Las Vegas Sun

September 2, 2014

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Letter to the editor:

The Medicare system is broken

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I’m self employed and pay more than $500 a month for mediocre health care insurance with minimal dental coverage and no vision coverage. My yearly deductible is $3,000 and there are co-pays for everything.

My wife is on Medicare and we pay an extra $100 a month for supplemental insurance to cover what Medicare doesn’t — and there are co-pays for most care.

Medicare, without changes, cannot survive intact into the future. The Affordable Care Act will bring more people health care insurance but does little to nothing to control the rising costs of Medicare.

The discussion about the debt and deficits cannot end with the cost of health care, but it needs to start there. The ACA isn’t a good answer to the problem and neither is leaving the system as it is.

One party wants to tinker with our present system and the other wants to add more people into the system without really addressing the constantly rising cost issue. These are both failed strategies. When are we going to admit the obvious and demand a better answer from those we elect?

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  1. Future,

    It is a given that the ACA is not the solution we need. However, you seem to be a Republican supporter and you and the Republican party are great at pointing out the flaws in the ACA, but seem to have nothing to offer as a substitute except returning to what we had.

    There is a reason medical care is so expensive here and is not affordable for so many. It is because doctors, hospitals, equipment makers, drug makers, insurance companies operate inside a 'closed' system that has very little real competition.

    I am not sure we can have a 'real' competitive medical care system and not have some people get real poor care, and if we can't, a government run system is the other alternative.

    The one thing I do know is that our system before the ACA was way too expensive and left way too many people outside and that the ACA does bring more people inside but does next to zero about the costs, which are bankrupting both Americans and America itself.

    It seems clear to me that having an insular health care insurance industry, doctors industry, hospital industry, pharmaceutical industry, and medical device industry that are all very wealthy, along wth all the other industries that are tied to this and also very wealthy, is NOT in the best interests of Americans or America.

    Michael

  2. Future,

    To continue....our legislators, our President and our two parties are dependent on the industries I named in my 4:05 AM post for money and support to gain and retain power. Under the system we have, every time a President and or Congress attempt to 'alter' our medical care and insurance system in any way that actually would benefit all Americans AND lower costs, these interests line up to protect 'their' very lucrative interests and we either end up with nothing or something that isn't a 'real' solution like the ACA.

    That is why we desperately need Congressional Term Limits, Public financing of campaigns and lobbying reform.

    Michael

  3. The size of the Medicare entitlement program has doubled in the last 10 years. Expanded by 100 percent in one decade. Do you think that the program is financially viable into the future at this rate of growth? And what did President do to fund Obama care? He raids the Medicare Trust fund for $700 Billion over the next 10 years to pay for Obama care. Where is the outrage?

    Carmine D

  4. I have 2 words for you: "Wisconsin Trust." That was a "group" health insurance program designed in the early 1970s by Blue Cross/Blue Shield of WI specifically for businesses with 25 or fewer employees. I know. I was an independent agent representing the "Trust" for some 5 years and enrolled hundreds, if not thousands, of folks. Their coverage was comparable to the giant companies and municipalities whose employees were insured by BC/BS. The package included a modest amount of life insurance and disability coverage. I had the wonderful experience of being told by many I had enrolled of how having that comprehensive coverage saved them from losing their businesses, savings or homes when sickness struck. The monthly premiums were modest, the coverage great and, best of all, no pencil-pushing bureaucratic drones to deal with. The private sector rose to occasion in the 70s. Let alone by sleazy politicans and economically ignorant "progressives," it could do the same today.

  5. When looking at Medicare you can't ignore a couple of facts.

    First there is demographics. Our population is aging and as such requires more medical care. Post World War baby boomers are reaching Medicare age in large numbers, something that should not surprise anyone. (It's been in all the papers for years)

    Second, 25% of Medicare expenditures occur in the last year of of the patient's life. We need to decide if this is really health care when there is little chance of the patient regaining health or is it a highly expensive way to extend life by a few months. A tough call!

  6. I was also self-employed before I retired, but I paid zero for medical care although I did have to pay for my own prescriptions and dental care.
    Now that I'm 65 I still pay zero for medical care, but still have to pay for my own dental care. I only pay the first $100.00 per year for any prescriptions I require.
    To borrow a line from the poster Jerry Fink, "I have two words for you", but my two words are UNIVERSAL HEALTHCARE.
    All that is required for Michael Casler, the letter writer, and the other posters above to obtain the same fantastic health care is a pleasant move up north to Canada. We most certainly welcome you (guns must be left at your border, however).

    Donald W. Desaulniers

  7. Michael Casler is truly a one-man Greek chorus, clutching his oiless lamp, trudging a path strewn with the boulders of doom and gloom. Cassandra would hold Mr. Casler up a role model. His starting point for this latest missive is [once again] a false analogy. Comparing an individual purchaser of private health insurance to Medicare is like comparing oranges to carrots....they're both orange and....??? I don't dispute that Medicare rates are comparatively low but they are designed specifically to encourage [even require] participation and to encourage health maintenance. Because its target population is all us folks over 65, who do have higher health care risks and costs, it is not only a medical health program but a social health program as well. After all, it is highly unlikely that society would throw elders to the wolves [well, except for Paul Ryan Republicans] so it makes abundantly more sense to promote universal coverage at subsidized prices. You could not purchase similar coverage on the private market at the same price. My Medicare Supplemental costs more than my Medicare.

    The "free market" of health insurance has administrative costs of 20%+ and sometimes quite healthy profit margins compared to Medicare. It also has people like Gov. Rick Scott [R, Florida], former HealthSouth CEO, who led the company while it was engaged in massive billing fraud.

    I was an opponent of ACA for the reason that it was and is a massive giveaway to private insurance companies. I believe that the best health care system should be a "Medicare For All" system with a wide variety of supplemental plans available through open markets.

  8. I worked on medical issues for decades in this country. I belonged to the International Foundation of Employee Benefit Plans and was one of the chief architects of the entire medical reimbursement trust industry.

    Medical costs are exorbitant because there are over 3000 lobbyists in Washington vying for greater and greater margins in the healthcare business. Next time any one of you go to the hospital get an itemized bill when you leave. $10 Q-tips and tampons are a symptom of the problem.

    On average a couple will pay a little over $100,000 into Medicare and pullout over $400,000. There are two major countries that practice for-profit medicine. The United States and Mexico! That should tell you something right there.

  9. http://money.cnn.com/2013/04/14/news/eco...
    Read the Medicare part in the middle. Whether we have Medicare/Medicaid for all or a private insurance system like Switzerland doesn't matter. You need limits on what providers charge. All major nations have strict limits. Here the latest cancer drugs can cost over a million. Medical costs are the cause of the debt and a major driver of poverty.
    Read about the prostate cancer drug Provenge. It will blow the lid off Medicare. $10,000.00 per infusion for life. Medicare administrators are sweating bullets over drugs like that.

  10. Bradley,

    Sometimes, what you write makes sense, but other times..... oh my!

    Is it OK with you that Pharmaceutical companies successfully lobby Congress for legislation that allows them to produce drugs that they sell worldwide (except here) for prices substantially lower than what Americans pay for the same drugs?

    Is it OK with you that they also get legislation passed that prevents Americans from purchasing these same lower costs drugs (which are completely safe) from outlets outside America?

    Does it bother you that health care insurance companies add about 20 % in admin costs to every medical event that they are involved with, which is just about 100 % of them?

    Does it bother you that anytime we 'insure' anything, the costs of whatever we insure rise substantially and because the costs are 'shared', prices can keep rising at a very fast rate?

    You can live in your little bubble with all the so called solutions that are available, but none of that is going to stop the health care industry in this country from eating the nations 'lunch' and eventually all our lunches as well as our economy continues in decline.

    Michael

  11. The solution to all of this is no great mystery. Several other countries have created health care systems that cost less than half of what we spend, cover 100% of their populations, and deliver measurably better care.

  12. Vidi,

    The issue I have with you is that you just don't believe the 'system' is rigged. As long as Congress is left as it is, big powerful interests, like big pharma will find a way to protect their interests and Congress will help them do it because they have to to make sure they have their support at election time.

    It's all just a 'game' and both parties play. The ACA could have resulted in better controlled costs but it won't and neither will any other legislation under either party .... unless we institute term limits, public financing and lobbying reform in Congress.

    There are no 'white' horses here; only two black horses.... one with and R next to it and the other with a D next to it.

    People in Congress are not evil, but they are trapped in a system that makes them unable to do the right thing unless they want to throw their careers in the garbage.

    Michael

  13. MKC: If we could eliminate provider and patient fraud AND eliminate the 25% of Medicare that goes to end-of-life "care" for the clinically dead and inevitably terminal patients....all we'd need to do is change from paying providers for every repeat office visit and unnecessary procedure and pay for improvements to patient quality of life...tell us how we can do this, please. Consumer-driven health care plans are extremely cost effective. The patients have skin in the game for treatment of illness and disease but preventive care is 100% covered. When a procedure or other treatment is likely to be effective in improving quality of life, the patient is likely to chip in and have it done. If the procedure is NOT likely to help, they opt out. FURTHER, we NEED a way to get providers to stop requiring repeat visits for ailments and to provide patients with enough info to determine if things are getting better or worse for that particular ailment.

  14. Bradley,

    Of course I have checked 'group' coverage. It's just me. We are a two person office and my wife is on Medicare. Groups are not one person and when my wife wasn't on Medicare, a two person 'group' was quite expensive for what was covered. You are offering advice without much knowledge it would seem.

    There are times when I think you are just another one of the persons, often found on these boards, who get their jollies by trying to 'tweak' others that write commentaries. I hope I am wrong about that, because those people are a waste of skin, in my opinion.

    Michael

  15. Roberta,

    When I was a kid, in the late 50's and 60's, Americans did have more 'skin' in the game, meaning that health insurance was less prevalent and people paid more directly. Those days are gone, never to return and this society is never going to accept not paying for end of life care of elderly Americans.

    Michael

  16. The funding problems experienced by Medicare are not the problem - they are only a symptom.

    The underlying problem? Among developed countries, people in the United States pay the MOST for medical care - regardless of the source of those payments. For that money, we receive substantially WORSE outcomes. The initial ACA strove to at least partially correct that dichotomy. NONE of the prior, or subsequent, plans to allegedly FIX Medicare address it. The Republican't "plans" actually increased the underlying problem - look at their "Medicare Part D" fiasco!

  17. Scrap Obama care and leave medicare alone. Then do something different and leave the money for SS and medicare alone.
    It was just fine till all the money went to the general fund or Obama took it to jumpstart a new losing program.....

  18. I'm starting to wish I was Canadian good affordable health care banks that aren't thieves and no gun toting war mongers.

  19. "Besides the obvious lack of facts in your statement, Paul Ryan uses the same dollar amount to try to balance his fantasy budget. Where's the outrage?"

    Victor:

    Interestingly that not until Ryan and the GOP used the same strategy as Obama care for Medicare did he/it get criticism for doing so. Raiding Medicare funds to pay for Obama care. Why is that?

    Carmine D

  20. I thought it was genius for Ryan and GOP to copy Obama care, with regard to Medicare, and take the flake for doing it. If nothing else, it brought needed attention to the shortcomings of Obama care WRT Medicare that all the 2012 Presidential debates about it could not. Interesting what happens when the positions are reversed.

    Carmine D

  21. Bradley,

    It is not lost on me that if all the paralegals got together and started a 'group', health care coverage might be available at a lower rate. In fact, when our former franchise, We the people, had 200 offices, the franchiser talked about doing that, but never did.

    The point I was attempting to make is that the health care insurance system here is not sustainable as it is. It is too expensive for many and not affordable for many others. The ACA is not going to change that dynamic. I simply pointed to myself as an example.

    Businesses all over the country are looking for ways to reduce what they pay for health care for their employees. Even group coverage is becoming a huge financial burden for businesses. Small businesses like mine are struggling even more with this issue. Tweaking the system by using 'groups' is a strategy, but it doesn't get at the root problem, which is the costs, and unfortunately, nether does the ACA. All the lobbyists for the powerful health care industry and our corrupted Congress saw to that!

    Michael

  22. Carmine, say "flack". Thanks. I'm with Michael on this. We cannot, without serious hits to our economy and way of life, GIVE everyone and anyone all desired "health care." Particularly when doctors and "the systems" indoctrinate patients into thinking we need tests and procedures to sustain life. We're told we need to be poked, prodded, tested several times a year to search out dormant disease. Yet, the time and money of the tests is more deleterious than the occasional dormant disease located before symptoms occur. Additionally, we dump mega-billions every year on comatose vegetables, the physical remnants of bodies that once housed people. We must learn to accept death and dying WHEN APPROPRIATE, when the time comes for each individual instead of pretending we can sustain life after the brain dies. We need to encourage health and discourage a government-supported "health care" industry that pays mega-compensation to pharma, doctors, investors. We need to turn it around so that your primary-care doctor is concerned with your health, not his ROI for investing in med school.

  23. Roberta is right to say we must really change the way we view health care in this country.

    Both of my parents (in their mid 70's) died of heart attacks in a hospital. Several attempts were made to revive both of them. If those attempts had been successful I would have been tempted to opt to have them kept alive, even though the damage done by the heart attacks and the time without blood flow and oxygen would most likely left them in a state where they were merely existing, and not living. I understand now that a decision like that is not one I should make for anyone. Our whole society needs to understand that. The medical and insurance businesses push us in this direction because it means more revenue, but it is wrong, ethically, medically, morally and financially.

    Michael

  24. Bradley don't say your not a Republican and our health care can't get much worse than it already is.

  25. Bradley,

    Are the three hospital stays you had really worthy of a $ 100,000 bill? If so, why is it that the hospital, doctors, etc are willing to accept $ 30,000 on a bill of $ 100,000? How can they afford that? Why is it that someone without coverage is charged $ 100,000 but for you, with coverage, it is $ 30,000? If one asks these kind of questions, then it begins to become apparent that this system is pretty messed up.

    You and many others think our present system just needs tweaking and people like hookershakey believe that the ACA will go a long way toward fixing this system.

    Me...I believe both of you are wrong and this system needs to be changed in a way that is more than tweaking and also in ways that are not a part of the ACA.

    Michael

  26. Roslenda:

    I was thinking Fluck!

    Thank you for the correction.

    Carmine D

  27. Bradley,

    You are, of course, entitled to your opinion. I see many things that make me disagree with you, one of those being that about 75 % of all bankruptcies we prepare contain huge unpaid medical bills. Also, when I had to take my dad to emergency rooms as he was slowly dying, they were always packed, especially at UMC. I asked why, because many people in there seemed to have minor ailments. I was told that people with no medical coverage to go emergency rooms for routine care.

    I am with you in not believing the ACA is a solution, but anyone that thinks the system we have is a good one has an outlook I just cannot share.

    Michael

  28. The Medical System in this country broken, not Medicare. Medical treatment should NEVER be a for (maximum) profit occupation. Not even the Government can keep up with the unlimited escalation of for profit treatments.

    Extracting the most money out of those in need of healing is the same experience as highwaymen demanding your savings in return for health along the next stretch of road. There is not difference.

    Medical care in America today has left millions with only two options: die from your affliction or be cured and sit out on the curb with nothing, waiting to starve or freeze to death. Helluvan option.