Epiphanyblog

All about ideas…

After the President’s speech, let me talk to seniors…

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and their children about health care reform.

In a few short years, I’ll join the ranks of Senior Citizens. So, the fate of Medicare is extremely important to me. I don’t know all the details in the House Bill, but I believe the President is working to preserve the same benefits that now exist in Medicare. But, let’s be honest, too much waste exists in the system. It could be better.

My daughter, before she was laid off, worked daily with doctors as part of the pharmaceutical industry for 10 years. She has story after story of doctors ordering tests upon tests because those tests paid more from insurance companies and Medicare. It’s not that doctors get a kick-back from ordering more tests. What they get is a payment for their time involved in looking over the results of those tests. Even when the tests are unnecessary. Points to think about regarding this item:

1- All of the administrative costs, including nurses, are not paid by insurance. The only fees insurance and Medicare pay are for the individual doctor’s time. As a result, if a doctor has high overhead costs – staff, nurses, rent, equipment – the only way that doctors can pay for these costs is to order additional tests so his/her time is needed to review the results.

2- Medical malpractice insurance is enormous. It costs every doctor tens of thousands each year. Doctors need to charge extra amounts just to cover their insurance…caused all because of wrong-headed law suits. (And again we’re talking about for-profit insurance coverage so who knows how much profit is built into the premiums.) Nevertheless, the fear of being sued, even when the doctor has followed best practices, is so high that doctors go to extremes in testing, etc., to avoid being sued. Still, regardless of how well doctors practice, they’re burdened by outlandish insurance costs.

3- Medicare is slow to reimburse. It takes as much as 90 days or more for doctors to receive payments from Medicare and at least 30 days from private insurance companies. Meanwhile, doctors still have their bills each month. As a result, they need to charge as much as they can, from whatever means, so they can survive while awaiting payments.

4- Doctors leave med school well over a $100,000 in debt. Often that debt is over $200,000. Doctors need some way to repay those loans. Ergo, do more tests, etc., to charge more.

We, as a country and our government, can change these problems that affect doctors and allow them to reduce their costs. Many of these solutions are common-sense. Many more have been put forward by leading specialists in the field.

Another thing the President has discussed is medical IT. How many of you have had the same tests ordered by two or more doctors? Each of those tests net revenues to the doctors and even more so to the labs doing the tests. Why? Imagine how much money Medicare and the insurance industry would save if the results of one test was transmitted to all of your doctors. Millions of dollars each year. Isn’t that s good thing? Your costs would go down.

I believe the Medicare will not be destroyed under this new plan. But I do know that Medicare can work better. I mean, why is it that Medicare cannot bargain for lower drug costs the way the Vet Admin. does? Why shouldn’t senior citizens pay less and Medicare pay less for needed meds? Fixing the Prescription Drug (so-called) Benefit will save both seniors and the government billions of dollars each year. Don’t we owe it to our country and our children to save them billions of dollars if possible?

Some say the reform is a government take over of health insurance. I have a problem with that idea. First of all, that argument assumes that insurance companies are weaklings who will just give up rather than reorganize and innovate. When in the history of this nation has any industry just given up when they could innovate?

Second, that thinking assumes that a non-profit government option will end the health insurance industry. Actually, it provides greater competition. Imagine you started a business that reduced the cost of a product. Do you really think you’re competitors would just give up and go home or would they figure out a way to become more competitive? They would innovate out the wahzoo to compete.

Another point about this take over business that just needs to be reiterated again and again and again: Medicare is a federal government run program. Yes, the federal government runs Medicare. It has an average administration of about 3%. Private insurance has administration costs of over 17%. So, even though Medicare is run by the Federal government, is slow to pay, and is fraught with waste caused by poor Congressional decisions, it still is significantly more cost effective than private insurance.

So, this whole criticism of socialism is spurious. In truth, Medicare and Social Security can be considered “socialism” because they are government-run social entitlement programs. If we really chose to eliminate “socialistic” policies from the Federal government, then the first programs we’d have to eliminate are both Medicare and Social Security.

I’m sure that many seniors believe that the payroll deductions they paid actually cover their expenses during their senior years. They think that the payments went into a kind of savings account for them to be paid out when they retired. To a degree that’s true.

What is not true is that amount taken in payroll deductions does not in any way, shape or form cover their benefit costs after retirement, especially medical costs. The actual deduction amounts taken probably only cover a few years of retirement and, given medical costs these days, probably less than a year or two of medical expenses.

Seniors, you’re taking full advantage of socialized medicine and socialized retirement…and have been for more than two generations. So, if the government eliminates “socialized” programs, Medicare and Social Security, as the only two socialized programs, would hae to be repealed. You, too, would have to go out into the open market for insurance. Do you really think you can afford it? Do you even think you can get health insurance?

Let’s face it, most seniors in this country would be fiscally up-a-creek-without-a-paddle without Medicare and Social Security. Just as I will be up a creek after I retire.

But I have yet another reason for supporting a public option. I truly believe it will spur private insurance to innovate and bring down costs. It will cause remarkable changes to take place in the private sector.

I believe that a public option can be designed to function just as corporate bought health insurance does. In other words, every member pays a monthly fee for their insurance, and because the risk pool is large the costs of health care are spread around amongst the entire pool. That’s the way Blue Cross worked, as a private non-profit health insurer, before it was bought by a for-profit.

But rallying against health care reform…and screaming, cussing, and behaving in ways my mother called “lack of good breeding”…does not solve the problem of health care costs that are too high for most of us to afford if we had to pay the full cost ourselves. Nor does it solve the problem of the millions who cannot get health insurance at any cost.

We need to come together and say this is too important for vitirol and spurious rhetoric. It is time to push for truth, honesty, and real, effective changes that will reduce costs for everyone, regardless of age or economic or health conditions.

If seniors, who hold so much power in this country, cannot come together to demand Congress work together to solve this problem in a fiscally responsible way that does not add to the debt or increase the debt burden on our children, then this country is in deep, serious trouble.

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Written by Valerie Curl

September 10, 2009 at 10:24 AM

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