Duh wake up folks... Medicare is privatized!

[Mac1958]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

 

[Freewill]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

And I'm diabetic, take medicine for it, blood pressure and cholesterol and pay ZERO as my Medicare Advantage plan pays!
Again your personal anecdotal stories as MINE also don't amount to a hill of beans as they are Personal,subjective anecdotal.
Over all Medicare Advantage plans are far superior as a whole to Medicare fee for service and Trump being the smart business man will see that quickly and take off some of the anti-capitalist restraints the idiot Obama did on Advantage plans.

Also one further point...because of state laws, Medicare Advantage plans are limited.
Here in Florida it is much more competitive then say in less retired population states... competition!

BUT Trump may introduce the truly exciting plan that IF when I started working in 1967 had been an option, I would have over $3 million in
my SS plan that I would then use to retire on PLUS pay my health expenses PLUS leaving a nest egg for my son!
But most of you anti-capitalists ignorant people shout this "don't gamble my SS in risky stock market"!
How many times have you heard that?
Well if I had been able to tell SS where to invest my and my employer's SS contributions (over $100,000) I figured out the other day, that
over 40 years...and investing the first 20 in the "risky stock market" then slowly phasing out of speculative market
and into bonds and more secured... as I said above I'd have over $3 million!

But these idiots that bitch about GOP wanting to put SS into "risky stock market"....GEEZ what idiots!

I pay nothing for my advantage plan and so far they have pretty much covered everything because I don't need to use it. That is why I got the one I did. If I had elected for a drug plan the plan changes and I would be paying a premium.

Now if I were in your situation I would have done something different. That is how I handle everything, why pay more for less? That is why I question them telling me the machine I have to buy, where is the competition? Why can't there be competition in at least durable medical goods?

Here is what I advise everyone. If you pay a co-pay for drugs go to the drug company's web site and look for coupons for brand names, you might get it even cheaper than your drug plan pays. I am not going to shill for any certain web site but there are sites that will search your area and tell you the cheapest price for the prescription. But even that is a rip off most pharmacies will charge you the lower price when you don't have a drug plan, you just need to tell them or at least present them with a coupon for the lower price.

But the bottom line, pharmacies and medical equipment suppliers are more than happy to charge a person full price. Paying for a drug plan and then having a company pay full price to me isn't a solution. The system is corrupted, in my opinion.

 

[Freewill]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

 

[Freewill]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

And I'm diabetic, take medicine for it, blood pressure and cholesterol and pay ZERO as my Medicare Advantage plan pays!
Again your personal anecdotal stories as MINE also don't amount to a hill of beans as they are Personal,subjective anecdotal.
Over all Medicare Advantage plans are far superior as a whole to Medicare fee for service and Trump being the smart business man will see that quickly and take off some of the anti-capitalist restraints the idiot Obama did on Advantage plans.

Also one further point...because of state laws, Medicare Advantage plans are limited.
Here in Florida it is much more competitive then say in less retired population states... competition!

BUT Trump may introduce the truly exciting plan that IF when I started working in 1967 had been an option, I would have over $3 million in
my SS plan that I would then use to retire on PLUS pay my health expenses PLUS leaving a nest egg for my son!
But most of you anti-capitalists ignorant people shout this "don't gamble my SS in risky stock market"!
How many times have you heard that?
Well if I had been able to tell SS where to invest my and my employer's SS contributions (over $100,000) I figured out the other day, that
over 40 years...and investing the first 20 in the "risky stock market" then slowly phasing out of speculative market
and into bonds and more secured... as I said above I'd have over $3 million!

But these idiots that bitch about GOP wanting to put SS into "risky stock market"....GEEZ what idiots!

If you were so f'ing bright you would have to depend on SS for your diabetic issues. Fuck Wall Street having any more control over other peoples retirement and health.

Well I KNOW I'm a whole hell of lot smarter then you it sounds like and maybe that's why I'm getting back what I PAID into SS/Medicare.
I'm certainly no dummy like you that bitches about "Wall Street" as "Wall Street's" been very good to me!

Bragging about not being healthy seems a bit desperate.

 

[Freewill]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

Hey Freewill don't forget to inform the Medicare agency about the lil' scam your provider has going. It may not amount to much for just one person with one item but its a bunch when you include them all together when those goes start pulling that crap. Your state probably has an agency in the AG's office a toll free number that looks into insurance racketeers.

I am going to as soon as I gather a little bit more information. One thing to consider is those who bitch raise their heads and who knows where that might go.

BTW, I left it out but I did call medicare and told them what was going on. The woman on the phone didn't seem to understand nor really care about what the advantage plan people were doing. I think this is systemic.

 

[Mac1958]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying maybe $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

 

[RodISHI]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

Hey Freewill don't forget to inform the Medicare agency about the lil' scam your provider has going. It may not amount to much for just one person with one item but its a bunch when you include them all together when those goes start pulling that crap. Your state probably has an agency in the AG's office a toll free number that looks into insurance racketeers.

I am going to as soon as I gather a little bit more information. One thing to consider is those who bitch raise their heads and who knows where that might go.

BTW, I left it out but I did call medicare and told them what was going on. The woman on the phone didn't seem to understand nor really care about what the advantage plan people were doing. I think this is systemic.

Yeah a lot of those agencies have dingbats or people that don't get it when you try to tell them about something like that. If you are concerned about having your name on it just give the names of the companies so it can be checked into.

 

[Freewill]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

So, why would a healthy retiree who uses the system very little sign up for a medicare supplement plan? The advantage plans are pay as you go but the pay as you go isn't as high as the primiums for the supplement plans.

And no, as my provider told me yesterday I do not still have medicare, I have a medical advantage plan (HMO). I signed up with the largest provider in our area. They own the only hospital in 20 miles and they contract with the most doctors.

I am not sure why you said I wouldn't be happy. I pay 122/month and as I said the plan is zero premium. Now I would question the supplement plans. Does their premium include the 122/month sent to SS? Or is it above that payment? A lot of people might forget about the 122 because it is taken right out of their social security payment.

What I did was go to a broker and they advised me on the best least cost plan. I am not sure they were not just shilling for the plan I did sign up for. So far I am happy with what I did.

 

[Mac1958]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

So, why would a healthy retiree who uses the system very little sign up for a medicare supplement plan? The advantage plans are pay as you go but the pay as you go isn't as high as the primiums for the supplement plans.

And no, as my provider told me yesterday I do not still have medicare, I have a medical advantage plan (HMO). I signed up with the largest provider in our area. They own the only hospital in 20 miles and they contract with the most doctors.

I am not sure why you said I wouldn't be happy. I pay 122/month and as I said the plan is zero premium. Now I would question the supplement plans. Does their premium include the 122/month sent to SS? Or is it above that payment? A lot of people might forget about the 122 because it is taken right out of their social security payment.

What I did was go to a broker and they advised me on the best least cost plan. I am not sure they were not just shilling for the plan I did sign up for. So far I am happy with what I did.

I'm not criticizing you at all. In fact, I wish every American had the excellent choices you have.

Medicare Supplements are best for two kinds of people: Those who know they will be utilizing a lot of care and those who aren't put off by the costs and just want to keep things simple - no co-pays, etc.

Otherwise, yeah, Medicare Advantage plans are freakin' great. I wish I could get one.

I only said that you may not like the answer because my guess is that you're a small government guy and the government is paying the insurer for your coverage, that's all.

My argument is that all Americans should be under your system.
.

 

[guno]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

Hey Freewill don't forget to inform the Medicare agency about the lil' scam your provider has going. It may not amount to much for just one person with one item but its a bunch when you include them all together when those goes start pulling that crap. Your state probably has an agency in the AG's office a toll free number that looks into insurance racketeers.

on the medicare web site there is a button to report scams and fraud

 

[Freewill]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

So, why would a healthy retiree who uses the system very little sign up for a medicare supplement plan? The advantage plans are pay as you go but the pay as you go isn't as high as the primiums for the supplement plans.

And no, as my provider told me yesterday I do not still have medicare, I have a medical advantage plan (HMO). I signed up with the largest provider in our area. They own the only hospital in 20 miles and they contract with the most doctors.

I am not sure why you said I wouldn't be happy. I pay 122/month and as I said the plan is zero premium. Now I would question the supplement plans. Does their premium include the 122/month sent to SS? Or is it above that payment? A lot of people might forget about the 122 because it is taken right out of their social security payment.

What I did was go to a broker and they advised me on the best least cost plan. I am not sure they were not just shilling for the plan I did sign up for. So far I am happy with what I did.

I'm not criticizing you at all. In fact, I wish every American had the excellent choices you have.

Medicare Supplements are best for two kinds of people: Those who know they will be utilizing a lot of care and those who aren't put off by the costs and just want to keep things simple - no co-pays, etc.

Otherwise, yeah, Medicare Advantage plans are freakin' great. I wish I could get one.

I only said that you may not like the answer because my guess is that you're a small government guy and the government is paying the insurer for your coverage, that's all.

My argument is that all Americans should be under your system.
.

As good as what I have seems to be it is not better than what I got working for company benefits. I now work as a contractor so I receive almost no benefits although they are offered in a state I don't live, basically they offer the benefit because of obamacare mandates they do.

When I got my first CPAP machine I paid nothing thus I didn't question the cost. Now I am paying so naturally I question the cost. Which is interesting when we talk about people getting stuff for free and not questioning the real cost.

I will say that the 1440 dollars I pay up front is peanuts compared to what I paid buying insurance on my own, and that insurance, bought on Obamacare web sites, was more expensive. There was a 500 dollar co-pay for using the emergency room.

 

[Freewill]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

Hey Freewill don't forget to inform the Medicare agency about the lil' scam your provider has going. It may not amount to much for just one person with one item but its a bunch when you include them all together when those goes start pulling that crap. Your state probably has an agency in the AG's office a toll free number that looks into insurance racketeers.

on the medicare web site there is a button to report scams and fraud

Not sure if it is a scam or fraud, I think it is just the system.

 

[velvtacheeze]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

So what? What's important is that Medicare be available to all Americans who are old enough to be eligible, and that it be funded through taxation on people like you. I'd support increasing it on the overpaid, or increasing the income threshold where FICA taxes apply. But who cares if some 3rd party vendors do the paperwork? Not me.

 

[healthmyths]

Ok, I am going to tell my CPAP story again.

I need a new/repaired CPAP machine.

My Advantage plan pays 80 percent I pay 20 percent.

If I had traditional medicare, medicare would pay 80 and I would pay 20 percent.

So I contact my provider and they gave me a number to call. So I call them and they tell me what I will buy and how much I will pay. In other words they just said you are going to pay this much over 13 months. So not knowing any better I said OK. I later called them because I had to change the appointment and I figured out that the machine they were sending would cost about 1900 dollars which seemed high to me. So I call and ask them exactly what it was I was buying.

After that I go on line and find prices for the same thing, 1000 dollars cheaper. I go on the medicare website and find out that we live in a competitive market area and they had a list of suppliers. So I call the first one and ask what they would charge me. After 5 minutes of explaining she finally relented and told me it would be 19 per/month for 12 months, for the same machine, which matches the INTERNET price and is 170 dollars less than what I will pay for the machine through the provider.

So I call back to my provider and ask if I can use that supplier, no dice. I ask if they have more names of suppliers. They give me two dentist numbers, dentists don't provide CPAP, believe me. I call again explaining why I am doing this and how I think that the supplier is ripping BOTH of us off. They don't care. I believe they think me nuts for even asking.

So, why would a for profit company not care about paying 1000 dollars more than they have to? I am thinking they just pass it along. Either they get reimbursed by the government or at the end of year they have more to claim to the government so they get more for the next year. Whatever the reason the system is broken. I don't see why if the price is lower for the same thing they wouldn't be happy to allow me to buy it.

In their defense if I wanted I could fill out a paper to go to another provider and take two weeks to get approved, or disapproved. I could also file a complaint but what would I be complaining about?

My wife told me that I can afford it I should just pay. I hate that attitude.

Boo f...king HOO! Your's is a single anecdotal story. I don't deal in anecdotal stories. I deal in real numbers and yea... there were probably some
stupid reason why like YOU are a smoker right???? Plus you said the key words "So not knowing any better I said OK. " WHAT a stupid reason your not knowing any better! In this day with the Internet you should have done just a little more research and I have NO pity for you!

But of course you are an anti-capitalist. Obama lover. Who hates business.
You know who you really should be disgusted with is the legal community as YOU obviously have no idea of what "defensive Medicine" which
costs over $500 billion a year both in private and Medicare insurance. Because idiots like you are so un-informed you let insurance companies
including your example do this! I pointed out the "medical loss ratio" which has obviously gone over your head!
But the real culprits are lawyers who file frivolous lawsuits 96% of which are settled out of court by the insurance companies!
Here read this and get a reality check on health care costs!

http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits
by the 1946 Federal Tort Claims Act. "
-- BUT........Only 48% practice defensive medicine compared to 92% of non-government physicians.

So why not TAX lawyers 10% of their $270 billion a year?
Take the $27 billion and use it to pay the annual premium per year of $5,000 for each of the truly less then
5 million people that needed AND WANTED health insurance.!

Again these numbers go way over your head I'm sure as the only thing you can relate to is YOUR OWN anecdotal experience!

I hope for your sake obamacare or medicaid covers being an asshole.

As I said, I didn't get the machine yet, i did some research but don't let that stop you from unhinged reactions.

I am one person and there are many others who never would have asked the question. I am thinking that you arguing against me with an argument against healthcare is preciously ironic.

I was trying to warn people that they just don't have to take it or pay whatever they are told. My wife sent me for a prescription and the pharmacist told me it would be 125 dollars for one month. When she saw my reaction she said, look on the Internet for coupons or ask your doctor. So i did, we ended up paying 5 dollars a month. I posted that story some months ago. The pharmacist was more than happy to take 125 dollars without saying one word. I take to generic drugs, ones all old guy take. When i was deciding to buy a prescription plan or not I called the pharmacy to see how much it would cost me, they would not tell me. They refused to tell me, they said I had to have my health plan card and a prescription. I told them that I would not have a drug plan and would be paying cash, didn't matter they wouldn't tell me.

One did say, it will cost you 350 dollars for 90 days. Searching the internet i found coupons and it ended up costing about 24 dollars for 90 days. So I so far have saved money not getting on a drug plan.

Hey Freewill don't forget to inform the Medicare agency about the lil' scam your provider has going. It may not amount to much for just one person with one item but its a bunch when you include them all together when those goes start pulling that crap. Your state probably has an agency in the AG's office a toll free number that looks into insurance racketeers.

on the medicare web site there is a button to report scams and fraud

Absolutely right... and CPAP devices are very much a concern. And that's a reason that Medicare honestly prefers Medicare Advantage plans.
Think about. Instead of having to have hundreds of fraud investigators, checking out these issues... Medicare pays the advantage plans a flat
monthly fee. It is the MA's problem to research out the better deal and if there is a "scam" being run on the MA the MA can't manage, guess what
the next year the MA's contract comes up and they can't meet the budget requirements of Medicare... the MA loses.
That's the beauty of competition!

 

[healthmyths]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

So what? What's important is that Medicare be available to all Americans who are old enough to be eligible, and that it be funded through taxation on people like you. I'd support increasing it on the overpaid, or increasing the income threshold where FICA taxes apply. But who cares if some 3rd party vendors do the paperwork? Not me.

So you think that employers who have employees that make over $118,000 (which is the cap today...) should pay the federal payroll taxes on
the entire amount the employee makes is that right?
Think that through because there are some extremely dire consequences.

As far as "who cares" if a 3rd party...?
I agree!
It is competitive rates that Medicare/SS should be dealing with! Then if the Medicare Advantage
plan can't cover their costs.. there are 500 more plans out there that have figured out how to do it.
As I've pointed out my MA is very cost efficient. They frequently call me advising me to see my physician for "PREVENTATIVE" CARE!
They know it is cheaper to prevent a problem then have to pay thousands due to an emergency hospitalization! Cheaper to have me see the
doctor early on. And that's the difference between current traditional Medicare they don't call me. They never pursued preventative care.
MY MA does and that's because the MA is cost driven!

 

[velvtacheeze]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

So what? What's important is that Medicare be available to all Americans who are old enough to be eligible, and that it be funded through taxation on people like you. I'd support increasing it on the overpaid, or increasing the income threshold where FICA taxes apply. But who cares if some 3rd party vendors do the paperwork? Not me.

So you think that employers who have employees that make over $118,000 (which is the cap today...) should pay the federal payroll taxes on
the entire amount the employee makes is that right?
Think that through because there are some extremely dire consequences.

As far as "who cares" if a 3rd party...?
I agree!
It is competitive rates that Medicare/SS should be dealing with! Then if the Medicare Advantage
plan can't cover their costs.. there are 500 more plans out there that have figured out how to do it.
As I've pointed out my MA is very cost efficient. They frequently call me advising me to see my physician for "PREVENTATIVE" CARE!
They know it is cheaper to prevent a problem then have to pay thousands due to an emergency hospitalization! Cheaper to have me see the
doctor early on. And that's the difference between current traditional Medicare they don't call me. They never pursued preventative care.
MY MA does and that's because the MA is cost driven!

No, I don't think it ought to be the entire income. But it can be higher. And yes, most companies can afford it. If their margins are so tight that they can't, then cry me a river.

 

[healthmyths]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

So, why would a healthy retiree who uses the system very little sign up for a medicare supplement plan? The advantage plans are pay as you go but the pay as you go isn't as high as the primiums for the supplement plans.

And no, as my provider told me yesterday I do not still have medicare, I have a medical advantage plan (HMO). I signed up with the largest provider in our area. They own the only hospital in 20 miles and they contract with the most doctors.

I am not sure why you said I wouldn't be happy. I pay 122/month and as I said the plan is zero premium. Now I would question the supplement plans. Does their premium include the 122/month sent to SS? Or is it above that payment? A lot of people might forget about the 122 because it is taken right out of their social security payment.

What I did was go to a broker and they advised me on the best least cost plan. I am not sure they were not just shilling for the plan I did sign up for. So far I am happy with what I did.

I'm not criticizing you at all. In fact, I wish every American had the excellent choices you have.

Medicare Supplements are best for two kinds of people: Those who know they will be utilizing a lot of care and those who aren't put off by the costs and just want to keep things simple - no co-pays, etc.

Otherwise, yeah, Medicare Advantage plans are freakin' great. I wish I could get one.

I only said that you may not like the answer because my guess is that you're a small government guy and the government is paying the insurer for your coverage, that's all.

My argument is that all Americans should be under your system.
.

A. ) Medicare Advantage plans are NOT supplements. Supplements are for traditional medicare beneficiaries that the "supplement" insurance pays
the difference...i.e. no co-pays as traditional Medicare requires. Under my MA there are no co-pays unless I see a specialist.
B.) Yes I'm a small government person and yes as my original post stated ALL Medicare claims are actually managed by "for-profit" contractors.
C) Finally there never were 46 million "uninsured Americans" as you and millions believed Obama's gigantic lie!
1) 10 million are NOT Americans but illegals... PROOF? http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
2) 14 million were eligible for Medicaid except for the incompetency of Obama's people!: http://coverageforall.org/pdf/BC-BS_Uninsured-America.pdf
3) 18 million Never wanted insurance. Never needed as they were under 34. Could afford (made over $50,000) but now forced to buy something
they didn't want! http://coverageforall.org/pdf/BC-BS_Uninsured-America.pdf
So that leaves truly 5 million Americans! That's it!
And for that Obama totally lied and hired Gruber who ADMITTED it took
"the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass."
ObamaCare architect: 'Stupidity' of voters helped bill pass

What should have happened is the $270 billion a year lawyers make should have been taxed 10% LIKE Obamacare taxes tanning salons.
Using that $27 billion would provide a $5,000 a year premium for each of the less then 5 million that truly want and need health insurance.
The 10% tax would reduce proportionately as the $800 billion a year in defensive medicine costs decline which would lead to lower premiums.
This $800 billion in wasted health expenses comes from here!

90% of physicians say they order duplicate tests, refer to specialists all because they fear being sued by lawyers!
As a result almost $500 to $800 BILLION a year is the estimated WASTED health expenses in insurance claims!
But doctors under federal contracts DON"T order, DON"T FEAR because of the 1946 Tort Reform.
http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits by the 1946 Federal Tort Claims Act. "

 

[Mac1958]

Of course it is. And it goes further with Medicare Supplements and Medicare Advantage plans, both offered by private insurance companies to fill the gaps in Medicare - significant gaps that most people aren't even aware of. Even people on Medicare.

It's an excellent, portable, dual-payer system that provides both foundational diagnostic and preventive coverage on the low end (public) and dynamic market competition and innovation on the higher-cost services (private). The systems are in place and perfectly functional.

We could just extend this program to all and take a massive cost monkey off the backs of American business overnight - not to mention putting a merciful end to our current, insane, seven (7)-headed beast of a delivery/payment "system".

But we won't, because that would require cooperation between our two fucked up parties.
.

Here's a question. How can medicare not cover everything but I "buy" an advantage plan that covers the gap for zero money? My father, who has had the plan for many years, pays no premium. He has had his knee replaced and if we paid 1000 dollars to have that done I would be surprised. He has also had several stays in the hospital and many tests and again the co-pays are small and very reasonable.

So, if the for profit company can make a profit off of medicare patients with better benefits with no added cost then why can't medicare do it themselves? Of course medicare isn't free, it cost at least 108/month going up as a person's income goes up. Which seems to me to be unfair but that is the way it works.

You may not like the answer.

First, Medicare Supplements are more pure insurance. They cover all the gaps in Medicare, from doctor visits to long-term hospital stays. So these people are paying $200 to $400 per month whether they go in or not, but everything is covered if they do. You still have Medicare, and the plan pays for the holes (and there are many) in your coverage.

Medicare Advantage plans, on the other hand, are more like an HMO - tighter, smaller networks and you pay as you go, if you go. You may pay $10 to see a doc, $100 a day while in the hospital. And yes, many of them have $0 premiums. The insurer is being reimbursed by the government every month (PMPM - Per Member, Per Month) for your coverage, and it completely takes over for Medicare. So the government may be paying, say, $800 monthly to your insurance company to handle all of your Medicare coverage for you, but you can shop for the best plans.
.

So, why would a healthy retiree who uses the system very little sign up for a medicare supplement plan? The advantage plans are pay as you go but the pay as you go isn't as high as the primiums for the supplement plans.

And no, as my provider told me yesterday I do not still have medicare, I have a medical advantage plan (HMO). I signed up with the largest provider in our area. They own the only hospital in 20 miles and they contract with the most doctors.

I am not sure why you said I wouldn't be happy. I pay 122/month and as I said the plan is zero premium. Now I would question the supplement plans. Does their premium include the 122/month sent to SS? Or is it above that payment? A lot of people might forget about the 122 because it is taken right out of their social security payment.

What I did was go to a broker and they advised me on the best least cost plan. I am not sure they were not just shilling for the plan I did sign up for. So far I am happy with what I did.

I'm not criticizing you at all. In fact, I wish every American had the excellent choices you have.

Medicare Supplements are best for two kinds of people: Those who know they will be utilizing a lot of care and those who aren't put off by the costs and just want to keep things simple - no co-pays, etc.

Otherwise, yeah, Medicare Advantage plans are freakin' great. I wish I could get one.

I only said that you may not like the answer because my guess is that you're a small government guy and the government is paying the insurer for your coverage, that's all.

My argument is that all Americans should be under your system.
.

A. ) Medicare Advantage plans are NOT supplements. Supplements are for traditional medicare beneficiaries that the "supplement" insurance pays
the difference...i.e. no co-pays as traditional Medicare requires. Under my MA there are no co-pays unless I see a specialist.
B.) Yes I'm a small government person and yes as my original post stated ALL Medicare claims are actually managed by "for-profit" contractors.
C) Finally there never were 46 million "uninsured Americans" as you and millions believed Obama's gigantic lie!
1) 10 million are NOT Americans but illegals... PROOF? http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
2) 14 million were eligible for Medicaid except for the incompetency of Obama's people!: http://coverageforall.org/pdf/BC-BS_Uninsured-America.pdf
3) 18 million Never wanted insurance. Never needed as they were under 34. Could afford (made over $50,000) but now forced to buy something
they didn't want! http://coverageforall.org/pdf/BC-BS_Uninsured-America.pdf
So that leaves truly 5 million Americans! That's it!
And for that Obama totally lied and hired Gruber who ADMITTED it took
"the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass."
ObamaCare architect: 'Stupidity' of voters helped bill pass

What should have happened is the $270 billion a year lawyers make should have been taxed 10% LIKE Obamacare taxes tanning salons.
Using that $27 billion would provide a $5,000 a year premium for each of the less then 5 million that truly want and need health insurance.
The 10% tax would reduce proportionately as the $800 billion a year in defensive medicine costs decline which would lead to lower premiums.
This $800 billion in wasted health expenses comes from here!

90% of physicians say they order duplicate tests, refer to specialists all because they fear being sued by lawyers!
As a result almost $500 to $800 BILLION a year is the estimated WASTED health expenses in insurance claims!
But doctors under federal contracts DON"T order, DON"T FEAR because of the 1946 Tort Reform.
http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf
90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
"Physicians contracted by the federal government practice significantly less defensive medicine as they are protected against lawsuits by the 1946 Federal Tort Claims Act. "

Correct, MA's are not supplements, although they are often confused with each other. That's why I specifically separated and explained them.

No, I did not believe "Obama's gigantic lie", no one here is more anti-ACA than I am, and I pointed out precisely what I want in post 29.

Covering everyone under this plan would increase access to preventive and diagnostic care, saving significant dollars in the long run by catching issues far earlier. It would also no doubt create a massive cottage industry of clinics that specialize in preventive and diagnostic care, helping avoid long lines at doctor's offices.

Covering everyone under this plan would take a massive cost away from American employers, allowing them to concentrate on what they actually do and participate more efficiently in the intensely competitive global market.

Covering everyone under this plan would put a final and merciful end to this amazingly stupid seven-headed (ACA, group health, VA, Medicare, Medicaid, Worker's Comp and indigent care) joke of a health care delivery/payment "system" we currently have, in which NONE of the seven heads communicate seamlessly with the other, increasing efficiencies even more.

The only reason not to do this is political.
.

 

[healthmyths]

Reading this story I couldn't help but laugh at how dumb the vast majority of the MSM really is!

If House Speaker Paul Ryan has his way, the 115th Congress won’t just repeal Obamacare, it will dramatically reform Medicare, turning the program into a form of private insurance.

Ryan has long supported the controversial idea and, immediately after the election, he suggested that any Obamacare reform should include Medicare reform. Another key player, House Budget Chairman Tom Price, said Medicare reform was a top priority for the unified Republican government.
Can Paul Ryan actually privatize Medicare?

Dummies! Medicare IS privatized!!!
Centers for Medicare and Medicaid services (CMS) employs over 6,000 employees.
So let's see... how do these 6,000 people pay the over 1 billion claims submitted by over 900,000 Medicare providers for a total of $500 billion a year?
My goodness these people must be so efficient that works out to 168,000 claims per employee but wait
do supervisors do that? NOPE... assume 1 supervisor for every 10 employees or now 187,407 per employee!
now working 2,000 hours a year that works out to 100 claims per hour for a six hour day..breaks,etc.
or 1.7 claims per minute. IMPOSSIBILITY!

So how are these 6,000 employees SO DAMN efficient!
IT is because CMS has contracted with private for profit what are called Medicare Administrative Contractors (MACs) that bid on a profit basis to administer all these 1 billion claims, over 900,000 providers and 35 million beneficiaries.
AGAIN privatized management of Medicare is already happening!
Then add to it the nearly 500 Medicare Advantage (MAs) plans ...almost all for profit that also contract with
Medicare to provide ALL services at a basic charge to Medicare of $800/month per beneficiary!
So Medicare simply manages these 500 advantage plans again most for profit and the MAs actually
manage better the 12 million plus beneficiaries then the MACs.
Again privatization of Medicare already has been happening since Bush's 2003 Medicare Modernization Act
which only the dummies of the world fault Bush for the Part D component.
This privatization and modernization of Medicare has managed fairly well 46 million Americans and
all this palaver about oh Trump will privatize Medicare...BULL SHIT... It's already been done!

So what? What's important is that Medicare be available to all Americans who are old enough to be eligible, and that it be funded through taxation on people like you. I'd support increasing it on the overpaid, or increasing the income threshold where FICA taxes apply. But who cares if some 3rd party vendors do the paperwork? Not me.

So you think that employers who have employees that make over $118,000 (which is the cap today...) should pay the federal payroll taxes on
the entire amount the employee makes is that right?
Think that through because there are some extremely dire consequences.

As far as "who cares" if a 3rd party...?
I agree!
It is competitive rates that Medicare/SS should be dealing with! Then if the Medicare Advantage
plan can't cover their costs.. there are 500 more plans out there that have figured out how to do it.
As I've pointed out my MA is very cost efficient. They frequently call me advising me to see my physician for "PREVENTATIVE" CARE!
They know it is cheaper to prevent a problem then have to pay thousands due to an emergency hospitalization! Cheaper to have me see the
doctor early on. And that's the difference between current traditional Medicare they don't call me. They never pursued preventative care.
MY MA does and that's because the MA is cost driven!

No, I don't think it ought to be the entire income. But it can be higher. And yes, most companies can afford it. If their margins are so tight that they can't, then cry me a river.

So most companies can afford it. Where did you get that assumption?
FACTS... I deal in facts before making wild ass statements with NO supportive documentation!
Tell me how it can be higher?
FACT:
If the average person could realize that a 36% profit margin isn’t even close to reality,
and that the typical, median firm has a profit margin of only 6.5%, or almost 30 percentage points below what the public thinks is a normal profit margin, then hopefully the average person would become a little more realistic about how the business world operates.
Companies aren’t being stingy when they pay competitive wages, they’re just trying to survive on what are sometimes razor-thin profit margins, in a competitive environment where there’s not a large margin of error. If they’re not operating efficiently and watching costs very carefully, it’s pretty easy for a business to go from a 6.5% profit margin to a 0% break-even situation, and then to losses and bankruptcy —
just look at the more than half a million businesses that fail every year.
The public thinks the average company makes a 36% profit margin, which is about 5X too high - AEI

SO based on that fact that you like most average out of touch with reality person's estimate of "profit margins" of 36% are so wrong!

SO given that FACT... the average profit margin is 6.5% before taxes mind you...
Tell me how given this FACT..
Employers paid employees an average of $31.09 per hour worked in March 2013, according to the U.S. .Bureau of Labor Statistics.
Those are general statistics, which are not broken down by industry or occupation. a general percentage of 30 percent of your gross sales for labor. In that 30 percent, factor in all forms of expenses that are connected to employee compensation.
So raising the employer payroll taxes on ALL employees over $118,000 will reduce the net profits.
What Is the Average Percentage of Labor for Retail Businesses?

 

[RodISHI]

There was a 500 dollar co-pay for using the emergency room.

Interesting. It was a hundred bucks for that emergency shot after a severe allergic reaction. Now all the sudden in the last ten years its gone up to $600.00 verses $100.00.