No wonder Medicare is going broke

Pratoman said...
Some of the ads are so annoying, they repeat the same phrases over and over and over again (I understand the technique they are attempting). I actually find my self turning off the sound. I'll be happy when open enrollment is over.

Probably OT, but I found nothing coming through a TV worth the insulting advertising that goes with it.

Pratoman said...
I've been lucky so far on Medicare, Part B with a Plan G Supplement, provided for and paid for by NYC, as my wire is a retired NYC teacher. We also get reimbursed for both Plan B premiums and IRMAA adjustments by the city,

That’s fantastic. In the teacher system I retired from we have the pension but are on own when it comes to health insurance. We can stay on the district’s plan, which I did for a while, but it’s very, very expensive. This is why many teachers stay in the classroom until they turn 65 which, for many of them, is beyond their “sell by” date.

Pratoman said...
…Based on promises made. The city isn't done yet though they will keep trying.

Yes, “promises.” Same with the VA. If I had just filed for VA healthcare before 2003 I’d have it now. Promises are easy ignored by some.

Pratoman, LOL… I started reading this long thread 30 minutes ago. I had to laugh when I read your comment about turning the TV volume off. I had the volume off my TV while reading this thread because of the same health insurance ad I heard a hundred times already. This is an interesting thread as I got confused early and stayed that way throughout. Almost like the ads on TV and in the mail.
LOL. Happy Thanksgiving all,
Jack

JNF said...

And for all the talk of managed care, I have a simple rule about my approach……my body and mind, my choice. I do not want someone that either doesn’t know me and/or could have a financial impetus to control, direct or ration my access to care. I can manage my health and medical care better than anyone else can. And so long as that is the case I will arrange things accordingly. That is the main driver of my choice to use traditional Medicare and a supplement plan. It has proven to be most effective, has provided great flexibility and access to care, and has controlled costs wonderfully.

I wish you and all the members of this fine forum the very best and extend the hope for a wonderful Thanksgiving for you and your family. Thanks for a friendly conversation.

This is exactly the reason I will never move to Medicare Advantage. If we were to lose on appeal, and be forced to MA, I will leave the system and pay on my own, which includes giving up the Part B and IRMAA reimbursement

Mumbo said...
I workout at a community fitness center and there are 12 TV screens displaying 6 stations (cable and broadcast) on the main wall facing the treadmills, elliptical, etc. I listen to music but it is amazing to watch the ads as there sometimes are two different stations showing the same ad at the same time…

That reminds me of a sort OT occurrence a few years ago. We workout/swim at the nearby liberal arts college where we are members of their fitness club. They rent the basketball gym out and one Sunday it had a kids’ tournament going on while I was in the workout room on the elliptical. The room has one TV, the old CRT type, that is in front of the elliptical and it happened to be on an ice skating competition. I had music playing in my headphones but was zoning out watching the skaters. A parent from the tournament comes in and changes the channel to a football game. I said “Hey, what are you doing? I was watching that.” He responded with “THE game is on.” I said “So what, I’m working out here and was watching that.” He said “Ice skating?” and laughed aa he stood between me and the TV sort of challenging me to do something about it. I certainly was NOT going to get into what he wanted and I just left. A month or two later that TV broke and it, thankfully, has never been fixed. (This just adds to my dislike of some sports fans.)

** “So what, I’m working out here and was watching that.” **

Busted!!! So Vince, you have watched TV in the last 30 years. 😀

Coincidentally, re TJ's comment on Medicare Advantage being a more cost effective model, the following was an editorial in the Wall Street Journal from two days ago.

Jim

Nikki Haley’s Medicare Advantage
A new study shows insurer competition reduces costs.
By
The Editorial Board
Nov. 23, 2023 4:16 pm ET

Few politicians are willing to touch entitlements these days, but Nikki Haley dared to do so in the recent debate on Medicare. A new study shows her pitch to expand the Medicare Advantage program could lower costs and improve care.

Medicare Advantage plans are growing rapidly and cover about half of the entitlement’s beneficiaries. Private insurers administer the plans and are paid by Medicare per beneficiary. Insurers compete for patients by offering benefits, including vision and dental care that aren’t available in traditional fee-for-service Medicare.

Lower premiums have made Advantage plans popular in particular among low-income seniors. Plans are able to offer more benefits at lower cost in part by reducing unnecessary care and expensive hospital stays.

Avalere, a healthcare consulting firm, analyzed utilization rates in traditional Medicare versus Advantage plans. After adjusting for disease and demographics, Avalere found that fee-for-service utilization was 12% higher for skilled nursing homes and 37% higher for hospital inpatient care in 2019.

Hospitals are the biggest driver of Medicare spending. The Centers for Medicare and Medicaid Services (CMS) has tried to use performance-based payment models such as accountable care organizations (ACOs) to improve preventative care and reduce hospital admissions. But these haven’t moved the dial as much as Medicare Advantage plans.

The Avalere study doesn’t dissect why healthcare utilization is so much lower in Medicare Advantage. Democrats who oppose private competition accuse insurers of putting up bureaucratic hurdles to treatments. That may be true in some cases, but it doesn’t explain why inpatient hospital utilization is so much lower among Advantage patients.

One reason is private insurers have a financial incentive to keep patients out of the hospital by improving adherence to treatments and coordination of care. CMS also scores plans based on quality metrics, including diabetes control, medication adherence and post-emergency room visits. Higher-rated plans receive bonuses.

As Ms. Haley noted at the GOP debate, the Medicare Board of Trustees estimated this year that the program’s hospital trust fund—financed by payroll taxes—would run dry by 2031. If fee-for-service utilization rates were similar to those in the Advantage program, Avalere projects that the hospital trust fund would remain solvent until 2048.

But instead of expanding Medicare Advantage, the Biden Administration is trying to limit the program’s growth by restricting plan marketing and reducing payments for treating higher-risk patients under the guise of rooting out waste, fraud and abuse. The reason is purely ideological: Progressives loathe private medicine and want the government to control all healthcare.

As an alternative to competition, the Administration is resorting to brute government force to curb Medicare spending: restricting access to new Alzheimer’s treatments, imposing price controls on other medicines, and reducing reimbursements to doctors. CMS recently finalized a rule cutting physician fees by 3.4% next year, which it purported to offset partly by increasing payments to ACOs that treat more minorities.

Medicare’s low reimbursement rates are driving doctors to leave private practice for hospitals, which reduces provider competition and increases healthcare spending. Ms. Haley’s idea of unleashing private competition isn’t a panacea to runaway entitlement spending, but it’s less painful than the price and reimbursement controls that Democrats want.