Medicare buy-in? by Don McCanne MD

[slipslidingaway]

http://pnhp.org/blog/2009/12/09/medicare-buy-in/

"The most efficient, most effective, and least expensive method of providing reasonably comprehensive health care for everyone would be to replace all current public and private financing programs with a single, improved Medicare program that covered absolutely everyone. Some have suggested that we can do this incrementally, with the first step being to allow individuals 55 and over to buy into Medicare. Is this a good idea?

Harvard professor Steffie Woolhandler provides us with some insight: “Lowering the eligibility age for Medicare to 55 only works if it is mandatory. Otherwise it becomes the place where all the sickest patients get dumped. That might be okay for the sick people since Medicare is often better and more secure than private coverage, but it would drive total health care costs (and premiums) up, not down.”

...Could we do that in incremental steps by first moving absolutely everyone over 55 into our existing Medicare program? Yes, but why would we do that? There would be complex transitional issues in changing this sector from a revenue source for Medicare into both a revenue source and an expense as they become beneficiaries of the program. Another increment could be MediKids for all children, though that would involve other transitional issues. Then how soon would we phase in everyone else, with yet still more transitional issues? Incremental steps increase the complexities and costs of the transition while delaying access for many who already have impaired access and financial burdens caused by our dysfunctional system.

A single, disruptive transition would actually be more efficient administratively, while lowering transitional costs. Much more important, a single transition would ensure that no person would have to wait any longer to access the care that he or she needs merely because of an inability to pay for that care.

If we advocate for less than we need, we’ll end up with cheap chits that will eventually be traded away, and then what are we left with?"

[NYC_SKP]

1. My stupid idea of the day is to move SCHIP up by 5 and Medicare down by 5...

And work toward the middle.

Those in between are largely working age and less costly to insure, more able to pay.

Of course there are better ideas, I'm trying to work within the realms of possibilities with the current corrupt congress.

[slipslidingaway]

3. The SCHIP program has an actuarial value close 100%, someone will ...

need to make up that difference as Medicare pays roughly 80%.

I'm hoping that Obama will now endorse a national, not for profit HC system.

:)

[slipslidingaway]

6. Here is the paper I was thinking of re the SCHIP program ...

2 page pdf
http://www.firstfocus.net/Download/10.1.SUMMARY.pdf

"In an effort to determine how children may fare in Congressional health reform proposals that eliminate the Children’s Health
Insurance Program (CHIP) and move kids into exchange plans, First Focus, a bipartisan children’s advocacy organization,
commissioned a study by Watson Wyatt Worldwide to compare the actuarial value of CHIP to exchange plans. The study
finds that depending on family income, children enrolled in CHIP are only exposed to 0-2% of medical expenses. Comparable
exchange plans in the House and Senate bills would expose children to anywhere from 5-35% of costs, greatly increasing their
financial burden and leaving low-income children worse off as a result of health reform.

Specifically, Watson Wyatt Worldwide finds that the actuarial value of the median CHIP plan is 100% at 175% of the federal
poverty level (FPL). The actuarial value of the median CHIP plan at 225% FPL is 98%. “Actuarial value” refers to the
percentage of total allowed medical charges paid by a health plan. The actuarial value is expressed as a share of all medical
expenses, i.e. an actuarial value of 75% means that the health plan would pay 75% of covered medical expenses for a standard
population. Actuarial values only consider benefits payments and do not include premiums. In the Senate Finance bill, there are
4 different plan benefit levels in the Exchange with actuarial values ranging from 65-90%. In the Senate HELP bill, there are 3
different plan benefit levels ranging from 76-93%. In the House Tri-Committee bill, there are 3 different plan benefit levels
ranging from 70-95%.

The study also examines the difference in premiums imposed by CHIP versus exchange plans, finding that on average,
premiums would be significantly higher in the exchange. If children are moved into exchange plans without mitigating these
costs, the combination of higher premiums and higher out-of-pocket costs would leave millions of kids worse off..."

[NYC_SKP]

9. Thank you.

I agree that the simplest approach is full coverage across the board, we don't need to screw with any of our programs that work.

I already feel that the proposed programs would divide us.

[slipslidingaway]

12. You're welcome and I agree about the division among classes of ...

people, which is why I have remained in support of a Medicare for All system. People should be afforded care based on need, not what kind of insurance they have.

[frazzled]

2. I dispute that only the sickest will chose the Medicare option

From what I've read, when the Exchange becomes operative, it will be a choice on the exchange. Speaking as someone over 55 but not yet 65, if I were in the position of needing to purchase health insurance on the open market, I would be highly inclined to choose the Medicare option over the nonprofit private insurer. Most of us at that age have seen how well Medicare has worked for their parents, and just out of principle, I would probably opt for it.

[slipslidingaway]

4. Sorry, but where is that quoted in the article ...

"I dispute that only the sickest will chose the Medicare option..."

:shrug:

[frazzled]

5. Um, you put it in bold

Lowering the eligibility age for Medicare to 55 only works if it is mandatory. Otherwise it becomes the place where all the sickest patients get dumped.

Nothing I've heard so far suggests that it will be mandatory to chose Medicare, but neither is there anything I've heard yet that, as the author suggests, funnels only the sickest into that choice. I guess we'll have to wait and see what is actually in the proposal.

I doubt Rockefeller, Weiner, Krugman, Howard Dean, and others would be positive about this if only those who can't get another type of insurance chose it. Besides, if pre-existing conditions are off the table, anyone should be able to get anything. It's just that private insurance will probably cost more.

[harkadog]

7. The premiums would be very high for Medicare under 65.

On the news tonight (ABC) they were talking about 650$ a month. Only the sickest would pay that cost. Others would look for cheaper non-Medicare coverage.

[frazzled]

11. Try to find cheaper private insurance when you are over 55

Insurance, that is, that actually covers everything ... not some crap that is advertised on TV.

You do know that insurers, when they are not busy simply turning down people over 55, charge them exorbitant rates.

[slipslidingaway]

8. IMO there is a big difference between people choosing Medicare, which is..

what you referred to, and the Medicare buy in only being available to those without insurance, therefore becoming a dumping ground for many of the sickest patients.

I think you are actually on the same page as Dr. Woolhandler, if it is not mandatory and only available to those who do not and cannot get insurance now, many of those will be the sickest patients.

[Dragonfli]

10. The "you can't touch our paying customers rule" put in for the IC's

If you have even ACCESS to a group plan (perhaps you are not insured because you can't afford it or that particular group plan is crap) you will not be allowed to buy in to medicare even if you are 55.

You can not choose any longer to "not choose" an expensive crappy plan you have access to because of the mandate, at the same time you will not be allowed to buy in to the medicare option.

It is a perfect fit for the IC's to keep the "good" 55 to 64 year olds, while providing the dumping ground for the remainder, largely the most expensive ones to be taken in by the expansion.

For the rest of us, basically mandated Romney-care insurance options with no competition or price caps.

It is easy to understand if you look at it like "if I were an insurance exec how would I write the expansion of Medicare to help rather than hinder my profits"

[slipslidingaway]

13. You are so right ...

"...It is easy to understand if you look at it like "if I were an insurance exec how would I write the expansion of Medicare to help rather than hinder my profits"

More food for thought

:)

Ten Questions About the Public Option Compromise
http://www.tnr.com/blog/the-treatment/ten-questions-about-the-public-option-compromise