The Truth About Medicare

Now that Obama has given his speech about health care, people are actively talking about their horrible experiences with Medicare and wondering if the "public option" will produce care for everybody that's as bad as what they've seen their own aging relatives  receive. These examples, however, show me there's a profound misunderstanding about what Medicare (or any public program) does.

Here it is in simple terms: Medicare writes the checks. It doesn't operate on the wrong leg, over-radiate a cancer patient, miss a cancer, or give people too many prescriptions.

That's the job of the provider, who is hamstrung by a larger problem, which is lack of continuity of care. And there's also a shortage of doctors.

Here's what Medicare is designed to do: provide a safety net for catastrophic illness. That's all. It covers mainly hospitalization, although you can buy a supplement that takes care of co-pays, tests and doctor visits, and another supplement that covers prescription drugs. I have fancy Medicare and supplements by AARP; everything is covered, For this I pay $132 a month. I pay a premium for Medicare part D, the drug plan, of $47.74 a month.

I can go to any doctor I want. At age 65, I had a hip replacement, no waiting, for which the bills totaled nearly $50,000. I paid only for the special physical therapy I wanted that was beyond what I really needed (I wanted to go back to athletics and yoga).

I have no complaints about Medicare. It covers a lot more than the insurance I had just one year previously, when in the same good health I paid $600 a month with a $1000 deductible. And I have chosen my providers with care. I get good treatment from people who treat me well. But that's because I've taken the time to learn the system, evaluate doctors, and look up information.

You see, folks, there are three players in any health care transaction–the payer, the provider, and the patient. All three have a responsibility. As the patient, your responsibility is to take care of yourself and to be informed and to be realistic.

Waiting? That's the provider. How busy is he/she? Family practice, internists and pediatricians are very busy because there aren't enough of them.  And there aren't enough of them because they don't make enough money to pay off their medical school debts by going into primary care.

Negligence? That's the provider, too. Medicare doesn't mark the wrong leg for surgery or fail to diagnose an illness. That's between the patient and the provider.

Kicked out of the hospital before you think you are well? Private insurance kicks people out of the hospital just as quickly as Medicare does, and often more quickly.

So when you have a beef with the health care system, which we all do, at least lay the blame in the right place. It doesn't matter who pays the bill. It's who does the job. When the government pays the bill, the entire "business" side of the issue gets taken care of more efficiently with less waste and expense.

Glossary:

Payer:

Establishes coverage guidelines
Juggles available funds to decide how much money is spent per patient per life
Decides if it is a hospital treatment (Medicare) or an outpatient treatment that's paid for
Gives money to provider for the treatment
[Medicare pays more over the life of a patient and includes more
treatments than almost anything else because it doesn't have to be profitable]

Provider:

Doctor or nurse or hospital or outpatient facility. That's who makes you wait, doesn't have automated records, makes you fill out forms over and over, and sometimes mis-diagnoses things because he/she is only a human being

Patient:

The person who receives the treatment and should know all this, but often doesn't. The person who likes to blame others for lifestyle choices that have to be corrected by the health care system at great cost to society

 

 

Follow Francine Hardaway on Twitter: www.twitter.com/hardaway

Comments

[Jim Jaffe - Huffpost Blogger]

too few doctors. sez who? in a field where supply drives demand, one should be wary of any argument that we need more doctors, particularly when the ratio between doctors and patients has been shrinking for years.

[Mike Hihn]

Sez me.

Doctor's are quitting their practices in disgust with Medicare underpayments -- especially in retirement communities where they can't pass their losses along to insurance companies like everywhere else.

Timothy Geither -- Treasury Secretary -- warns of a looming doctor shortage under CURRENT conditions.

But YOU --- and who ARE you? -- claim there will be no problem treating an additional 50 MILLION patients, based on your totally unsupported assertion.

Geither also notes that the President calls for additonal cuts in doctor/hospital Medicare reimbursements if his promised savings don't appear. That means seniors wont have our benefits cut -- we'll just find more doctors refusing to accept Medicare.

This is all in the Medicare Trustees Report for 2009.

Meanwhile, can anyone think of a bigger politician's lie than soothingly claiming everything can be paid for by eliminating "waste, fraud and abuse"? I've heard the same lie for 45 years as a voter. I stopped believing it 25 years ago.

If Republicans weren't such idiots, instead of screaming "socialist" they should just ask the President one word: How? And no more empty platitudes.

Meanwhile -- this has been in all the papers -- the President has told Doctors he would get them out of ANOTHER 21% cut in their fees, if they support his reform plans. HUH?

What if a politician came to your door, saying he would cut YOUR income by 21%, unless you vote for him. That may not be fascism, as the Republicans say. Looks to me

[Medtral]

We hear and deal with many people not covered by Medicare who themselves are asked to come up with $50,000 or even greater amounts for their hip replacement.
Main stream or not, embrace it or not, medical travel is a real and increasingly considered option for people who simply can not afford or gain access to non-acute surgery in the US healthcare system. Be they uninsured or in our experience ,more likely underinsured, the chance to have personalized, quality surgery in an environment that is both culturally and medically aligned to the US yet at a dramatically reduced price, is attractive.
Medical travel and coming to New Zealand for surgery is not for everyone, either due to the nature of their medical condition or because it involves traveling overseas and putting your failth in another healthcare system.. But increasing number of people are experiencing it as a way of gaining access to high quality, affordable surgery where due to a variety of factors not least of which is dedicated, intensive post-op recovery time, the outcomes are excellent.

[gfulmore]

You say "people are actively talking about their horrible experiences with Medicare," which is a mouthful. Then, you go on to correctly say that Medicare is only the payment system, not the provider, as such. The latter is the key. There have been some HMOs across the country, for example, that have horrible track records under Medicare. Horrible. Others, like Kaiser Permanente, are not perfect, but have good results, overall. There will always be the Medicare "haters." Most of these had Social Security, the New Deal, the post office, DMVs and all the rest. They are "haters." Medicare will never be perfect, but it is a great start. Its admin costs are far lower than private insurance costs. And, of course, it does not return a profit to investors in the form of a dividend. Instead, it should guarantee catastrophic, comprehensive health care to Americans 65 and older, plus those who qualify under other conditions. Long live Medicare. I think your clarifications are needed. There are so many misconceptions over Medicare.

[Mike Hihn]

Medicare overhead is HIGHER than private insurance.

The lie is expressed as a percentage of reimbursements. But Medicare subscribers have 5-6 times higher annual expenses than non-Medicare patients. So, if a billionaire spends $5 on something, and a homeless person spends $5 on the same thing, we could say that the billionaire spends a much smaller percentage of his income -- which is true, but totally useless.

On a per-patient basis, several studies show that Medicare overhead is more costly (dollars per patient, per year).

Do the math. Medicare underpay doctors by 40% (another 21% in the pipline) and hospitals by 15%. These losses are shifted to those with private insurance which causes insurance rates to skyrocket. (Underpayments to hospitals increased tenfold from 2000 through 2006, the latest data available). So Medicare is being subsidized by insurance companies.

And subsidized by income taxes.

The Medicare Trustees Report -- signed by Timothy Geither -- issued a "Medicare Funding Warning" for the fourth year in a row, because 45% of Medicare revenues are now being subsidized by income taxes instead of payroll taxes.

Also from Geither: Medicare's unfunded liabilities are $38 TRILLION. Under current funding, a 54 year old has no assurance that Medicare will even be there when he or she turns 65.

Point being: the left is just as ignorant as GOP Birthers. Denying the "inconvenient truth."

[Johnniedog]

You really need to get your facts straight before writing an article. You are dead wrong about the purpose of Medicare.

You say: "Here's what Medicare is designed to do: provide a safety net for catastrophic illness. That's all."

Wrong! Wrong! Wrong!

Medicare was always, and will always be, a full service Health Insurance program. It was never simply intended to be a safety net for Catastrophis Illness. It was always intended to be a complete insurance program...­.period!!! That is, of course, unless the Republicans get their hands on it again. They will further cheapen it up to the point of destroying it like they tried to do under Bush.

[Mike Hihn]

Medicare is a disaster. Read the Medicare Trustees Report chaired by .... Timothy Geither.

“... under the current payment structure, a person who is 54 years old today can not be assured that Medicare hospital insurance benefits will be there when he or she turns 65 and first becomes eligible for Medicare,”

http://www.hhs.gov/news/press/2008pres/03/20080325a.html

For the fourth year in a row, trustees have declared a "Medicare Funding Warning". Nearly 45% of Medicare revenues now come from INCOME TAXES instead of payroll taxes.

Unfunded liabilities total $38 TRILLION, but doctors are underpaid by 40% and hospitals by 15%. These underpayments are recovered from higher fees to private insurance - on top of subsidies from your income taxes.

Hardaway should check her own city, to find how many doctors REFUSE new Medicare patients. Small retirement towns, like Ocean Shores, WA have lost their only physician. My best friend lives there. He's 70. Hs closest doctor is now 14 miles away. How would readers like to be 70 years old, with NO nearby physician?

Congress has schedued ANOTHER 21% cut in doctor payments. The President has offered to cancel that cut if physicians support his reform. That's like a politician coming to your door and saying he'll cut your income by 21% if you don't vote for him. I won't call that fascism, like the Republicans would. It seems more or a Mafia-style protection racket. What would YOU call it?

Ask your own Doctor about Medicare.

[MJinCanada]

So much common sense in one small blog post!

Ms. Hardaway, you are terrific!

[tompoe]

Required reading for every elected official. For Baucus, Grassley, and the rest, it is recommended they practice reading it, and then stand in public, and read it again. I have filed it away, and will bring it out just before election, to use as the reason why I won't vote for a single one of these jerks.

[NordicSci]

You use Medicare to make a great point that too many people don't know how the current system really works and therefore have a hard time understanding the various aspect of reform currently being debated. Few of us really understand how current insurance rules are structured, myself included. All I really know about insurance is that each year I get a chance to choose from several plans my employer offers and they all cost a lot more every year.

[Mike Hihn]

Here's one major reason your employer health insurance keeps increasing. Cost-shifting from Medicare.

Medicare severely underpays both doctors and hospitals. In the most recent 6 years reported, Medicare payments to hospitals at below their costs have increased more than tenfold, in dollars.

If you ran a non-profit hospital, meaning you break even, and Medicare pays you 15% below your costs, what will you do -- go out of business, or sock it to the patients with private insurance?

Doctors are unpaid by 40% already, with another 21% scheduled by law. The Medicare Trustees Report, signed by the Treasury Secretary, blames Congress for repeatedly delaying 10 years of severe reductions in physician fees.

Doctors and hospitals, to the extent they can, pass along these Medicare lossses to ... you, as paid by you employer.

But in retirment communities, with nobody else to absorb the Medicare losses, Doctors simply abandon their practices. Or move.

But when they move, they still refuse Medicare patients. I'm 67 years old, and recently moved to Boise. You may need to be on Medicare, seeking a new doctor, to see how bad it is. Of the ones I contacted, more than half refused to accept new Medicare patients. I'm now in one of the largest group practices in America. Over a dozen clinics in Greater Boise alone, but only TWO of their physicians accept new medicare patients.