% of beneficiaries are subject to these premiums, said Nawrocki.

In addition, a 15% surcharge will be added to Medigap premiums starting in 2017. “The administration is concerned that Medigap plans that pay all of the copay and deductible amounts for beneficiaries cause people to use services without considering costs and encourage use of services that may not be required,” said Nawrocki.

According to Paul Clark, a senior Medicare analyst with CCH, the surcharge on Medigap policies proposed as part of the president’s deficit reduction plan would not go into effect until 2017, and would apply only to new Medicare beneficiaries that year. “Current beneficiaries and ‘near-retirees’ — I’m assuming that means people qualifying for Medicare between 2011 and 2017 — would not be affected by this proposal,”

Breaking in here to point out these figures and age/year aspects are not set in stone. Also, that if newer beneficiaries are hit with higher premiums via surcharges, I can't imagine there won't be a hue and cry for "fairness" and "parity," that some pols will begin attacking the Greedy Oldest Geezers....

Clark said. “The surcharge is equal to 15% percent of the average Medigap premium or about 30% of the Part B premium. This applies across the board to new beneficiaries, regardless of income.”

As a guesstimate as to how much the Medigap surcharge would cost new beneficiaries, Clark said the Part B premium is pegged to income, so, in 2011 numbers, this surcharge on Medigap policies would cost somewhere between $35 and $110 per month extra per individual. The additional cost by 2017 would be slightly higher than that, he said. At the moment, Medigap policies cost between $85 per month and $250 per month, depending on where you live and the type of plan you select.

Using 2010 figures, Clark said about 17%, or 8 million, Medicare beneficiaries purchase a Medigap policy. But many more beneficiaries get coverage similar to a Medigap policy from their employers or former employers, Clark said.

Clark also noted that President Obama’s plan calls for an across-the-board increase of $25 in the Part B deductible in 2017, 2019, and 2021 – but, again, this would only apply to new beneficiaries, not current or near-retirees.

As for Medicare Part B and D premiums, Clark said President Obama’s proposal “could be a little clearer.” It calls for a 15% increase in income-adjusted premiums, again, starting in 2017, and ‘would maintain income thresholds associated with income-related premiums until 25% of beneficiaries under Parts B and D are subject to these premiums.’

Currently, Clark said there is a set monthly Part B premium for individuals with incomes of $85,000 or less ($170,000 for people filing a joint return). Then, the premium is adjusted between $85,000 and $107,000; between $107,000 and $160,000; between$160,000 and $214,000; and finally above $214,000. For 2011, most Medicare beneficiaries pay either $96.40 or $110.50 per month in premiums. But, according to the Social Security Administration, about 5% of Medicare beneficiaries, or some 2.3 million older Americans, presently have income above $85,000 and pay a higher premium. “I’m guessing that this 15% increase would apply to people with incomes above $85,000 or whatever the equivalent number will be in 2017,” said Clark. (My emphasis)

I'm hoping there will be some more firm reporting coming along on these changes.

Also, I'd greatly appreciate input from our health insurance/Medicare/Medicaid mavens on whether the analysis available to date is correct. Or, I'm guessing, there's no real way to know?

And everything is subject to all that lobbying power and money hitting the Commitee of the Twelve (Puppet) Caesars, aka Obama's Politburo. And party pressure We the people can contact Last I looked it's not easy to reach these senators and representatives. The Dems reps I looked into had email set-ups requiring 7 freaking digit zipcodes!

But lobbyists sure can get through to them....