Will policymakers ever learn? It is not possible to pay for health care, make it affordable and meet the unrealistic expectations of Americas patients.
Medicare beneficiaries flock to MA plans for the promise of more benefits and lower costs only to find limited provider access and management of their care.
Nobody seems to ask how the MA insurers can provide what they do for less.
The other part of the question is simple, Medicare – that is taxpayers – over pay MA.
The tougher challenge is on the regulatory side. The Biden administration’s changes, from releasing stingier payment rates to changes in how programs can code patient risk, signal an era of tighter purse strings. With such a big part of their business at stake, the industry’s effort to sway public and policymakers’ opinions is expected to go into overdrive.
For decades, policymakers have sought to bring private insurers along as a way to manage soaring Medicare costs. In 2003, Congress passed the Medicare Modernization Act, which created Medicare Advantage as we know it. The idea, in a nutshell, is to bring down costs and improve care by allowing insurers to manage care, much like they do for the nation’s employers.
But critics point to studies showing that Medicare Advantage plans cost the government and taxpayers billions of dollars more than traditional Medicare.
“For well over a decade, Medicare Advantage plans have been making extremely high profits. What’s going on now are long overdue policy changes to bring their pricing and coding practices back into line,” said Dr. Don Berwick, former head of the Centers for Medicare and Medicaid Services.
Excerpt: The Wall Street Journal
And then, of course, we have the election year negative spin which many people will simply accept.
QUINNSCOMMENTARY 
Better ideas exist. The beltway idiots are not interested. A better idea won’t allow them to buy votes with your tax dollars. They won’t be able to promise taxpayer subsidized coverage paid by someone else. Until that changes, Americans will continue to want the best coverage YOUR money will buy.
I offered a better idea to all three candidates in 2008 – Clinton, Obama and McCain. It is still a better idea than what we have today.
Health reform did not lower cost, it simply mandated taxpayers (today, and to the extent we run deficits and debts, tomorrow) to subsidize the purchase of coverage for individuals, most of whom were capable of buying coverage, but were unwilling to do so.
Success requires appropriate accountability allocation:
Taxpayers here means every adult – regardless of income level. Yes, that would be a per capita tax. No, the tax would never be waived, but would accumulate as necessary.
So, individuals would have to shoulder at least some baseline level of expense, out of pocket or via insurance. And, individuals would have to shoulder a proportionate amount of the per capita tax to fund societal burdens.
Much like defense spending, it is inappropriate and a huge mistake to ask only a small portion of Americans to shoulder the cost of “general welfare” – such as defense, health care for those who have no income or are otherwise unwilling to spend their own money to purchase coverage.
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You are lucky. Medicare has no out of pocket limit. In three days my wife racked up over $150,000 in charges from an accident and $100,000 more with all follow up treatment. Thats just one incident.
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Out of pocket? That would have nearly decimated my life savings.
I went with Kaiser Insurance on my first job and almost automatically switched to Kaiser Advantage when I retired. For two years of immunotherapy, they paid in the order of half million or more, and my copays were negligible. Probably $100 per year.
May be its better to be lucky than smart, but I’ve always been happy with Kaiser. Total copays for childbirth…$50 in 1970. Package deal.
Just got notices last year or so that they will pay transportation for appointments, up to 24 visits per year, I think. Plus “free” health club membership.
I wondered how they could do that.
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No, deductible plus 20%. Still a hefty sum.
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here we go again–let’s do Medicare For All which is the grand scheme of the Quinn like folks–we will start by taking away your Medicare Advantage and work on from there–no doubt we will hear something akin to; “you can keep all your doctors and the cost will not exceed $2,500′. Politico called that one the lie of the decade. Fool me once shame on you–fool me twice shame on me.
Had dinner with lefty friends last night who all have Medicare Traditional and have no issues–also have folks with Advantage and they have constraints but are satisfied.
Have friends with Kaiser which seems Advantage like and they love it and have been participants for maybe 50+ years.
I only do “A” because it is “free”–insurance covers the rest as well as drugs–so far it works for me.
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Let’s hear a better idea other than Medicare for all (not the Sanders version) that assures at least a fair distribution of costs and universal coverage? We must eliminate adverse selection, assure that the total cost distribution is based on ability to pay.
You only do A? What insurance covers B expenses?
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