Professor Krugman: as a wise person once told me; "Privatisation has never been about providing a cheaper, better service. It has always been about rich getting their hands on things we own."
It is so the rich can take s 20% cut straight off the top before and then we are left with what they didn't take. That is why they want to privatize the education system.
There isn't some evil group out there doing this; it's just the system is broken and we need to fix it. Everyone's 401k holds these same companies. Let's build something better, not attack a group of fellow humans.
States are now allowing vouchers — taxpayer money — to fund religious schools. I have a say in how my public schools are run through my elected school board but I have no say about the curriculum in private schools funded by my taxes. I should not have to pay for schools that teach kids I am a threat to this country because I do not share their religious beliefs. That is a violation of my freedom of religion.
How much influence do you and your fellow 401k 'owners' have over the behavior of a given insurance company, even collectively? For example, on executive salaries and bonuses? How much does a rich stockholder have, or collectively rich stockholders? Why do you think efforts at systemic reform are shot down or watered down? Who lobbies and pays for the campaigns of politicians blocking reform, and politicians misdirecting voters' attention to emotional culture war issues, away from questions of wealth and influence?
It's absolutely a question of constraining the behavior and reducing the excessive wealth of rich *individuals*. Their are no 'systems' deciding things, human beings have designed and maintained them, and abuse them for, ultimately, *individual* gains.
I think there is a good dividing line question: is it an essential service or one where the free market should compete? Phones and cell phones are one we shouldn't have public services IMO. Just some regulation. Health care's base services should not be private.
The distinction between public and private goods is one of practicality. It's not practical for my neighbor and I to each subscribe to a different Army or Navy, but there is no logistical reason that we can't choose different health care providers or different schools for our kids.
Sometimes, advancing technology will make a "natural monopoly" obsolete, as in your example of phone service.
The question isn't about choosing providers - we don't have a national health service in the US. The question is about choosing insurance - and having some restrictions on provider choice is FAR from new (ie HMOs).
I have traditional Medicare and have far more choice than someone with Medicare Disadvantage. In fact, more providers are beginning to refuse to take patients in Disadvantage. The providers know they will have to fight for prior authorization and for every penny.
Marge, do you know if you end up paying more or less for medical services? To me, that needs to be the biggest determinant. I can't find any research on this.
Something that Professor Krugman has written about frequently is that some sectors such as the health care sector lack the features necessary for a free market to function.
A more accurate term than “privatize” is “profitize”.
The argument for insurance companies made to allow private insurers to participate in Medicare was the classic free market argument — that for-profit companies are able to provide goods and services more efficiently, making those services cheaper and better. Too bad the media won’t call them out on their hypocrisy by demanding to know why they are getting more money per enrollee than traditional Medicare does.
Advantage plans are great if you are not actually that sick. I needed the dental coverage more than anything. My final choice was:
1. Citizenship in another country (not an option for everyone).
2. Move to and establish a residence in the other country (Italy), after a brief stint in Austria. Vienna, Austria has excellent healthcare and one of the largest (5th) hospitals in the EU. https://en.wikipedia.org/wiki/Vienna_General_Hospital
3. I opted out of Medicare Part B because I will probably never return to the USA. That saves me a fair amount of money every year. It took almost a year to get that processed by a US Consulate. I guess they don't like people doing that.
4. The USA should be happy. My SSA check goes into an EU economy, but they don't have to foot the bill for my health care in their country, which was very substantial while I was there.
5. I have remarkably been much better off since leaving and have barely utilized the health services thus far in the EU. My assigned doctor in Italy is a few blocks away and she has 5-star reviews.
Old people are no longer valued in a country ruled by Capitalists. Dental, hearing and optical care are crucial for the health of the elderly.
If you are older and deaf, or maybe just have a listening problem, you might consider getting your hearing checked. Rumor has it that deafness plays a role in the development of Alzheimer's.
"Advantage plans are great if you are not actually that sick."
Thanks for that opener; I'm not mocking you. The insurance companies behind Medicare Advantage know that the greatest medical expenses are incurred at end-of-life. That's why they never talk about what great deals they are at this stage, because they aren't. They are a cruel business, luring people into a situation not easy to get out of.
So the question is why don’t Americans want the same type of health care? Why is that? Gullibility is one due to poor education, bad food which makes you stupid. Love those uneducated fools as trump says.
I think Americans do want excellent healthcare, but they're inundated by messaging that implies you'd be a fool for not signing up with Medicare Advantage. Free groceries, dental care, gym membership... What's not to like? When it comes home to the MA members that prior authorizations and delay, delay, delay are the rules of the game when they desperately need care, THAT'S when it dawns on them what a rotten deal they've been handed.
Sometimes, It's just about money. Something like 25% of seniors have Social Security as their only form of income. Medicare Part B costs about $175 monthly, and I'm paying another $140 per month for a medigap policy to cover the other 20% of expenses that Medicare doesn't pay.
If your only income is $1200 a month in Social Security, that additional $140 per month would be a huge burden. But look! Over there! There's a Medicare Advantage plan that gives you dental, vision, and a gym membership, and the monthly payment is $0!
So they sign up. And it's fine...until they need surgery.
It wouldn't be hard to tweak Medicare so that it covered 100% of expenses instead of 80%. I'm paying almost as much to cover the last 20% of my expenses as I am to cover the first 80%. A change to the tax rates and monthly payments could fix that. But that would require that our politicians actually care about our health, and many of them clearly don't have that as a priority.
Some of the people who can't afford a Medigap policy can be covered by Medicaid. Each state has its own rules. But Medicaid pays the Medicare Part B premium and offers drug coverage as well.
Each state also has its own rules for how Medigap policy premiums are determined. I pay less now in SC than I did in a northern state, but mostly because I discovered that I could get a medically rated policy cheaper than a general policy. That is not well known.
As a rural resident, I did my research, and for out here, Medicare Advantage is a BAD idea.
Mostly because of the provider networks (regular Medicare allows you to go to ANY doctor that takes Medicare)- a provider network often means you drive hours, sometimes to another state, to see a specialist.
Except that I am in an MA plan and I do not need prior authorization. If I want to see a specialist, I make an appointment. If my doctor wants to order tests, he writes the order .(Physical therapy requires authorization, but has never been denied.) I don't get free dental care or free glasses, but they cover whatever Medicare covers and pick up the 20% that traditional Medicare does not pay and, yes, I have a free gym membership, and it comes with the same Rx pan I had while working.
I recognize that mine is an uncommon situation (provided through a very large employer) but it's out there.
None taken either, Chris. My deal is through state-employee retirement system that covers 500,000 people total, 100,000 in the MA plan. I assume that's pretty good negotiating position.
I know how lucky I am because I saw what happened to my brother-in-law when he had cancer. His network was fine but the costs were crazy, whereas I've got nationwide access have access to any doctor or hospital that accepts Medicare.
I am beginning to believe the food supply in the USA does make people stupid.
There is so much artificial stuff in there, and very little is known about how it affects people in terms of auto-immune diseases, chronic inflammation, etc.
My health improved immensely after shopping at open-air markets in Austria and Italy. Bad nutrition is simply bad.
They make it very difficult to drop Part B! I’ve been in the process for months!
(I decided it’s more cost efficient to use my money towards healthy diet and exercise rather than being pushed to take yearly tests based on my age rather than any actual concerns/symptoms that then actually end up costing me money because I apparently never manage to meet deductible for medical coverage-aargh!
You may regret dropping Part B if you don't have other coverage. It can be very costly to visit a hospital, get tests or see a doctor multiple times when you do develop a problem.
Can't say that I agree with the dichotomy of efficiency created by competition vs privatization. I spent a couple of decades of my career writing software and I was constantly looking for more efficient ways to do things. As far as I can tell, it was driven by the culture created at the specific organization - that is, the shared values which were continuously cultivated. I think we would get a lot more from our society by understanding such things and promoting actions and policies for both public and private sector which encourage, or sometimes force, well-balanced & positive values.
My husband and I moved from Seattle to Baltimore so he could receive treatment for CLL. We had always been on a MA plan as it is heavily lobbied at you in the Seattle area. To our surprise John’s Hopkins will not take any MA plan. This began a journey which opened our eyes. We are both straight Medicare now and will not go back. I think many seniors are given no or very skewed education on their choices. And although it is obscene to not provide dental care to seniors on Medicare, no decent dentist took our MA plans anyway. Virtual worthless. Although we are happily returning to Seattle we will not go back to MA. I wish we had better education for seniors before the sharks get them.
"Word on the street" is that once you're in MA, you "can't go back" to traditional Medicare. Good to hear the fact that that's wrong. Sounds like an interesting journey getting back to the nonprofit original version. Any wonder Johns Hopkins got out of the for-profit disadvantage?
“Medicare Advantage is extremely attractive when you’re healthy,” says Leslie T. Beck, a CFP in Rutherford, New Jersey. “But when something happens — and something always happens — and you’re in a Medicare Advantage plan, you can’t switch back. You can switch into regular Medicare, but you’ll never get a Medigap policy.”
(This is because in all but four states, once you’re past your first 6-month Medigap open enrollment period, you must medically qualify for a Medigap plan. Those with serious health issues may not be able to get a plan.)
Not to mention the fact that Mayo Clinic takes no advantage plans. Lots of hospitals are also dropping Medicare Advantage plans from their list of insurance they accept. I follow beckerspayer.com to get the inside knowledge on what is happening behind the scenes as broker and agency owner. I implore everyone who is on Medicare to do the same.
More like they ditched MA for the usual reasons that healthcare providers hate all insurance plans (except for the platinum ones): getting authorization is a total pain; and getting paid after you've done the work for patients is an even greater pain.
I just looked that up, and you can switch back during the enrollment period, and you have to have Part D coverage (drugs):
"Easy to change - that's one of the things open enrollment is for. My 74F husband changed from MA plan to OG Medicare last year. He did the underwriting questionnaire which was super easy. People are afraid of the underwriting yet they don't know what it involves. They ask about serious medical conditions, not the common things like high BP or cholesterol, ulcers, back problems, etc. If you don't quality, you don't lose anything, just stick with an MA plan.
Yes, OG Medicare plans cost more per month, but with that you get more choice in providers and less (or no) hassle with pre-authorization requirements."
Not every state requires medical underwriting to return from an MA plan to Original Medicare. But I agree, the underwriting process is not difficult. I used it to get a medically rated supplement, cheaper than other supplements. I was approved even though I have asthma and some other chronic illnesses.
I was and am fortunate in having a Medicare advisor who, from the get go, heartily warned against any Advantage plan, even though he, personally, would make more money. I’ve had straight Medicare since I retired.
You have a great advisor then. As an advisor and agency owner myself, I am straight with every one of my clients and tell them I would not put my own mother in an advantage plan. I also break down why and direct them to follow beckerspayer.com to read behind the scenes reporting on Medicare. I also think all the advertising for Medicare advantage should not be allowed. It’s very deceiving, especially for our senior population. Most of what they advertise is for people who are on dual plans (Medicare and Medicaid) so the plans look more attractive and they fish for people to contact them and they change them without doing all the research they should be doing to make sure they are putting these poor people into the correct plans. 82% of all Medicare advantage clients are in the WRONG plans for them. I learned this as a broker and about had a heart attack. Yes we make almost double signing people up into an advantage plan. It’s ridiculous. Terrible brokers do not care about what is ethical and right for their clients, some are out for the $ and will put clients into these plans without actually educating them on their options. I do not do that and advocate for original Medicare with a supplement. Why? Because it is far superior and will cover my client when they need it the most and not drain their pocketbook. It’s far superior. But don’t get me started on why dental, vision and hearing are not included. They should be. I hope this changes at some point in the near future. Sentinel Retirement Services
I think moving opened it up for us. But I believe you can do it under the birthday rule and open enrollment. This is outside my scope but I recommend talking to Medicare or the insurance regulator in your state.
How did you go back to regular Medicare? I thought that once you signed with an MA plan, you were permanently locked out of Medicare. Or does it depend on specific MA plans?
You can switch back to original Medicare and get a supplement (if you qualify and can pass underwriting). You have the ability to do so at AEP (October 15-Dec 7) or you also have OEP for people in advantage plans to switch to another advantage plan or return to original Medicare. If you do not have a broker, I suggest you seek out one you trust. If you need any assistance, I am happy to help. I am licensed in 23 states. My company is Sentinel Retirement Services. I am online and I have lots of great information on my website as well as a Medicare 101. My services are free of charge. I am contracted with 20 plus insurance companies. I get paid by whatever plans you choose to be enrolled into. The only thing I charge for is estate planning and notary services.
I’ve been told that if you have traditional Medicare and switch to a MA plan you cannot go back but if you start with MA plan you can switch to traditional Medicare. You might have higher cost/premiums or something due to health/age however - NYT had an article about this last year. I’d like to know more as I think about my parents as they continue to age.
Sloan-Kettering( except for NYC retired employees, Hospital for Special Surgery, some of the Mayo Clinics will no longer take MA plans. These do not hit the news. My small school district put retired employees on a MA plan. We raised $30,000 and found an attorney who forced the board of Education to put us back onto traditional Medicare with gap coverage if we chose this. For some reason I can not comprehend many did not choose to return to Medicare.
Thank you for highlighting the health care economy. It is deceptive that Medicare Advantage has the word Medicare in it because it’s not Medicare. In fact, the only advantage goes to the INSCOs that run them.
The only patients who are happy with Medicare advantage are seniors who haven’t gotten sick yet….
And when they do get sick, Medicare Advantage drops them. It happened to my brother.
I keep wondering who agreed that Medicare Advantage could use the name “Medicare” and their signature colors, thus confusing seniors to believe they are signing up for traditional Medicare.
Also, who agreed that the private plans can advertise (ad naseum) while traditional Medicare can’t?
Very good point about the advertising. I also sensed, from the number of emails I received during the last open enrollment period that Medicare.gov was pushing hard for Medicare “Advantage” plans—and this was under a Democratic administration. I can only imagine the burrage we are going to receive under the new admin.
They cannot deny you based on pre existing conditions for an advantage plan. The person above was incorrect, nor can they drop you from your plan if you have conditions. You can be dropped if the plan discontinues in your area (which you will be granted a special enrollment period to find a new plan) or you do not pay your Medicare part B premium. As a broker, I can’t stand advantage plans. They are awful. I give my clients the good and the bad. It is up to them to decide. The one thing most do not understand is that if you become sick on an advantage plan, you may not pass underwriting to get back into a supplement and original Medicare. Then you will be stuck paying for copays and co insurance permanently. You only get one 12 month look back period after enrolling into an advantage plan to be accepted into a supplement without underwriting. So it is very important that you choose wisely. Sentinel Retirement Services is my company and I have a Medicare 101 posted that explains lots of things for people. Take a look and I’m here if anyone needs anything or has questions. I have a chat widget. I’m licensed in 23 plus states and also do ACA under 65, notary, estate planning as well.
This wasn’t a preexisting condition. He needed cataract surgery and they dropped him. He hadn’t missed a payment. To my knowledge, they had not pulled out of the market in his area.
A word about life in the oppressed socialist country Norway: hospital stays are free and health expenses are capped at ca 400 $. Of course if you want botox and silicon you have to pay for it yourself, and there are private clinics for those who want to avoid queues. I saw my doctor today, it was booked last Friday. That's part of what 25 % income tax will buy you.
My husband had a minor health problem in Florence, Italy on a Sunday. The desk in our tourist level hotel called the doctor. Two hours later, she came to the hotel and spend 30 minutes with him. She gave him 2 prescriptions. They worked almost immediately. She is the ONLY doctor my husband truly respected and admired. Only cost $120.
Why stop at just Medicare vs. Medicare Advantage? The entire cloudcoocooland of American healthcare needs to be blown up and replaced. How do you manage anything when no one has any idea what things actually cost? If you look at an Explanation of Benefits and see what a provider has charged and see what the insurance has paid (and the provider has accepted) it appears that both parties are living in fantasyland. And we absolutely, positively need to get hedge funds out of the healthcare business!
EOB's are useful for explaining the insider economics of medicine. E.g., a doctor charges an insurance company $300 for performing procedure #123; but only gets paid $200. Said doctor claims that it cost him $150 to perform procedure #123, and thus only pays taxes on $50 of what insurance paid.
The feds sponsor "senior center" medicare consultants nationwide. I was one. The charter is to provide original medicare-fee for service and medicare advantage-capitated coverage information to 65 yr olds. Huge difference in incentives for insurance companies. To long a story for this format, but as volunteer consultants we never tried to talk people into capitated (all medicare advantage) plans. The deny, delay, defend business model has been understood for many years. Teeth cleaning and $40 a year for glasses never made up for DDD above, or out of network cost (that don't exist in original Medicare)... or the inability of getting a second opinion... or, or, or. Bottom line; incentivize a public company to deny coverage and oddly, they will do just that. And btw healthcare, be it hospital ownership or medical care should never be "for profit".
Yes, and in most states it goes through their state Department of Aging or equivalent. Do a search. I was so glad to find this, because I really didn't want to pour *more* government money into private programs by hiring a broker.
Hedge funds buy hospitals and nursing homes that own the land their sitting on in urban, expensive settings. They pay $x, separate the land from the business in an LLC, and lease it back to the business for $2x over 5yrs. It starves the hospital or nursing home (they could care less if the staffing is cut, capital improvements cannot be made). in 5 yrs they close the business and walk away... or as here in Watsonville, locals bail it out and retake it over. Good for the hedge fund, bad for the community-it's called "capital extraction". Medical facilities and care should be structured as non-profits. Period.
A note someone formerly in the insurance industry: Health care insurance is not really an insurance business; it is a financing business.
Prototypical insurance businesses are about risk diversification--think about the distinct actuarial occurrence of hurricanes v. earthquakes v. floods v. tornadoes v. drought. That difference in actuarial risk is what Property & Casualty insurance is based on.
But with health, everyone eventually gets very sick. Everyone eventually dies. You can't insure against death. You can only "cream" off the healthy population.
Therefore, health insurance is mostly a financing business--the young/healthy policyholders finance the older/unhealthy policyholders.
At some point, everyone is going to access their healthcare insurance. (Which isn't the case with other events, e.g. hurricanes, tornadoes, floods, etc.)
So in a very direct way, Medicare is like Social Security--the young finance the old (in our current demographics).
Would anyone, acting in good faith, really believe that we need an intermediary/middleman for the Social Security--having the old financed by the young? As Dr. Krugman noted, even the 2nd Bush administration ran rapidly away from that idea.
Similarly, it makes no economic sense for intermediaries/middlemen to be involved in a financing business like health care insurance. Middlemen don't make transfer from young to old more efficient. MIddlemen typically don't make the delivery of any public good more efficient.
And make no mistake: allowing the private sector into such health care financings is the equivalent of allowing a theoretical wealthy landowner to graze his cattle on the village green, typically to the detriment of most of the villagers.
Every late fall enrollment period we are inundated with “Medicare Advantage” advertising ad nauseam. How can Humana, United Healthcare and other private providers be allowed to offer a “plan” that literally takes you away from Medicare into the limited networks of private insurance? Isn’t it false and misleading advertising to use the name “Medicare” when, once enrolled, you have opted out of Medicare? While Republicans have always salivated over the privatization of Medicare, Democrats have stood idly by and have also failed to communicate the costs and risks of underwriting this scam with taxpayer money. From what I understand, traditional Medicare operates with a 2% administrative overhead while your typical dis-advantage plan has about a 14% administrative overhead. How is it that private industries have sold us on the myth of government inefficiency when Humana and others utilize billions of tax dollars on advertising, lobbying and shareholder profits while limiting access and denying coverage that Medicare routinely provides?
Well said, and particularly this: “While Republicans have always salivated over the privatization of Medicare, Democrats have stood idly by and have also failed to communicate the costs and risks of underwriting this scam with taxpayer money.” Though the Rs are worse, the Ds have been extremely lax on this.
I was not looking forward to being on Medicare, as we had good coverage prior to turning 65. But between Medicare and a supplemental policy, healthcare is relatively painless, and virtually every doctor accepts it. Having an advantage plan means dealing with a network that is always limited, just as it is with commercial insurance. This is something people getting ready to move to Medicare need to understand.
If Republicans had a brain, they’d quickly realize that a Medicare for all system would save people, companies, and governments at all levels hundreds of billions a year.
Sure, private insurance might mostly cease to exist, but how much more EPS would be added to let’s say GM stock or Walmart stock if their heath care costs fell by a third or a half?
Politicians in general benefit from insurance company kickbacks. Medicare Advantage, for example, is insanely profitable; and the insurance companies that deal in it share some of that profit with friendly politicians to make sure any attempts at reducing waste by Congress are quickly quashed.
I always thought the best way to do this is just to expand the Medicare program to younger and younger people every year. The program is already set up, no court cases from Republicans trying to kill the program, and it wouldn't be as hard as coming up with a whole new program for universal health care.
Yes, but Americans do not like being forced into anything. It needs to be a choice.
Medicare would cost about 50 to 60% of private insurance currently costs. That savings would be seen by employees in a larger net pay check. (What comes out now for a private insurance premium would disappear, and their Medicare premium- currently 1.45% would rise to cover their new insurance. The net difference would certainly be a positive for workers.
Employers would be able to radically shrink their health insurance costs as most workers would opt for Medicare- the net pay rise alone would be a huge incentive. Some employers could even offer bonuses or pay raises because they'd still save so much money.
Here's an example: I was a NYC public school teacher. NYC paid for my health insurance in full. (And it is an excellent plan). It costs the city about $25-30k a year. If Medicare was let's say half the cost- $15,000. NYC could save well over $3 BILLION a year on cost for the roughly city 240,000 employees. They could give everyone a $2000 a year raise (would cover the cost of higher Medicare deductions) and still save $2.5 billion a year.
For private companies, let's take Apple as an example: They have about 165,000 US employees. If they were able to save $10,000 per person on insurance, that would be $1.65 billion. With about 15.1 billion outstanding shares, that add eleven cents per share to earnings. In the last quarter (ending September 30) that would've pushed their EPS from 96 cents to $1.07.
What so many politicians and one percenters don't seem to realize, is whatever they're making from the private insurance business- in the form of campaign contributions, stock gains, etc.; they'd all make a boat load MORE if all companies were able to reduce their insurance costs by 40-50-60%.
Don't underestimate the leverage of having captive employees who depend upon the company for insurance. Cobra can be sky-high (and companies can add an administrative fee) and you have to run that out before turning to ACA.
So the key word is “stakeholders”…and that’s what went wrong with Obamacare although I am strong supporter of Obamacare. So in order to make Humana and BCBS and Aetna happy the Obama administration and Democratic senators brought health insurance companies into the discussion because they are considered “stakeholders” in our health insurance system. So in retrospect Obamacare should have been everyone up to 250% FPL without health insurance is automatically enrolled in Medicaid and everyone else without an employer provided plan gets a $2500 refundable tax credit to pay for their existing coverage which can be used to buy into Medicaid. Instead they brought in health insurance companies and they wanted access to this new market and so they tailored the legislation for them.
The problem is new stakeholders were created like the Kushner family and so in 2016 we should have just scrapped the ACA Exchanges (because the Medicaid expansion is what proved popular) but the Kushners had created a new company and so they lobbied to keep the ACA Exchanges. Florida actually has the most robust ACA Exchanges and it’s a big reason so many wealthy people can move there without a job lined up…so they can work in a state with a unique population like Florida.
You hit the nail on the head, profe! Its hard for seniors to not give in to the pressure they’re under to get into Advantage plans. And the plans are much more likely to hurt their health than offer any advantage. People are dying because of the delays insurers have built into these plans. Additionally “medigap” coverage is not necessarily a ggod buy either, but seniors are scared into buying it. Plain old vanilla Medicare is the best insurance plan we have and we must do more to unmask the fraud that Advantage providers are perpetuating on seniors AND all taxpayers. Keep up the great work, professor Krugman!
Medicare is far from perfect though. Since it covers only 80% of medical fees, people are required to pay for (you guessed it) private insurance supplemental policies.
You can get a Medigap policy to cover that 20% Medicare doesn't cover, but you don't have to. I have straight Medicare, but I can afford the 20% Medicare doesn't cover.
We had to sign my husband up for Medicare advantage because he is not 65 yet he is disabled. But Medicare only covers 80 percent and no drugs. People need to add a plan d drug plan and a plan for the other 20 percent and some just cannot afford it so they take Medicare advantage. I think this is mainly why people take the Medicare advantage plan, not the dental or vision
And how in the wide, wide world of sports did it EVER make sense to allow health insurance that doesn't cover dental or vision? Do my teeth or eyes have out of body experiences every time they visit the dentist or optometrist/ophthalmologist?
I’ve always thought that separating teeth and eyes from medical coverage was absurd.
Soon we’ll be required to buy individual insurance for liver, bones, skin, and pancreas. “Sorry, your plan only covers your stomach, not your esophagus.”
Dental, vision and hearing are all very important throughout life and I have never understood why that isn't automatically included in all healthcare. I didn't understand how important until years ago working with an older man he told me about finally giving in and getting hearing aids. He was practically crying because he felt he had missed out on so much with his grandchildren.
Professor Krugman: as a wise person once told me; "Privatisation has never been about providing a cheaper, better service. It has always been about rich getting their hands on things we own."
It is so the rich can take s 20% cut straight off the top before and then we are left with what they didn't take. That is why they want to privatize the education system.
There isn't some evil group out there doing this; it's just the system is broken and we need to fix it. Everyone's 401k holds these same companies. Let's build something better, not attack a group of fellow humans.
States are now allowing vouchers — taxpayer money — to fund religious schools. I have a say in how my public schools are run through my elected school board but I have no say about the curriculum in private schools funded by my taxes. I should not have to pay for schools that teach kids I am a threat to this country because I do not share their religious beliefs. That is a violation of my freedom of religion.
How much influence do you and your fellow 401k 'owners' have over the behavior of a given insurance company, even collectively? For example, on executive salaries and bonuses? How much does a rich stockholder have, or collectively rich stockholders? Why do you think efforts at systemic reform are shot down or watered down? Who lobbies and pays for the campaigns of politicians blocking reform, and politicians misdirecting voters' attention to emotional culture war issues, away from questions of wealth and influence?
It's absolutely a question of constraining the behavior and reducing the excessive wealth of rich *individuals*. Their are no 'systems' deciding things, human beings have designed and maintained them, and abuse them for, ultimately, *individual* gains.
Plutocracy, Pollyanna.
I think there is a good dividing line question: is it an essential service or one where the free market should compete? Phones and cell phones are one we shouldn't have public services IMO. Just some regulation. Health care's base services should not be private.
The distinction between public and private goods is one of practicality. It's not practical for my neighbor and I to each subscribe to a different Army or Navy, but there is no logistical reason that we can't choose different health care providers or different schools for our kids.
Sometimes, advancing technology will make a "natural monopoly" obsolete, as in your example of phone service.
The question isn't about choosing providers - we don't have a national health service in the US. The question is about choosing insurance - and having some restrictions on provider choice is FAR from new (ie HMOs).
Ya which is pointless as they don't do anything. We should just have one federal entity manage it and push to lower costs and streamline things.
I have traditional Medicare and have far more choice than someone with Medicare Disadvantage. In fact, more providers are beginning to refuse to take patients in Disadvantage. The providers know they will have to fight for prior authorization and for every penny.
Marge, do you know if you end up paying more or less for medical services? To me, that needs to be the biggest determinant. I can't find any research on this.
Something that Professor Krugman has written about frequently is that some sectors such as the health care sector lack the features necessary for a free market to function.
https://archive.nytimes.com/krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/
A more accurate term than “privatize” is “profitize”.
The argument for insurance companies made to allow private insurers to participate in Medicare was the classic free market argument — that for-profit companies are able to provide goods and services more efficiently, making those services cheaper and better. Too bad the media won’t call them out on their hypocrisy by demanding to know why they are getting more money per enrollee than traditional Medicare does.
Thanks, Mr Krugman, for explaining this. The money quote for me was that privatization doesn’t make for efficiency; competition does.
Medicare: if you’re sick, you get care.
Medicare Advantage: if you’re sick, jump through a few hoops before you get care. If you’re still alive by then, you get Silver Sneakers!
Advantage plans are great if you are not actually that sick. I needed the dental coverage more than anything. My final choice was:
1. Citizenship in another country (not an option for everyone).
2. Move to and establish a residence in the other country (Italy), after a brief stint in Austria. Vienna, Austria has excellent healthcare and one of the largest (5th) hospitals in the EU. https://en.wikipedia.org/wiki/Vienna_General_Hospital
3. I opted out of Medicare Part B because I will probably never return to the USA. That saves me a fair amount of money every year. It took almost a year to get that processed by a US Consulate. I guess they don't like people doing that.
4. The USA should be happy. My SSA check goes into an EU economy, but they don't have to foot the bill for my health care in their country, which was very substantial while I was there.
5. I have remarkably been much better off since leaving and have barely utilized the health services thus far in the EU. My assigned doctor in Italy is a few blocks away and she has 5-star reviews.
Old people are no longer valued in a country ruled by Capitalists. Dental, hearing and optical care are crucial for the health of the elderly.
If you are older and deaf, or maybe just have a listening problem, you might consider getting your hearing checked. Rumor has it that deafness plays a role in the development of Alzheimer's.
https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/hearing-loss
I do miss my Silver Sneaker's perk. I have to pay for a gym membership in Italy.
"Advantage plans are great if you are not actually that sick."
Thanks for that opener; I'm not mocking you. The insurance companies behind Medicare Advantage know that the greatest medical expenses are incurred at end-of-life. That's why they never talk about what great deals they are at this stage, because they aren't. They are a cruel business, luring people into a situation not easy to get out of.
So the question is why don’t Americans want the same type of health care? Why is that? Gullibility is one due to poor education, bad food which makes you stupid. Love those uneducated fools as trump says.
I think Americans do want excellent healthcare, but they're inundated by messaging that implies you'd be a fool for not signing up with Medicare Advantage. Free groceries, dental care, gym membership... What's not to like? When it comes home to the MA members that prior authorizations and delay, delay, delay are the rules of the game when they desperately need care, THAT'S when it dawns on them what a rotten deal they've been handed.
Sometimes, It's just about money. Something like 25% of seniors have Social Security as their only form of income. Medicare Part B costs about $175 monthly, and I'm paying another $140 per month for a medigap policy to cover the other 20% of expenses that Medicare doesn't pay.
If your only income is $1200 a month in Social Security, that additional $140 per month would be a huge burden. But look! Over there! There's a Medicare Advantage plan that gives you dental, vision, and a gym membership, and the monthly payment is $0!
So they sign up. And it's fine...until they need surgery.
It wouldn't be hard to tweak Medicare so that it covered 100% of expenses instead of 80%. I'm paying almost as much to cover the last 20% of my expenses as I am to cover the first 80%. A change to the tax rates and monthly payments could fix that. But that would require that our politicians actually care about our health, and many of them clearly don't have that as a priority.
Some of the people who can't afford a Medigap policy can be covered by Medicaid. Each state has its own rules. But Medicaid pays the Medicare Part B premium and offers drug coverage as well.
Each state also has its own rules for how Medigap policy premiums are determined. I pay less now in SC than I did in a northern state, but mostly because I discovered that I could get a medically rated policy cheaper than a general policy. That is not well known.
Indeed it isn't. I'd never heard of such policies, googled it, and Google tells me that they're typically more expensive, not less.
As a rural resident, I did my research, and for out here, Medicare Advantage is a BAD idea.
Mostly because of the provider networks (regular Medicare allows you to go to ANY doctor that takes Medicare)- a provider network often means you drive hours, sometimes to another state, to see a specialist.
Except that I am in an MA plan and I do not need prior authorization. If I want to see a specialist, I make an appointment. If my doctor wants to order tests, he writes the order .(Physical therapy requires authorization, but has never been denied.) I don't get free dental care or free glasses, but they cover whatever Medicare covers and pick up the 20% that traditional Medicare does not pay and, yes, I have a free gym membership, and it comes with the same Rx pan I had while working.
I recognize that mine is an uncommon situation (provided through a very large employer) but it's out there.
No aggression meant. But just make sure wherever you travel that you have coverage.
None taken either, Chris. My deal is through state-employee retirement system that covers 500,000 people total, 100,000 in the MA plan. I assume that's pretty good negotiating position.
I know how lucky I am because I saw what happened to my brother-in-law when he had cancer. His network was fine but the costs were crazy, whereas I've got nationwide access have access to any doctor or hospital that accepts Medicare.
I am beginning to believe the food supply in the USA does make people stupid.
There is so much artificial stuff in there, and very little is known about how it affects people in terms of auto-immune diseases, chronic inflammation, etc.
My health improved immensely after shopping at open-air markets in Austria and Italy. Bad nutrition is simply bad.
They make it very difficult to drop Part B! I’ve been in the process for months!
(I decided it’s more cost efficient to use my money towards healthy diet and exercise rather than being pushed to take yearly tests based on my age rather than any actual concerns/symptoms that then actually end up costing me money because I apparently never manage to meet deductible for medical coverage-aargh!
You may regret dropping Part B if you don't have other coverage. It can be very costly to visit a hospital, get tests or see a doctor multiple times when you do develop a problem.
My thought, too. If you're old enough for Medicare, you're old enough that the risks are very real.
If you can even get the care.
Can't say that I agree with the dichotomy of efficiency created by competition vs privatization. I spent a couple of decades of my career writing software and I was constantly looking for more efficient ways to do things. As far as I can tell, it was driven by the culture created at the specific organization - that is, the shared values which were continuously cultivated. I think we would get a lot more from our society by understanding such things and promoting actions and policies for both public and private sector which encourage, or sometimes force, well-balanced & positive values.
My husband and I moved from Seattle to Baltimore so he could receive treatment for CLL. We had always been on a MA plan as it is heavily lobbied at you in the Seattle area. To our surprise John’s Hopkins will not take any MA plan. This began a journey which opened our eyes. We are both straight Medicare now and will not go back. I think many seniors are given no or very skewed education on their choices. And although it is obscene to not provide dental care to seniors on Medicare, no decent dentist took our MA plans anyway. Virtual worthless. Although we are happily returning to Seattle we will not go back to MA. I wish we had better education for seniors before the sharks get them.
"Word on the street" is that once you're in MA, you "can't go back" to traditional Medicare. Good to hear the fact that that's wrong. Sounds like an interesting journey getting back to the nonprofit original version. Any wonder Johns Hopkins got out of the for-profit disadvantage?
I found this: https://www.nerdwallet.com/article/insurance/medicare/why-do-so-many-older-adults-choose-medicare-advantage
“Medicare Advantage is extremely attractive when you’re healthy,” says Leslie T. Beck, a CFP in Rutherford, New Jersey. “But when something happens — and something always happens — and you’re in a Medicare Advantage plan, you can’t switch back. You can switch into regular Medicare, but you’ll never get a Medigap policy.”
(This is because in all but four states, once you’re past your first 6-month Medigap open enrollment period, you must medically qualify for a Medigap plan. Those with serious health issues may not be able to get a plan.)
Not to mention the fact that Mayo Clinic takes no advantage plans. Lots of hospitals are also dropping Medicare Advantage plans from their list of insurance they accept. I follow beckerspayer.com to get the inside knowledge on what is happening behind the scenes as broker and agency owner. I implore everyone who is on Medicare to do the same.
More like they ditched MA for the usual reasons that healthcare providers hate all insurance plans (except for the platinum ones): getting authorization is a total pain; and getting paid after you've done the work for patients is an even greater pain.
I just looked that up, and you can switch back during the enrollment period, and you have to have Part D coverage (drugs):
"Easy to change - that's one of the things open enrollment is for. My 74F husband changed from MA plan to OG Medicare last year. He did the underwriting questionnaire which was super easy. People are afraid of the underwriting yet they don't know what it involves. They ask about serious medical conditions, not the common things like high BP or cholesterol, ulcers, back problems, etc. If you don't quality, you don't lose anything, just stick with an MA plan.
Yes, OG Medicare plans cost more per month, but with that you get more choice in providers and less (or no) hassle with pre-authorization requirements."
https://www.reddit.com/r/medicare/comments/1fzdor8/changing_back_to_medicare_advantage_to_original/?rdt=41651
Not every state requires medical underwriting to return from an MA plan to Original Medicare. But I agree, the underwriting process is not difficult. I used it to get a medically rated supplement, cheaper than other supplements. I was approved even though I have asthma and some other chronic illnesses.
Johns Hopkins offer its own MA called Johns Hopkins Advantage MD. https://www.hopkinsmedicare.com/what-medicare-doesnt-cover/
So why does Congress allow it? More importantly why do voters allow their congress folks screw them? Stunning.
Because Americans may or may not be stupid, but they are undeniably ignorant.
And because the insurance companies have lobbyists, and our lobbyists are the representatives they're giving money to...
True. Easily manipulated.
Campaign contributions to elected officials who support the insurance industry
I was and am fortunate in having a Medicare advisor who, from the get go, heartily warned against any Advantage plan, even though he, personally, would make more money. I’ve had straight Medicare since I retired.
You have a great advisor then. As an advisor and agency owner myself, I am straight with every one of my clients and tell them I would not put my own mother in an advantage plan. I also break down why and direct them to follow beckerspayer.com to read behind the scenes reporting on Medicare. I also think all the advertising for Medicare advantage should not be allowed. It’s very deceiving, especially for our senior population. Most of what they advertise is for people who are on dual plans (Medicare and Medicaid) so the plans look more attractive and they fish for people to contact them and they change them without doing all the research they should be doing to make sure they are putting these poor people into the correct plans. 82% of all Medicare advantage clients are in the WRONG plans for them. I learned this as a broker and about had a heart attack. Yes we make almost double signing people up into an advantage plan. It’s ridiculous. Terrible brokers do not care about what is ethical and right for their clients, some are out for the $ and will put clients into these plans without actually educating them on their options. I do not do that and advocate for original Medicare with a supplement. Why? Because it is far superior and will cover my client when they need it the most and not drain their pocketbook. It’s far superior. But don’t get me started on why dental, vision and hearing are not included. They should be. I hope this changes at some point in the near future. Sentinel Retirement Services
Looks like folks are figuring out how to switch. So read thru the threads for information. I personally did Part G as well so I don’t have copays.
I think moving opened it up for us. But I believe you can do it under the birthday rule and open enrollment. This is outside my scope but I recommend talking to Medicare or the insurance regulator in your state.
Neither will the Mayo Clinic in Florida.
How did you go back to regular Medicare? I thought that once you signed with an MA plan, you were permanently locked out of Medicare. Or does it depend on specific MA plans?
My mother was on a MA plan a number of years ago and it was awful. She switched back to regular Medicare.
You can switch back during the open enrollment period, which runs from October to December.
https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
You can switch back to original Medicare and get a supplement (if you qualify and can pass underwriting). You have the ability to do so at AEP (October 15-Dec 7) or you also have OEP for people in advantage plans to switch to another advantage plan or return to original Medicare. If you do not have a broker, I suggest you seek out one you trust. If you need any assistance, I am happy to help. I am licensed in 23 states. My company is Sentinel Retirement Services. I am online and I have lots of great information on my website as well as a Medicare 101. My services are free of charge. I am contracted with 20 plus insurance companies. I get paid by whatever plans you choose to be enrolled into. The only thing I charge for is estate planning and notary services.
Isn’t there an open season. Call Medicare and find out.
I’ve been told that if you have traditional Medicare and switch to a MA plan you cannot go back but if you start with MA plan you can switch to traditional Medicare. You might have higher cost/premiums or something due to health/age however - NYT had an article about this last year. I’d like to know more as I think about my parents as they continue to age.
Sloan-Kettering( except for NYC retired employees, Hospital for Special Surgery, some of the Mayo Clinics will no longer take MA plans. These do not hit the news. My small school district put retired employees on a MA plan. We raised $30,000 and found an attorney who forced the board of Education to put us back onto traditional Medicare with gap coverage if we chose this. For some reason I can not comprehend many did not choose to return to Medicare.
Thank you for highlighting the health care economy. It is deceptive that Medicare Advantage has the word Medicare in it because it’s not Medicare. In fact, the only advantage goes to the INSCOs that run them.
The only patients who are happy with Medicare advantage are seniors who haven’t gotten sick yet….
And when they do get sick, Medicare Advantage drops them. It happened to my brother.
I keep wondering who agreed that Medicare Advantage could use the name “Medicare” and their signature colors, thus confusing seniors to believe they are signing up for traditional Medicare.
Also, who agreed that the private plans can advertise (ad naseum) while traditional Medicare can’t?
Very good point about the advertising. I also sensed, from the number of emails I received during the last open enrollment period that Medicare.gov was pushing hard for Medicare “Advantage” plans—and this was under a Democratic administration. I can only imagine the burrage we are going to receive under the new admin.
Question: I thought they couldn't deny you based on pre existing conditions. Do they just raise your rates dramatically?
They cannot deny you based on pre existing conditions for an advantage plan. The person above was incorrect, nor can they drop you from your plan if you have conditions. You can be dropped if the plan discontinues in your area (which you will be granted a special enrollment period to find a new plan) or you do not pay your Medicare part B premium. As a broker, I can’t stand advantage plans. They are awful. I give my clients the good and the bad. It is up to them to decide. The one thing most do not understand is that if you become sick on an advantage plan, you may not pass underwriting to get back into a supplement and original Medicare. Then you will be stuck paying for copays and co insurance permanently. You only get one 12 month look back period after enrolling into an advantage plan to be accepted into a supplement without underwriting. So it is very important that you choose wisely. Sentinel Retirement Services is my company and I have a Medicare 101 posted that explains lots of things for people. Take a look and I’m here if anyone needs anything or has questions. I have a chat widget. I’m licensed in 23 plus states and also do ACA under 65, notary, estate planning as well.
This wasn’t a preexisting condition. He needed cataract surgery and they dropped him. He hadn’t missed a payment. To my knowledge, they had not pulled out of the market in his area.
A word about life in the oppressed socialist country Norway: hospital stays are free and health expenses are capped at ca 400 $. Of course if you want botox and silicon you have to pay for it yourself, and there are private clinics for those who want to avoid queues. I saw my doctor today, it was booked last Friday. That's part of what 25 % income tax will buy you.
My husband had a minor health problem in Florence, Italy on a Sunday. The desk in our tourist level hotel called the doctor. Two hours later, she came to the hotel and spend 30 minutes with him. She gave him 2 prescriptions. They worked almost immediately. She is the ONLY doctor my husband truly respected and admired. Only cost $120.
Perfect example!
Why stop at just Medicare vs. Medicare Advantage? The entire cloudcoocooland of American healthcare needs to be blown up and replaced. How do you manage anything when no one has any idea what things actually cost? If you look at an Explanation of Benefits and see what a provider has charged and see what the insurance has paid (and the provider has accepted) it appears that both parties are living in fantasyland. And we absolutely, positively need to get hedge funds out of the healthcare business!
EOB's are useful for explaining the insider economics of medicine. E.g., a doctor charges an insurance company $300 for performing procedure #123; but only gets paid $200. Said doctor claims that it cost him $150 to perform procedure #123, and thus only pays taxes on $50 of what insurance paid.
The feds sponsor "senior center" medicare consultants nationwide. I was one. The charter is to provide original medicare-fee for service and medicare advantage-capitated coverage information to 65 yr olds. Huge difference in incentives for insurance companies. To long a story for this format, but as volunteer consultants we never tried to talk people into capitated (all medicare advantage) plans. The deny, delay, defend business model has been understood for many years. Teeth cleaning and $40 a year for glasses never made up for DDD above, or out of network cost (that don't exist in original Medicare)... or the inability of getting a second opinion... or, or, or. Bottom line; incentivize a public company to deny coverage and oddly, they will do just that. And btw healthcare, be it hospital ownership or medical care should never be "for profit".
Yes, and in most states it goes through their state Department of Aging or equivalent. Do a search. I was so glad to find this, because I really didn't want to pour *more* government money into private programs by hiring a broker.
and don't get me started:
Hedge funds buy hospitals and nursing homes that own the land their sitting on in urban, expensive settings. They pay $x, separate the land from the business in an LLC, and lease it back to the business for $2x over 5yrs. It starves the hospital or nursing home (they could care less if the staffing is cut, capital improvements cannot be made). in 5 yrs they close the business and walk away... or as here in Watsonville, locals bail it out and retake it over. Good for the hedge fund, bad for the community-it's called "capital extraction". Medical facilities and care should be structured as non-profits. Period.
A note someone formerly in the insurance industry: Health care insurance is not really an insurance business; it is a financing business.
Prototypical insurance businesses are about risk diversification--think about the distinct actuarial occurrence of hurricanes v. earthquakes v. floods v. tornadoes v. drought. That difference in actuarial risk is what Property & Casualty insurance is based on.
But with health, everyone eventually gets very sick. Everyone eventually dies. You can't insure against death. You can only "cream" off the healthy population.
Therefore, health insurance is mostly a financing business--the young/healthy policyholders finance the older/unhealthy policyholders.
At some point, everyone is going to access their healthcare insurance. (Which isn't the case with other events, e.g. hurricanes, tornadoes, floods, etc.)
So in a very direct way, Medicare is like Social Security--the young finance the old (in our current demographics).
Would anyone, acting in good faith, really believe that we need an intermediary/middleman for the Social Security--having the old financed by the young? As Dr. Krugman noted, even the 2nd Bush administration ran rapidly away from that idea.
Similarly, it makes no economic sense for intermediaries/middlemen to be involved in a financing business like health care insurance. Middlemen don't make transfer from young to old more efficient. MIddlemen typically don't make the delivery of any public good more efficient.
And make no mistake: allowing the private sector into such health care financings is the equivalent of allowing a theoretical wealthy landowner to graze his cattle on the village green, typically to the detriment of most of the villagers.
Every late fall enrollment period we are inundated with “Medicare Advantage” advertising ad nauseam. How can Humana, United Healthcare and other private providers be allowed to offer a “plan” that literally takes you away from Medicare into the limited networks of private insurance? Isn’t it false and misleading advertising to use the name “Medicare” when, once enrolled, you have opted out of Medicare? While Republicans have always salivated over the privatization of Medicare, Democrats have stood idly by and have also failed to communicate the costs and risks of underwriting this scam with taxpayer money. From what I understand, traditional Medicare operates with a 2% administrative overhead while your typical dis-advantage plan has about a 14% administrative overhead. How is it that private industries have sold us on the myth of government inefficiency when Humana and others utilize billions of tax dollars on advertising, lobbying and shareholder profits while limiting access and denying coverage that Medicare routinely provides?
Well said, and particularly this: “While Republicans have always salivated over the privatization of Medicare, Democrats have stood idly by and have also failed to communicate the costs and risks of underwriting this scam with taxpayer money.” Though the Rs are worse, the Ds have been extremely lax on this.
One being active; one being passive. Both paid off.
I was not looking forward to being on Medicare, as we had good coverage prior to turning 65. But between Medicare and a supplemental policy, healthcare is relatively painless, and virtually every doctor accepts it. Having an advantage plan means dealing with a network that is always limited, just as it is with commercial insurance. This is something people getting ready to move to Medicare need to understand.
If Republicans had a brain, they’d quickly realize that a Medicare for all system would save people, companies, and governments at all levels hundreds of billions a year.
Sure, private insurance might mostly cease to exist, but how much more EPS would be added to let’s say GM stock or Walmart stock if their heath care costs fell by a third or a half?
Politicians in general benefit from insurance company kickbacks. Medicare Advantage, for example, is insanely profitable; and the insurance companies that deal in it share some of that profit with friendly politicians to make sure any attempts at reducing waste by Congress are quickly quashed.
Nothing like a good PAC to enrich those old geezers sitting in Congress. Yep, they have very good health care.
I always thought the best way to do this is just to expand the Medicare program to younger and younger people every year. The program is already set up, no court cases from Republicans trying to kill the program, and it wouldn't be as hard as coming up with a whole new program for universal health care.
Yes, but Americans do not like being forced into anything. It needs to be a choice.
Medicare would cost about 50 to 60% of private insurance currently costs. That savings would be seen by employees in a larger net pay check. (What comes out now for a private insurance premium would disappear, and their Medicare premium- currently 1.45% would rise to cover their new insurance. The net difference would certainly be a positive for workers.
Employers would be able to radically shrink their health insurance costs as most workers would opt for Medicare- the net pay rise alone would be a huge incentive. Some employers could even offer bonuses or pay raises because they'd still save so much money.
Here's an example: I was a NYC public school teacher. NYC paid for my health insurance in full. (And it is an excellent plan). It costs the city about $25-30k a year. If Medicare was let's say half the cost- $15,000. NYC could save well over $3 BILLION a year on cost for the roughly city 240,000 employees. They could give everyone a $2000 a year raise (would cover the cost of higher Medicare deductions) and still save $2.5 billion a year.
For private companies, let's take Apple as an example: They have about 165,000 US employees. If they were able to save $10,000 per person on insurance, that would be $1.65 billion. With about 15.1 billion outstanding shares, that add eleven cents per share to earnings. In the last quarter (ending September 30) that would've pushed their EPS from 96 cents to $1.07.
What so many politicians and one percenters don't seem to realize, is whatever they're making from the private insurance business- in the form of campaign contributions, stock gains, etc.; they'd all make a boat load MORE if all companies were able to reduce their insurance costs by 40-50-60%.
Don't underestimate the leverage of having captive employees who depend upon the company for insurance. Cobra can be sky-high (and companies can add an administrative fee) and you have to run that out before turning to ACA.
So the key word is “stakeholders”…and that’s what went wrong with Obamacare although I am strong supporter of Obamacare. So in order to make Humana and BCBS and Aetna happy the Obama administration and Democratic senators brought health insurance companies into the discussion because they are considered “stakeholders” in our health insurance system. So in retrospect Obamacare should have been everyone up to 250% FPL without health insurance is automatically enrolled in Medicaid and everyone else without an employer provided plan gets a $2500 refundable tax credit to pay for their existing coverage which can be used to buy into Medicaid. Instead they brought in health insurance companies and they wanted access to this new market and so they tailored the legislation for them.
The problem is new stakeholders were created like the Kushner family and so in 2016 we should have just scrapped the ACA Exchanges (because the Medicaid expansion is what proved popular) but the Kushners had created a new company and so they lobbied to keep the ACA Exchanges. Florida actually has the most robust ACA Exchanges and it’s a big reason so many wealthy people can move there without a job lined up…so they can work in a state with a unique population like Florida.
You hit the nail on the head, profe! Its hard for seniors to not give in to the pressure they’re under to get into Advantage plans. And the plans are much more likely to hurt their health than offer any advantage. People are dying because of the delays insurers have built into these plans. Additionally “medigap” coverage is not necessarily a ggod buy either, but seniors are scared into buying it. Plain old vanilla Medicare is the best insurance plan we have and we must do more to unmask the fraud that Advantage providers are perpetuating on seniors AND all taxpayers. Keep up the great work, professor Krugman!
Medicare is far from perfect though. Since it covers only 80% of medical fees, people are required to pay for (you guessed it) private insurance supplemental policies.
You can get a Medigap policy to cover that 20% Medicare doesn't cover, but you don't have to. I have straight Medicare, but I can afford the 20% Medicare doesn't cover.
Good luck if you ever need a heart replacement or other very expensive surgery. 20% of a huge number is a very big number.
I'm currently taking a medication that costs about $40k a month without insurance. I understand that things can get out of hand.
We had to sign my husband up for Medicare advantage because he is not 65 yet he is disabled. But Medicare only covers 80 percent and no drugs. People need to add a plan d drug plan and a plan for the other 20 percent and some just cannot afford it so they take Medicare advantage. I think this is mainly why people take the Medicare advantage plan, not the dental or vision
And how in the wide, wide world of sports did it EVER make sense to allow health insurance that doesn't cover dental or vision? Do my teeth or eyes have out of body experiences every time they visit the dentist or optometrist/ophthalmologist?
I’ve always thought that separating teeth and eyes from medical coverage was absurd.
Soon we’ll be required to buy individual insurance for liver, bones, skin, and pancreas. “Sorry, your plan only covers your stomach, not your esophagus.”
Dental, vision and hearing are all very important throughout life and I have never understood why that isn't automatically included in all healthcare. I didn't understand how important until years ago working with an older man he told me about finally giving in and getting hearing aids. He was practically crying because he felt he had missed out on so much with his grandchildren.
Privatization of Public Services always comes at a cost. That cost becomes profits/earnings for CEO’s and wealthy stock holders… and the beat goes on.
GOP Mantra:
Vote Republican, we want to kill you.
Along with, "We hate the middle class, but don't tell anyone."