Local View: Private health plans are solution
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By BOB GRUNDMAN
I echo many of the comments from the July 11 LJS opinion “Medicare games show why confidence ebbs.” Unfortunately, election-year decisions show many of our elected representatives “playing to the sound bite crowd of today” rather than considering the long-term ramifications of their actions. That was especially true in the recent debate over Medicare reform.
For decades, America’s seniors were promised prescription drug coverage as well as new and improved health care options. The Medicare Prescription Drug Plan program, begun in 2006, provided a competitive environment between private carriers that not only has saved seniors thousands of dollars, but has resulted in premiums averaging nearly 20 percent less than the government had anticipated and has saved the program millions of dollars. Medicare Advantage plans were expanded at the same time and gave people eligible for Medicare several options other than original Medicare to receive their health care.
They are especially popular with those having low incomes, being disabled under age 65 and requiring few healthcare services. So popular, in fact, that almost 10 million beneficiaries enrolled in just the first three years. Unfortunately, having found programs that saved people money, Congress decided they needed to be changed.
“The Medicare Improvements for Patients and Providers Act of 2008” sounds grand but, as we all know, the devil is in the details. The original intent of the legislation was to fix the automatic 10.6 percent cut in reimbursements to Medicare physicians. The cut already had been delayed since January while Congress attempted to find a remedy and was further delayed beyond the July 1 implementation date while they played “political football.”
Few argue that the cuts would reduce the number of doctors willing to accept Medicare patients and, thus, reduce accessibility for that more vulnerable population. But, where to get the money? How about the Centers for Medicare/Medicaid Services’ recommendation to institute competitive bidding for Durable Medical Equipment? That alone is estimated to save the government $1 billion and individuals another $280 million in co-pays annually. No, the bill delays that savings for another 18 months of “study.”
According to the Congressional Budget Office, Medicare Advantage plans receive approximately 12 percent more per beneficiary than traditional Medicare. These extra benefits are the result of Congress’ original decision to ensure that most of the savings from competitive bidding would be given back to seniors through better benefits or lower premiums … and they have been. But, the success of the private program became an easy target for those seeking greater government control.
On July 15, both the House and Senate overrode the presidential veto of the bill. As a result, the legislation will turn back the clock for millions of seniors at the expense of the old, poor and disabled. These private plans may now be reduced or eliminated and leave seniors with no choice other than traditional Medicare and the more expensive supplements. Many will be forced to live without the additional benefits the private Medicare Advantage plans provided at a lower cost. Now, perhaps, we see why the approval rating for Congress has dropped to just 9 percent.
And no, the fun isn’t over. Another automatic cut in reimbursements is scheduled in just 18 months. Where will Congress look for money then? You may be getting nervous, and you should be! The problems in funding and services we see Medicare and Medicaid experiencing are symptomatic of what happens with a government-controlled health care system (also note the VA).
To squeeze the expanding desire for health care within ever-tightening government budgets, rationing must occur. Whether it is the amounts paid to providers or the services allowed for patients, there will be greater limitations at higher costs to all health-care consumers. Studies show that the cost shifting because of the already low Medicare and Medicaid provider reimbursements has increased private health insurance premiums by nearly 25 percent.
The American people have tough decisions to make and expect our legislators to do likewise. Will we continue to expand under-funded government-run health plans that further limit the services we can access, like our Canadian and European neighbors, or will we embrace private health plans vying for our business through innovation and competition? We still have a choice. You can’t afford to sit this one out. Contact your legislators and make your desires known.
Bob Grundman of Senior Benefit Strategies in Lincoln is chair Medicare Advisory Group of the National Association of Health Underwriters, which has 20,000-plus members.
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Greg wrote on July 25, 2008 9:00 am:
Wolf in the hen house wrote on July 25, 2008 9:26 am:
The truth is that a single payer health care plans do work. Canada and Europe have better health care systems than the US. They have longer live spans and generally live healthier lives. This is because the insurance companies purpose is to return money to their stockholders. What better way to do that than to make the patient pay for expensive treatments by denying needed services? If that doesn't work, get the person declared uninsurable for a "preexisting condition". And if they manage to slip thru and the insurance company has to pay, raise their rates!
Or current system of health care is broken, it is not the fault of Congress or the doctors. It is the fault of the insurance companies and their quest for profits. It is the fault of a group of people who pressure senators to block legislation that would help the American people but hinder their bottom line. Being able to see a doctor should not be a matter of if you have money, but thanks to the insurance companies money trumps patients health. "
perspective wrote on July 25, 2008 11:43 am:
If the health care in Canada is so great, why do those who can afford it travel to the US for their care? Why is the wait for most procedures 18 months? Take a look at the YouTube video "A Short Course In Brain Surgery" which details one Canadian couple's experience when the husband developed a brain tumor. This is not the type of system I want for my family.
I also question the statistics on uninsured. I read an article about a year ago that stated people who are on Medicare and Medicaid will indicate on surveys that they are not insured - again, Medicare and Medicaid are govt provided universal health care.
And as for the comment that private health insurers limit benefit? I have always had health insurance for my family. It has been one of the important factors my husband & I consider when we apply for jobs. We have never been denied a service. Has chiropractic been limited? Yes, the insurance co will only pay for about 20 visits a year - but we are still free to go after than - we just pay the bill ourselves. "
BPete wrote on July 25, 2008 1:26 pm:
He praises the Medicare drug plan as being an example of how the insurance industry manages plans. But ask any senior in Nebraska about what it is like to struggle through understanding 50 or so insurance plans so that a reasonable decision can be made each January 1. Or ask us about the massive premium increases we have sustained over the last 3 years as insurers have corrected their “low-ball” marketing campaigns. If the Medicare drug plan were run by Medicare the cost would be cut in half if not more.
Medicare Advantage (private Medicare plans) are simply another give-away to insurance companies that make huge contributions to our politicians in Washington. There is no “competitive bidding” of services – MA plans pay the same rate to providers and suppliers that Medicare does. But they waste a lot more on administrative fees and to commissions to insurance agents who cherry pick the healthy seniors in exchange for large commissions on sales.
This vote showed the fear that Congress has as we approach the November elections. All of a sudden Congress seems to have hear to people speak. At least they heard us old folks speak. "
BPete wrote on July 25, 2008 1:36 pm:
(2) Go to the U.S. Census data at:
http://www.census.gov/prod/2006pubs/p60-231.pdf
and you will see you are wrong on that item too.
(3) Most universal healthcare countries have no waiting periods. France and Germany are 2 examples.
A few do have waiting periods for NON-CRITICAL or NON-EMERGENCY care. Canada and the UK are examples here.
But no industrialized country has waiting periods for CRITICAL care or EMERGENCY care except the UNITED STATES. We exclude 1 in 6 of our public from access to decent healthcare because they have no health insurance. We have the most irrational, meanest, and most cruel healthcare system in the modern world. "
Dave wrote on July 25, 2008 2:01 pm:
No thanks-- I think we've had all the corporate healthcare that we can survive. "
Mike wrote on July 25, 2008 2:04 pm:
Social medicine lovers can tell anyone who asks exactly WHY we must change our system, HOW we should do it, and how to PAY for it. They would never preach the gospel of change without reason. They can tell you exactly why the market is bad, why government is the only true fix to this or any other problem, and why all the existing social medicine systems are superior to ours. They have perfectly rational, logical explanations for why people die waiting for procedures in those other, hallowed systems, or why medical tourism to America exists. All this and much, much more folks. Just ask them!
Yes, the socialists among us are fonts of wisdom & knowledge, with lots of historical & empirical evidence to back it all up. There is certainly none of the hate talk all others are famous for. Nor is there any room in them for labeling businesspeople or corporate America out of hand. Yes, they know the way, for they are pure. Pure of spirit, mind, conscience & soul. They really are better than the average humans they seek to protect & serve through their purety, piety, selfless actions and thoughts. They alone know the way, for they are simply beyond reproach. Just look at all the good these individuals do every single day. But why stop there? Check out the good deeds done by socialists throughout history. That's all you really need to do - just check the fruit of all their collective (!) labors. Their actions scream of love, compassion, mercy, and of course, rational, unbiased, individual thought.
Just ask them, Lincoln - for they will enlighten you. And please do so before November! You wouldn't want to waste your vote. "
another view wrote on July 25, 2008 2:17 pm:
In addition, it's naive to assume that government-sponsored health care would be unlimited. If the government is going to pay the bills, and the government doesn't have unlimited amounts of money to pay them, they're going to do essentially what the insurance companies do--identify limits, conditions and parameters on what they'll pay through government-sponsored health plans--just like Medicare and Medicaid. In one way or another, we will wind up with rationed health care, or else the government will be bankrupted by providing open-ended care. It may be fine if the care that's being rationed is somebody else's. But when it's you that need a procedure or want routine care and the wait is 6-12 months or more, rationed care won't look so attractive. And when your neighbors abuse the system and take advantage of 'free' government health care for any and every small or imagined ailment, watch what happens to your tax bill. "
windsurfer wrote on July 25, 2008 3:37 pm:
Socialized healthcare is a dream that we as a country are not likely to afford. Currently, the healthcare for the biggest blocks of insured (27000 for Nebraska Teachers Association , 14000 for the State of Nebraska) cost over 1200 per month per family, If we expand it to all citizens,the government can't tax us enough to pay for it. So if we drive down what doctors get paid, how do we get them to train 8 years for a career that pays like a 2 year degree?
So compare to the costs of existing government medicine: tricare, medicare, and medicaid. Not only expensive, but my opinion is that medicaid is very wasteful, and is poorly administered and loaded with those who should not qualify.
Medicine for the masses needs some accountability: deductibles and coinsurances. Without some skin in the game, the public will abuse the system.
So I contend that the real path to affordable health insurance is to create more competition between hospitals, doctors, and all providers. Free enterprise has made America great, so lets harness that competitivness found everywhere in our economy. Competition creates efficiency and better quality. So if there is no competition, who sets the prices the providers get paid?
The government has made a mess of medicare. Lets not expand it to every age group. "
Butch wrote on July 25, 2008 5:15 pm:
People complain about the plethora of plans available and how hard it is to understand them, and then complain about the payment an experienced professional gets through sales for helping them work their way through the offerings to make sure they get the best plan for their needs. Kind of like having the boss call you on Sunday to come in and work for free. You didn't do it, won't do it. Why should these people be expected to do it?
You want guaranteed health insurance? Check out the Nebraska Comprehensive Health Insurance Plan. Great plan, but look at the price. Set by government. Yep, 6 month waiting period for all but a few conditions. Why do you think the federal government would do any better? Look how they treat our returning injured veterans. Lots of promises and little treatment in crappy buildings that are a disgrace. These people put their lives on the line and come home for treatment. If our government treats our vets this way, how do you think they'll treat the everyday man or woman? Good luck buddy. Promises are cheap. Delivery is not. Know how to tell if a congressman or senator is lying? Their lips are moving. "
dewboy wrote on July 26, 2008 3:56 pm:
shredder wrote on July 27, 2008 9:09 am:
Free enterprise is what has made our country great. Government intervention into healthcare is just another step toward socialism. One of the greatest moves to free enterprise going on now is China, who is moving rapidly to free enterprise and becoming a world financial power....While USSR clung to the socialist ways, and is where????? "
James wrote on July 28, 2008 1:44 pm: