Medicare 101: New Vouchers and Change to Medicare

My last long article was about the first privatization of Medicare.  Current proposals to privatize  focus on Premium support and Vouchers.   This will change Medicare’s structure, what it covers, and how services are paid. The following is a quick look at the proposal.  Even Fox News has qualms about  this new direction.  Read on:

Medicare, Specific Services  and Vouchers

Medicare currently pays for specific services (defined benefit).  Briefly, Medicare Part A covers hospitals, limited skilled nursing care, hospice, lab tests and home health care. Part B covers doctors and some other providers, outpatient care, home health care, durable medical equipment (such as wheelchairs) and many preventive services, such as flu shots. Medicare did not cover prescription drugs until Medicare Part D became law in 2006.  Medicare Part C created Medicare Advantage (managed care) programs that combine both A and B, and often D.  Medicare Advantage programs receive federal subsidies which ‘traditional’ Medicare does not.  Seniors must use the plan’s doctors and hospitals or pay for services themselves. Most seniors buy a Medicare Part B supplement that covers what Medicare Parts A and B do not, such as co-payments and other services.

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Privatizing Medicare and Me: A Story from the First Privatizing

I was the Medicare Marketing Director at a private for profit health insurance company in the late 1980’s and early 1990’s and the first attempt to privatize Medicare during the Reagan Administration. That job made me the ardent consumer advocate I have been ever since.  What I learned then is happening again now in a slightly different way. It is not good news for seniors. Here’s why:

Congress and Medicare

Congress oversees Medicare coverage as well as mandated commercial insurance coverage.  It required an act of Congress for Medicare to cover preventive services, such as mammograms or prostate screenings. Kidney dialysis coverage for End Stage Renal Disease required an act of Congress. Mental health was added as an insurance benefit in 2008 with the Mental Health Parity act. Expanded mental health and addiction coverage was added as part of the Affordable Care Act. All required Congressional action.  Medicare covers what Congress allows in statutory language or specific legislation. For example, adding prevention coverage or prohibiting Medicare from negotiating prices  with pharmaceutical companies.  Physician fees for doctors who accept Medicare patients are set by a committee that was authorized by Congress.

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Best Wishes for Holidays and New Year: Two Specials–Privatized Medicare My Story

Privatizing Medicare: I was the Medicare Marketing Director for a for-profit HMO in the late 1980’s, early 1990’s.  Coming up will be my inside story of  lessons learned and  how the first attempt to privatize Medicare played out and left seniors in the lurch.

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 10 Things You Need to Know About Your Electronic Medical Record, by Alden Roberts, MD, MMM, FACs, retired Chief Medical Officer. He holds a certificate in Medical Ethics from the University of Washington. He has been involved in implementing two inpatient electronic medical records systems and has over twenty years experience as a physician, and surgeon and nine as a hospital administrator.

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The Real Price of Silence

My son was killed in a car accident 25 years ago this month.  He was proud of my work for health reform so I cannot remain silent now as major changes loom.  We live with a system that can be soul crushing wrong.  We ignore it at our peril. Here’s why.

43 million people are driven into debt, bankruptcy or lose their home from medical costs.  43 million people is roughly the combined populations of Ohio, Illinois and Florida.

Only we don’t see their faces or combined numbers. Their stories are one at a time.  News media too often turn away or feature just one heart rending story: “Medical bankruptcy? We did a story on Medical Bankruptcy last week.”  I know. A reporter told me.  All stories aren’t told, just trickles.  There are no collective faces. We don’t see them as the massive group they are.

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American Health Care and You: A Call to Conscience–Our Veterans and the ACA

Today, November 11 is Veterans’ Day a day to remember and honor those who served our country.

Yet now nearly 25% of our veterans are homeless.  Over 20 commit suicide every day. They fought grizzly wars for us in Korea and Vietnam and now in Afghanistan, Iraq, the Middle East, Africa and elsewhere.  We no longer have the draft. These brave men and women volunteered to serve our country, many with multiple deployments.

My father was a career Naval Officer who served as a fighter pilot in the Pacific during World War II and in Korea.  We had health care benefits for life as a career officer. This included me until I turned 21 as it should. I was not on active duty.

Our Veterans Administration began in the 1930’s to care for wounded soldiers from World War I.  Our World War II soldiers and sailors returned to ticker tape parades and the GI Bill.  There has been no such recognition or reward since.

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Drug Money: Companies Flipping Drugs for Profit and Costs of Cancer Care and Drug Company Political Contributions, Drug Coupons and Costly Diabetes Drugs

I don’t usually do this, but these four articles speak for themselves on drug costs and I am on my way to a conference.

1) Drug companies are selling their drugs to others after a patent expires and those companies can/do jack up the price.  This is from Bloomberg News, a reputable business publication:

http://www.bloomberg.com/news/articles/2016-11-02/buy-and-flip-booms-in-drugs-market-as-private-equity-moves-in?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=36890353&_hsenc=p2ANqtz-8ApeujdzXuBIbsRKwqN4-EykDsc-YnQl6YLc5GamDQhbzH5Oi5kboDkf22XJCYIBn3_VWA1rk1mbI-ZbKVR7UhsZzAig&_hsmi=36890353

2) The cost of cancer care:  One of the reason some people file for bankruptcy or go into deep debt and often re-finance their homes. This from the National Center for Biotechnology Education:

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Under the Radar: Foreign Investments in Our Health Care

The debate over universal coverage vs. the marketplace rages on, but little attention has been paid to  foreign investment in our health care system. Investments and ownership range from physician practices, to hospital systems and now home health and hospice care through mergers and acquitions.

The O’Connorreport first reported on these foreign investments in 2014 with a little known fight that started at a hospital in Eugene, Oregon between the hospital, its hospitalists and Peace Health over Peace Health’s decision to contract with a private for profit company, Sound Health, for hospitalist services.  http://oconnorreport.com/2015/03/european-companies-financing-american-health-mergers-under-the-radar/

Sound Health is a private for-profit physician services organization of hospitalists and post-acute services based in Tacoma, Washington.

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An Economist’s Insights on Cost and Access; World Stroke Day Oct.29. (new web coming soon)

Those wondering about our costs and access might find this article on some research findings of interest. http://theincidentaleconomist.com/wordpress/why-the-u-s-still-trails-many-wealthy-nations-in-access-to-care/

The findings may surprise you!

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National Contest for Patient Stories: $1,000 first place (new website under construction)

The national Patient View Institute in conjunction with the Leapfrog Group is sponsoring its 2nd Annual Patient’s View Impact Award. www.GoPVI.org , www.leapfroggroup.org

The award is for patient stories that can change health care for the better.  All stories must be told by patients or their loved ones. Submissions with multimedia elements are strongly encouraged. The award winner will receive $1,000 and a trip to Washington DC for the award ceremony on December 6th.  

DEADLINE: NOVEMBER  11  6PM

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When the System Works

I have long been a critic of our health care system. I remain a critic of the system itself, as I believe it serves neither patient nor provider well with all its rules, rates, eligibility, networks, access, coverage and too often poor quality and inadequate safety.  In this morass, however, are gems that shine when the system works.  The system worked for me when I had my stroke two years ago. It worked again when I had a recent health crisis.  Neither time could I speak for myself.  The first I had an ardent advocate. The second time it was doctors I did not know in a local hospital that happened to be under contract with my insurer. I was just an unknown patient who came through the Emergency Room.   And the system worked.

Because the hospital was under contract with my insurer, the doctors had access to my medical records indicating a series of urgent visits. When I met with them in the morning, they had a summary for me about what had happened, why I was having some of the symptoms and started a round of antibiotics to deal with an advanced infection.   I was dehydrated and confused.  They were compassionate, straight forward and thorough. They explained the tests and why. They explained why it was important that I stay.

That was the surprise.  I hear stories of people being discharged a day or two after heart surgery.  Short lengths of stay—and pushed out.  One friend in her mid-80s was discharged two days after a hip replacement until she quite insistently protested. This is what I was expecting—a quick in and out and you’re on your own.

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