Category Archives: HealthCare

Why Sign Up for Medicare If I Have Insurance Already?

My Comments: I’m increasingly asked about signing up for Medicare at 65 or not. This happens as more and more of us are still working at age 65 and expect to keep working for several years to come. This article by Matthew Frankel will give you the background necessary to help your decision.

by Matthew Frankel \ Jul 16, 2017

The standard eligibility age for Medicare in the United States is 65. However, many people don’t know if they need to sign up for Medicare if they already have other health insurance coverage, such as through a job, a spouse’s employer, from their former employer, or through COBRA. Here’s a quick guide that can help you determine if you need to sign up for Medicare when you turn 65 or if you can wait longer without paying a penalty.

How Medicare works with your other insurance

When you have more than one insurance provider, there are certain rules that determine who pays what it owes first and who pays based on the remaining balance. For seniors who don’t have other insurance, Medicare is obviously the primary payer. However, when you have other insurance, it’s a little more complicated.

Depending on the type of insurance you have (group coverage, retiree coverage, COBRA, marketplace coverage, etc.), Medicare can either be the primary or the secondary payer. If Medicare would be a secondary payer to your current insurance, you can delay signing up for Medicare Part B. If your current insurance would become a secondary payer to Medicare, you should sign up during your initial enrollment period, which is the seven-month period that begins three months prior to the month you’ll turn 65.

It’s also worth noting that although I’m specifically mentioning Medicare Part B, which is medical insurance, this applies to Part A (hospital insurance) as well. However, Medicare Part A is free to the vast majority of Americans, so it’s probably worth signing up for Part A whether you’re required to or not. On the other hand, Medicare Part B has a monthly premium you’ll have to pay, which is why it can make sense to delay signing up if it’s not going to be your primary insurance.

Who can delay signing up for Medicare?

So, whose insurance remains the primary payer? In a nutshell, if you have coverage through your or your spouse’s current employment, and the employer has 20 or more employees, your insurance plan remains the primary payer.

If you aren’t sure if your employer meets the “group health coverage” criteria, ask your employer’s benefits manager.

If you do qualify, you can delay signing up for Medicare for as long as you (or your spouse) are still working. Once the employment or your employer-based health coverage ends, you’ll have eight months to sign up for Medicare Part B without paying a penalty, which is a permanently higher premium.

It’s also important to note that regardless of whether you’re still working or not, if you’ve already signed up for Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. If you don’t want to keep Part B, you’ll need to cancel it (instructions are on the Medicare card you’ll receive).

Who should sign up at 65, even if they have other insurance?

This leaves a fairly long list of other types of insurance that become secondary payers to Medicare. Therefore, if you’re turning 65 and any of these situations apply to you, you should sign up for Medicare during your initial enrollment period.

• You have group coverage through your or your spouse’s employer, but the employer has fewer than 20 workers.

• You have retiree coverage, either through your former employer or your spouse’s former employer.

• You have group coverage through COBRA.

• You have TRICARE, the healthcare program for military service members, retirees, and their families. Retired service members must get Medicare Part B when eligible in order to keep their TRICARE coverage. (Note: If you’re still on active duty, you don’t have to enroll in Medicare until after you retire.)

• You have veterans’ benefits.

• You have coverage through the healthcare marketplace or have other private insurance. Once your Medicare coverage begins, you’ll no longer get any reduced premium or tax credit for marketplace coverage, and you should drop this coverage as you’ll no longer need it (unless you’re not eligible for premium-free Part A, which is not common).

If one of these situations applies to you and you don’t sign up for Medicare Part B during your initial enrollment period, you could face permanently higher premiums when you do.

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GOP confronts an inconvenient truth: Americans want a healthcare safety net

My Comments: Some of my friends continue to decry the notion of socialism. They seem to equate it with communism, a very different animal. It’s too bad they haven’t yet figured out that it’s not a rejection of capitalism. For me, because the word has accumulated so many negatives, not unlike the Confederate flag, I’ve searched for an alternative.

I’m a profound believer in capitalism. But I’m smart enough to know that unfettered capitalism becomes an attack on society, where the have’s get to enslave the have nots.

There are hundreds of millions of people on this planet who benefit from social order, whether it’s rules that tell us which side of the street to drive on, or taxing the population to provide national parks. Where along the lengthy path of human development over time would anti-socialist have us return in their efforts to reject the benefits of social order? And does anyone have a suggestion for what to call it?

by Noam N. Levey – July 28, 2017 – Los Angeles Times

The dramatic collapse of Senate legislation to repeal the Affordable Care Act may not end the Republican dream of rolling back the 2010 healthcare law.

But it lay bare a reality that will impede any GOP effort to sustain the repeal campaign: Americans, though ambivalent about Obamacare in general, don’t want to give up the law’s landmark health protections.

“There may be a whole lot of Americans who are complaining about government, but that doesn’t mean they agree with eliminating the safety net,” said former Sen. Dave Durenberger, a Minnesota Republican and healthcare policy leader in the 1980s and ’90s. “We saw that with Social Security and Medicare in Reagan’s day. Now it is a much broader group of people who rely on those health protections.”

And as the Senate debate this week illustrated, Obamacare’s safety net — both guaranteed insurance for the sick and expanded Medicaid coverage for the poor — proved too valued to tear apart.

That means that, while attacks on Obamacare will probably continue, it’s increasingly unlikely that President Trump or GOP congressional leaders will be able to rip out the law “root and branch,” as Senate Majority Leader Mitch McConnell (R-Ky.) once promised.

The GOP’s failure to dismantle the expanded healthcare safety net also may provide an opening for Republicans and Democrats to cooperate on measures to help Americans who have struggled in recent years with rising premiums brought about, in part, by Obamacare.

“Now the real work lies before us,” March of Dimes President Stacey D. Stewart said Friday, following the defection overnight of three GOP senators who voted against a last-ditch Republican bill to begin unraveling the law.

“Our healthcare system and the laws that govern it are far from perfect, and many opportunities exist to find areas of common ground to make improvements,” Stewart said

The March of Dimes is among scores of patient advocacy organizations, hospitals, physicians’ groups and others who bitterly fought the GOP repeal push, warning of disastrous consequences for tens of millions of sick and vulnerable Americans.

This was not how Republicans had sketched out repeal.

For years, GOP politicians cast themselves as saviors, promising to deliver Americans from a law that former Republican presidential candidate Ben Carson, now Trump’s Housing secretary, once called the “worst thing that has happened in this nation since slavery.”

Demonizing Obamacare, initially a derisive label the GOP coined for the ACA, proved good politics. Republicans scored major victories in the 2010, 2014 and 2016 elections on pledges to roll back the law.

But the successful political message — which built off deep partisan divisions — obscured much broader support for the law’s core elements.

For example, 80% of Americans in a national survey last fall reported favorable views of allowing states to expand Medicaid to cover more poor adults, and of providing aid to low- and moderate-income Americans to help them buy health coverage, two pillars of the law.

The same proportion, according to the poll by the nonprofit Kaiser Family Foundation, liked the law’s insurance marketplaces, which allow consumers to shop among health plans that must offer a basic set of benefits.

Nearly 70% backed the law’s coverage guarantee, which prohibits insurers from turning away people due to their medical history of preexisting conditions.

“As a law, Obamacare got caught up in the politics of the time. It became the symbol of the Obama administration,” said Mollyann Brodie, who oversees polling for the Kaiser Family Foundation. “But the policies themselves have always been quite popular, even among Republicans.”

GOP politicians didn’t have to reckon with that contradiction as they took dozens of essentially meaningless repeal votes while Obama was still in the White House to veto their bills.

That changed after the 2016 elections. No longer was repeal an abstract political slogan.

It was a concrete set of plans that cut insurance subsidies for millions of Americans, slashed hundreds of billions of dollars in federal Medicaid assistance to states and weakened coverage guarantees by allowing insurers to once again charge sick people more for coverage.

That is not what Americans wanted, said Dr. Jack Ende, president of the American College of Physicians.

“No version of legislation brought up this year would have achieved the types of reforms that Americans truly need: lower premiums and deductibles, with increased access to care,” said Ende, a University of Pennsylvania primary care doctor.

Independent analyses of the GOP repeal bills by the Congressional Budget Office and others estimated they would leave tens of millions more Americans without health coverage and drive up costs for many older and sicker consumers.

In the crosshairs were not just unemployed adults whom conservative critics derided as freeloaders, but also poor children, disabled Americans and seniors who worked all their lives but depended on Medicaid for nursing home care.

Altogether, nearly 1 in 4 Americans rely on Medicaid and the related Children’s Health Insurance Program for coverage.

And as the repeal debate dragged on in Washington and in congressional districts across the country, stories of these Americans and others who rely on Obamacare’s healthcare protections brought the safety net to life.

National polls ultimately showed that fewer than 1 in 5 Americans surveyed supported the Republican repeal legislation.

By contrast, 60% of Americans in a recent Pew Research Center poll said that it is the federal government’s responsibility to ensure all Americans have health coverage — the highest level in nearly a decade.

Even many Republican state leaders — including the governors of Ohio, Nevada and Arizona — balked at the congressional rush to roll back the Medicaid safety net. In a bipartisan letter to Senate leaders this week, several of these governors urged lawmakers to turn away from the repeal push.

“We ask senators to work with governors on solutions to problems we can all agree on: fixing our unstable insurance markets,” wrote the governors — five Republicans and five Democrats.

Some congressional Republicans seemed reluctant to give up the repeal campaign. “As long as there is breath in my body, I will be fighting for the working men and women of this country that are being hurt by Obamacare,” Texas Sen. Ted Cruz said after the vote early Friday morning.

And conservative activists continue to demand action. “In Washington, there are no permanent victories or permanent defeats,” said Heritage Foundation President Edwin J. Feulner.

The president, meanwhile, reiterated his threats to “let Obamacare implode,” as he said in a Twitter post after the early Friday vote.

The administration could potentially sabotage insurance markets across the country by refusing to enforce the current law’s requirement to buy insurance or withholding payments to health insurers that subsidize costs for very low-income consumers.

But at the Capitol, Democrats and some Republicans appear willing to begin considering legislation to protect those markets and help millions of American consumers who have seen insurance premiums rise dramatically in recent years.

“Simply letting Obamacare collapse will only cause even more pain,” warned Rep. Kevin Brady (R-Texas), chairman of the powerful House Ways and Means Committee.

Fixing the safety net represents a far better approach than a new push to tear it down, said Durenberger, the former GOP senator.

“Bipartisanship is the only option,” he said.

How Did Health Care Get to Be Such a Mess?

My Comments: trump famously commented that he had no idea health care reform could be so complicated.

There are five principal stakeholders in our health care delivery system: insurance companies, pharmaceutical companies, hospitals, the medical profession, and lastly, we the consuming public.

All five have vested interests they want to grow and preserve, and all five have legitimate claims against the other four. None of them have enough leverage by themselves to either correct or make the system better.

I endorsed the introduction of the ACA because it created another vested stakeholder that by its nature, could put the other five in a subordinate role and slowly cause remedies to surface with the ultimate goal being a better outcome for all of us.

But it was flawed from the start and for political reasons alone, no one had the necessary leverage to fix the flaws. So we are where we are and everyone is still pissed off. The one redeeming thought from the past 8 years is that there is an increasing acceptance in our society that access to health care is a social benefit. The discussion will slowly evolve to figuring out how to pay for it, and by whom, instead of a purely capitalist approach which says, in effect, it’s everyman for himself. Leaving people out in the street to die is not an acceptable outcome for most of us.

I don’t claim to know the answer. But discuss it we must, and that calls for a better understanding of how we got to where we are today. This article by Ms. Chapin is useful in that regard.

By CHRISTY FORD CHAPIN \ JUNE 19, 2017

The problem with American health care is not the care. It’s the insurance.

Both parties have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model. The insurance company model drives up prices and fragments care. Rather than rejecting this jerry-built structure, the Democrats’ Obamacare legislation simply added a cracked support beam or two. The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.

An alternative structure can be found in the early decades of the 20th century, when the medical marketplace offered a variety of models. Unions, businesses, consumer cooperatives and ethnic and African-American mutual aid societies had diverse ways of organizing and paying for medical care.

Physicians established a particularly elegant model: the prepaid doctor group. Unlike today’s physician practices, these groups usually staffed a variety of specialists, including general practitioners, surgeons and obstetricians. Patients received integrated care in one location, with group physicians from across specialties meeting regularly to review treatment options for their chronically ill or hard-to-treat patients.

Individuals and families paid a monthly fee, not to an insurance company but directly to the physician group. This system held down costs. Physicians typically earned a base salary plus a percentage of the group’s quarterly profits, so they lacked incentive to either ration care, which would lose them paying patients, or provide unnecessary care.

This contrasts with current examples of such financing arrangements. Where physicians earn a preset salary — for example, in Kaiser Permanente plans or in the British National Health Service — patients frequently complain about rationed or delayed care. When physicians are paid on a fee-for-service basis, for every service or procedure they provide — as they are under the insurance company model — then care is oversupplied. In these systems, costs escalate quickly.

Unfortunately, the leaders of the American Medical Association saw early health care models — union welfare funds, prepaid physician groups — as a threat. A.M.A. members sat on state licensing boards, so they could revoke the licenses of physicians who joined these “alternative” plans. A.M.A. officials likewise saw to it that recalcitrant physicians had their hospital admitting privileges rescinded.

The A.M.A. was also busy working to prevent government intervention in the medical field. Persistent federal efforts to reform health care began during the 1930s. After World War II, President Harry Truman proposed a universal health care system, and archival evidence suggests that policy makers hoped to build the program around prepaid physician groups.

A.M.A. officials decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model.

In this system, insurance companies would pay physicians using fee-for-service compensation. Insurers would pay for services even though they lacked the ability to control their supply. Moreover, the A.M.A. forbade insurers from supervising physician work and from financing multispecialty practices, which they feared might develop into medical corporations.

With the insurance company model, the A.M.A. could fight off Truman’s plan for universal care and, over the next decade, oppose more moderate reforms offered during the Eisenhower years.

Through each legislative battle, physicians and their new allies, insurers, argued that federal health care funding was unnecessary because they were expanding insurance coverage. Indeed, because of the perceived threat of reform, insurers weathered rapidly rising medical costs and unfavorable financial conditions to expand coverage from about a quarter of the population in 1945 to about 80 percent in 1965.

But private interests failed to cover a sufficient number of the elderly. Consequently, Congress stepped in to create Medicare in 1965. The private health care sector had far more capacity to manage a large, complex program than did the government, so Medicare was designed around the insurance company model. Insurers, moreover, were tasked with helping administer the program, acting as intermediaries between the government and service providers.

With Medicare, the demand for health services increased and medical costs became a national crisis. To constrain rising prices, insurers gradually introduced cost containment procedures and incrementally claimed supervisory authority over doctors. Soon they were reviewing their medical work, standardizing treatment blueprints tied to reimbursements and shaping the practice of medicine.

It’s easy to see the challenge of real reform: To actually bring down costs, legislators must roll back regulations to allow market innovation outside the insurance company model.
In some places, doctors are already trying their hand at practices similar to prepaid physician groups, as in concierge medicine experiments like the Atlas MD plan, a physician cooperative in Wichita, Kan. These plans must be able to skirt state insurance regulations and other laws, such as those prohibiting physicians from owning their own diagnostic facilities.

Both Democrats and Republicans could learn from this lost history of health care innovation.

Christy Ford Chapin is an associate professor of history at the University of Maryland, Baltimore County, a visiting scholar at Johns Hopkins University and the author of “Ensuring America’s Health: The Public Creation of the Corporate Health Care System.”

CBO: Conservative Bulls**t Obliterator

My Comments: I am relatively powerless as one of some 325M people living in these United States of America. But I have a voice and at least a few people read my blog posts.

I’m disturbed by 45’s apparent glee in ceding global economic and moral leadership to China and Germany and other nations. I’ve concluded he’s actually Our Man in DC. That is, Moscow’s Man in DC.

Universal health care is becoming the accepted norm among these 325M Americans. We are a wealthy nation, and our values, developed over 250 years and more suggest it’s appropriate to take care of our elderly, our children, our less fortunate brethren.

But there are those in 45’s inner circle whose expressed values significantly contradict my values. I’m happy there exists a potential Bulls**t Obliterator to help draw attention to this.

By Jon Perr \ Sunday May 28, 2017

This past week was a very big one for some very big promises from Republicans in Washington. It didn’t go well for them.

Three weeks after House Republicans voted to pass a new version of their “American Health Care Act,” the nonpartisan Congressional Budget Office (CBO) weighed in on high-profile pledges from President Donald Trump and House Speaker Paul Ryan. While Trump guaranteed “insurance for everybody” that is “much less expensive and much better,” Ryan insisted the revised AHCA “protects people with pre-existing conditions.” Not content to rest there, HHS Secretary Tom Price boasted that Trumpcare’s $880 billion in cuts to Medicaid will “absolutely not” result in millions losing coverage.

Meanwhile, the Trump administration also unveiled its fiscal year 2018 budget proposal. With its draconian spending cuts to the social safety net programs, the White House blueprint was proclaimed “dead on arrival” even by some Republicans. But more embarrassing to Donald Trump was its double-counting of $2 trillion in revenue for Uncle Sam magically generated by “sustained, 3 percent economic growth.” As Treasury Secretary Steven Mnuchin declared a month ago, “the plan will pay for itself with growth.”

Unfortunately for the White House and GOP leaders on Capitol Hill, the CBO demolished all of those Republican myths. Again. That’s because whether the issue is health care, taxes, job numbers, or the impact of the President Obama’s 2009 economic stimulus, the acronym “CBO” doesn’t just stand for “Congressional Budget Office.” It’s also shorthand for “Conservative Bulls**t Obliterator.”

As it turns out, in recent years that’s been true even when Republicans have their hand-picked choice running the agency.

Consider, for starters, the decades-old GOP myth that “tax cuts pay for themselves.” In January 2015, the new Republican majorities in the Senate and House selected former Bureau of Labor Statistics chief Keith Hall to lead CBO. But by that August, Hall had some bad news for the Red team: “No, the evidence is that tax cuts do not pay for themselves. And our models that we’re doing, our macroeconomic effects, show that.”

Of course, it’s not just a question of economics models, but more than 40 years of economic history. Almost from the moment that Arthur Laffer first sketched his now-famous curve on a napkin in 1974, right-wing pundits, politicians, and propagandists have declared as an article of faith the belief that tax cuts incentivize so much economic growth that revenues to Uncle Sam will be at least as high as they would have been without the reduction in rates. Unfortunately for the American people, four decades of supply-side snake oil have produced only mushrooming national debt and record-high income inequality. Far from paying for themselves, the Reagan and Bush tax cuts delivered a windfall only for the wealthy while unleashing oceans of red ink from the United States Treasury. It’s no wonder why every economist surveyed by the University of Chicago Booth School of Business in 2012 and again in 2017 disagreed with the claim that “a cut in federal income tax rates in the US right now would raise taxable income enough so that the annual total tax revenue would be higher within five years than without the tax cut.”

As former Obama administration economist Austan Goolsbee put it:
Moon landing was real. Evolution exists. Tax cuts lose revenue. The research has shown this a thousand times. Enough already.

But the CBO is hardly finished in debunking the rubbish being shoveled by Messrs. Trump, Mnuchin, and Mulvaney. Candidate Trump didn’t just promise average annual economic growth of 4 percent during the campaign. The White House web site currently pledges “to get the economy back on track, President Trump has outlined a bold plan to create 25 million new American jobs in the next decade and return to 4 percent annual economic growth.” No President since JFK and LBJ ever achieved that target. When Mulvaney and Mnuchin promised 3 percent GDP growth over the next decade, their rosy scenario represented a 1.1-point gap over CBO’s forecast of 1.9 percent.

Medicare Statistics

My Comments: Medicare is a critical element for retired Americans. These statistics are not jaw-dropping but re-affirm our need to be very careful about making changes to Medicare.

I’m not convinced the folks in Congress have my best interests in mind when they talk about making changes.

Consider yourself enlightened.

Maurie Backman | Apr 20, 2017

You’re probably aware that Medicare provides health coverage for seniors 65 and older. But did you know that Medicare has several distinct parts, each of which provides its own set of services?

Here’s a quick breakdown:
• Medicare Part A covers hospital visits and skilled nursing facilities.
• Medicare Part B covers preventative services like doctor visits and diagnostic testing.
• Medicare Part D covers prescription drugs.

There’s also Part C, Medicare Advantage, that offers a host of additional services. Whether you’re approaching retirement or are many years away, here are a few key Medicare statistics you should be aware of.

1. There are 57 million Medicare enrollees in the U.S. 
A good 16% of the U.S. population is covered by Medicare, but it’s not just seniors who get to enroll. Younger Americans with disabilities are also eligible for coverage.

2. About 11 million people on Medicare are also covered by Medicaid.
Though Medicare offers a wide array of health benefits for seniors, it doesn’t pay for everything. In fact, about 20% of Medicare enrollees rely on Medicaid to pay for services Medicare won’t cover, such as nursing home care.

3. Net Medicare spending totaled $588 billion in 2016.
That’s about 15% of the federal budget. And that number is expected to rise to nearly 18% of the budget in about a decade’s time.

4. The standard Medicare Part B premium amount in 2017 is $134.
Many people assume that Medicare enrollees don’t pay a premium to get coverage, but it isn’t true at all. While Part A is generally free for most seniors, Part B comes at an estimated cost of $134 per month. That number may also be higher depending on your income, or lower if you were collecting Social Security as of earlier this year and had your Part B premiums deducted directly from your benefits.

5. Poor health can be 2.5 times as expensive for Medicare enrollees.
A 2014 report by the Kaiser Family Foundation (KFF) revealed that the typical Medicare enrollee who identified as being in poor health had out-of-pocket costs that totaled 2.5 times the amount healthier beneficiaries faced. This is just one reason it’s crucial for Medicare enrollees to capitalize on the program’s free preventative-care services. Catching medical issues early can often result in a world of savings.

6. A single hospital stay under Medicare can cost almost $4,500 out of pocket. 
Here’s some more discouraging news out of KFF. Back in 2010, Medicare enrollees who had a single hospital stay incurred $4,475, on average, in out-of-pocket costs.

7. Medicare enrollees 85 and older spend three times more on healthcare than those aged 65 to 7.  It’s probably not shocking news that older seniors spend more money on medical care than those a decade or more their junior. But what may be surprising is just how much those 85 and over wind up spending. According to KFF, in 2010, Medicare enrollees 85 and older spent close to $6,000 to cover their healthcare needs.

8. In 2015, 243 medical professionals were charged with Medicare fraud. It’s not uncommon for members of the medical establishment to engage in Medicare fraud, whether it’s in the form of inflating bills, performing (and charging for) unnecessary procedures, or billing for services that were never rendered. The good news, however, is that officials are getting better at identifying and prosecuting Medicare fraud. In fact, in 2007, the Medicare Fraud Strike Force was created to put a stop to fraudulent activity that eats away at the program’s limited financial resources.

9. More than 17 million Americans are enrolled in a Medicare Advantage plan. Medicare Advantage is an alternative to traditional Medicare that offers a number of key benefits, such as coverage for additional services (including dental and vision care) and limits on out-of-pocket spending. Between 1999 and 2016, 10 million Americans signed up for a Medicare Advantage plan, and enrollment now represents roughly 30% of the Medicare market on a whole.

10. A good 38% of Medicare funding comes from payroll taxes.
Nobody likes paying taxes, but without them, Medicare simply wouldn’t have enough money to stay afloat. Currently, the Medicare tax rate is 2.9% for most workers (which, for salaried employees, is split down the middle between worker and employer), but higher earners making more than $200,000 a year pay an additional 0.9%.

Getting educated about Medicare can help you make the most of this crucial health program. It pays to learn more about how Medicare works so that you can take full advantage when it’s your turn to start using those benefits.

Our Distorted Health Care System

My Comments: As a tax paying mortal, I’m not happy with our incredibly expensive system, one with less favorable health outcomes for us than exists in other countries, at far less cost.

Given my background, I have a reasonably good understanding about health insurance and the role it plays in our society. I also have the benefit of five decades with both health care issues and with insurance coverage for myself and my family.

The American health care system is broken. It’s been out of whack for at least 40 years. The ACA (Obamacare) was an attempt to impose a fix, but like 45 says, it’s complicated. Since the ACA is here to stay, as per Paul Ryan, somehow we have to fix it.

As a start, it might help to better understand how we got to where we are. These comments from Myron Magnet below are instructive. Where we go from here is anyone’s guess, but that we must go is an absolute necessity.

Myron Magnet / Mar 28, 2017

A World War II-era mistake distorted the U.S. health insurance system. Reformers tried to fix the problem with patchwork solutions until Obamacare dumped yet another layer of misguided policy onto what was already a mess. Now the tangle is so perplexing that a Republican Congress, under a Republican president, could not even bring a health-insurance reform bill to a vote last week. But legislators will no doubt try to tackle the issue again, and when they do, they should consider erasing the original error instead of merely papering it over.

As World War II raged, competition for scarce labor grew fierce, what with so many able-bodied men in the military. Legislators, worried about possible runaway inflation, imposed wage controls in 1942. In response, employers began enticing workers by offering rich benefits in lieu of increased wages, and, as these benefits were not income, they were exempt from income and payroll taxes, a subsidy to workers and employers alike. Chief among these benefits was health insurance, whose cost was originally modest.

But as the cost of healthcare rose in the 1950s, retirees and the poor found insurance unaffordable, and President Johnson, who never saw a problem he didn’t think big government could solve, injected Medicare and Medicaid into the health-insurance business. Prices continued to rise, in part because of spectacular advances in medicine, such as the development of coronary bypass surgery in the late 1960s. By 1980, corporations found their medical-insurance costs increasingly burdensome. They tried all sorts of schemes to bring those costs under control, from health-maintenance organizations, which added administrative costs, to employee wellness programs, which helped keep workers alive long enough to develop the diseases of aging. Employer costs, in short, went up instead of down. Behind closed doors, executives remarked that it might be better if workers died before they retired, to ease the strain on the corporate pension fund.

Aside from all this lay a great inequity. People with corporate jobs got (relatively) affordable group insurance, subsidized by the two tax exemptions. People without such jobs had to buy unsubsidized and therefore more expensive individual insurance.
Future reforms, then, ought to get employers out of the healthcare business entirely, since they are there by accident and add nothing of value to the health of the nation. The tax deduction should go to the individual, not the employer.

Obamacare provided health-insurance subsidies to individuals without employer coverage; House Speaker Paul D. Ryan’s bill would have given those same individuals a tax deduction or refundable credit. But until the government removes the double tax deduction that encourages employers to provide insurance — not to mention the mandates forcing them to do so — corporations will retain the real leverage in healthcare finance. Only when the individual wields the power of the purse will his needs come first.

A second worthwhile reform would be to encourage the rebirth of the mutual health-insurance company, such as Blue Cross Blue Shield used to be. Like the Victorian Friendly Societies, early American health insurers were just vehicles for pooling risk. Everyone knew that he or his family was subject to serious illness, but no one knew whether he would be among the lucky or the unlucky, so it made sense for all to pool their money to pay the expenses of those among them unfortunate enough to contract one of the thousand natural shocks that flesh is heir to.

In the 1940s and ‘50s, the owners of these insurance companies were the policyholders, and their employees were just administrators who calculated the risks, collected the premiums, and paid out the benefits. Blue Cross and Blue Shield were in the insurance business, not the investment business, and they needed no high-paid top executives to make investment decisions to enrich non-policy owning shareholders. There were none. No insurance company presumed to tell a doctor how to treat his patient to promote the interests of the insurance company, for the interests of insurer and patient were identical. The demutualizing of these companies was a huge policy mistake, vastly increasing the cost of health insurance in order to reward public shareholders and executives, not policyholders. Now the tail wags the dog.

I’ve said nothing about healthcare for the poor. I’d only point out there were always doctors who wouldn’t charge patients who couldn’t pay, always charity hospitals staffed by the same doctors who staffed the fancy hospitals, always union clinics and company doctors, always emergency rooms that would treat first and ask about ability to pay later. And all these delivery systems, in midcentury America, arguably provided better care than Medicaid.

The ruling concept in America’s technology companies is continuous improvement. Health-insurance reformers, starting now, ought to make it their watchword as well.

Myron Magnet is editor-at-large of the Manhattan Institute’s City Journal, from which this essay was excerpted.

3 Ways to Maximize Your Medicare

My Comments: Given that we are living much longer and that death is inevitable, if follows that access to affordable health care plays a role in our quality of life. This is especially true for those of us moving into or are already well into, our ‘golden’ years.

Medicare has become a critical component in the health and well being of Americans of every stripe. The fact that some of our elected officials see it as a threat to our survival as a nation is beyond comprehension. But then I remember I have clients who freak out if you suggest the current euphoria on Wall Street will not last forever.

I get asked frequently about Medicare and it’s implications. For me and my wife, our ability to seek help whenever a health issue surfaces, without having to first calculate it’s likely cost, is an enormous contributor to our peace of mind and quality of life. Here are three important suggestions.

Selena Maranjian \ Mar 27, 2017

There’s significant uncertainty about Medicare’s future in our current political environment, but for now, the program is helping more than 57 million people, or 18% of the U.S. population, have access to affordable healthcare.

Medicare will likely play an important part in your future health — and how you pay for healthcare in retirement will have a major effect on your overall finances. For maximum benefit and minimum cost, it’s smart to learn more about Medicare and how to get the most out of it.

Don’t be late signing up

Enrolling late can increase the cost of coverage for the rest of your life. You’re eligible for Medicare at age 65 and can sign up anytime within the three months leading up to your 65th birthday, during the month of your birthday, or within the three months that follow. That’s your Initial enrollment period. Miss it and your Part B premiums (which cover medical services, but not hospital services) can rise by 10% for each year that you were eligible for Medicare but didn’t enroll.

If you fail to enroll during your initial enrollment period, you can always enroll during the “general enrollment period,” which is from Jan. 1 through Mar. 31 of each year — though that coverage won’t begin until July and the late penalty might apply.

Fortunately, if you’re already receiving Social Security benefits when you turn 65, you’ll be automatically enrolled in Medicare. Many people don’t start collecting Social Security that early, though. And even if you are already collecting benefits, be sure to double check that you’ve been enrolled.

If you’re still working, with employer-provided healthcare coverage, at age 65, or are serving as a volunteer abroad, you can delay enrolling in Medicare without penalty.

Choose between original Medicare or a Medicare Advantage plan

Medicare enrollees get to choose between original Medicare, featuring parts A and B, and Medicare Advantage plans, which are sometimes referred to as Part C. With traditional (or “original”) Medicare, Part A covers inpatient hospital stays, hospice, and skilled-nursing facility stays, while Part B covers outpatient services, such as preventative care, laboratory tests, ambulance services, medical equipment, and necessary doctor services.

Medicare Advantage plans, meanwhile, are administered by private insurers but are regulated by the U.S. government. Each must offer at least as much coverage as original Medicare (i.e., the benefits you’ll find in Part A and Part B). Many go beyond that, though, offering broader coverage, such as vision care, dental care, and/or prescription drug coverage. (Those in original Medicare typically buy Part D for prescription drug coverage.) Roughly a third of Medicare enrollees are in Medicare Advantage plans.

So which Medicare plan is best for you and why should you choose one over the other? It depends on your needs and preferences. Original Medicare is accepted by the broadest swath of doctors and you can see them without referrals. So you can find and see a doctor anywhere in the U.S., which is especially handy if you’re a traveling retiree. Medicare Advantage plans, often similar to HMOs, feature defined networks of doctors (though some of the networks are quite large) or steeper costs for seeing out-of-network physicians, and they’re typically limited to your local region. (Some do, on a limited basis, cover healthcare outside the U.S., unlike original Medicare.)

While original Medicare will often have you footing 20% of many bills with no limit on how much you end up spending, your out-of-pocket costs in a Medicare Advantage plan are capped. (The average out-of-pocket cap was recently $5,223, but many plans feature caps below $3,000, and the limit for 2017 is $6,700.) Once you hit the limit, the plan will pay all further costs. Better still, many plans charge the enrollee nothing in premiums. (The Medicare program pays the insurance company offering it a set sum per enrollee and if the insurer thinks it can make a profit without charging its customers anything, it can do so.) The average monthly premium for Medicare Advantage plans was recently $33.

When deciding between original Medicare and Medicare Advantage, think about what doctors you see, what services you need, and what drugs you take and then compare coverage and costs for available plans. The Medicare Plan Finder at the Medicare website can help you compare plans and choose. Note the star ratings of your candidate plans and aim to choose only a four-star or five-star plan.

Once you decide, know that you can change your mind and choose a different plan next year. In fact, it’s a good idea to review all your options and their costs on an annual basis.

Take full advantage of your plan’s offerings

Medicare offers lots of screenings and preventive care that’s generally at no extra cost to you. Getting screened and seeing your doctor regularly can help identify problems early, before they grow worse and more costly. That can keep you healthier and living longer and better, while also keeping your healthcare costs down.

The kinds of services that should cost you nothing (though some require doctor’s orders) include: abdominal aortic aneurysm screening, alcohol misuse screening and counseling, bone density measurement, cardiovascular disease screenings, cervical and vaginal cancer screenings, colonoscopies and other colorectal cancer screenings, depression screenings, diabetes screenings, flu shots, hepatitis B shots and hepatitis C screenings, HIV screenings, some home health services, lung cancer screenings, mammograms, nutrition therapy services, obesity screenings and counseling, pneumonia vaccine, prostate cancer screenings, sexually transmitted infection screenings, and smoking & tobacco-use cessation counseling.

If your Medicare plan offers telehealth services, give them a whirl. They permit you to consult with doctors and other healthcare professionals electronically, often via a Skype-like video connection. These consultations can cost less than an in-person visit to your doctor and can be more convenient, happening immediately or within hours. They can be particularly helpful if you’re traveling and have a health concern. Telehealth isn’t generally an option for all original Medicare enrollees, but it’s available to some. And some Medicare Advantage plans offer it, too.

Finally, make use of wellness benefits included in your Medicare coverage. For starters, you’re entitled to one wellness visit annually. That’s when you can see your primary care doctor to review your health. Don’t skip this, as it’s available at no cost to you and gives your doctor a chance to discuss ways to get you healthier instead of just ways to treat the illness or injury you walked in with. You may have access to other health benefits and perks, too, such as discounts on gym memberships. Find out what your plan offers and make the most of those benefits. When you’re shopping for a Medicare plan, review available wellness perks, too, to see which would serve you best.

You can maximize your Medicare by signing up on time, choosing the plan that will serve you best while keeping your costs low, and making the most of screenings, telehealth services, and wellness benefits. Doing these things can not only boost your health, but they may also save you a lot of money.