|
Post by greykitty on Jul 29, 2019 9:23:20 GMT -6
Classic Medicare covers only 80% of approved medical costs. Supplemental plans offered by private insurers and having varying premium costs cover the rest. If private insurers say they'll move out of the supplemental market, you will indeed here screams from affected voters. And I don't see where the carrot is for private insurers in this plan. I know they exist in other countries, but I admit I don't know how much those premiums are in general and how many people in those countries opt for supplemental insurance.
One thing - and maybe I've just missed this from most of the candidates - what will happen to Medicare premiums? Obviously now it's based somewhat on income and also on the assumption that most of the covered will have paid in 40 quarters of Medicare taxes. I don't see how the premiums can remain relatively low if income taxes don't go up substantially. Will those currently enrolled in Medicare be grandfathered out of any possible premium/coverage changes?
|
|
jkjacq
Ruby
Posts: 21,742 Likes: 94,334
|
Post by jkjacq on Jul 29, 2019 9:33:54 GMT -6
Classic Medicare covers only 80% of approved medical costs. Supplemental plans cover the rest. If private insurers say they'll move out of the supplemental market, you will indeed here screams from affected voters. One thing - and maybe I've just missed this - what will happen to Medicare premiums? Obviously now it's based somewhat on income and also on the assumption that most of the covered will have paid in 40 quarters of Medicare taxes. I don't see how the premiums can remain relatively low if income taxes don't go up substantially. Supplemental premiums IME are far less expensive than a regular premium.
And there are some really good plans. My dad is on one. It has a rather high deductible but his premium is less than 150/month.
As far as other premiums go, back to the more people paying into a pot the more money available for claims, plus more negotiating leverage.
The other piece of this and it sort of goes hand in hand with single payor, is the cost CHARGED by drug manufacturers, for profit hospitals, medical equipment suppliers, etc. This was also my concern with the ACA. With a larger population on a single policy, you have more leverage with those companies and they will have to bring what they charge down.
Every one thinks their insurance is terrific until a catastrophe strikes, thats when you learn how good or bad it is. We need to get out of that mindset. Its doing the insurance industries job for it.
|
|
jaygee
Diamond
Posts: 28,296 Likes: 219,949
|
Post by jaygee on Jul 29, 2019 9:40:14 GMT -6
I’m not entirely certain but I thought in the Sanders plan, the amount Medicare covers will increase. Basically share of cost will decrease to almost nothing.
|
|
jkjacq
Ruby
Posts: 21,742 Likes: 94,334
|
Post by jkjacq on Jul 29, 2019 9:44:37 GMT -6
to expand further.
The course we're on is not sustainable. And I honestly think in THIS country a supplemental system will just keep us where we are, because you will begin to see niche medial markets carved out to cater to 'those who can afford it' and we're right back to square one. At least at an onset.
Hospitals in lower income areas, rural hospitals will start to lose even more funding and/or doctors because the money isn't there, they will (and already are) shutter, or fall into horrible conditions. It doesnt do any good to have coverage if you can't see a competent doctor within 4 hours of your home.
At some point we NEED to level the playing field. People aren't asking for the moon when they talk affordable reliable access to healthcare. This well I have a job so I should have better care than Joe who is 'lazy and doesn't work' regardless of the 'why' is inhumane at this point. We're allegedly the richest nation in the world its stupid that we can't treat everyone or expect people to start gofundmes for medical needs. Its criminal
And I have heard the 'he doesnt deserve to get care because he is lazy' argument in person. So there are people out there who truly believe that.
|
|
|
Post by greykitty on Jul 29, 2019 10:25:57 GMT -6
jkjacq, thanks for your reply. Supplement G plans, which is a good one with low deductibles and pretty full coverage, in my area start around $150 a month, plus Traditional Medicare premiums currently is $135 and increasing next year, I believe. That's after paying in the 40 quarters. I believe premiums are higher for those who haven't paid in the minimum 40 quarters. It's not nirvana, but I agree, Medicare is pretty upfront about what's covered and what's not. I have not seen or read about CMS and how they feel covering the 'younger' medical issues will affect Medicare. I'm not sure enough data came out of ACA to provide a solid footing for that, but I haven't kept up. A lot of seniors can't afford the supplementals, or pick low coverage ones, so they again face catastrophic expenses in many cases. Or they go with Medicare Advantage but far more have restrictive networks. Granted, you have to pick your 'poison' regarding MA, Medicare Classic and Supplemental quickly during open enrollment seasons and preexisting conditions can play a huge role in the Supplemental premium cost. Can't see how that would change right now for the buy in population. Again, I'm not sure how the challenges facing seniors would differ for the younger generation. I do agree a universal mandate for insurance coverage would help with costs, since everyone would, and should, have to pay in. That's where I'm stuck with most of the Democrats - they seem to be glossing over payment structures. They darn well all know taxes have to go up. I'll honestly give that to Sanders that he's mentioned it. I do agree that concierge medical access is going to boom even more going forward. And that no-cost sharing refers to payment at the provider. Costs will certainly be shared in taxes and premiums. I just hate that this important issue is becoming election fodder with glitz and glossing over the painful parts - and worse, if handled badly, will drive more voters to sit it out or vote for Trump.
|
|
|
Post by greykitty on Jul 29, 2019 10:35:55 GMT -6
I’m not entirely certain but I thought in the Sanders plan, the amount Medicare covers will increase. Basically share of cost will decrease to almost nothing. I think Sanders is pushing for Medicare Advantage but doesn't want to mention phasing out traditional Medicare. MA has far more restrictive networks but does look appealing when you first glance at the' enhancements' offered. I always think of MA as being kind of a giant HMO and also a loss leader for private insurers offering MA. Initial premiums are low but.....you're pretty much stuck. See, that's the thing for a lot of people- until you're approaching Medicare age, it's all just one rosy cloud of "Medicare" that appears so much more appealing than private insurance. Who knows about the difference between Medicare and MA? What do you mean the doctor I've seen for 10 years doesn't take MA but does take Medicare? What are all those supplemental plans and how are they different? What the heck is Plan D drug coverage and why are the premiums all so different? What do you mean I can only go to one drugstore? Why do I have to be so careful about how/if the doctor is admitting me to the hospital? And for those approaching Medicare and also vote - does Medicare for All swamp the boat? That's going to be an awfully effective campaign question, I think.
|
|
piratecat
Diamond
Posts: 36,030 Likes: 143,897
|
Post by piratecat on Jul 29, 2019 10:43:12 GMT -6
My H was on Medicare with a private supplemental plan for several years after he was diagnosed with ESRD. The combined premiums were quite affordable (to us and relative to comparable private plans) and the coverage and deductible were very good, and he was only in his late 20s. He is now paying more for a very high deductible plan that covers basically nothing. I know that we're lucky that ESRD qualifies you for Medicare - who knows how we would have afforded the life-saving treatments and procedures for him with the shitty insurance he was on at the time.
|
|
|
Post by greykitty on Jul 29, 2019 10:52:47 GMT -6
I'm sorry for your husband health challenges and glad he's doing better. Yes, Medicare is good with end stage renal disease and glad you knew to apply for it.
|
|
|
Post by blurnette989 on Jul 29, 2019 10:53:35 GMT -6
greykitty what healthcare reforms do you think would be effective? Also in case this reads blunt/rude, I'm not trying to be, just genuinely curious your thoughts.
|
|
|
Post by blurnette989 on Jul 29, 2019 11:01:04 GMT -6
Am I the only one who think americans in general actually don't really understand or give a shit about how things are paid for? My assumption has been that politicians haven't given huge details on that because 1) people don't pay attention to it and 2) those things are typically hammered out it later when actual legislation is drafted?
|
|
piratecat
Diamond
Posts: 36,030 Likes: 143,897
|
Post by piratecat on Jul 29, 2019 11:03:13 GMT -6
I'm sorry for your husband health challenges and glad he's doing better. Yes, Medicare is good with end stage renal disease and glad you knew to apply for it. Thanks. We had great social workers at the hospital that helped us navigate it.
|
|
|
Post by greykitty on Jul 29, 2019 11:19:38 GMT -6
Mostly being upfront about how much things will cost to implement effective change. As I mentioned, IMO Harris wants to tell voters their taxes will not go up, but they're going to gain universal access while nothing else changes for them. She knows that's not true. Sounds pretty, isn't realistic.
Altering the taxation levels to improve healthcare access should indeed be worthwhile - but don't pander to potential voters and say it's not going to happen. We're looking at a huge economy, a huge industry and a very large and diverse country. It'd be nice if we were just a relatively homogenous country the size of, oh, Indiana - much faster and easier to test and implement anything, I would think.
I supported ACA and think it would have eventually worked out if the universal mandate had been kept. Premiums in the third year started looking as though they were settling to a more stable area. I do think too many candidates here jumped on Medicare for All simply as a campaign promise and know that it'll be a long hard slog to get legislation passed.
And, yeah, I'd like to see that there's an offset between the logistically necessary much higher taxes and hopefully lower insurance premiums....I guess I don't have a lot of faith that's going to happen without painful changes for many. And I resent candidates who gloss over that fact. I didn't believe Trump on his tax cut; I don't believe Harris on this.
|
|
|
Post by greykitty on Jul 29, 2019 11:37:42 GMT -6
Am I the only one who think americans in general actually don't really understand or give a shit about how things are paid for? My assumption has been that politicians haven't given huge details on that because 1) people don't pay attention to it and 2) those things are typically hammered out it later when actual legislation is drafted? Yep to a large extent (like probably every other human being). I'm on my condo board. Owners will appear and ask why we didn't get all the roofs replaced in one year. We say, well, we could do it over four years by planned distributions from the reserve fund, we could ask for special assessments, or we could drain the reserves. People at that point may say, oh, then four years is fine but even though they get the budget every year and see the reserve studies, they don't read and/or apply to themselves. Honestly, until I got onto the board, I didn't understand the nuances and really hard decisions you have to make when you have a limited amount of resources to work with. I really do have more sympathy with politicians these days. It's a hard sell to simply tell the truth and say, guess what, monthly association fees are going to go up X% because our reserve study indicates we'll need new streets in five years. People tend to want immediate gratification (more money in their pocket right this minute as opposed to no special assessments in five years). Extrapolate that over a village/county/city/state/country. Yay that I won't be paying high premiums for health care - oops, don't like that my taxes jumped $5,000 annually. And, I'm shamed to admit, most US citizens simply don't vote - and if they do vote, they tend to vote for whomever promises them the most 'candy' with the least pain. Single issue voting is an challenge as well for us. Also, I think it is true - the older you get, the more you do consider budgetary issues. Usually that's not a bad thing, as you can strike a balance between ideals and paying for them. But politicians want, and need, to be elected - and they're addressing a huge electorate of widely diverse opinions and needs. No real surprise they may just go for a pretty, shiny sound bite - sadly, works really well for Trump in a lot of cases.
|
|
jkjacq
Ruby
Posts: 21,742 Likes: 94,334
|
Post by jkjacq on Jul 29, 2019 11:39:43 GMT -6
Am I the only one who think americans in general actually don't really understand or give a shit about how things are paid for? My assumption has been that politicians haven't given huge details on that because 1) people don't pay attention to it and 2) those things are typically hammered out it later when actual legislation is drafted? Nope
NOBODY asks how we're gonna fund a couple dozen 1.5B jets or a new AF1. Nobody asks how we're funding a 20 year war overseas. NOBODY CARED WHAT THE 1% TAX CUT DID TO MIDDLE AMERICA!!! and how we were going to pay for that. (hint middle income people are paying for it and our debt/deficit is exploding)
but by golly, you better tell us upfront how we're all going to get medical care or how we're going to feed and house people.
its.ridiculous
(and I'm being hyperbolic on the first part but it IS mostly true)
|
|
richard
Emerald
Posts: 13,699 Likes: 128,724
|
Post by richard on Jul 29, 2019 17:01:33 GMT -6
I feel like Harris and probably other candidates are getting stuck because of the soundbite factor. Like at the debate they didn’t ask what’s your plan for healthcare, they asked raise your hand if you would end private insurance. So if you don’t raise your hand, but you don’t have time to explain your plan, it just looks like you are not progressive enough. So, Harris keeps saying no to private insurance and walking it back which is not a great look either way. I feel like this is definitely true of the debate. The town hall tho...that was an unforced error. She just didn’t seem ready. That said, I do like what she laid out and I think she needs to hammer it home from here on out. She does need to be careful about not making a promise about taxes tho. Be vague and skirt the issue if you must but don’t tie yourself to something you can’t guarantee. She’s definitely not the first candidate to get fuzzy on how to pay for things while campaigning.
|
|
richard
Emerald
Posts: 13,699 Likes: 128,724
|
Post by richard on Jul 29, 2019 17:16:54 GMT -6
I think a 10 year phase-in makes sense logistically.
I just worry that it would leave a whole lot of room for GOP sabotage. It takes something like this time to get working but it also takes time for people to get used to it and like it to the point where it’s accepted and attempts to roll it back become politically dangerous. (Like we saw with the ACA in 2017-18.)
|
|