MM: Letting them buy in at an earlier age would smooth their transition to Medicare. Because Medicare has to take all comers, people would no longer have to worry about preexisting conditions and being rejected by insurers in the individual market at an age when health conditions start to surface. But that creates other challenges. If all the healthy people continue to buy insurance from private plans and only turn to Medicare when they get sick, the costs to Medicare would be very high. This unlevel playing field would lead policy makers to tough choices: Should Medicare be subsidized to keep costs low? If so, who should pay for that? That could mean higher payroll taxes which many people believe are necessary. Others are vehemently opposed to higher taxes.
TL: How serious is Medicare’s so-called waste, fraud, and abuse problem?
MM: We know that there is fraud on the part of doctors and hospitals that game the system, and that should be aggressively handled. The issues of waste and abuse are more subtle. Was a particular treatment or test necessary, or was it wasted money? Sometimes we can judge that only after the fact. One person’s waste is another’s valued benefit. We need to know much more about what works and what doesn’t. This will require investment in research and communication, and it will take time to change the system. The public also needs to realize that refusing to insure certain tests and treatments that do not work is a good approach, not a bad one as some critics have charged.
I went on Medicare in March after 30 yrs as a self-employed person scratching up insurance. If this admin gets "universal health care" or makes changes, will I still have Medicare or will I be in the same boat as everyone else--trying to find insurance and pay for it?
#1 Posted by Star, CJR on Thu 9 Apr 2009 at 11:00 AM
Among gamers of the system, suppliers of home medical equipment (special beds and the like) need to cited.
In my own experience, taking care of an ill parent living with me, vendors would charge and be reimbursed by Medicare for items at a rate 4 and 5 times the cost they would charge me if I bought the item in person for cash.
I wonder what the annual costs to Medicare are for vendors. There needs to be a realistic "fair and customary" price index for them, as there is for physicians' fees.
#2 Posted by Jane, CJR on Thu 9 Apr 2009 at 06:05 PM
Two industries which do not have a shortfall, and in fact are thriving on the very conditions that are sapping Medicare's trust funds, are this country's health insurance and pharmaceutical industries.
If the "rising costs of healthcare," are the source of our problems, especially in this downward economy, these industries are far and away the primary cause. It is futile to look for solutions to Medicare without regulating these industries.
The health insurance industry currently occupies an Entitled position in our economy. True entitlement reform would be Health Insurance industry Reform.
#3 Posted by Jane, CJR on Thu 9 Apr 2009 at 06:30 PM
In response to Star: I do not believe there will be many changes to the Medicare program that should cause you concern. It will likely stay pretty much as is, but hopefully with some modest improvements in the benefits offered.
#4 Posted by Marilyn Moon, CJR on Fri 10 Apr 2009 at 11:14 AM