Newest Public Option Compromise: Medicare Buy-In
This week is when the most intense negotiations are going on in the Senate. The most contentious part is the fate of the Public Option, with the Senate A%#hole Caucus (Lieberman, B. Nelson, Lincoln and Landrieu) threatening to torpedo the bill if it contains it and several progressives (Sanders, Burris) threatening to vote against a bill that doesn’t contain a public option. The newest trial balloon (in addition to the expanded exchanges) is a Medicare buy-in for people ages 55-65:
Sources who have been briefed on the negotiations say that Medicare buy-in is attracting the most interest. Expanding Medicaid is running into more problems, though there’s some appeal because, unlike increasing subsidies, expanding Medicaid actually saves you money. There’s also ongoing discussion about tightening regulations on insurers, but I don’t know the precise menu of options being considered.
The negotiations are fluid right now, and there’s nothing close to agreement. But there is interest, and everyone remains at the table. The broader point is that the public option compromise is increasingly becoming a health-care reform compromise, and the focus is returning, usefully, to the goals of the bill. That’s good for both moderates and liberals, as everyone who votes for this bill has a stake in seeing it work, and the intense attention to the increasingly weakened public option had begun to distract from the need to improve other elements of the legislation.
I think this is a positive development and will certainly help a lot of people but there still needs to be an option for the rest of us. Perhaps we can have a trigger for Medicare buy-in for the rest of us? I just don’t see how we can start dealing with the cost inflation issue without addressing the monopolies of the private insurance companies. We’re only going to be band-aiding the current system until we start to address this issue.
What do you all think? If the public option is dropped, what do you want in return?
Tags: Health Care Reform
OH NO UI–not a Medicare buy-in. The reimbursement operates flat if not a loss for physicians, they cannot afford to remain open if their practice is that base. I would expect HUGE pushback from the provider/hospital/ services if this is agreed upon. The enrollee would think they have coverage..when in fact they need supplemental insurance to be anywhere near palatable to the healthcare industry. here’s a microcosm example right now…try finding a nursing home bed for a loved one who only has Medicare. Nursing homes only have to have so many–because others have a different insurance reimbursement, that is more reality reimbursable. If nursing homes operate at the lowest daily reimbursement rate, and you can’t get takers; what about high end health care and that market? Don’t do it to me UI, Don’t do it to me UI–please give me more than Medicare:). I need tires w/ that car!
The reimbursement operates flat if not a loss for physicians, they cannot afford to remain open if their practice is that base.
Yes they can; they just need to adjust their business model and their personal profit expectations. And if you are correct, and a shortage of physicians starts to develop, we can always adjust the payments upward (if that is in fact the cause of any shortage). But if we expand Medicare at current rates and no shortage develops, that is a win for America.
try finding a nursing home bed for a loved one who only has Medicare
Medicare doesn’t pay for long term care, perhaps you mean Medicaid. Right now, nursing homes allocate very few beds for Medicaid residents because they are trying to keep as many beds open as possible to chase the fat private dollars. But when everyone is on a public option for long term care, operators will have to adjust their business models to live on the public payments. And if they don’t, they are free to shut down. And if a shortage develops, we can increase the payments, or build public facilities. But the status quo is not an option.
Speaking of the status quo… Does everyone understand that Medicaid is like an estate tax on the middle class?
Medicaid will pay for your nursing home in your old age if you are poor, the key word being “poor.” To get Medicaid, you have to sell off all your assets, including your house and all your savings.
So – and this is a very typical scenario – if your parent develops Alzheimers, say, and you add up all their money, kick in some of your own, and then put him in a nice for-profit nursing home that smells nice with kind attendants, freshly washed sheets, and flowers in the windows – that will cost you about $5000/month. When the cash runs out, you have to start selling assets like the house. Once you are flat broke, congratulations, you can apply for Medicaid. But the odds are you won’t be able to stay in that nice nursing home, because they “only have a small number of Medicaid beds allocated.” So now you are shopping around for second and third-tier nursing homes for your deteriorating parent. Not because Medicaid payments are too low, but because the operators (rationally) prefer to chase the fat private dollars.
We went through the nursing home scenario with my aunt who suffered from advanced Alzheimers. Her monthly bill was 7000.00. My uncle had nursing home insurance, and yet had to battle the nursing home and the insurance company every month. And it’s this constant fighting for health coverage that frustrates the insured. It’s why most people despise the insurance industry.
Yesterday, we had what turned out to be a minor medical situation involving my son. After returning from the doctor my husband asked if our insurance would cover the visit. I honestly hadn’t even considered insurance. My thoughts, and fears, were focused solely on my child, where they should have been. Situations like these are where public resentment of insurance companies come from. How dare they insert themselves into my crisis! How dare they demand I take time to consider their fine print when all I can think about is my kid. It’s disgusting how they prey on people at their most vulnerable.
Joanne,
I’m sympathetic to the problems with Medicare reimbursement. I think it should be strengthened. The issue now is that our current system is broken and there are many people that lack basic medical care. The liberals suggested single payer or a compromise of a public option. The conservadems and Republicans think that is unacceptable and yet fear-mongered about Medicare (the most popular health insurance option). Blame them for this, the don’t want “government run” health care but Medicare is great. Well, this is looking like the only way we’re getting any expanded coverage. It’s pretty ironic to me. The so-called fiscal conservatives don’t want an option that will actually reduce the deficit – they just want to shovel money at private industries who of course don’t find anything wrong with taking taxpayer money.
I think we won’t really fix health care until we break two destructive paradigms: linking health insurance with employment and paying doctors by procedure.
No anon–UI wrote Medicare–which would mean decreasing the age for eligibility. As of now, physicians see an automatic decrease in Medicare payment every June (but of course the real public doesn’t know), unless Congress votes to increase it, or hold level.
“We can always adjust the payments upward”–anon, they are running now–why should the providers trust the future? “Build public facilities”–you are simplistic aren’t you? Sure, just throw those buildings up there, for commenters like you to decry we have gone back to building “poorhouses”–and it’s not fair.
And 5k a month for nursing home care? Medium rate I’d say. Semi-private room, professional care, 3 squares, activities, incontinence managed, safe surroundings–breaks out to about 165 bucks a day. Much less than private duty, or a hospital bed. Even cheaper than an all-inclusive hotel room. What I don’t get, is why are people so averse to using their assets (and yes, I’m talking about a home) to pay for their end of life care? We are supposed to pay our own way in this society, and help those who can’t. Why do people feel entitled to leave their kids the house for the big pay-out? Pay your bills of what you want in a nursing home. Don’t look at the public to pick up the tab, so junior can have his windfall.
Don’t look at the public to pick up the tab, so junior can have his windfall.
There you go again. Why do conservatives always see the government as “other?”
I am Junior and I am the public, and my vote is that I will contribute to a public system to help take care of my parents and yours. A public system should not be designed to bankrupt the public.
“What I don’t get, is why are people so averse to using their assets (and yes, I’m talking about a home) to pay for their end of life care?”
Can’t argue with that, JC.
And selling your house may buy you time in a “nice” nursing home, but what happens if you live longer that a couple years? (I’m figuring if a person gets 200,000 out of their house) What happens when the money from your “assets” runs out? And why isn’t this considered a sort of “death tax.”
Sorry, Joanne, but it seems like expanding Medicare is a good idea – not saying there aren’t bugs to work out.
Took my daughter to her annual physical. She was measured, weighed and read the eye chart by the nurse. The doctor had her bend over to check her spine, looked in her eyes and ears and did a general puberty check. She received no immunizations during this visit that lasted, from start to finish, 15 minutes – which includes the time we spent waiting for the doctor in the examining room. The bill was 300.00.
I don’t mind paying for expertize, but, geez, that seems excessive.
When I took my son into the doctor’s yesterday I counted 2 nurses, 2 doctors and 4 people behind the reception desk – only one of those four people answered the phone, scheduled appointments, and checked patients in and out – the other three were dealing with insurance company paperwork and billing. Something is seriously out of whack.
“A public system should not be designed to bankrupt the public.”
As it applies to EOL care? What else does a EOL patient need, a trip to Cancun?
Aplogies anon, UI actually mentioned Medicaid too. Medicaid I would love to have–the platinum card right now for a young person!!
And Pandora–I carry a high deductible. Received a phone call last week in regards to a relative’s needed regularly scheduled infusion treatment. 3700 bucks today by 3pm, or we are cancelling the appt.!!! I said huh? Were you going to send me a bill? They said they had the EOB, and that was the insurance determination, how do you want to pay for that? I said, but I don’t have an EOB, or ANYTHING, this is the first discussion from your office…..(2 year no problem paying BTW relationship). Can you imagine…off a phone call, to ask for that money and no bill even sent? Not a lost bill, not a later bill,not an outstanding bill but just the EOB trigger finger doing the dialing–when I wasn’t even aware an EOB was generated. Well, my deductible is now met for this year:)!!!
“A public system should not be designed to bankrupt the public.”
As it applies to EOL care? What else does a EOL patient need, a trip to Cancun?
When you get on a bus, do you have to prove that you can’t afford a car?
What I know of the current compromise talks:
– Allow Medicare buy in starting at age 55. This will probably be limited to uninsured people I believe.
– Expand Medicaid to cover up to 150% of poverty
– Allow uninsured to buy into the federal employees exchange program
What I’d like to see is for the exchanges and buy-in not to be limited to uninsured.
What I’d like to see is for the exchanges and buy-in not to be limited to uninsured.
I am OK with waiting for that. Either way the public wins:
1. Private insurers (and benefits-paying employers) realize they are competing with a public option, so they have an opportunity to clean up their acts and lower their costs to compete. Public wins.
2. If they don’t lower costs and compete, they shut down and people go on the Medicare buy-in. Public wins.
3. If the Medicare buyin is successful, it will be expanded later. Public wins again.
Get this, Joanne… my friend who suffers from cancer and whose husband lost his job and was completing the paperwork for COBRA was told she could not receive her chemo treatment unless she paid in cash. She had to put off her treatment until the paperwork cleared. WTF?
Exactly pandora. People with severe illness should not have to have a full time job of fighting with insurance companies and shouldn’t face medical bankruptcy. We’re the only developed country in the world with this problem.
I will contribute to a public system too. But selling assets to pay for EOL care is not bankrupting the public–it’s taking care of your personal business. Bankrupting the public is when those assets are needed to fund the other minors/survivors who remain dependent or live in that house–as in surviving spouse or younger minor children. Eldercare needs to be paid for–not by the public, when there are viable funding options–when sorry Junior–that rowhome deed is not yours free and clear as your new nest egg, or bonanza pay out.
“When you get on a bus, do you have to prove that you can’t afford a car”
No, you bought a bus ticket. That’s the operative–bought. Buy up or down from there, depending on what you want. If you can afford none, the state/fed shuttle will be along at designated times to designated sites to assist you. Now get in.
It’s not a buy in but a Sell out by those we Elected who are to weak to use the power we gave them
Given that few US public transportation systems exist solely on the fares collected and get substantial taxpayer subsidies, I don’t think that the extension of this metaphor works as you’d like, Joanne.
It is entirely possible to put your home in trust to protect it from Medicaid. It is called a “Medicaid Trust” and people do it all the time; it is a simple thing for an accountant. But lots of people don’t know about it and don’t take advantage of it. It is probably the second biggest thing you can do to help your children build wealth (after “sending them to college”).
what do i want in return? Carper’s resignation.
Aw c’mon cass–I was talking about Greyhound…and heck at this point the cars have our taxpayer subsidies too, so it’s moot!
Buy up or down from there, depending on what you want. If you can afford none, the state/fed shuttle will be along at designated times to designated sites to assist you. Now get in.
Sorry Joanne, America has rejected the conservative vision of a society stratified on economic class divisions.
Publicly subsidized buses exist because the rich need the poor to get to work. Publicly funded nursing home care exists because we want a guarantee our parents will be taken care of with dignity. And if we want that guarantee for our parent we have to extend it to everybpdy’s parents, and not accept a two-tier system. I think that guarantee could be improved.
This whole thread exemplifies one of the things that has bugged me throughout this whole debate. Whether intentional or not, Joanne has successfully been allowed to use one of the most useful weapons in the anti-reform arsenal — distraction. They harp on one small aspect of the issue and bog the whole thing down in it. The original post was about expanding Medicare to 55 year olds and what other things we could get instead of the PO. Instead, the thread got stuck on
death panels, I meanimmigrants, I meanabortion, I mean EOL care.Health care reform is a large and worthy undertaking, and one that, if done right, will greatly help millions of Americans. Yes, a strong public option would be a huge help, but it’s only a means to an end (cost control) and not an end to itself. If we can only get something like increased subsidies or stronger regulation or expanded Medicare/Medicaid, then that would be something. Let’s make sure we don’t get bogged down in specific details and lose track of the big picture. Thank you. I’ll now get down off of my horse.
That guarantee comes then when EVERYONE chips in what they can, to afford the care–and not hold back–because they want the kids to have…..Not a two-tier system–you are the one who wrote to build “public facilities”–that screams two tier system. I’m all for equity–but let’s see what you need AFTER we see what you have. Then the public can kick in with subsidy. But, I am not here to underwrite your legacy intentions. Pay the bills you incur.
Joanne has successfully been allowed to use one of the most useful weapons in the anti-reform arsenal — distraction.
I knew, but I was willingly following along because I thought her points needed to be countered.
The original post was about expanding Medicare to 55 year olds
A great idea with a built-in, heavily voting constituency.
I always thought the best public health care would be “Medicare for all” and the way to get there is to phase in one age group at a time.
“One small aspect”–Scott P.–I don’t know how old you are-but this a HUGE issue for us in the “sandwich generation”, who are looking at long term care right now for loved ones, who are living longer, and longer, but have been retired for 2 dozen years–and Medicare is it. So dear, this “distraction” is a front and center reality for millions of Americans who never expected to have such a quality and quantity of life. Believe me Scott–your 20’s only last 10 years. Old is forever:)!!!!
OK, after writing my comment I realized that it might have sounded more dismissive to the “small aspects” than I meant it to be. Any aspect that applies to you is a big aspect. Some of the things I mentioned (death panels and immigrant coverage) are either made-up or greatly exaggerated issues. Others (abortion and EOL care) are very real and very important. They absolutely need to be addressed. The point I didn’t make very well is that often these individual issues are used as excuses to scrap the whole thing, usually by people who are just looking for excuses to scrap the whole thing.
Those who truly believe reform is necessary must not fall into the trap of thinking the choice is between a perfect bill and nothing. Yes, there are going to be imperfections and holes in whatever gets passed. Not every issue is going to be worked out in the best possible way. That’s how legislation works. The trick is to get as much as you can and identify the problems so you can address them next time. But without a first time, there won’t be a next time.
And regarding this discussion, yes, EOL care is a very important issue that needs to be made workable for everyone. And despite what Joanne assumes, it’s one I’ll personally have to deal with sooner rather than later (my 20’s are, sadly, long gone 🙁 ). But again, the original post dealt with offering Medicare to those 55-65. I don’t think a lot of people in that range have been “retired for 2 dozen years” (although there might be some) and are looking for nursing homes. How Medicare deals with extended eldercare is certainly a worthy thing to address — it’s just not very relevant to the discussion of this health care reform bill. We can work on that with the next one.
And what I argue is Medicare is lousy. At least let me buy in to Medicaid. You speak of distraction as if I’m calling foul on “lack of vision coverage”. Buying into Medicare is the car w/ no tires. A horrible alternative for a large group of people, who probably would not be able to afford supplemental, if they are already 55 and looking at Medicare. Now who’s the progressive here?
And Scott P., I accept your contrite reflection of the intent of your remarks. But really,(anon too) the “distraction” card was unfair distraction, from this topic of huge impact that needs to be thought through. I think I have a record here of spirited, provocative discourse that should engage serious inquiry and deliberation–and not the knee-jerk response of making this partisan by exclaiming “party of no”, or “distraction”, or for that matter Republican. Trust me, we’re not being sorted in the nursing home, or the hospital, or the lab, so we better get it all together right here. I’m for access w/ sliding fee payment scale, assets assessed, liquidated to pay for the care–as long as no surviving “other” (depending which state you live:), or minors needing care. Do you realize we are approaching the phenomena of 2 generational nursing homes? Yup, grandma and great grandma both there…for years!!!
I suggest a 55-65 year program called Medican’t–too young for Medicare, too rich for Medicaid, just carrying this card for ID–maybe a discount on services:) that falls between Medicaid and Medicare? Or it mandates whatever private insurance I buy is the accepted rate by the provider for those “tween years? Who knows.
I think the point is – we’ve already got some government-run systems which function pretty well. Let’s let some of us buy into it.
Joanne, you might like Howard Dean’s approach. His approach was have Medicaid cover everyone under 30 and Medicare (with an improved payment structure – he agrees with you that it’s underfunded) for everyone over 50.
What are we doin’ w/ the 31-49 y.o.?
I won’t support any plan that doesn’t expand coverage for people under 40.
TPMDC is reporting that Snowe is a no on this proposal. nada.
Yeah, but Lieberman is signalling he is open to the idea. So Snowe is irrelevant is you have that bastard Lieberman.
Joanne… your Republicans and some of my conservative Democrats are opposed to letting them have healthcare. That is what is happening with them. If you are angry about that, you know who to blame.
yup and as Atrios likes to say, the DEMs offer shiny objects and then jerk them away at the last minute. This whole process is going to get uglier before it gets done but by god I hope it gets done.
It is interesting that Reid (and possibly Obama – I do wonder if he had any input) now have the ten member committee FINALLY adding some progressive and liberal Senators to the mix.