Tag Archives: Medicare

2012 Retirement Security Survey Ha! Ha! Ha! LOL

24 Feb
 
English: A member of the audience holds a &quo...

Thank you indeed, we will take all we can get, even from the millionaires and billionaires

I recently received the “2012 Retirement Security Survey” in the mail.  Great I thought; somebody is really looking at this important subject.  I will fill this one out for sure.  Oops, upon closer examination the document turns out to be propaganda from Democratic National Headquarters and a request for a donation.  There is no serious attempt to gain any valuable information.

Of course, Democrats are not alone with such nonsense, but some of the text of the “survey” really caught my eye because it is so outrageous in its claims and more than anything else it panders to people (mostly elderly) while ignoring the consequences for us all of staying a course of unlimited entitlements, irresponsible spending and long-term growing liabilities.

Here is an example:

“Republicans are working to turn back the clock on civil rights, destroy trade unions and the right to collective bargaining, deny women health care and vital family planning services, dismantle the Environmental Protection Agency, slash investments in education and medical research and to repeal President Obama’s historic health care reform.”

Another few examples:

“They (Republicans) abandoned seniors who fall into the prescription drug “donut hole” to give tax breaks to millionaires and billionaires. And they’ve developed plans to cut Social Security by slashing benefits and raising the retirement age.”

I’m still trying to figure out how much of this has to anything do with a retirement survey, but of course I know the real purpose of this mailing which is to scare the hell out of people, especially seniors.  This message and misleading information is not unlike that frequently issued by the AARP.

Then we have the objective questions contained in the actual survey:

  • Do you oppose the decision by House Republicans to end Medicare while protecting tens of millions of dollars in subsidies for Big Oil?
  • Do you oppose the Republican Party’s position of cutting Medicare for future retirees so they can extend the Bush tax cuts for millionaires and billionaires?
  • The health care reform law passed last year closes the Medicare prescription drug benefit donut hole.  Do you support this plan to help seniors pay for expensive prescription drugs?

How is all that for an objective set of survey questions?  Hey, doesn’t everyone love Big Oil, billionaires and donut holes? 

Within this blog I have addressed many of these issues over the last few years, especially why it is so important to future generations for this generation to fairly and prudently address the growing costs of Medicare and Social Security.  Any political party that panders to people creating the we can have it all expectation and the only thing that needs to change is to place higher taxes on millionaires and billionaires (defined as families earning $250,000 or more) is doing a great disservice to this Country and its citizens.

Extreme right Republicans who believe that the average American can do without many government programs is equally irresponsible.  The left underestimates Americans and sees them as totally dependent on government and the right over estimates the American ability or willingness for self-sufficiency.  Dare I say that puts us some place in the center?

I see no purpose in addressing the other side of some of these claims, but I can’t resist pointing out a few items.

A few Republican governors have taken on public employee unions and rightly so and in the best interests of all of a state’s citizens. 

Republicans are the ones who started Medicare drug coverage in the first place, albeit with no funding to pay for it.

Nobody is denying women health care or vital family planning services, not even a big bad insurance company denies anyone health care . . . think about it.

Nobody is proposing to slash Social Security benefits, but rather to slow the growth in future benefits, quite modestly as a matter of fact once you look at the numbers.

Nobody is going to destroy Medicare or Social Security, but to keep denying the need for meaningful reform will cause just as much harm.

You may want to review the Social Security, Health Care and Medicare categories on this blog for additional discussions on these topics.

Why you should care about your governments long term liabilities for Medicare

24 Jan

Defense, foreign aid, a bloated bureaucracy don’t matter at all.

The reality is that while we hear lots of rhetoric about debt and deficits, what really matters is long term liabilities. If you don’t believe me consider what happened with General Motors and it’s liabilities to retirees mostly with regard to health benefits. The latest example is Kodak filing bankruptcy during which the promise of retiree health benefits is likely to disappear along with some pension promises for higher paid workers who are affected by income limits on pension funding. Losing a substantial portion of your pension after you have already retired sounds like more than ones fair share to me ( and we are not talking about CEOs).

If you want more examples of this liability thing causing trouble just look to the various states that have agreed to unrealistic pension and health benefit commitments to state workers. And then you look at the results of all this. In Wisconsin the unions have gotten 1,000,000 signatures to force a recall election of the governor who did the right, albeit painful, thing to correct the State’s problems.

What is the most significant problem affecting the U.S., it is the same as I have just described above; long term liabilities for health care first and pensions second. That means Medicare, Medicaid and Social Security, but mostly Medicare.

So now the question is what will you do for the politician who tells you the truth (assuming you can find one)? Chances are you won’t vote for him because it is far easier to ignore a long term problem than deal with it. It is more abstract to believe foreign aid is the culprit than something that affects you directly. It is less stressful to agree with a politician who claims to have a solution while leaving Medicare and Social Security untouched.

The difficult part is accepting the truth. The U.S. has made open ended, demographic based commitments that it can’t control and can’t pay for. Twenty to thirty years from now there will be hell to pay. The longer it takes to implement corrective action the worse it will be… and that’s the truth like it or not

 

Medicare premiums 2014, the bogus rumor persists. $247 per month is ridicules

8 Jan

 

An Internet e-mail still circulates that come 2014 the Medicare Part B standard premium will be $247 per person. That’s nonsense for several reasons.

1. The calculation of the premium is set by law and that law has not changed.

2. There is nothing in the Affordable Care Act (Obamacare) that affects the Medicare premium calculation.

3. The President does not, as has been alleged, have the ability to unilaterally change any of this.

4. The standard 2012 premium for Medicare Part B is $99.90 (higher for the 5% higher income beneficiaries). If you used the highest rate of inflation to hit Medicare in the last forty years for both 2012 and 2013 you would get a premium of less than $130.00. The likelihood of that kind of inflation in the next two years is non-existent.

5. There is nothing in the 2011 Medicare Trustees report to indicate other than normal rates of cost increases over the next several years. In fact, the Trustee’s project that by 2020 the Part B premium will be $158.60. Even that is based on a premium for 2012 of $106.60 (not $99.90).

6. Most Medicare beneficiaries (95%) are protected from high increases in Medicare premiums under the Social Security hold harmless provision. This means that an increase in Medicare premiums cannot cause a net reduction in the Social Security payments. So, for example, if you are receiving $1,000 a month in Social Security benefits and you receive a 3% COLA increase, your Part B premium cannot increase my more than $30. Do the math and you will see there would have to be whopping COLA increases in Social Security in the next two years to get most people anywhere near $247 and that ain’t gonna happen.

English: President signing the Medicare Bill a...

1965

Are any of these projections 100% accurate? Certainly not, there are too many unknowns. However, before you pass along some outrageous story about Medicare premiums (or a tax on the sale of your home, or that the value of health benefits is now taxable income or that Obama was stopping the 2011 Social Security COLA – all of which were circulated in the last year), get the facts.

Unfortunately too many people out there are so obsessed with opposition to this or that, their judgement is clouded …or they are simply ignorant and that’s scary because they can still vote.

By the way, the story about a brain surgeon being at a meeting in Washington where denying care to Americans 70 and over was discussed is also a lie. There was no such meeting, there is nothing in the Affordable Care Act remotely related to that and the caller to a talk show giving the story was not a brain surgeon.

Read other articles related to Medicare under the “Medicare” and “Healthcare” categories on this Blog. 

A decline in the Medicare Part B deductible is a poor long-term strategy

6 Jan

Spend now, worry later!

Through 2005 the Medicare Part B deductible was set by statute. Thereafter it reflects the per capita cost for Medicare beneficiaries. In 1967 the Part B deductible was $50.00. Today after decreasing for 2012 it is only $ 140.00.  

However, if the deductible had been allowed to increase at the rate of general inflation (not even medical inflation) it would be $338.00.         

As a result of the Medicare Modernization Act, the Part B deductible was increased to $110 in 2005 and is indexed thereafter by the annual percentage increase in the Part B actuarial rate for aged beneficiaries.  In 2012, the Part B deductible will be $140, a decrease of $22 from 2011.  (The actuarial rate is set by law at one-half of the total estimated per-enrollee cost of Part B benefits and administrative expenses, adjusted as necessary to maintain an adequate contingency reserve.)

This seems to mean that the per-enrollee cost of Part B is expected to decrease by 13.5%, is that really a likely occurrence?   Did the contingency reserve used in calculating the Part B deductible consider the likely reversal of cuts to physician payments as was apparently the case with the Part B premium?  Regardless, a deductible that should by simple math be $338, should not be decreased under any circumstances, that is simply poor long-term planning.   

Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. By law, the standard premium is set to cover one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over, plus a contingency margin. The contingency margin is an amount to ensure that Part B has sufficient assets and income to (i) cover Part B expenditures during the year, (ii) cover incurred-but-unpaid claims costs at the end of the year, (iii) provide for possible variation between actual and projected costs, and (iv) amortize any surplus assets.  Most of the remaining Part B costs are financed by Federal general revenues.  (In 2012, about $2.9 billion in Part B expenditures will be financed by the fees on manufacturers and importers of brand-name prescription drugs under the Affordable Care Act.) 

The largest factor affecting the contingency margin for 2012 is the current law formula for physician fees, which will result in a payment reduction of about 29 percent in 2012.  For each year from 2003 through 2011, Congress has acted to prevent smaller physician fee reductions from occurring. The 2012 reduction is almost certain to be overridden by legislation enacted after Part B financing has been set for 2012. In recognition of the strong possibility of increases in Part B expenditures that would result from similar legislation to override the decrease in physician fees in 2012, it is appropriate to maintain a significantly larger Part B contingency reserve than would otherwise be necessary.  The asset level projected for the end of 2012 is adequate to accommodate this contingency.  

In summary, benefits have increased, the deductible is lower, the premium increase is extremely modest, nothing related to the Affordable Care Act has been implemented that would measurably lower Medicare costs or future trends, the planned cut in physician payments will not happen and all is right with the world.  In many ways CMS has little discretion in administering Medicare because most provisions are set by law, but that is the point.   Setting something as massive as Medicare on automatic pilot is not the best way to administer such a program.  It replaces prudent budget decisions with political decisions.

Obamacare regulations and hidden costs

27 Dec
Senate Passes Insurance Industry Aid Bill

Money, money everywhere

By now we all know that the Affordable Care Act contains thousands of pages of new legislation mostly unread by those who enacted the law. It also contains about 1500 references to discretion to be exercised by the Secretary of Health and Human Services. Since enactment, various government departments have issued a flood of regulations, including in some cases changing provisions of the law (although for the better).

Medicare has initiated scores of pilot programs designed to change the way Medicare operates, pays for services and the way health care is practiced. Rules for employers are in process and of course, the biggy will be the rules operating the health insurance exchanges beginning in 2014. That’s a lot of rules and regulations for a lot of people to comply with.

On December 27, 2011 the Wall Street Journal published an editorial about regulations and this section caught my eye.

Then there’s the Affordable Care Act. Christopher Conover and Jerry Ellig of the Mercatus Center at George Mason University, in a trio of forthcoming papers, systematically examine every rule issued to date to create the new health-care entitlement. They conclude that “the federal government used a fast-track process of regulatory analysis that failed to comply with its own standards, and produced poorly substantiated claims about the ACA’s benefits and costs”—including an upward bias for benefits, a downward bias for costs, and numerous material omissions. Little wonder for a law that contains the phrase “the Secretary shall” 1,563 times. The Mercatus Center evaluates all major rules that cost over $100 million a year on a composite score of a dozen regulatory best practices. The Health and Human Services Department’s highest-scoring ObamaCare rules came in at 25 out of 60 points, the lowest at 13. These are not merely bad grades. They are relative Fs on the regulatory curve—about 35% to 40% lower than the averages for the other rules that the executive branch put out in 2008 and 2009. The ObamaCare rules score lower than other HHS rules in 2009.

You can think what you like about the ACA, but the fact remains it is a complex law and growing more so each day. It is not at all clear that the benefits outweigh the costs nor do we know the true costs, especially those hidden in employer and other entity compliance. The bottom line is that for good or bad the ACA is only the start of what must be done to manage health care costs in America.

We can only hope that first expanding coverage and enhancing benefits does not make the real task impossible to achieve.

Accountable Care Organizations (ACO) and the promise of savings without managed care or patient limitations.. I wish you all the best.

20 Dec

 Here is a text of an e-mail I received from HHS:

 Affordable Care Act helps 32 health systems improve care for patients, saving up to $1.1 billion

12/19/2011 12:01 AM EST

Thirty-two leading health care organizations from across the country will participate in a new Pioneer Accountable Care Organizations (ACOs) initiative made possible by the Affordable Care Act, HHS Secretary Kathleen Sebelius announced today.  The Pioneer ACO initiative will encourage primary care doctors, specialists, hospitals and other caregivers to provide better, more coordinated care for people with Medicare and could save up to $1.1 billion over five years

That headline really grabs you doesn’t it.  Seems like it’s a done deal and the savings are in the bank.  That’s far from the truth, of course. There is no new information here other than we know the names of some health care systems that will participate in this trial (“Pioneer”) effort for Accountable Care Organizations.  

Don’t get me wrong, this is a good idea because if there is one thing we need, it is more coordinated care, but we have a long way to go before we start patting ourselves on the back with a success under the Affordable Care Act.  We need it to work in terms of saving money and improving the care people receive.  That’s a tall order even for spin doctors.

I have one major reservation on the ability for this program to succeed and that is the limited involvement by the patient and the limited ability for the ACO to manage all of a patient’s care.  Working efficiently, the process should be virtually invisible to the patient, but that assumes the patient only uses health care providers within a given ACO.  Will the ACO that receives financial incentives to provide efficient care be reluctant to make outside referrals thereby losing some of the control over patient care?  In the long run there is no benefit to the ACO to do so, but this is one of the criticisms made of HMOs.  Here is what HHS says about patient rights.  I am concerned that we are again trying to have it both ways; efficient management of care and total freedom when seeking care.  I don’t think that can work, let’s hope I am wrong.

Beneficiary Participation

Under the Pioneer ACO Model, beneficiaries do not enroll in an ACO.    Primary care providers and other healthcare providers make the decision to participate in ACOs, meaning a beneficiary will not need to take proactive action to receive the benefits offered through an ACO.  ACOs are required to notify beneficiaries of their participation, ensuring the beneficiary is aware of the new arrangement, and his or her rights described in this document.  In addition, beneficiaries may affirmatively attest that their primary provider is in a Pioneer ACO, and can then be aligned with the ACO and benefit from the enhanced care coordination that it offers.

Beneficiary Rights and Protections

A beneficiary aligned to an ACO maintains complete freedom to visit any healthcare provider accepting Medicare, just as all Medicare beneficiaries participating in original, fee-for-service Medicare do.  These beneficiaries do not need a referral to see a specialist outside the ACO.   Unlike a managed care arrangement, like an HMO or a Medicare Advantage plan, a beneficiary aligned to an ACO is free to see any healthcare provider accepting Medicare at any time.  In addition, beneficiaries maintain all the benefits to which they are entitled in original, fee-for-service Medicare. 

Beneficiaries will have direct channels of communication to CMS to ask questions and relay concerns.  Through the initial notice of participation, beneficiaries will be informed that they can call 1-800 MEDICARE at any time to ask questions about the program,   alert CMS of any concerns they may have about the ACO.  Beneficiaries will also be surveyed each year to assess their experience with the new program.

 Here is a link to the list of the 32 organizations

Wyden-Ryan Medicare reform … Ah, not so much

15 Dec
English: Photograph of President signing the M...

With a stroke of the pen

I just did a quick read of this plan, so there is more to come.  However, let’s get one thing over now. It has no impact on current Medicare beneficiaries or anyone who will retire in ten years.

 
Beyond that I must say I am not impressed. That is unless you gauge achievement by the number of times you can use “quality, “affordability” and “competition” in a proposal.

 
The plan  relies on private insurers competing for Medicare customers and that is supposed to lower costs and improve quality.  We’ll see, but let’s not forget that even if you have five insurers in a state competing for customers, for all practical purposes they all must use the same doctors and hospitals as does Medicare.

A thought comes to mind, will the quality of care you receive from one doctor vary based on your insurer?  Will any innovative efficiency by Medicare or a private insurer not be used by all?
And what about the competition we already have among Medicare Advantage plans, why hasn’t that kept Medicare costs under control?

 
As I said,  there is much more to come as we get into the details, but it appears once again we are barking up the wrong “competition” tree.

Threatening politicians if they cut Medicare, it’s not only the elite who influence for self interest at our collective peril. What would you do to rein in Medicare costs?

20 Nov
WI: Then-Senator Barack Obama and AFSCME membe...

Lobbying by any other name

Twenty-six year old history majors are protesting on Wall Street, the influence of the wealthy is decried, lobbyists are bedeviled and yet when a politician even thinks of trying to fix problems that were caused by the promises of past politicians and the actions of us all, they are targeted and threatened with unemployment.  

We are shocked at influence peddlers for one group and then do exactly the same thing in the name of seniors, or teachers or public employees.  The answer is not that one group of the other is bad or good, deserving or not, it is that we are unable to grasp the concept that everything we do is connected.  There are consequences, unintended or not, to the promises we make, the policies we establish, the money we borrow, the decisions we make.

In the quest to deal with the deficit, both Medicare and Social Security must be addressed.  They are the two largest components of federal spending and growing.  To ignore that is irresponsible and yet we have groups like the AARP and the unions listed below who choose to ignore the realities of our spending and inability to fulfill unrealistic promises.  You simply cannot look at one element of spending in isolation and expect to solve a spending problem as desirable as that spending may be.

Take a look at this report from Capsules the KHN Blog 

TV Spots Target Three Republicans On Medicare Cuts

By Karl Eisenhower

November 16th, 2011, 4:16 PM

The AFSCME and SEIU trade unions, along with the liberal advocacy group Americans United for Change, are warning Sen. Dean Heller, R-Nev., Sen. Scott Brown, R-Mass. and Rep. Denny Rehberg, R-Mont., that votes in favor of Medicare and Medicaid budget cuts will be unpopular with seniors.

The groups launched ads today featuring the voice of a woman who sounds as though she’s old enough to be eligible for Medicare.  The script of each version is the same, with only the name of the targeted member of Congress changing.  Heller and Brown are seeking reelection, and Rehberg is running for the Senate against Democratic incumbent Jon Tester.

The ad targeting Sen. Brown, embedded below, is running only in the Boston market, and only on cable television.  The Heller ad is running on broadcast stations in Reno, and the Rehberg ad is running on broadcast stations in Billings and Missoula.  All three spots will run through the end of this week.

A transcript follows:

If you vote to cut Medicare, Sen. Brown, I will remember it every time I visit my doctor. I’ll remember you cut Medicare and Medicaid every time I fill a prescription. I’ll remember you cut Medicare if I fall or get hurt. I’ll remember you chose protecting millionaires over protecting my health. My friends will remember it too –- all of them. Call Senator Heller. Tell him to protect Medicare and Medicaid.

Here is a quote from the Americans United for Change website:

For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children. These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold. The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors. We are working to set the right priorities for an economically secure future while continuing to protect health care coverage for those who can least afford it.

They are right, the key to making Medicare sustainable is reining in costs.  Ok, now just tell us how or more important, who will receive less when those costs are reined in?  Here is a check list of possibilities:

 [] doctors [] hospitals [] drug companies [] patients [] high-tech equipment manufacturers [] nursing homes 

The Affordable Care Act already claims to have saved over $400 billion in Medicare costs, plus raising an additional $100 billion plus from new taxes on the wealthy and employers.  The Act contains 160 programs and projects designed to lower costs over time and all this is still not enough.  Doctors are supposed to see their payments cut  27% in January 2012, but that will never happen. 

So, let’s have suggestions for “reining in costs!”

Related articles

Putting five million retirees at risk for higher health care costs – why changing the status of the Medicare Part D rebate to employers is a bad idea

26 Mar

 

As companies take the accounting charge related to the loss of the tax deduction for prescriptions drugs under the Medicare Part D rebate, the Administration is spinning the issue as no big deal. Well, yes it is a big deal because five million retirees may lose their company prescription benefits or see them reduced. If they are forced into Medicare Part D drug coverage these retiree’s out of pocket costs for prescription drugs will rise and they will lose the safety net of having their former employer manage their benefits and provide assistance when necessary.

This rebate was crafted not as a windfall for corporations as some in Washington now claim, but to encourage them to keep the coverage and to save the federal government money on Part D subsidies.

The White House press secretary recently said they were just closing a loophole. What nonsense, it is a pure revenue raiser for health care reform. However, keep in mind that the cost of this rebate is less than half of the governments cost per person for Part D. In a joint letter to Sen Harry Reid in December 2009, the American Benefits Council and the AFL-CIO pointed out: 

 

Independent calculations show that if as few as 24 percent of retirees are dropped from employer plans and obtain coverage through Medicare Part D, then Section 9012 will be a net revenue losing provision. 

 

This alert was dismissed out of hand as were many others pointing out the likely unintended consequences of reform as then conceived and now the law of the land.

During the Fall of 2009 I and several colleagues from other companies  met with dozens of House and Senate staffers on this issue trying to explain the impact of the change, it’s implications for retirees and the potential increase in government costs. Not one person we talked to knew about the issue or was aware it was even in the legislation. Several expressed shock, some asked that we talk to other staffers and to budget staff members.

As you can see, the result was simply ignoring all they were told.  Today the White House and others in Washington blame employers for overreacting, who will they blame when retirees lose their prescription coverage…as if we had to ask.

blogsurfer.us

See where Medicare costs are headed and what it means for federal deficits

19 Mar

 

The following is from the website of the Congressional Budget Office (CBO).  It very succinctly states the problem that is facing our government.  The problem is obvious, the cost of Medicare is unsustainable which means that the real problem we are trying to solve is the cost of health care.  It also means that saving money on Medicare by attacking “waste and fraud” and then spending that money on a new government entitlement that will also grow at unsustainable rates based on the cost of health care is not logical.

The federal budget is on an unsustainable path, primarily because of the rising cost of health care and the aging of the U.S. population.

Projected Federal Spending Under One Fiscal Scenario
(Percentage of gross domestic product)
This figure, an area chart, shows federal spending from 1962 through 2082 under one scenario for Medicare and Medicaid, Social Security, and all other programs (excluding debt service). Most prominently, net federal spending on Medicare and Medicaid rises from 4 percent of gross domestic product in 2007 to almost 20 percent in 2082.

Premiums are not the problem

11 Mar

 

According to the President, insurance company health insurance premium increases are the main problem with our system. Attacking premiums and profit is in his speeches and all over the White House blog, the President is attempting to stir up resentment against health insurance companies.  It is almost as if there is no connection between the cost of health care and premiums, only a connection with profit. So how does the federal government deal with rising health care costs and premiums.  Remember in these examples there is no insurance involved?

In short, it simply artificially caps the premiums and shifts the real costs someplace else. For example, if there is no increase in Social Security benefits because the COLA does not kick in the majority of Americans on Medicare see no increase on their Part B premium. The costs have gone up but not the premiums. Where did the costs go?

From the 2009 Social Security and Medicare annual report:

It is expected that about one quarter of Part B enrollees will be subject to unusually large premium increases in the next two years. This occurs because it is projected that the other three-quarters of Part B enrollees will not be subject to premium increases in those years due to low projected Social Security benefit COLAs and a “hold-harmless” provision of current law that limits premium increases to the increase in Social Security benefits.

Congressional Research Service

If there is no Social Security COLA, Medicare Part B premiums would be affected in two ways. For about three-quarters of Part B participants, the hold harmless provision would prevent their Part B premiums from increasing, and so their Social Security checks would remain flat. For the other one-quarter of beneficiaries, the hold harmless provision would not apply. These beneficiaries would shoulder the entire beneficiary share of the increase in Part B costs. In other words, their collective premium increase would be nearly four times greater than if there were no hold harmless provision.

There are three groups of beneficiaries to whom the hold-harmless provision would not apply:  

  • new enrollees (about 2% of beneficiaries),
  • high-income beneficiaries who are subject to income-related Part B premiums
  • low-income beneficiaries whose Part B premiums are paid by the Medicaid

    • The underlying cost of health care is what drives premiums and while the federal government may be able to simply pass legislation and avoid  necessary premium increases, that does not work in the real world (or for the government truth be told).  Unfortunately, that does not stop the President or the White House from aggressively making insurance companies the scape goats or deceiving the American people into believing that simply limiting premium increases solves any problem. Barack Obama’s Speech on March 3, 2010.

    The President’s proposal for health care reform requires that insurance companies spend 80-85% of premiums on health care with the remaining 15% or so covering all expenses and profit. Let’s say this one shot change is enacted, then what?  The premiums still continue to escalate beyond general inflation just as Medicare does. How is that solving the problem of escalating health care costs – and premiums?  In addition if you are one of the 70 million Americans covered by your employers self-funded health benefits plan, there is no impact whatsoever on your costs, your contributions and your employers costs will continue to rise each year at a substantial rate.

    Here are some recent trend rates for different types of health plans, trend rates are the anticipated increase in claims considering increasing costs for medical services and the frequency and type of services provided.  For a discussion on how trend rates are used to develop premiums click here. 

    • HMO = 10.5%
    • POS = 10.5 %
    • PPO = 10.9%
    • Indemnity = 12%
    • CDH (consumer driven health) = 10.7%

     

    With general inflation nearly nonexistent isn’t’ the real problem we need to solve the increasing cost of providing health care?  High premiums and high premium increases are the symptom not the illness, but to hear the White House tell it, insurance companies discriminate, ration care, make your health care decisions and make abusive profits.  You are being conned and your attention is being diverted from the real issues that underlie the need for health care reform.

    Applying for Social Security, are we having fun yet?

    30 Oct
    charlie_napping_couch_lw

    Now that's out of the way, I'm back to my Twitter account

    Government in action 

    Being the tech obsessed person that I am, I recently applied for my Social Security on line.  Frankly, it was easy.

    About a week later, I received a call from a representative of my local Social Security office.  She left a message that she had some questions and few things needed to be cleared up….oops.  I called and left a message.

    As promised, she called me back right on time, 8:00 am to be exact.

    She said there was a problem with my name, apparently when I applied for my original Social Security card 50 years ago I did not add the 3rd on to my name which is my legal name.  They could not go forward I was told until this was corrected and that I would have to bring my birth certificate to the office to prove I was in fact the 3rd.  Ok, no big deal.

    We then talked about the effective date of my benefit, which appeared as October.  She asked me why I selected October on my application as my full benefit birthday was in November.  I informed her that I did not select October, but rather checked the box on the Web that said, “Earliest month possible without an age-related reduction.”  The system put in October and I thought I was going to get an extra months benefit, silly me.

    She noted that my wife was already collecting a Social Security benefit but probably wanted half of my benefit instead of the amount on her own earnings.  I said sure but since they already had all the info on my wife, I thought the change would be automatic.  Oh no, she has to apply for that benefit, I was told.  Ok, so how do we do that?

    “We can do it now if you like, you can apply for her.” The nice woman said.  “Eh, well sure let’s do it.”  “Where were you married, when where you married, are you still married?”   Yup, sure am and I even remembered my anniversary.  I didn’t bother to tell her all that information was provided on the form I filled out online the week before. Ok, that’s it.

    We just have to clear up your name.  I happened to mention that sometimes I use the 3rd and sometimes I don’t.  “Oh,” she said you do not care if the 3rd is on your check (actually direct deposit)?  “Not one bit,” said I.  “In that case you don’t have to worry about the birth certificate.”  Yikes, more red tape avoided.

    “You checked that you don’t want Medicare Part B, are you still working?”  “Yes, I am.”

    “You didn’t indicate if you are enrolled in a group health insurance plan.”  Actually, I did check yes to still working and enrolled in group health benefits and my printout of the online application shows both.  Has the Social Security system caught the H1N1?

    Finally, I asked about the income tax withholding form I had completed.  The instructions on the form say to mail the form or bring it to the local SS office. Can I just drop if off on Friday I asked?  “You don’t have to do that just tell me what percentage you want withheld and I will take care of it.”   Now we have circumvented the IRS procedures as well.  I’m in bureaucratic heaven.

    So that’s my tale, the lady representing Social Security was very nice, very friendly, very helpful and so far as I know very efficient.  Thank goodness for that, because apparently the system is not sure what it is telling people or what it is doing.

    Oh, how I dread that first Medicare claim…However, I suspect I can’t file on line.  Actually never filing a claim would be just fine.

     

    blogsurfer.us

    Optional confusion, confusing options or perhaps no option

    27 Oct

    Public option, no public option, sort of a public option, a public option the states can opt out of, a public option if this or that happens. A public option that is called something else. Are we having fun yet…just wait.

    I have a public plan and I don’t even have an option to take it or not. While I can choose among some alternative designs, I can’t opt out (and still have coverage) and people in Congress and the federal bureauocracy can take away my choices at any time, determine my benefits and what I pay.

    In fact, I have been paying for that option since 1965 and so have you. Because part of my pension is not from a qualified trust I even had the priviledge of writing a check for $16,000 to cover my Medicare tax for the rest of my expected life even though I am retired.

    There must ber a better way to do this

    There must ber a better way to do this

    So now Congress wants to lower the government’s cost for my public option so it can start another public option one paid for with premiums even though my public option is paid for with payroll taxes and premiums and is going broke. And many in Congress want a STRONG public option meaning the payments are based on my public option’s payments which are set by Congress irrelevant to the cost of services. How does that work again?

    Does the UAW represent workers in insurance companies? What jobs are we saving or creating this time?

    I know, we need a $4,500 credit for anyone who buys an efficient health insurance plan before December 31. Ah nuts, that plan will never meet the new minimum benefits package standards.

    How long will it take to reform the reforms?

    blogsurfer.us

    I wish I were wrong in this somewhat negative assessment of the current state of affairs, but my experience, history and even a touch of common sense tell me otherwise.

    22 Oct

     

    As we continue the rush toward health care “reform” – a misnomer in the making, perhaps it is time to recap where we have been.  Frankly, I am a bit confused myself. After reading so many versions of this concept, participating in numerous conference calls and meetings and speaking with the staff of a dozen members of Congress, I can’t remember who told me what, but I do remember they told me conflicting “facts” and they were all Democrats.

    Yes I remember now, they all told me they were going to save the Country from certain crisis if health care costs were not controlled, but they were unclear as to who was going to benefit.  On the other hand, I have been hearing that same song since 1978 or so and I am still waiting for that universal health care ID card that Bill Clinton held up in his first State of the Union speech.  However, I must admit that when GM lamented over the $700 per car that represented their health care costs back in the 1970s they were on to something, but they too failed to do anything to correct the problem and you know who ended up paying for that.  One has to wonder if nobody can fix a problem, is there a problem to fix?  Perhaps Americans like paying a lot for what they believe is good health care.

    From the start, the health care debate has been more about expanding coverage to the uninsured than truly reforming the health care system.  In fact, along the way, the debate became reforming health insurance and as I write this, the insurance companies have managed to make themselves the villains again drawing the rath of the White House before providing Pelosi and friends more fuel to push a public option. 

    Competition among who, could it be among health care providers? Nah, that would be too logical

    When there is talk of saving money is it about the federal budget, when there is talk about making something affordable it is about subsidizing premiums to lower the cost to the individual or expanding Medicaid.  Even when there is talk of changing the system, such as comparative effectiveness studies it is in the context of Medicare.  The Senate Finance Committee bill calls for a new Medicare panel to manage costs without lowering benefits or cutting payments.  Translate that to some form of rationing as that is the only option left.

    If you among the people who believe that we can have all what we want, when we want it and that any expense can be justified in some manner, I ask you to simply take a look at the federal and state budgets, the deficits and the collective taxes you pay.  If you like what you see…stop reading Quinnscommentary.com

    Members of Congress and large segments of the population see insurance premiums as the cost of health care and the cause of our woes.  In fact, premiums reflect true costs not the other way around. Large emploeyrs, including state govenrments are seeing double digit incrases in their health care costs for 2010 and they don’t even use isnruance companiens…how can that be, no CEO pay to blame and costs still out of control?  Ask Nancy.

    When there is talk about the need for a public option, the failures of Medicare are ignored.  In fact, one commentator recently noted that Medicare “our most successful public option, is going broke”.  GM was successful too, until it went broke.  Again, we define success in health care reform as coverage for more and more people.  I am not sure that is all we are looking for.

    My point is that we are missing the point.  We should be talking about the ills of fee for service medicine, the incentives to render more rather than the most efficient (or best) care, and the lack of clear definitions and application of quality health care. We should be curtailing the advertising in health care services that misinform and encourage utilization, the practice of defensive medicine and many of other real issues largely ignored by Congress in large part because they fear losing political contributions.

    (more…)

    Hey, it’s all coming from the same pot

    19 Oct

     

    Let us see if we can get this right, for 2010, there is no increase in Social Security benefits, and  Congress is considering legislation to stop the scheduled increase in Medicare premiums.  Inflation is low so there is no increase in Social Security, but health care inflation is high so there should be no increase in Medicare premiums despite the fact there failing to increase premiums in 2010 will add to the Medicare financial problem and may cause higher increases in subsequent years.

    More Congressional math. 

    Sooner or later they are coming home to roost

    Sooner or later they are coming home to roost

    It seems to me that a 5.8% increase in Social Security in 2009 should be good enough for two years at a time when there is virtually no inflation and workers are seeing no pay increase or worse.  On the other hand, I have been unable to convince my wife who is receiving Social Security of my logic so I suspect the AARP has the same problem.  We seniors are a greedy lot. 

    Now, because there is no inflation the amount you can place in your 401(k) or receive from a qualified pension plan is not increasing either from 2009 levels. This should not matter much as pensions are disappearing, people are not getting raises, they cannot afford to save and probably are not motivated to save because their employer match is gone from the 401(k) as well.   

    However, my favorite is the pending legislation that will stop the cuts in Medicare payments to physicians (again) to appease the AMA while adding to the deficit to the tune of a quarter billion dollars or so.  Now, to avoid confusing us Congress insists that this is not part of health care reform so the planned “saving” from Medicare of $404 billion are unaffected by spending half of it.   

    Hey, it’s only money…yours.

     

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