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twitterWhat cuts in Medicare would mean for seniors
AARP says they’d be felt by insurers and providers, not patients
Sunday, Oct. 4, 2009 | 2 a.m.
Sun Coverage
Sun Archives
- Sticker shock: How the overhaul could exact a heavy toll on state finances (9-20-2009)
- How the overhaul could alter the popular but costly Medicare Advantage (9-20-2009)
- Desperate for insurance, residents share health care woes (9-18-2009)
- Harry Reid: Health care bill won't work for Nevada (9-16-2009)
- Grant to aid 400 waiting for Medicare (9-14-2009)
- Editorial: Lowering Medicare costs (9-2-2009)
- Medicare Advantage plans may lose federal cash (1-16-2009)
Washington — For seniors, the nearly $500 billion in Medicare cuts proposed in the health reform bills moving through Congress can be a frightening proposition — less money for the popular program they rely on to help pay their medical bills.
Barry Gold of AARP of Nevada understands the worries expressed in phone calls to the organization and community meetings across town.
“They hear the large number and they’re concerned where these dollars are going to come from,” Gold said of the proposed cuts. “There are scare tactics; there is misinformation that is making people afraid.”
Getting the explanation (without the cuts Medicare will soon be insolvent) and key details (cuts won’t alter seniors’ policies) heard above that din can be challenging, he said.
If costs aren’t reduced, Medicare is expected to go insolvent in 2017 as health care costs soar and more money is spent than is paid into the fund in taxes.
The bills under consideration in Congress would reduce Medicare expenses by about $50 billion a year over the next 10 years to help slow the spending and spare Medicare from bankruptcy.
Gold tells seniors the reductions would come not in their benefits, but by reducing waste, fraud and abuse and changing the way Medicare pays hospitals and doctors.
He offers a favorite example: You get an X-ray for an ailment. Then you go to a new doctor who doesn’t have a copy of that X-ray. So the doctor orders another one.
“There’s really no reason to do that,” said Gold, AARP’s director of government relations. “That’s the cost of Medicare, and those are the things we can avoid.”
Medicare has a long history as a tool for health care reform fear tactics.
When Congress began laying the groundwork for its creation in the early 1960s, the American Medical Association denounced the proposal as socialism. Ronald Reagan at the time cut an advertisement warning of the perils of “socialized” Medicare.
Today 45 million Americans are enrolled in Medicare, most of them seniors 65 and older who benefit from low monthly premiums and deductibles, and guaranteed health care. It is one of the most popular government-run programs.
But as health care costs have skyrocketed and demographics shift to an older populace, Medicare costs have spiraled out of control, experts say. Legislation in both the House and Senate aims to reel in Medicare’s rising costs by trimming out excesses.
The biggest single cut in Medicare would come by trimming as much as $150 billion in payments to insurance companies for the Medicare Advantage program, which allows seniors to use Medicare benefits to buy coverage from a private insurance company.
The program is popular in Nevada, where one in three seniors have opted for Medicare Advantage, with its extra coverage for vision, dental and other services, over traditional Medicare.
But Medicare Advantage pays insurance companies higher reimbursements and costs the government 14 percent more per person than standard Medicare, draining the system and creating an inequity, critics say.
Those who are enrolled in Medicare Advantage are benefiting at the expense of those who are not, according to critics. Studies show seniors in traditional Medicare pay higher premiums to cover the excess costs of Medicare Advantage.
By some estimates, Medicare would be able to forestall bankruptcy by several years solely by trimming back the extra pay for Medicare Advantage.
Legislation being considered in Congress would not eliminate Medicare Advantage programs. But some health insurance companies have suggested they won’t continue to offer the plans if they do not receive the higher reimbursement rates. That would force seniors to find a new Medicare Advantage plan or enroll in traditional Medicare.
Nevada’s Democrats in Congress — Reps. Shelley Berkley and Dina Titus and Sen. Harry Reid — support the changes in Medicare and Medicare Advantage as a way to bring overall costs down. Republican Sen. John Ensign is opposed.
“These steps will improve Medicare and lower costs for all beneficiaries,” Titus spokesman Andrew Stoddard said.
The rest of the Medicare cuts would come from targeting waste, fraud and abuse and changing the way doctors, hospitals and other providers are reimbursed by the government.
AARP notes that although the nearly $500 billion in Medicare cuts “sounds like a huge sum, it’s actually only a small fraction of the $6.4 trillion expected to be spent on Medicare from 2009 to 2019.”
According to the association for older adults, the remaining cuts would come from “paying doctors more for practices that improve quality of care and save money ... and paying providers (notably hospitals and home health agencies) a little less of an increase each year in an effort to gradually trim the rate at which Medicare costs climb over time.”
Also lost in the debate are the improvements in Medicare that the legislation hopes to bring about — namely the effort to shrink the so-called doughnut hole in the Medicare Part D prescription drug program.
Under the current program, Medicare beneficiaries have most of the costs of their prescription drugs paid for until they hit a threshold, about $2,700. Then they must pay the full costs of the drugs, spending about $1,500 out of pocket, until they hit the next threshold and coverage kicks back in.
The House and Senate bills take different approaches to closing the hole — either by narrowing it over time or providing drugs at a 50 percent discount.
Cuts in Medicare are part of a broad plan to help reduce costs and raise new money to help pay for expanding health care to the more than 30 million Americans who are uninsured.
Gold said the scare tactics over Medicare changes have worried seniors, but AARP is trying to assure older Americans that Medicare needs to be reformed to remain viable.
He offers seniors this selling point: “People at AARP have read the whole bill,” he said. “We are definitely getting our message out.”
Discussion: 35 comments so far…
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Just another Sun editorial masquerading as a news story. Nice to see all of Greenspun's employees march to his beat.
But what about all my health insurance stocks and dividends and my life savings in that sector including medical devices and drug companies? If they don't keep making huge profits on us as we are sick and ill how will their stocks keep doing so well? What's with all this? What about that little family down the street from a land far away who does not have a doctor and at the local block party told me they cannot afford health insurance and the office where they work (docotors' clerks) does not offer it? What about that lady next door living with her daughter who is a casino tee shirt clerk and the lady has two teeth rotting and cannot bite on her entire left side and lives with a perpetual toothache? Am I to be the Dr. Coburne good neighbor and offer to pull 'em out? What about that guy who just graduated from Wayne State and said he probably can't pay back his student loan if he has to pay for health insurance on his new job as a shuttle driver at the airport? What about the 11 guys from a far away land who live behind me who all work for the landscape guy up the street and none of 'em have health insurace and every week one or all of 'em buys a quart of tequila and downs it in one day and is too sick to work the nest day? The landscape company owner said he cannot afford to provide health insurance for any of 'em and also make successful bids for jobs, too. What about the man across town who has been really ill for three months in pain and they cannot find out what it is and he keeps doing MRI's and X-rays and tests in and out of the hospital and doctor's offices and he says so far he has been billed about $82,964 none of which he has been able to pay after his trailer park home rent and electric. He smokes and drinks a lot he said to ease the tension in his life as he wife holds down a job behind the counter in a casino selling tabs and mints and stuff like that. He gave away the family pet to reduce expenses. Where is all this coming from? He told me he has already told the grandkids they won't be getting any Christmas presents this year even if he's still around to see it arrive. I have zero idea where all this is going to come from after we send aircraft carriers, huge tanks, ships, container ships, hundreds of thousands of men and women, jets, fighter jets, copters,hovercraft, drones, construction companies and engineers to the middle east of nowhere. None at all. How does this all happen. Is there any way at all we can get Palin down here to be our Gov. and she can do here what she did up there in Alaska when she took cash from some oil company and disbursed a nice check to each and every citizen in the state? We need her here to do this amongst our casinos. Maybe we can get Gov. Perry up from Texass to threaten thousands of executions which would reduce the number of uninsured. I have zero idea how all this can happen. Zero.
I found a way to reduce the cut to $499 BILLION. Arrest Neil Bush and take back the $1 BILLION he stole from Denver's Silverado Bank. To the rescue: Obama, Holder, FBI, and FDIC. When PIGS fly!
Comment removed by staff.
Regardless of the rhetoric, it seems to be that if you include 50 million more people in the health care system, most of which arent paying now and wont pay except through government subsidies, the cost of health care for the rest of us is going to go up !!! Anytime I have seen a rise in demand, with no increase in supply, the prices just rise, period.
More visitors to Las Vegas means hotel rates rise. It just happens.
By the way, the public option is already here, its called MEDICARE, and its bankrupt. Its the second biggest PONZI scheme going, next to social security. New subscribers are needed to pay for existing subscribers- Isnt that a ponzi scheme??
The only way they can expand medical care for the currently uninsured is going to be to cut services for the people who now get services. How else would it be done without massive new tax increases?
I am sorry to inform you all that the Obama administration does not care about any of your health reform concerns.
The Obama administration is ONLY interested in the total government takeover of the health care system.
You see, a government takeover of the health care system advances their socialist agenda.
The Sun, Democrats and Obama wants to Seniors to sell magic seeds to grow a beanstalk.
Yeah, we are going reduce Medicare expenditures by $500 billion and it is not going to affect Seniors one bit.
Yeh, it is mostly comprised of cutting waste and fraud (errr....how that was not "cut" before.) Obviously, this smell of so much BS.
By just using plain common sense one will see right through this BS.
Some of the other arguments are laughable too.
The Sun states that by cutting this waste and fraud and reducing Medicare Advantage that is it help save Medicare from bankruptcy.
I am OK with that. Then that means not red cent from these cuts will go pay for ObamaCAre right?
Opppps........I let the cat out of the bag.
Yep.....the grand reporting by the Sun failed to mention that all these cuts are not to make keep Medicare out of bankruptcy but will be spent on funding ObamaCare.
Obviously, THIS IS NOT A NEWSSTORY but it is just a list of talking points from the Democratic Party.
This should be reported to the finance campaign watchdog agency and the owners of the Sun should be fined for not reporting a campaign contribution to the Democratic Party.
It would be interesting to scroll forwarda couple of years and see how seniors are faring with the new, diminished Medicare.
I love the Las Vegas Sun. I can count on about a dozen rightwing loons to state daily how much they hate this paper. But, the same complainers come here every day to read the paper they hate, and then post their disgust. Love it, love it, love it. Starts my day off with a laugh.
The funny thing is that libs koolaid drinkers on one hand say that Medicare is great.
But on the other hand they are saying that they are going to help pay for ObamaCare by cutting hundreds of billions in waste and frand in Medicare.
So which is it???????
Is Medicare great?
or does Medicare have tons of watse and fraud in it?
Who every said that medical care was a universal "right". There has always been have and have nots thru out history. You have the resources to pay for insurance and medical care or you dont. If you dont, you survive as best you can. That mentality that "everyone" has a right to this or that lead to everyone having a right to own a home. The genius politicans thought up all sorts of "programs" and incentives to allow every tom,dick and harry to buy a home! Well folks how did that work out ??? Noone wants to say the reality outloud, but, some people have what it takes to make it and others dont, the ones who dont fall by the wayside and the world moves on! This is cruel but the true nature of every civilization.
Medicare should focus on preventing illness instead of after-the-fact-diseases. Case in point: medicare will not pay for the shingles vaccine BUT if you contract shingles they will pay for the doctor visit and treatment. Back asswards ...the "horse already out of the barn" approach ratchets up the cost of doing business.
What I have not heard much of is that by medicare underpaying for services to doctors and hospital by 20 %, those same doctors and hospitals have to charge insurance companies 20 % more to recoup their losses, and worst, medicare is getting ready to decrease their payments by another 20%. As of now 30% of doctors do not accept medicare, so how many doctors will be left after this next round of cuts ?
Well, well,well--The right wing brownshirt bloggers are showing their true colors. They want to turn America into a third world country. I'll betcha they hate their parents, grandparents, and the disabled. The feeling is probably mutual. They conveniently forget that Social Security and Medicare is a stimulus to the economy and we all know that Nevada is really hurting from unemployment. Do they want Nevada turned into ashes? I wonder--How many of these right wing bloggers goose step?
GooberCommander....do you know Obama wants to cut Medicare by hundreds of billions of dollars...
Does that make his Medicare cuts to be un-stimulus to the economy?
Does Obama hate old people?
"Gold tells seniors the reductions would come not in their benefits, but by reducing waste, fraud and abuse and changing the way Medicare pays hospitals and doctors."
In other words, Mr. Gold of the AARP is a liar.
Like the RJ wrote a few weeks ago, UMC can either spend $24M/yr on dialysis for illegals through the ER, or it can pay $4M a year through an out-patient service to take care of these people. You could cut $20M off UMC's 70M budget deficit. As a Clark County taxpayer I want them to reduce expenses whatever legal ways they can (which means they cant turn them away). Even if it does mean giving illegals "free" care.
The right doesn't seem to get that we're all paying for each others health care right now, and we will in the future - legal or illegal, insured or uninsured. And its cheaper to take care of people through PCPs and urgent care facilities than it is through the ER.
Its like one of the stories in the Freakonomics books - you "common sense" aka anti-intellectual wingnuts wont ever get it because you cant think the entire ecosystem through in your tiny brain.
Nevada Social Security recipients in Nevada receive a total of $407,088 per month--a positive stimulus. There are 327,629 medicare recipients in Nevada, what is the total outlay for those recipients? This message is for the right wing bloggers to do a little research. Will they do it?
"Anytime I have seen a rise in demand, with no increase in supply, the prices just rise, period."
Excellent point. Everyone should download the legislation HR3200 (and the republican ver HR3400) and read the table of contents.
A large portion of the legislation is dedicated to increasing the supply through a number of methods including tuition forgiveness and pipeline programs. I don't know it they will be effective but they are at least there.
I wish 10,000 people would write their legislators and demand that the thing be reformatted for better readability. It's awful. And, it would be nice if an unbiased independent organization would be tasked with spelling it out carefully. It's 1017 pages long.
On the supply-demand thing. It's actually more tricky than simply "increased demand, increased price". What we observe is neither the demand or supply curves, it's the movement of the equilibrium point.
If 50 mill more people are dumped into the system, the first thing that happens is a shortage.
Consider that more doctors would mean more competition for patients and therefore lower prices.
I got to take a couple of econ classes last year. They were excellent and informative.
Your right, on the supply side, all other things being equal (economicsts say Ceteris Paribus), for each additional quantity supplied, the cost increases. My text used crabs as an example, the crabbers have to go farther out to sea to get more crabs so it costs more.
But, and this is a big "but".... (and I'm sure you will agree) if there are way more doctors, then there is more competition which drives prices down.
The difference is a change in the supplied quantity and a shift in the supply. Demand does the same thing, there are changes in the demanded quantity and shifts in demand (the curve moves).
Typically, all four happen at the same time, both curves shift and the quantity on both curves shift. The final equilibrium point ends up somewhere....
My concern is that the sudden 50 million new people will create a shortage and anger alot of people. I believe that's the simple explanation of complaints about Canada and the UK. It happened with the VA when solders started coming back from Iraq.
More importantly, the economy is a funny thing. It's a carefully balanced thing. It doesn't do well with sudden changes. If 50 mill people suddenly show up in the system, it will create havoc as supply and demand all the way down the supply chain tries to settle. It will create "oscillations".
GooberCommander....not really sure what your point is?
Nobody is talking about Social Security.
Obama is wanting to cut Medicare which is exactly against what you are rooting for.
So.....exactly what are you trying to say?????
You seem to be attacking Republicans when it is Obama who wants to cut Medicare which you claim to be a "stimulus".
I think you need to rethink your position.
Just a FYI in your Social Security stimulus for Nevada point.
I am confident that Nevadans pay more in Social Security taxes and Medicare taxes then what Social Security money and Medicare money comes into the state.
Nevada is a donor state and is near the bottom of ranking of getting tax dollars returned back to the state.
1) If health care costs are reduced then Medicare expenses will go down.
2) We start on the road to illness and disability the day we die. Insurance functions by pooling everyone's small contribution to cover the expenses for the few that get sick today. But insurance isn't a "pay today for service today" thing. The pool of funds and the risks are spread out over time. People want to opt out while there healthy and expect to be let in when they are older and ill. How does that make any sense?
2) We don't pay enough taxes. Taxes are the lowest ever since about 1945. The difference between the highest and lowest bracket haven't been this low since 1913.
And, higher taxes simply won't really affect spendable income like we think.
For 95% of us, any decrease in our taxes results in an increase in prices somewhere else. We do not benefit in the least from tax increases. Think about what happens when the government provides an incentive to purchase a car or house. What happens to the price of cars and houses? They go up.
Then there is the fact that government spending in services and investments actually stimulates the economy and increases our buying power by increasing the supply of goods and services by stimulating demand. It's called the multiplier effect. Depending on other things, every percent in taxes increases the GDP by a larger percent (up to a point). A larger GDP means there are more goods per person. Remember, people that work for the government buy consumer products, food, pay rent, etc. Tax money doesn't just disappear, it circulates.
Another excellent concept is the Laffer curve (check wikipedia). It's actually obvious when we think about it. If taxes were 0%, no government. If taxes were 100%, no one would bother to work. Somewhere in between, there is an optimal tax rate (probably changes constantly) where government spending has the most effect. I think it's less than 75% and more than 25%.
3) I don't doubt that Medicare and SSI have budget problems. But, for future reference, mistrust news reports and analysis from organizations. They get it wrong, they report out of context, the are biased (both ways).
You can trust Medicare, the CBO and other federal agencies in charge of accounting. They really do a better job. And they publish the numbers so you can see for yourself. They don't lie because they can't lie. And don't easily believe the reports that they "hide" things.
4) Half of the government expenses are military. The other half is SSI, SSDI, Medicare etc. How about we cut waste, fraud, abuse, and excessive spending from the military. I mean really, the total number of people in the military doesn't come close to the total on SSI, SSDI and Medicare. Just a thought.
When I would have a root canal and crown at the dentist, it would cost something like a thousand for the dental insurance company and a thousand for me. When I was between jobs, the dentist would just charge me a thousand and not bill an insurance company.
It didn't cost him two grand to do the work, he made insane profits when he could bill insurance.
The way the health insurance and health care markets work is different than something like food. Farmers are lucky to be able to just cover costs. That's because if prices for something like bell peppers goes up high enough, everyone with backyard will be growing bell peppers and having their kids selling them on the street corner. Health care and insurance markets have highly restricted supply, not because they have to, but because it's just that hard to get into. The forces of supply and demand hold the prices up, way up. The profit margins for health care and insurance are considerable. Why are there law suits? cuz that's where the money is. Doesn't do any good to sue a farmer, can't get blood from a stone.
Hospitals do have to recover something somewhere for free service provided to the uninsured at the ER. But, a 20% reduction in payment off of the list price doesn't mean the 20% must be made up elsewhere.
Frankly, I believe that if it wasn't for Medicare holding prices down, they would be way higher.
"Who every said that medical care was a universal "right". "
Dude, you simply don't get the difference between what is and what can be.
If I could, I'd simply treat you as you would treat others. I'd make sure my neighbor's grandmother got medical care and yours died.
See, we don't live in caves anymore either.
"So which is it??????? Is Medicare great?
or does Medicare have tons of watse and fraud in it?'"
Both. I know that's hard for you to get. "And" is a hard concept. My wife has Medicare. It's great compared to getting nothing. That doesn't mean that every penny is well spent, just that the care she receives when she gets it is great.
Suppose that the actual care costs $5000 a year and Medicare collects $7000 with $1000 going to administration costs and the other $1000 going to some MRI company that is sending in fraudulent claims. Well, the it's great AND there is fraud.
I read part of HR3200. It had to do with adjustments to the base DRC payments. It's awful to read. The formatting is horrible.
The way it works, as I read it, is that hospitals get an upward adjustment to the base payment for care. If a patient is admitted to the hospital multiple times for the same condition, they collect for each hospital stay.
This piece of the legislation basically looks at what is the average number of times patients should be re-admitted for the same problem.
When a hospital is averaging more per patient over all of their patients, then the upward adjustment is reduced.
This gives the hospital a little incentive to look at their system and figure out how to get it right in the first place.
It is typical for doctors, who make a @#$% load of money, to invest in start up companies. There is actually and industry that gets them to invest in companies that will lose money, that way they can write the losses off on their taxes. Of course, they lose more than they save in taxes. The don't actually end up with more money. They just feel better knowing that the government doesn't get their money in taxes.
Not all doctors are like this. But there are many. If the government were to pay my educational expenses in exchange for working in a county hospital for $75,000 a year, I'd do it in an instance. Many people would. Many doctors go into it just to make bank.
The AMA controls the supply of doctors, ensuring that they do make bank.
The government is incapable of running any enterpruise without bankrupting the taxpayer. What makes any one out there believe that they can run medicare efficiently so that 50 Billion a year can be saved? My parents and my grandparents are happy with their healthcare insurance choices as it is today. Keep the government out of it!
I'll tell you one way costs can be reduced,stop Doctors overcharging and inflated office visit charges.
A couple of years ago I went to my regular doctor he and I, after examination, noticed that my blood pressure was not where it should be even though I have been on medication for years. He decided to change my precription, he sent me to a cardiologist for a new one, few years before I had congentive heart failure. I waited ro see the cardiologist in his waiting room for two hours even though nobody else was waiting when I got there or for that two hours.
The nurse finally calls my name, I go back in the hallway where I stand while she asks me some questions,(G-d forbid If I was suffering chest pains), and then we go to the examining room. That took 15 minutes. Not once did she ask me why I was there but in spite of that she says I should take an EKG which I do and that is over in what seemed like 10 minutes. I then wait another 30 minutes in the room before the doctor finally shows up. He too doesn't ask me why I'm there even though he's never seen me before. Fact is the only thing he says is for me to sit on the examining table where he quickly proceeds to put his stethoscope on my chest once and then my back.That took 2 minutes. He finally asks me why I was there, I tell him for the new prescription, he takes his pad out and writes the prescription and hands it to me, another 2 minutes for all that. He says, "everything sounds good." He then says,"You should come back for regular visits." Which bewildered the hell out of me because he did not know about my previous heart episode. I said to myself, "Looking to bill Medicare some more doc?"
Two weeks later I get a statement not a bill from Medicare, he charged $663 for the office visit alone. $73 for the EKG.
The two hours and 59 minutes of waiting time was worth more to me than the 29 minutes he and his nurse were in my presence.
So Medicare got billed $736 for his 4 minutes and the 15 minutes his nurse asked me questions except the one she should have asked, "Sir, why are you seeing the doctor today?"
Multipky that by all the doctors who bill the same exhorbitant charges and stop those practices and Medicare will not go insolvent. And that's not even mentioning the hospital bills.
For my hospital stay I was put in there for basically having fluid in my lungs and they wanted me to get rid of it, that's what they termed congenitive heart failure. For almost one week I laid in bed or sat up in a chair watching TV and peeing my brains out. I even brought my own personal prescriptions with me to take per my regular schedule.So the hospital didn't have to supply them.
Three weeks after I got out I received another Medicare statement that showed the hospital billed Medicare $19,000 for renting a bed and a chair while I peed my brains out.
Who said there's fraud and overcharging to Medicare?
You think Medicare is tough to deal with, try the private insurance industry! If private corporations were in charge of other "human utilities" we'd all be choking on bad air, there would be freeways only for the rich, schools only for the well-to-do, and you'd eat food not knowing where it's been or what's in it. This irrational, little kid, boogeyman fear of government pales by comparison to the power of the titans of the insurance industry. Wake up folks. Smell your homework.
Theres really no other solution to the USAs "healthcare system", but to get the NHS that most of the worlds industrial nations have had in place since after the 2nd WW.
Its as simple as that.
Of course it wont come cheap. Had the US decided this decades ago, it would have come naturally bit by bit, and the cost would have been acceptable, and the only loosers would have been the greedy insurance and drug companies, these are the people who run Americas healthcare, and making Mega mega bucks from it as well, whilst the people suffer.
I don't believe that Gold mentioned that destroying the Medicare Advantage program will force many to purchase very expensive Medicare Gap Insurance policies, which AARP makes money from, and do not provide the added coverages found under the Advantage program.
AARP is not representing the interest of Seniors, they are representing the interest of AARP.
AARP is not an organziation that cares about senior rights. They care about selling AARP memberships and car and life insurance along with them. It's a free enterprise org masquerading as a charitable org.
vpin,you are right about your concerns. What you fail to realize is that the cardiologist as well as most other specialists and health care providers have to make up for the illegals that will not pay or can't.This means they have to make up the difference some how. Guess who?
I am sorry to inform you all that the Obama administration does not care about any of your health reform concerns.
The Obama administration is ONLY interested in the total government takeover of the health care system.
You see, a government takeover of the health care system advances their socialist agenda.
Larry speaks the truth, As the seniors come to age and look for the benefits they paid into their whole life means nothing to this government.