Roger wrote: Can someone explain to me exactly how Medicare is a broken system?


My biggest issue with Medi-Care/Aid is that the government uses its heavy hand to pay 20% below market rates.  That would be fine if it actually lowered costs, but instead of lowering costs, it merely transfers them.  No big deal, except that the market rate isn't changing, the costs are borne by the insured and still Medicare is going bankrupt/ There are plenty of other bills to be paid, so raising the line item continually in the federal budget can't be the answer.  

We're looking to the government for health-care reform, but instead of innovating the existing programs are part of the problem.  The government should be innovating within the existing progams, abandoning fee-for-service in favor of lumped fee-for-care models, in which price is set according to the illness and the outcome, rather than by what tests are run or how many visits are scheduled with a patient.  Private insurance is no visionary enterprise either.  However, self-insuring corporations large enough to negotiate with physician/hospital networks (e.g., Toyota, Microsoft, GE) have adopted fee-for care models and have promoted preventative care by the incentives they offer their insured employees.  While this model is easier to adopt when you control the paycheck of both the insured and the care provider, it is indisputably a better model than Medicare.  

Whether a public health insurance plan is part of the health care reform bill or not, some mechanism changing the way health care is managed is necessary if we expect a high standard of care without astronomical costs.  Absent a public health insurance plan, the health care reform bill will simply be another transfer of wealth as subsidies to insurance companies will cover the costs for the now uninsurable with pre-existing conditions (i.e., significant health care needs) and those currently without health benefits.  Meanwhile Medicare will continue to underpay hospitals, who transfer the cost to insurers, who pass it along in premiums.  Absent a plan (public or private) that innovates the delivery of health care, the new bill is going to be nothing more than a different flavor of Medicaid.  However it gets written, and something will pass, we'll be back at this in a few years trying to solve the problem, but more likely than not debating the
 merits of public/private along party lines yet again, while the fundamental issues go unresolved.  

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From: roger Klinger <[log in to unmask]>
To: [log in to unmask]
Sent: Tuesday, August 18, 2009 5:36:32 PM
Subject: Re: [SKIVT-L] OT - HCR

On Tue, Aug 18, 2009 at 3:42 PM, Geoff Devine <[log in to unmask]> wrote: Medicare is a

pretty broken system.  

Can someone explain to me exactly how medicare is a broken system?

I understand that, due to the large amount of retiring baby boomers, funding it needs to be rethought.
On the other hand, since it pays only ~.80 on the dollar, it can be thought of as a bargain(until you realize that the twenty cents  gets paid through private insurance premiums).  As for quality of care, the medicare patient is seeing the same doctor that I am, so that aint' broken.  Without quoting party lines, can someone fill me in on what I'm missing? 

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