End (of) Medicare?

[Spleen]

*note: I am reposting an earlier post of mine from a different forum in order to illicit more discussion*

The heart of the issue: No one wants to leave our seniors left out in the cold with no healthcare. We fear the notion of someone suffering when they didn’t need to. And the trillion dollar question is how much are we willing to pay to alleviate this fear?

There is the paramount issue of the economy and the impact that this huge money shredder will cause for decades to come once it finally bankrupts (and it will). Then there will be no money to handout for healthcare – for anyone. Some one will be caught holding the proverbial hot potato and not receive the money they paid in taxes. It isn’t just today’s seniors who will be denied their handout, but also you and I. This article illustrates the bleakness of our national debt: http://articles.moneycentral.msn.com/Investing/JubaksJournal/USDeepInDebtAndStillDigging.aspx?page=3
This one is specific to medicare: http://www.heritage.org/Research/HealthCare/wm1869.cfm

Now, raising the point of handouts – the government should not be doing this. Social services are the obligation of the people – you and I. This can be done by giving to non-profits, volunteering time, donations to religious groups, etc. pick one or several. Furthermore, we as (future) clinicians are in a unique place to reach out and offer that care for the numerous who will be without insurance via pro bono and free clinics. It is our duty to reach out to our fellow man – not the governments. This is a horrible precedent we have begun. “The American Republic will endure until the day Congress discovers that it can bribe the public with the public's money.” ~Alexis de Tocqueville

The Supreme Court even agrees that healthcare is not a right. http://www.iht.com/articles/ap/2008/01/14/america/Scotus-Experimental-Drugs.php
This case illustrates the legal foundation that our country will not go down the path of creating another inalienable right.

From the sociology perspective, we are destroying ourselves. We no longer reach out to our neighbors, family, and friends. We demand the government do something at every misfortune. (Ex: My house flooded because I live near the river or below sea level. I can’t afford my mortgage because I overstretched my finances. I can’t afford my healthcare because I chose not to acknowledge the fact I will get old and become sick requiring savings, despite the capacity with my life long middle class income.) We are losing our independence. We are becoming dependent. As a consequence, we are by default, losing incentive to be personally responsible for ourselves.

Lack of personal responsibility has even expanded to include the culture of suing, and assigning blame to everyone else.

Although blame can’t be assigned to medicare for destroying the extended family unit; you can bet that if it didn’t exist we would have a greater reliance on it. This can only be good for America. It would reinforce the value of family, increasing young child supervision, strengthening the sense of purpose for the elderly staving off mental health issues like their high depression and suicide rates. It may even decrease the rarely recognized issue of elder abuse. Having more family around means better care, more eyes, more attention, and more accountability.

By ending the program now, we will set the precedent that we should take care of ourselves – the family caring for their own, and charities for those with no one. As it once was historically and as it should be now.

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[Faebinder]

At this point what medicare should do is simply calculate how much money it will spend on each individual per year and when that limit is reached the individual and their family should pay for it. Sounds reasonable? That's the only way to do be fair.

 

[futuredo32]

At this point what medicare should do is simply calculate how much money it will spend on each individual per year and when that limit is reached the individual and their family should pay for it. Sounds reasonable? That's the only way to do be fair.

A lot of seniors can't pay for it. A lot of their families can't or won't pay for it. How many young adults refuse to pay for their own health care? They're not likely to pay for healthcare for their parents.

 

[Faebinder]

A lot of seniors can't pay for it. A lot of their families can't or won't pay for it. How many young adults refuse to pay for their own health care? They're not likely to pay for healthcare for their parents.

So?

If they wont pay for it...

and their families wont pay for it...

you want ALL of us to pay for it (increase medicare taxes?) or do you just want the doctors/hospitals to do the work for free??

 

[futuredo32]

So?

If they wont pay for it...

and their families wont pay for it...

you want ALL of us to pay for it (increase medicare taxes?) or do you just want the doctors/hospitals to do the work for free??

I said a lot of seniors CAN'T pay for care. There's a huge difference between can't and won't.
I have no problem paying higher taxes for Medicare so that the elderly can receive care. Today's elderly paid into Medicare and they should receive the same care that their tax dollars provided for others. What's the alternative? Let them die? Line them up in the street and shoot them when they can no longer care for themselves?
I don't like the idea of paying taxes for a lot of things, but I don't mind the portion of my tax dollars that goes to Medicare at all.

 

[Faebinder]

I said a lot of seniors CAN'T pay for care. There's a huge difference between can't and won't.
I have no problem paying higher taxes for Medicare so that the elderly can receive care. Today's elderly paid into Medicare and they should receive the same care that their tax dollars provided for others. What's the alternative? Let them die? Line them up in the street and shoot them when they can no longer care for themselves?
I don't like the idea of paying taxes for a lot of things, but I don't mind the portion of my tax dollars that goes to Medicare at all.

Why do you assume that if you give them XXX yearly amount of medicare money they will necessarily die? France does this you know. The government will pay for healthcare of an individual up to a certain number per year.

 

[genesis09]

In all reality, they need to increase the Medicare tax. If things don't change, it will go bankrupt in about 10 years.

 

[futuredo32]

Why do you assume that if you give them XXX yearly amount of medicare money they will necessarily die? France does this you know. The government will pay for healthcare of an individual up to a certain number per year.

I would never want the waitlists that patients face in France, but that's a little off topic.

People can have a bad year. Say a senior citizen breaks a hip through no fault of their own. The operation for hip surgery is pretty costly. What if the person was taking coumadin and had to stop it for the surgery and had a stroke or an MI? That will add to the bill. After the hip surgery, Medicare now pays for about three weeks of inpatient rehab, that's not cheap either, but necessary for the patient. What if they contract a nocosomial disease in rehab? That's more money.
What about the senior who needs to live in a nursing home? Do they just get booted out of the nursing home when they've maxed out their alloted amount for the year?
I'd rather that we did more to encourage/force the younger able to work population to pay for their own health insurance, disallow them to declare bankruptcy for their unpaid medical bills. If we didn't spend so much on paying for healthcare for those who could and should pay for their own insurance, we'd have a lot to spend on seniors. We spend a ton of money caring for illegal immigrants who have never and will never pay a dime into Medicare. We spend gazillions on so many things with our tax dollars. I just think that if our government stopped wasting money, there would be plenty for Medicare. We could raise the age of Medicare to 67 or 68, that would save a lot of mnney. There are too many alternatives to rationing Medicare and we need to look to those alternatives before we begin denying care.
To me, it's just unthinkable that we're going to pull the rug out from under seniors who can not pay for their own health insurance. They weren't prepared for rationed healthcare and there is really nothing most of them can do to change their situation.

 

[cpants]

I am starting to think we should go the way of England and get a National Health Service. Free, government-run hospitals for anyone who needs care. The trade-off is you don't get to choose your doctor or where you get your treatment. If you want better or more care you can pay for it yourself.

 

[futuredo32]

I am starting to think we should go the way of England and get a National Health Service. Free, government-run hospitals for anyone who needs care. The trade-off is you don't get to choose your doctor or where you get your treatment. If you want better or more care you can pay for it yourself.

For the love of God, no NHS in the US. It's not free, it's paid for with tax payer dollars. We'd be paying more in taxes. If we wanted private insurance we'd have less money to pay for it because our higher taxes would be paying for the NHS that we may not want to use.
One problem they're having with people using the NHS and wanting to pay for better care http://www.nytimes.com/2008/02/21/world/europe/21britain.html?_r=2&hp&oref=slogin&oref=slogin
Looking at Romney care in Mass, it doesn't look like it'd be good for the rest of the nation. http://www.nytimes.com/2008/04/05/u...elated_content&referer=sphere_related_content
But, let's not hijack the Ops thread.

 

[cpants]

For the love of God, no NHS in the US. It's not free, it's paid for with tax payer dollars. We'd be paying more in taxes. If we wanted private insurance we'd have less money to pay for it because our higher taxes would be paying for the NHS that we may not want to use.
One problem they're having with people using the NHS and wanting to pay for better care http://www.nytimes.com/2008/02/21/world/europe/21britain.html?_r=2&hp&oref=slogin&oref=slogin
Looking at Romney care in Mass, it doesn't look like it'd be good for the rest of the nation. http://www.nytimes.com/2008/04/05/u...elated_content&referer=sphere_related_content
But, let's not hijack the Ops thread.

Eh, hijackings are fun. Here is the thing...we already pay so much for Medicare/Medicaid, and so much of that goes to administrative BS, that it might be cheaper just to hire the doctors directly, pay them salary, and have the clinics and hospitals open for free for eligible people. As we have seen from other countries an NHS would probably be crowded and you would have to wait longer for services. I don't really see this as a problem. Medicare/Medicaid should be a safety net for people who absolutely cannot afford care. If people can afford to buy better care or go to private hospitals, let them...but the taxpayers won't be paying for it. If they are too poor to pay for luxury care, then they still have a place to go.

 

[AwesomO]

Eh, hijackings are fun. Here is the thing...we already pay so much for Medicare/Medicaid, and so much of that goes to administrative BS, that it might be cheaper just to hire the doctors directly, pay them salary, and have the clinics and hospitals open for free for eligible people.

Ron Paul would be ashamed

What we pay in taxes for Medicare is not that much compared to what the British pay for NHS. I think the number is 15-20% of your income just for the NHS.

 

[futuredo32]

Eh, hijackings are fun. Here is the thing...we already pay so much for Medicare/Medicaid, and so much of that goes to administrative BS, that it might be cheaper just to hire the doctors directly, pay them salary, and have the clinics and hospitals open for free for eligible people. As we have seen from other countries an NHS would probably be crowded and you would have to wait longer for services. I don't really see this as a problem. Medicare/Medicaid should be a safety net for people who absolutely cannot afford care. If people can afford to buy better care or go to private hospitals, let them...but the taxpayers won't be paying for it. If they are too poor to pay for luxury care, then they still have a place to go.

Medicaid and Medicare are two separate issues.
IMO, we pay TOO much for Medicaid. Too many able bodied people are just scamming the system. Too many welfare moms having many kids and getting "Free" (to them) healthcare for the kids they couldn't afford to have in the first place. Those who are scamming the system are paying little or no taxes to support the program that sustain them. I don't have too much sympathy for those who are working the system to get all of the "free" (to them) benefits they can get. If the scammers get a lower quality healthcare, that's fine and dandy with me. Hell, let the Dr.Nurses (from the DNP articles posted all over this forum) take care of them. The lazy and aimless have a choice and they can take charge of their lives and earn the money to buy private insurance.

Medicare is for the elderly living on fixed incomes, many of them have paid taxes for 40+ years. They paid for our roads, our schools, etc. And, they paid into Medicare thinking it wouldn't be the last resort safety net type of healthcare. They don't deserve crappy safety net healthcare. It's too late for them to choose to go back to work. They thought Medicare would provide them with a high quality of care.

One more issue with your proposal is that the mentality in the US is quite different from that of the UK and other countries with socialized medicine. Most of us in the US want to make more money than the government is likely to want to pay at the government run hospitals and clinics. How many of us hope to complete a residency and then get a job at a VA hospital? How many of us want to graduate so that we can cater exclusively to the Medicaid/Medicare population?

 

[AwesomO]

One more issue with your proposal is that the mentality in the US is quite different from that of the UK and other countries with socialized medicine. Most of us in the US want to make more money than the government is likely to want to pay at the government run hospitals and clinics. How many of us hope to complete a residency and then get a job at a VA hospital? How many of us want to graduate so that we can cater exclusively to the Medicaid/Medicare population?

A medicaid/Medicare only practice would lose money every month. I'm not talking about "Oh no I can't afford a new BMW this year" I'm talking about "Holy @#$! I lost money this month as in I actually have NO MONEY. I owe this much on my office lease and can't pay it. I can't pay my staff. I can't even afford food for myself."
The overhead required to take medicare patients (medicaid is worse) actually results in you losing money with every patient you see. So yeah it's not a mentality it's just common sense.

 

[cpants]

Ron Paul would be ashamed

What we pay in taxes for Medicare is not that much compared to what the British pay for NHS. I think the number is 15-20% of your income just for the NHS.

Haha I know he would. I didn't write my initial statement well. I meant to say that I think an NHS-like system of government run clinics/hospitals would provide cheaper care to Medicare/Medicaid patients than the current system does.

Of course, the complete elimination of both programs would be the best option. In our welfare state that is not gonna happen. Therefore, I think we need to find a way to make these programs cheaper without screwing doctors.

 

[futuredo32]

A medicaid/Medicare only practice would lose money every month. I'm not talking about "Oh no I can't afford a new BMW this year" I'm talking about "Holy @#$! I lost money this month as in I actually have NO MONEY. I owe this much on my office lease and can't pay it. I can't pay my staff. I can't even afford food for myself."
The overhead required to take medicare patients (medicaid is worse) actually results in you losing money with every patient you see. So yeah it's not a mentality it's just common sense.

Geriatricians make a living, so taking only Medicare patients is possible without going broke.

 

[Faebinder]

huh?! You guys clearly are not seeing the surgery business like I am. If all my program director's patients were medicare he would be making a lot more $$.

Private insurance rips off procedures way more than medicare does. Medicare pays quickly compared to them. Sure it doesnt pay what you bill but at least it pays. You should read some of the articles out there. I need to link that one article by UMDNJ vascular surgeon how he went from the red to black by cutting out private insurances.

Private insurance maybe nice in the clinic world, but in the hospital world medicare is king and the rest are chumps. Unlike medicare, the private insurance needs to make a profit. Hence why I suggest limiting medicare money per person.

 

[AwesomO]

Geriatricians make a living, so taking only Medicare patients is possible without going broke.

Having never worked with a BC geriatrician in my life I would say most of them probably work in a group with an orthopod, nephrologist, etc etc and serve to bring in new patients to the group or help with follow up visits allowing the specialists to do high priced procedures instead of being in clinic all day.

I have heard of free standing Geriatricians who do very well but they run a cash practice.

Relying solely on medicare is a sure way to go broke if you are in solo clinic practice. Anyone who can make it work is one heck of a business man.

 

[AwesomO]

huh?! You guys clearly are not seeing the surgery business like I am. If all my program director's patients were medicare he would be making a lot more $$.

Private insurance rips off procedures way more than medicare does. Medicare pays quickly compared to them. Sure it doesnt pay what you bill but at least it pays. You should read some of the articles out there. I need to link that one article by UMDNJ vascular surgeon how he went from the red to black by cutting out private insurances.

Private insurance maybe nice in the clinic world, but in the hospital world medicare is king and the rest are chumps. Unlike medicare, the private insurance needs to make a profit. Hence why I suggest limiting medicare money per person.

It is a lot different in clinic. I can't find the link but simplecare had a table showing that for a $79 clinic visit medicare will pay $21. According to them the average clinic admin costs and medical equipment costs for an average patient is $50. So Medicare causes them to lose $19 per visit. If you just take admin costs alone needed to file a medicare claim thats $20. Which nets you a whopping $1 a visit.

Most attendings I work with echo this. They limit their medicare patients to about 20% so they can keep the practice a float.

 

[futuredo32]

Having never worked with a BC geriatrician in my life I would say most of them probably work in a group with an orthopod, nephrologist, etc etc and serve to bring in new patients to the group or help with follow up visits allowing the specialists to do high priced procedures instead of being in clinic all day.

I have heard of free standing Geriatricians who do very well but they run a cash practice.

Relying solely on medicare is a sure way to go broke if you are in solo clinic practice. Anyone who can make it work is one heck of a business man.

I did a rotation where the practice consisted of two geriatricians and an NP in an office and all their patients had Medicare. They were older physician, went to med school when med school was less expenive and interest rates were lower.
I thought about doing geriatrics. Fortunately, I found another field that suits me better. I can't imagine living on cheerios and living in a cardboard box.

 

[futuredo32]

Hence why I suggest limiting medicare money per person.

But what are you going to do when a person on Medicaid in a nursing home maxes out their allotment for the year? I was talking to a geriatric social worker today and she said that Medicaid currently pays about 56k per year for one person in a nursing home that is pretty healthy. I can only imagine how much it costs for a sicker person who needs a lot of assistance in a nursing home.

 

[genesis09]

I just read this article about Medi-Cal. Apparently, starting in another month or so, they are going to decrease pharmacy reimbursement by 10%. For most pharmacies, chain and independent, it will mean they will lose money for each prescription filled. Many of them have to make some hard decisions. Some are planning on not accepting Medi-Cal. Others are trying to figure out ways to decrease the number of Medi-Cal patients. It'll be interesting to see what will happen.

 

[futuredo32]

I just read this article about Medi-Cal. Apparently, starting in another month or so, they are going to decrease pharmacy reimbursement by 10%. For most pharmacies, chain and independent, it will mean they will lose money for each prescription filled. Many of them have to make some hard decisions. Some are planning on not accepting Medi-Cal. Others are trying to figure out ways to decrease the number of Medi-Cal patients. It'll be interesting to see what will happen.

Is Medi-Cal for the elderly or the poor?
That's one of the problems with government funded healthcare. It doesn't pay enough for people to be able to accept the insurance. What good is that type of insurance if no one accepts it?

 

[AwesomO]

Is Medi-Cal for the elderly or the poor?
That's one of the problems with government funded healthcare. It doesn't pay enough for people to be able to accept the insurance. What good is that type of insurance if no one accepts it?

It's basically Medicaid.

 

[Danbo1957]

Here in Texas, many private practice PCPs have stopped taking payment from medicare, medicaid, FirstHealth, and Workman's Compensation (state insurance), and choose to take payment from certain insurance companies only.

 

[genesis09]

Medi-Cal is Medicaid in California.