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9/30/2009
No seniors, you haven’t paid for your Medicare coverage
Ok, as long as we’re talking about seniors and Medicare, we might as well stay on the subject a few more days. Again I’ll say, I’m not a heartless old ogre and surely do not have it out for Medicare recipients – after all, I almost am one!
John Hyland's response was typical of some readers’ comments in response to Monday’s FoxPolitics piece, Seniors must bear their fair share.
Jo....Sorry, you have it a bit wrong. Seniors paid all their lives through payroll deductions. Now, after 65, and on Medicare, they still have to pay about … $4,000 annually....plus all we put in all our lives. Far from free and certainly we have, and are, paying our fair share.
On the other hand, Susan Squires got it absolutely right when she wrote in to say:
Yep, people, it's time to pony up the sacrifices. Medicare, Medicaid and Social Security will eventually bankrupt this country and responsible patriots should relinquish some entitlements for the benefit of their country. Yet, you see the response from your readers, including the putative conservative and patriot John Hyland: ‘Oh, no, not [me.] I deserve that.’ The reality is that seniors absolutely do not pay their fair share for Medicare. I’ve seen the unmistakable conclusion expressed a couple of different ways. Economist Charles Hugh Smith recently offered a short primer and does some simple arithmetic.
[Medicare] isn't really insurance, and here's why. Insurance is essentially protection against the lottery wheel of life…. But getting old and dying of some disease or illness is not something that only happens to a few unfortunates -- it happens to all of us.
…. Once we understand Medicare/Medicaid is not really insurance, then we can understand the system's fundamental problem. No matter what their wage level, marital status, or retirement date, a recipient will receive benefits that far exceed the taxes he or she paid into the system.
[Running through some simple arithmetic], the average wage earner (and his/her employer) will pay in about $36,000 in Medicare taxes [during his/her working career].
The average benefits extracted from the system run from $393,000 to $525,000 (due to the benefits extended to non-working spouses, benefits for never-married people may be somewhat lower). [Emphases mine.] Steurle and Carasso at the Urban Institute look at the ratio of benefits to lifetime Medicare taxes paid for couples at three different wage levels. Figure 2 in the paper shows that workers will cost Medicare (by 2030) three to five times what they pay in to the system.
Medicare taxes are so low relative to promised benefits… that most current workers, rich or poor, may never be fully required to pay for their own benefits. Seniors: Someone besides you and your lifetime of Medicare “insurance payments” is most likely paying for your medical care. Current workers. Current medical providers accepting what may be lower than market reimbursements. And most importantly, Chinese and American bondholders and our children and their children. As a society, we may ultimately decide to continue these very large subsidies for our seniors, but we cannot continue to pretend they have paid their way.
Sounding like a broken record here, the answer is that all of us must control health care spending by knowing what the heck we’re paying for and including cost factors in all critical care decisions. Yes, none of the decisions America and seniors and their families – all of us - have ahead of us are easy ones. But we all must begin to make them.
Jo Egelhoff, FoxPolitics.net
COMMENTS
Sure, Medicare and Medicaid may eventually bankrupt us.
But left unchecked, the insurance companies and the medical industrial complex will get to us first, and Medicare and Medicaid will have only our bones to pick over.
Rich Eggleston (Wed Sep 30 08:09:46 2009)
Jo,
Spot on. You're on to something here. Something real and something without political slant because the facts are out there somewhere. Why does our "system" cost so much?
dave allen (Wed Sep 30 08:36:33 2009)
Medicare has problems, but nowhere near those of the private industry. It doesn't deny patients and doesn't deny critical care because the patient failed to disclose acne as a teenager.
Yes, Medicare is underfunded, too much fraud and overuse, and over-generous to the pharmaceutical industry (Part D drug program). But it's a hell of a lot better than our current insurance bureaucracy that has all of those problems and more.
It's a good system that bypasses only the insurance industry, and that's why the opposition. For the same dollars this country spends on health care (16.5% of GDP) we could improve and extend medicare to 100% of our people. We'd pay for it differently, through taxes rather than business expenses that kill competition with other countries. But you know, that's "socialized" and we can't go there.
Jack Lohman (Wed Sep 30 08:53:05 2009)
Jack, please provide credible, responsible documentation for your "acne as a teenager" claim.
Jo (Wed Sep 30 09:50:15 2009)
Try this: Insurers Revoke Policies To Avoid Paying High Costs
Jack Lohman (Wed Sep 30 10:01:21 2009)
And there's more here: singlepayer.info/resources/
Jack Lohman (Wed Sep 30 10:05:05 2009)
My husband and I don't WANT Medicare. We did not get a CHOICE. Enrollment is automatic! We'd rather just keep our private insurance. Medicare handicaps its "beneficiaries" with rationing, price controls, bureaucratic hassles, etc.
Jan T (Wed Sep 30 10:05:24 2009)
Not enough Jack. Your second source merely links to the first. The NPR article reports the apparent testimony (can you source the testinony?):
Robin Beaton of Waxahachie, Texas, did know that her health history included acne and a rapid heartbeat. But she didn't think they were relevant to her current health and left them off her application. This is anecdotal Jack - and important, critical policy changes should not be made on anecdotal evidence. What was the actual testimony? What was the insurer's response? Did you notice that a rapid heartbeat was not included in the applicant's history, as well as the acne that soundbites repeat over and over? At the risk of charges of hard-heartedness, the quote could just as easily be used to demonstrate fraud on behalf of the applicant. Should every person who wants it be able to get health insurance? Yes. In risk pools as large as possible - but with all risk factored in - and affordability aided with tax credits where hardships result. Insurance is a risk-adjusted proposition and a 2-sided contract. Perhaps that's something you're forgetting Jack.
Jo (Wed Sep 30 10:16:15 2009)
Wow, Jo. You are beginning to sound like an industry apologist.
Do you deny that rescissions occur? It came out in recent congressional testimony... 20,000 over the last five years, admitted to by industry CEOs who then refused to cease the practice.
Not just one acne case... 20,000!!!
And can you tell me how, in this one case and the many others, acne and a rapid heart beat can cause breast cancer? Clearly you must be astute enough to recognize an industry ploy.
Sometimes I think we do need a two-tier system; one for you rich folks and the other for commoners. But sure enough, when you get old or things don't go as planned, conservatives will want into the system they've ridiculed all these years.
Why you want to spend another 31% on industry middlemen is beyond me.
Jack Lohman (Wed Sep 30 10:37:48 2009)
Here's some more anectotal stories, Jo. Real to the people who died or will die, but anectotal to the rest of us.
12-year-old boy ... 17-year-old girl died ... 21% Denials ... A new heart, for our system ... Cigna ... Dawn's Story ... Denials = 21% ... Health care yanked ... Nikki White ... Rescission
Jack Lohman (Wed Sep 30 10:48:05 2009)
Name calling and accusations don't address the problem Jack. And anecdotes don't make policy.
Jo (Wed Sep 30 10:49:15 2009)
No, but industry money does. Aren't politicians great?
Jack Lohman (Wed Sep 30 11:00:09 2009)
Jo and Jack:
I think you have both gotten off the main track here and the retorical question of whether people who are receiving Medicare and Medicaid benefits have paid that amount into their account.
The answer, as Jo pointed out, is that they have not. My 87 year old mother certainly is getting more benefits than my Dad or her paid in and I do not begrudge that. I don't think the system was ever set up to have the current people getting benefits required to have paid in what they will be getting out.
The theory was that with population growth and standard of living growth that the next generation could pay for the previous generation and "take care" of their parents in their old age. However, the "baby boomers" are going to break that cycle since population expansion will not keep up with the amount of "baby boomers" who will be retiring. The other factor is the economy which is resulting in loss of real earnings rather than growth.
I agree with Jo that we have to start looking at ways to cut Medicare costs and it begins with fraud. My 87 year old Mother questions everything concerning her health and sees fraud very often in unneccesary tests and drugs.(She has turned in two doctors already to Medicare for fraud). I think more seniors should question their doctors and stiffer penalties should be in place for proven fraud.
Therefore, my opinion is that we can do a lot to reduce costs before we expect our seniors to "give up benefits" they expected when they were brought into the system. The government is already making them pay more by not giving cost of living increases for the next several years while increasing their Medicare Part D fees. Let's go after the "low hanging" fruit before we go after "grandma and grandpa".
Mike
Mike Thomas (Wed Sep 30 11:08:58 2009)
I am a Medicare recipient and, yes, I believe we all need to help lower healthcare costs,including seniors. I have seen many of my peers, who would rather take a drug than work on a healthier lifestyle that includes exercise & dietary changes.
Rather than a complete overhaul of our healthcare system, Congress & the President should focus on reducing the cost & increasing the efficiency of what we already have ...Medicare & Medicaid. Obama said there is $500 billion of fluff & fraud in these programs. Okay, let's go after those savings. No new legislation is needed; the newly created Health Czar could spearhead this effort! Wouldn't it be refreshing to see the government able to SAVE money as well as SPEND it! Perhaps even some element of trust would return on the part of the taxpayer.
A public option in any shape or form, such as co-operatives, must be dropped at this time. We just cannot afford it! Anyone who believes we can add millions of people to the system at no additional cost is dreaming. Both Medicare & Social Security are going broke because actual costs far outstripped the estimates.
To repeat: At this time the majority of folks don't want a complete overhaul of our healthcare system nor can our country afford it. Let's make the most important reforms now, such as disallowing insurance companies to reject people because of pre-existing conditions. Then let's improve our healthcare system step-by-step while taking the time to do it right. The only reason for rushing is to allow President Obama to ram through what he wants before his popularity wanes....a purely political objective.
Lynne Lneius (Wed Sep 30 11:23:43 2009)
Absolutely Lynne!!! YES! Thank you!
Jo (Wed Sep 30 11:28:28)
Jo - thanks for pointing out the fundamental problem with Medicare. Our current system of health care financing is broken. Putting the federal government in charge of it will NOT fix the problem.
I was a federal employee (US Navy) for 11 years, and an insurance industry professional for 19 years. To the gentleman talking about recessions, yes, there are recessions. In my career I have seen two of them. And both times it was the insured lying on the application that caused the rescission. Insurance companies pay a LOT of claims that they could contest; when a company goes to a rescission (in my experience) the person is lucky they aren't going to jail for insurance fraud in addition to losing their coverage.
This line about losing the coverage due to failure to disclose acne is smoke. A failure to disclose acne would much more likely result in the policy being amended with an acne endorsement exclusion, not a policy rescission (which is what would have happened had the material misrepresentation not happened in the first place). But the 99.9% of the coverage (for heart attacks, accidents) would still be in place and claims paid. Claims for acne treatment would have been declined. Now if the person "forgot" to tell the insurance company that they had an uninsurable condition (ie certain heart murmurs), where the company would have declined to issue the policy in the first place, yes, the policy would be rescinded.
Getting back to the fundamental point, health care is a limited good, just like Lexus cars. I am much more willing to spend YOUR money on something I want than I am to spend MY money. (You probably are too, even if you don't think so). So when I'm spending MY money to buy a car, I'm going to buy a Saturn or similar.
Were I spending YOUR money to buy a car, I might buy a Lexus. Same thing with Health Care. When the consumer has little to no skin in the game, and prices aren't transparent, and "other people's money" is being spent, my consumption is higher.
There is no easy way to efficently and fairly allocate LIMITED resources to an UNLIMTED demand - especially because my definition of "fair" changes a LOT when the "need" for health care is mine or my families; and your definition of "fair" does likewise.
All this being said, the 11th amendment to the Constitution as I read it leaves no room for the Federal government to be involved in the health care delivery market. Short of a constitutional amendment (or an activist judicial reading), health care financing is a power reserved to "the States or to the People". If you think it's bad now, let the Federal Government be more involved in health care financing.
My old friend that I worked for at the Pentagon used to say "The Federal Government should do three things: Defend my shores, Deliver my mail, and STAY OUT OF MY WAY". Local, state by state solutions to health care financing are much more likely to have a better effect than anything the Federal government could possibly do. But until Christ returns, there will be problems with this and every other thing on this world.
Federalized health care defined:
- The purchasing efficiency of the Pentagon,
- The compassion of the IRS, and
- The customer service of the DMV.
Harry Dorman (Wed Sep 30 11:43:47 2009)
Do we reaaly know how this supposed information put out by Jo is accurate. Did they take into account that many die before even collecting a dime. Or perhaps live only a few years after 65. Did they take into account that if you are on regular Medicare, it is necessary to get a supplement at a cost of near $2,000, give or take a few hundred depending on the coverage. How did they arrive at their figures.I have heard just the opposite from other stats. And also, the amount Medicare pays the doctors, hospitals is only a fraction of the doctors actual charges. Sometimes they don't pay anything for some things. All this taken into account. We don't know, do we. Some lab work charges are like several hundred dollars and medicare pays maybe $15.
And Lohman: The lady claimed acne but actually was treated by a derm specialist for a precancerous problem.
But, please don't blame seniors because the government has miss-managed the program and it's going broke.
Talk to the liberals who have refused to correct the problem for 8 years now.
Not seniors! Bush was after them to act all his term. They always stopped it.
John Hyland (Wed Sep 30 11:54:16 2009)
Pay your own way is ludicrous! How many people can afford $50,000, $150,000, $500,000 or more in medical treatment? Very few. Don't blow fairy dust by suggesting that even in the best case scenario of cost cutting treating cancer, life-long disabilities, and so many other terrible diseases can be reduced to a level where the average family can foot the bill. So people acquire insurance to share the risk, just as they do with life, property and casualty insurance. The concept of insurance is twofold: (a) some will not recoup what they pay in and (b) over time, insurance companies will generate sufficiently high returns to cover claims by investing the premiums paid. Medicare is defined as a health insurance program. Clearly it has not been well-managed, both in terms of costs and investment returns. Nevertheless, when I paid my medicare taxes 40 years ago, I was earning an average U.S. salary of $8,500 per year. Ten years later I was professional with two master's degrees earning $11,500 per year. I and my employers continued to be taxed at what officials felt was a reasonable rate to provide me identified benefits beginning at age 65. Over the years I built my family financial portfolio, including retirement provisions, based on the understanding of what I could expect to receive for my 50 years of responsible tax paying. Now, when I have limited economic options, I am asked to accept the argument that the promises cannot be fulfilled. Why? Not because the government has insufficient money. Rather because the stewardship of that money was poor. Susan speaks of patriotism as " relinquishing entitlements." B.S.! Patriotism is valuing commitments and promises made. It's setting priorities for the collective well-being of the nation's citizen. It's balancing justice with mercy. Sacrifices are required of all patriots, but not when those who have sacrificed for years are asked to go the extra mile so those earning far more propotionately than ever before in history (adjusted for inflation)can buy luxury cars, upscale residences, 2nd and 3rd homes, frequent and elegant vacations, etc. all in the name of some bastardized notion of personal independence in a free market economy. It would be enlightening to have all those who post here state their annual income, value of property owned and overall net worth. I suspect few are truly oppressed by the cost of government entitlements. A great multitude of us "boomers" built the society that enables its present day citizens to life the best lifestyle on the planet. To deprive us our long suffering promised benefits in our final years is patriotic? Give me a break!
Dennis (Wed Sep 30 13:14:10 2009)
You are right Dennis. It is patriotic to continue to support the greatest Ponzi scheme ever sold, and to saddle our children and grandchildren with insurmountable debts and tax rates of at least 80%.
To be sure, not everyone wins under any insurance program, but an actuarily sound insurance plan would support itself with payments from those who will be covered, not by passing those costs on to someone else.
PS- I will be eligible for ss and medicare in 3.5 yrs.
Ken Van Doren (Wed Sep 30 14:27:51 2009)
A FoxPolitics reader sends over this AP Fact Check piece on the 'acne-rejection' story.
Jo (Wed Sep 30 17:11:15 2009)
Oh, wow. "Beaton did not lose her insurance because she failed to own up to a skin problem in her past. She lost it because, when enrolling in the plan, she had not reported a previous heart condition and did not list her weight accurately."
So now heart conditions and weight loss/gain affect breast cancer??? How about the other 19,999 cases of rescission? Can we find errors in each of them? Or are we unfairly lambasting the poor insurance companies?
Why are we screwing around with this? Why don't we simply fix it correctly? Eliminate all of the wasteful bloated administrative costs and spend the savings on health care. Period. Get corporations out of the business of funding health care so they can better compete with foreign companies.
Jack Lohman (Wed Sep 30 17:49:31 2009)
Jo! Just received an interesting e-mail about the dollars put into the system by payroll. No where was it mentioned, that the $36,000 we put in for 40 years has received any interest. With compound interest for 40 years, would that make a difference? Considerable! I'm not an accountant (but did have it in college), maybe 5 to 10 times the original amount? Ask a banker! Just contemplating! Isn't this fun. By the way, my best city for selling my "conservative" book is Seattle. One of the biggest liberal cities in the nation. Who knew! Ready for another run at politics? Not an easy decision. I know when I was appointed to the La Crosse School Board (hundred years or so ago), it was very rewarding, but very difficult fighting city hall, etc. Go get 'em! JCH
John Hyland (Wed Sep 30 20:03:38 2009)
While there is nothing more to add , the reality remains a simple reality, my mother and many of her age, continue to hold on to the reality, they somehow have earned and deserve the benefits they receive.
Lo, let it not be I that reject or object or reject such a claim. Have the sacrifices of the "greatest generation, " a commitment to country difficult to recede. Are we so forlorn to rewarding their sacrifices? What a tragic time we live within.....
Richard Parins (Wed Sep 30 22:52:44 2009)
Richard, we have a segment of the population that strongly believes that "what's mine is mine," and to some extent I'm that way too. But we also have a segment that adds "if I can get some of yours, that's mine too," and they do that by buying off politicians so they pass laws that transfer wealth from the poor to the rich. And yea, the rich get richer and the poor get poorer, as occurred over the last year.
It occurs when special interests buy (through political graft) taxpayer-funded subsidies and no-bid contracts. In my view we could stand a little more taxing of the rich, though I know some will puke at the thought. But when you look at "Taxes as Share of Revenues," the US is near the bottom.
Jack Lohman (Thu Oct 01 08:06:22 2009)
Re: Jack's post, US taxes near the bottom.
OK, let us look at the total cost of government. According to Americans for Tax Reform, COG went from 54% last year, to over 61% this year. 7% increase in one year. AND as David M. Walker has been saying now for some years, we either cut government by 60% TODAY, or tax rates will double in order to fund our unfunded mandates. When he said that, our state, federal and local taxes came to 36% (The rest of the costs are for your accountant to do your taxes, other costs of mandates PAID by individuals and businesses.)
Not sure how your math works, but that according to mine, that comes to 97% of our GDP for costs of government. BEFORE we add another 8% or so for the privately paid medical care, BEFORE we are Obamized with other new or expanded government programs. Not to mention, the more government has gotten involved in ANYTHING, including health care, the price has gone up. With a pro-union government, and SEIU waiting in the wings, a thoroughly unionized health force scares the crap out of me, especially when you see the tactics SEIU uses to confront people who object to their program. Thugs, pure and simple. Just like the Chicago gang.
So in the Brave New World we are creating, does money grow on trees? If we can not pay for what we do now, how are we going to pay for more? And can consumers get along on net zero income? To push for more government, the opposition answers all those questions affirmatively, whether they see it or not.
Ken Van Doren (Fri Oct 02 09:12:19 2009)
Jack, you're right when you attack the middlemen. But changing from a private, to a government-entity middleman is not the answer. GETTING RID OF ALL MIDDLEMEN is the answer. Just look at the relatively cheap procedures not covered by any insurance company ever, and tell me a free market doesn't work.
BTW, we do NOT have a free market system right now--we have a THIRD-PARTY-PAYER system; the third parties being gov't and private insurance co's. Ask yourself, if your electrician or mechanic was paid through a third party, would he ask for more or less money? It's self-evident!
All anybody needs is MAJOR MEDICAL insurance, not health insurance. If the gov't had the gumption to try REAL reform, they'd insist on that.
emily matthews (Fri Oct 02 17:27:08 2009)
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