three items in the healthcare package

[katkat]

Good, imho:

(1 and 2) http://www.nytimes.com/2009/12/05/health/policy/05health.html?adxnnl=1&adxnnlx=1260097234-gI4aJu3+Lrx4H6iwaan+wQ

"Senate Democrats on Friday beat back Republican efforts to strip out two major provisions of their health care bill that would make deep cuts in payments to private Medicare Advantage plans and create a new long-term-care insurance program."

The Medicare Advantage plans are a pig at the trough for BigInsurance, costing 14-17% more than plain Medicare+ Medigap, which offer approximately the same benefits.


I was dubious about this one, until I read up on the long term care option above. Now, I dunno what to think.:

(3) http://www.nytimes.com/2009/12/05/health/policy/05home.html
http://www.nytimes.com/2009/12/06/health/policy/06health.html?hp

"By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries."

Nice quote of the day:

Senator Sheldon Whitehouse, Democrat of Rhode Island, said he had yet to see any instance in which the Republican argument “does not happen to coincide with the interest of the insurance industry.”

[OHdem10]

1. Yet, Schumer , Nelson(Fla) and Wyden got waivers to keep

Medicare Advantage for their constituents. It is this sort of
thing that puts Democrats in a bad light.

What will be cut so that Med. Advantage plans in those states
keep their subsidy.

[katkat]

2. Wyden? cripes.

Well, 3 states is not too bad. Pretty darn good compared to all of them.

[eilen]

3. I woke up late and am a little groggy

Did I just read that the Democrats fought to keep the crappy expensive Medicare Advantage programs and cutbacks to home health agencies? The Democrats?

[katkat]

5. no, you're groggy

The Democrats, except for the three named above, ripped out some of the profits Medicare Advantage(sic) is making.

They are claiming home health agencies can be more efficient, which I don't believe for an instant, having seen how these people work - RNs working like dogs, minimum wage caregivers (often not up to snuff, which is a good reason to attract people who would work for higher wages) but it isn't clear to me how this interacts with the new long term care provision, which seems to cover some home health stuff.

Actually the fact that Medicare Advantage got sliced makes me think some good stuff is actually going on. If it weren't for the war and lack of environmental action (some of which the administration could do without Congress), I would think Obama might know what he's doing.

[eilen]

6. One of the three senators is my senator-- Schumer

And yes, home health care nurses do work like dogs. I am one of them and the agencies are great for pushing unpaid overtime. I put my notice in last week and it has been sad saying goodbye to my patients. We are already operating in the red with the changes that were made in reimbursement last time and the admin is blaming it on the nurses. Guv. tools are actually to blame. I bet our agency will have to close after this bill is passed-- and they have been caring for the community since 1897.

[C_Lawyer09]

4. I've grown fonder of Sheldon Whitehouse by the day

I hope he doesn't dissapoint me, as so many other politicians I used to hold in high esteem have, Wyden being one of them.

[Cleita]

7. If traditional Medicare closed the gap of the deductible and copays, Medicare

advantage plans could be eliminated altogether. The money the insurance industry siphons off of Medicare to cover the programs and their profits could be used more efficiently and cost effectively by an improved Medicare that would cover everything. Since one of the selling points of Medicare advantage programs is the prescription drug coverage, we could eliminate the corporate welfare Medicare Part D and bargain for lower prescription drug rates under Medicare itself.

Also, most doctors don't like the Medicare Advantage programs and refuse to take them after a while when they find out they are being stiffed by the insurers.

[slipslidingaway]

9. Instead of negotiating drug prices for all Medicare recipients, an 80 billion...

deal was cut.

Could we save another 220 billion in addition to the 80 billion using VA prices...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8667526&mesg_id=8667647

Since Medicare will experience a significant rise in the number of enrollees over the next twenty years, it appears the drug companies got a great deal.

:puke:

[katkat]

11. confusion

I'm bit confused by your post, Cleita.

People can buy Medigap, which will close the deductible and cover copays if you buy that type of policy. It does not earn BigInsurance the extra profits that Medicare Advantage does, but the combo Medicare+Medigap has the same benefits as Medicare Advantage.

You can also buy Plan D (prescriptions) separately. That's what I have Medicare + Medigap + Plan D.

Plan D does have the huge problem that the Repigs and Blue Dogs prohibited Medicare from negotiating drug prices. I have not seen anything in the news about what the proposed bill does about that, but obviously getting rid of that would result in huge savings, not only for the government/taxpayers but for Seniors who fall into the donut hole, because when we're in there we have to pay the Medicare price = full price of meds,

[Cleita]

12. I have what you describe, Medicare plus medigap insurance.

I have to work to afford it and I'm almost seventy. If I fall ill and can't work anymore, I really don't know what I am going to do. It is still costly and many seniors who can't afford the copays and/or premiums are thrown onto the Medicare Advantage programs and find out too late that most of the list of doctors that they are given don't accept the plans because of poor payment records. I can't find a single doctor that does in my area. Some seniors get thrown on to Medicaid that closes the gap but again since Medicaid's fee schedule isn't in today's dollars and reimbursement so low, most doctor won't take it either. Their other recourse is Community Health Services that is locally government run. Since it operates like a free clinic, the facilities are always crowded and there are hours long waits to see the doctor because they too are underfunded and operating on a shoe string.

Medicare D sucks and I can't afford the extra premium, deductibles and copays anyway. It doesn't help me buy anything but I know the pharmaceutical companies are getting mucho corporate welfare from it. Thank you again Republicans for nothing. If we ran Medicare to cover everyone and everything in basic health care, and if we updated the fee schedule, then you would see real savings and doctors willing to treat Medicare patients. Some doctors won't treat Medicare patients who don't have Part B and don't have medigap insurance because it's up to the patient to pay for what isn't covered, even the 20% copay, and they often don't get it reimbursed because poor seniors don't have the money to pay.

I disagree that Medicare Advantage and Medicare+Medigap are the same. The first promises to pay the same benefits but often stiffs the health care providers. I read a state that Secure Horizons, a subsidiary of Pacific Care routinely denied 40% of claims against them, which is why no health care providers take them, yet they are still selling their shell game insurance in my area with impunity. If Medicare were extended to cover what part D and medigap pays, I would gladly hand that premium money over to them instead to get full coverage and I know that none of it would be paying for Wall Street profits.

[katkat]

13. Medicare + Medigap and Plan D

are not without fault. When I looked at Plan D originally, I was told it covered all FDA approved meds. I just got a notice from United Healthcare that they are not covering a med I take in 2010 because technically it is not approved for the condition I take it for.

Having gone thru their stinking approval process and appeals for a different med when I was on my former employer's plan run by UHC, I know it is futile to appeal. After looping enough times then I finally talked to HR and was told UHC/my employer was never going to approve the med because it was too expensive (note, not because it wasn't the right med.)

Until people's doctors have the last word, we will not have good health care.

On a glimmer of light note, I think I read that there is an increase in funding for community health centers in the bill.

[nightrain]

8. the home care reductions border on insane. This is just robbing Peter to pay Paul (insurance robber

barons).

I am amazed and horrified at the options/amendments supposed Dems are supporting (including the bs public option). There seems to be little chance of REAL health care (not insurance) reform. I feel disgusted with how Obama has left this major issue up to Congress and the corporations, rather than work to actually provide services to people when they need them.

[slipslidingaway]

10. Exactly, robbing Peter to pay Paul, another example is the new long term...

care plan. It might be a great plan, but what will happen in the future when the money is needed to pay for care???


http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=7926&mesg_id=8540

Both bills reduce the deficit because they collect money for a new long term care plan that will not have any cash outlays in the beginning years.

Generating revenue to cover the plan's cost over the 10 year period...bottom of page 7 in the CBO report. While the program itself sounds good, notice how this new piece reduces the deficit by 72 billion in the 10 year window.

Nice way to reduce the cost for Now.

The headline news was that this bill would reduce the deficit by 104 billion...

BREAKING: CBO Releases Numbers On House Health Care Bill : Reduce Deficit by $104 Billion

...so where did that reduction come from, it appears a large portion (72 billion) is due to this new long term care insurance, aka CLASS.

While that is something to celebrate, the plan would have people paying in over the 10 year budget window for something they will need in the future, naturally this will be all gains until people start drawing from the fund. For reference this is shown on page 26, Table 3 of the CBO report.

It reminded me of the SS Trust Fund that was pre-financed and helped to reduce the deficits, especially during the Clinton and Bush years...]/b]