Medicare Part E: Everybody

[OwnedByFerrets]

Thom Hartmann from Common Dreams

"The President this morning admitted on national television that he lost control of the message with health care. It's time to reboot - and use a very, very, very simple message so all Americans can understand it.

Let's use Medicare, which nearly every American understands. Just create "Medicare Part E" where the "E" represents "everybody." Just let any citizen in the US buy into Medicare."

"This blows up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with United Healthcare and it's $100 million/year CEO. Those who like Medicare can buy into Part E. Simplicity itself.

Of course, we'd like a few fixes, like letting negotiate drug prices, and fill some of the other holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first."

Rest of the essay here:http://www.commondreams.org/view/2009/09/09-9

[bkkyosemite]

1. close the holes yes the prescription hole the 20% hole and ADD dental for all even those on Medicare

now

[GreenPartyVoter]

5. I like the sound of that

[ejpoeta]

2. AMEN!! on top of that, if they are so worried about medicare's sustainability...

which of course would be a problem when the only people allowed in the system are going to be needing to use it, is that opening this up to everyone would bring a big influx of cash into the pool... cash from people who don't generally need to really use it because they are young and healthy. and then instead of starting from scratch to create some new entity from whole cloth, we can work on fixing the problems with the system we already have.... to make it better for everyone... seniors, young people... and then if there is a mandate, then at least people have a choice and can't be strong armed by the for profit insurance companies. but i do not believe a mandate should be allowed until we have addressed the reasons why people do not have insurance currently.

[SPedigrees]

3. Yes, expand medicare and forget the public option.

It amounts to the same thing but the morons will think they won.

[FLDCVADem]

8. I'm all for making Medicare the public option for those that want it

I'm not in favor of making Medicare the ONLY option.

Put it out there for anyone that wants to buy that instead of other insurance.

[SPedigrees]

10. No one has ever suggested that medicare/public option be the only insurance.

The operative word is *option.*

[FLDCVADem]

12. Actually, yes they have n/t

[SPedigrees]

16. I wasn't including ignorant ranting minions of the right wing. I meant sane, rational people,

including President Obama.

[FLDCVADem]

18. Um...

...people here on DU have advocated Medicare for All.

[SPedigrees]

20. for all *who want it.* The last 3 words are understood.

[FLDCVADem]

21. People on DU have advocated

for Medicare for All as a single payer plan, not just for those who want it, but for everyone.

Have you really not seen that? That's what HR 676 is all about.

[bkkyosemite]

19. HR 676 has and it is what this nation needs. 27 easy to read pages especially pages 3-5

http://www.johnconyers.com/healthcare this link is a very easy way of understanding what our legislators don't want and we desparately need.

[SPedigrees]

26. Well there are unrealistic people everywhere. I want health care reform that can actually be enacted

President Obama has made it very clear from the start that a public option would coexist with private health insurance cos. Expansion of medicare is simply a better way to create a public OPTION.

[bkkyosemite]

17. I'm on Medicare believe me you want that over any for profit murdering insurance company handling

your health and literally your life. HR 676 covers all on a Medicare for all with dental, mental health, prescriptions, vision, hearing, etc. with an affordable premium. Not the for profits taking their chunk it would go to coverage instead.

[FLDCVADem]

23. No, I don't

I'm glad you like Medicare, but I don't want it.

I'm all for making it the public option, but that's as far as I would go.

[bkkyosemite]

40. Right now on Medicare (I'm disabled not 65 or over) I cannot be denied coverage for pre-existing

conditions nor be dropped because I have a devestating and expensive illness. That right now is not what other insurance coverage can provide. You get sick you are dropped. You have a pre-existing conditon and you are denied. Medicare does not allow that. That is what I meant about wanting it but suit yourself. :-)

[csziggy]

4. And insurance companies can still make billions selling supplemental plans

Like they do for the current Medicare system.

[eomer]

6. How will you get me to pay while I am well?

Why wouldn't I cut my healthcare cost down to zero while I am well? Then when I get sick I can just opt in to Medicare.

All that would be fine except that the amount you will have to charge for Medicare Part E will be prohibitive if only sick people pay for it.

You've got to have some kind of mechanism to make people pay during times when they are well. And I don't see that mechanism in your proposal.

[area51]

9. Need I point out...

that you're already paying into Medicare with every paycheck?

[Laelth]

11. Exactly. Payroll taxes -- the most fair way to do it. n/t

:dem:

-Laelth

[eomer]

27. So are you going to tax everyone for it? If so, that is different than the OP proposal.

The OP proposes: "Just let any citizen in the US buy into Medicare." That implies that each person can choose whether to participate and only those who opt in will then have to pay anything.

By payroll taxes I assume you mean that you would tax everyone. If you tax everyone then it would only make sense that everyone would also receive benefits. Then what you're talking about is Medicare for all - single payer. I'm in favor of that, like most everyone here on DU. But it is very different than what the OP has proposed.

[FLDCVADem]

29. Everyone already pays

Medicare taxes. I'm not sure what you're saying.

[ctaylors6]

30. Maybe eomer means the medicare premiums and other out of pocket costs?

Here's link to 2009 premiums, coinsurance costs, etc.: http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100

table of premium costs by income level: https://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2099&p_sid=1RKUYwHj&p_lva=2100

eomer, I'm sorry if I spoke out of turn and that's not what you meant

[eomer]

33. Well, we've got a couple of different proposals being discussed in this subthread.

The OP implies that the costs will be paid by each participant, since it proposes letting anyone buy into Medicare.

The more recent post that I was replying to was talking about the payroll deductions that most of us pay all our lives, during times when we are not actively on Medicare for our health benefits. We are "paying our dues" during our working lives so that we can then receive the benefits we need later, when we are retired and our resources are lower.

My critique of the OP proposal is that it will let people not "pay their dues" while they are well, but still somehow expects that we would be able to provide them benefits later on when they get sick. You won't be able to make a system like this work. You need a mechanism for spreading the cost broadly across a group, so that people pay in while they are well because that is what will let them draw out funds when they are sick. It is the basic concept of insurance. That concept breaks down if you make it possible for people who didn't pay in to then come along and draw out.

My problem with the second proposal -- that we can just use the monies that we already pay in payroll taxes -- is that those funds are already fully spent to provide the current Medicare benefits. It's not like there is a bunch of money sitting there unspent that can be tapped into to pay for these new benefits. (Well, there is, sort of, because there is a current surplus that is being held in reserve for the time in the near future when benefits paid out will exceed funding coming in, but I don't think there is much chance we would tap that surplus, politically, or that it would be a good idea).

[eomer]

31. The Medicare taxes that everyone pays are used to provide existing benefits.

They are used to pay benefits that are provided under the current Medicare program.

If you create a bunch of new benefits in Medicare then you will need to also create a bunch of new funding to pay for them.

[ctaylors6]

7. Medicaid & SCHIP -- can they be consolidated into Medicare?

I thought I saw a proposal for this by someone in Congress. Maybe Bernie Sanders. I couldn't find it again when I googled. Seems like there'd be a lot of cost savings in consolidating those programs, along with all federal employees, into Medicare "Part E." Seems like Medicaid is so inefficient to be spread among the 50 states. I know the states partially fund it -- that could be continued, or the federal government could begin funding it fully. It would be cutting government programs too -- republicans like that, right?

Part C (Medicare Advantage) already uses insurance companies. Medicare Part E could use that. That's built-in choice right there. Again, republicans like that, right? I know there are some problems with the various parts of Medicare, but in the grand scheme of health care reform, those are much easier fixes than some of these complete overhaul bills that have been proposed. They could even change the rules about buying insurance across state lines for Part C (as long, of course, if they put safeguards and minimums in so some states can't offer bad plans).

I think a lot of these polls that show big numbers of people not approving of the health care reform are people who can't say they approve of something they don't understand. I really think that the percentage of people who are talking crazy and would scorn a reasonable plan is a very small percentage. I think many of the "disapproves" and "do not have opinion" are people who just worry about all the various bills and proposals floating around Congress. If they'd just started with something as simple and easily understood as Medicare I don't think those numbers would be nearly as high.

Frankly it doesn't even need to apply to everyone right away. Of the ones I've seen that have been scored, the best congressional proposal I've seen covers at most 20 million people within 5 years. (I'm sorry if I missed one! Please correct me if I missed something.) People could be added incrementally, going from the lowest income levels up. Medicaid already in many states (if not most/all) has cost-sharing; that could simply be extended as the plan covers more and more people. Eventually, anybody could buy into the plan.

And I really like the idea of federal employees being part of the consolidated plan. You know problems with the plans will get fixed quickly if your Senator was in the plan. :)

[ipaint]

13. Only allow subsidies for this new medicare or this will destroy it.

Medicare is successful because it doesn't compete with private ins. for customers. Force it to and you can kiss it goodbye.

[FLDCVADem]

24. We've gone through this before

Medicare DOES compete with private insurance for customers. All earners pay the Medicare tax, but no one is FORCED to pay Medicare premiums and use Medicare at age 65. It most certainly DOES compete with private insurance for the over 65 group, and it wins.

[ipaint]

34. Yes we have and medicare does not compete with private insurance for customers.

Everyone pays into medicare. If people decide not to use it when they reach the qualifying age that is their choice, they don't get their money back.

If people where given a choice to put those dollars automatically taken out of their paycheck to either private insurance or medicare then medicare would have to compete with private insurance for those dollars.
Fortunately medicare is not forced to compete for those dollars with any private insurance companies, those dollars are automatically taken from everyone's paycheck and given to medicare.

[FLDCVADem]

35. I can't believe you don't understand this

It is SO simple.

No, they don't get their money back BUT they don't have to pay Medicare premiums either. You do realize that Medicare taxes and Medicare premiums are two completely different things, right?

If Medicare wasn't competing with private insurance, everyone would be FORCED into Medicare. They aren't - it's a CHOICE, meaning there IS competition. And in that competition, Medicare wins most of the time.

Please stop spreading misinformation, as it does nothing to help the cause.

[ipaint]

36. Yes, part B, just like in any country with universal health care.

Medicare Premiums for 2009:

Part A: (Hospital Insurance) Premium

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.



Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
$96.40 per month


Some folks have pensions which provide ins. Medicare part B treats group benefits differently

"Employer/Union based health insurance. This coverage may come from a working spouse, a full-time employee over age 65, or from a former employer who continues health insurance for disabled employees. Medicare will coordinate their payments with other group insurance from employers or unions. One plan will be determined to be Primary, and it will pay its full benefits. The Secondary Plan will cover all that the Primary plan didn’t cover up to its own maximum benefit. Generally the result of these payments is that medical bills are paid in full."

If the beneficiary didn’t take Part B when they were first eligible, the cost of Part B will go up 10% for each full 12-month period that they could have had Part B but didn’t sign up for it, except in special cases. They will have to pay this penalty as long as they have Part B.


Most people buy supplemental for Part B, not replace it unless they have a group pension with insurance.


Insurance companies are not competing for 96.40 per month to cover the elderly.

Most of the time they are screwing people who choose to opt out of medicare part B for individual ins. thinking they can save money:


"First, unlike coordination with group health coverage, this allows the insurance company to reap the benefit of the other insurance since Medicare’s benefits are subtracted from its regular benefit. Of course, there is generally no premium reduction passed on due to this savings.

Secondly, people who thought they were saving money by not enrolling in Part B Medicare suddenly find that they are forced to pay far more of the medical bills out of pocket since the insurance company is subtracting the computed Part B benefits, even if none are actually paid."

Otherwise private insurance sells supplemental insurance to cover what medicare doesn't. Just like in universal coverage countries.


I will repeat, throwing medicare into direct competition with for profit private insurance without allowing it to set the rules including overhead caps, profit caps and premium prices, will kill medicare.
Medicare would not be able to compete in a marketplace where private insurance sets the rules.

[FLDCVADem]

38. I'm simply amazed that you truly don't understand competition

Let's try this...

Are all people over 65 forced to use Medicare?

No.

Are people over 65 permitted to buy private insurance?

Yes.

Does giving people over 65 an option mean there is competition?

Yes.

End of story.

If you can't understand that, then you're hopeless.

[ipaint]

39. HMO's have been trying to break into the market to directly compete with medicare for years.

Never happen. Bush tried to push through direct competition between medicare and private insurers in six markets in his medicare bill in 2003. Massive Fail. End of Story.

[Cleita]

14. This is what the majority of us have been clamoring for eons it seems.

Yet the insurance company operatives have kept changing the dialogue to the media, to Congress and to everyone involved to confuse the issue and they have succeeded. You won't believe the insults I have gotten even here on DU because I'm not settling for what's possible meaning what the insurance company bought legislators want. Thom is spot on with this and always has been although many of us at DU came to this conclusion even before Thom started beating the drum for it.

[juno jones]

15. The cooks I work with ask me why 'they' can't do this.

(I'm considered the political one.)

If it makes sense to them, the quinessential apolitical working class shlub, then it will make sense to just about anybody.

I'd gladly pay a bit more tax for medicare. I do however resent the idea that I might be forced to spend my money on bullshit insurance.

[OwnedByFerrets]

22. It would make sense to millions and millions....IF it were

the position of the administration.

[Vinca]

25. This makes so much sense . . . but when has government

ever operated on good sense.

[OwnedByFerrets]

28. When? When it wasnt run by the corporate masters.

[Javaman]

32. Or "E" for Edward Kennedy! nt

[bvar22]

37. HERE!

First in Line.