Medicare Benficiaries More Satisfied Than Those In Employer-Based Insurance Plans

While conservatives resort to scare tactics about “government take over of health care,” it turns out that those in the major government plan are happier than those in employer-based private plans. The findings from The Commonwealth Fund also have a bearing on the question of whether a public plan based upon Medicare should be part of a health reform plan. Their findings:

  • Medicare beneficiaries are more satisfied with their insurance coverage. Only 8 percent of elderly Medicare beneficiaries rated their insurance “fair or poor,” in contrast with 18 percent of individuals with employer-based insurance. Thirty-two percent of Medicare beneficiaries had at least one negative insurance experience, compared with 44 percent of those covered by an employer plan.
  • Medicare beneficiaries report easier access to physicians. Ten percent of Medicare beneficiaries’ physicians did not accept their insurance, compared with 17 percent of respondents with employer-sponsored plans.
  • Medicare beneficiaries are less likely to report not getting needed services. Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints. Of individuals with employer-based plans, 26 percent reported experiencing these cost/access issues.
  • Medicare beneficiaries are sicker and poorer but report fewer medical bill problems. Elderly Medicare beneficiaries were more likely to rate their health as fair or poor than the employer-coverage group (28% vs. 11%); more likely to have multiple chronic conditions (38% vs. 11%); and more likely to have incomes below 200 percent of the federal poverty level (51% vs. 27%). Yet, Medicare beneficiaries were less likely to report a medical bill problem than those covered by employer plans.
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36 Comments

  1. 1
    Fritz says:

    It sounds, from a cursory examination, that the study is comparing the attitudes of two groups of people without controlling for age, education, or income level. 

    Consider that many people on Medicare went through the Depression.  Perhaps they are grateful to be getting anything.  Comparing their attitudes against the attitudes of their children and then blaming the difference on the medical plans seems statistically problematic at best.

  2. 2
    Nance Confer says:

    Well, that’s encouraging.

    And may keep me from hurling a shoe at the next talking head on TV who assures us that most people are happy with their current healthcare coverage.

    They always fail to mention that they are, of course, talking to people who HAVE healthcare coverage.

    Nance

  3. 3
    Ron Chusid says:

    Fritz,

    If this came up with off the wall results then we might question things such as differences in age. However these findings are consistent with what I see in dealing with different plans every day. Patients in employer-paid plans are far more likely to run into problems such as having care denied for economic reasons, having problems because of doctors who not participate in their plans, and abruptly having their coverage either reduced or eliminated.

    These findings are really to be expected based upon the realities of employer-based insurance in this country. The fact that the Medicare patients are older and sicker really means that Medicare is satisfying people despite greater obstacles.

  4. 4
    Ron Chusid says:

    Nance,

    Most likely many people with insurance are happy with it. Some actually have good coverage. In many other cases their health is good enough (after all, these are employed people) so that they have not run into serious problems from their insurance denying care.

    The real issue, as you note, is the people who have no healthcare coverage.

  5. 5
    Fritz says:

    People compare, not against some Platonic ideal, but against what is potentially available to them.   Employed workers compare against the wide range of what other employers offer.

    For 80-year-olds the alternatives to Medicare for primary (not supplemental) medical insurance are, well, close to zip.  And whatever might be available would cost a great deal of money whereas Medicare is free (OK, already paid for, whatever, but the current cost to the recipient is zero).

  6. 6
    Ron Chusid says:

    No Fritz, that doesn’t explain it. There are real areas where Medicare surpasses private insurance as I mentioned above.

    There are also multiple alternatives to Medicare with the private Medicare Advantage plans. Of course they also create more headaches, while costing more to treat Medicare beneficiaries.

    I know it his hard to believe.  I didn’t believe it when I first got into medicine, but I was forced to give up my prior free market economic biases when I found that government does a better job than private insurance of providing health care and preserving greater choice.

  7. 7
    Fritz says:

    I never put “free market” and “health care” together.  There are so many legal constraints in so many different directions that it doesn’t make much sense.

    No, I don’t have a great set of solutions.  In some ways, the coming nationalization will be less costly.  Unfortunately I think we will wind up with something on the British model — which seems likely to be rather unpleasant.  And since Americans are the last people in the world to actually be paying for Big Pharma R&D, we won’t even know what we will be missing once that money spigot dries up.

  8. 8
    Ron Chusid says:

    I doubt we will wind up with anything on the British model. With the exception of Michael Moore, nobody in this country is calling for anything like that.

  9. 9
    Fritz says:

    Ron, I clearly have more faith in the incompetence of the American government than you have.

  10. 10
    Ron Chusid says:

    Fritz,

    I might have every bit as much faith in the incompetence of the government as you do. The difference is that I have more faith than you in the incompetence of big business.

    It isn’t entirely a matter of competence. Health care has problems when covered by the private sector. The motivation by health insurance companies to make money often conflicts with actually delivering health care. They found a much more profitable business model in denying as opposed to providing health care.

  11. 11
    Fritz says:

    Ron, you wound me to the core.  Have I ever in my postings here exhibited the slightest shred of faith in either the competence or honesty of big business?

    Health care also has problems when covered by the public sector.  I honestly am not sure which tends to be worse.  I just reflexively go for “less coercion”.

  12. 12
    Christopher Skyi says:

    Medicare is in even worse shape. The trustees said the program for hospital expenses will pay out more in benefits than it collects this year, just as it did for the first time in 2008.

    Well, Medicare has one definitive advantage over private plans — private plans must live w/in their means. Medicare can just spend whatever it needs:  the fact that in order to meet it’s objectives it has to spend more $$ than it has can be simply ignored given it’s a government program.  Real people, businesses, and organizations in the “real” world don’t have that option. They meet their costs or they’re soon out of business.

    But,  setting aside how responsible and ethical it is to live outside your means w/the expectation someone else will pick up the slack  — how long can this reasonably continue for Medicare? 

    I suspect if Medicare had to operate under the same constraints as everyone else much in the private sphere, the quality of their service would be much less.

    And I guess we need to set aside the whole point of health care reform — controlling cost.  We’ll just following the current Medicare model: don’t worry about costs.  And don’t worry about that happens next after you stop trying to control costs.

    As for the competence of big government in terms of responsibility and accountable when it comes to OUR money, check out this from the Naked Capitalism Blog:

    Federal Reserve Inspector General Unable to Answer Basic Questions on Where the Trillions Went

    “Rep. Alan Grayson asks Inspector General Coleman of the Federal Reserve some very basic questions of about various Fed programs and activities and gets nowhere. And the worse is that the IG isn’t stonewalling, but instead is clearly completely clueless.”

    Yup, big government can’t manage to stay on top of what they’re trying to do right now with the Fed and monetary policy, so let’s hand even more control of the economy over to big government. 

    OK Guys — have at me. If I’m wrong about this, I’m here to learn.

  13. 13
    Ron Chusid says:

    Fritz,

    The problem here is that the plan with “less coercion” turns out to be the one where people are less free.

    The government program, despite “coercion,” interferes less than many private plans with regards to interfering with choices made by doctors and patients.

    The plan with “less coercion” results in over 40 million being uninsured. It also leads to many being so terribly under-insured that many wind up declaring bankruptcy because of medical expenses despite having insurance.

  14. 14
    Ron Chusid says:

    Christopher,

    Private insurance is in a far worse off position than Medicare. With all its problems, Medicare is doing a better job of providing medical care at a lower cost than the private system. The private system is collapsing. Less and less people are covered at all.  The system is the largest cause of bankruptcy in this country.  Tweaks need to be made to Medicare, but it has cared for the elderly and disabled since the 1960’s and continues to provide care. It is doing far better than the private insurance industry.

    If you want to compare the government plans to private plans, look at Medicare Advantage. It costs 13% more to care for people in the private plans as compared to the government plan. Simply eliminating the subsidies to the private plans will help make Medicare fiscally sound again. Saying Medicare is not as good a program because it is not living within its means is nonsense–it is functioning with less money per person and still manages to provide better care than the private plans.

  15. 15
    Ron Chusid says:

    Medicare also works at a major disadvantage compared to private plans. It cannot say it will not cover people once they get sick as many private plans do. Instead it suffers from having to fix all the problems from people not receiving adequate care until they reach 65. Expanding Medicare would both save money and provide better care.

  16. 16
    Christopher Skyi says:

    “If you want to compare the government plans to private plans, look at Medicare Advantage. It costs 13% more to care for people in the private plans as compared to the government plan. Simply eliminating the subsidies to the private plans will help make Medicare fiscally sound again.”

    OK, this is really interesting, and I’ll probably have to research this more on my own, but let me pose this and you can give me your feedback:

    I’m a web designer.  I’m going to claim that I make web sites cheaper than all other available alternatives or companies. 

    Wow, that’s a great potential client says.  And it IS great — for them.

    Now consider that I’m cheaper because I’m undercutting my competition, which happens all the time and that’s fine, but let’s say that to undercut my competition, I have to charge LESS than the cost of running my business.  At the end of each month, I make up the difference by taking a cash advance out on my credit card.

    So — am I really more efficient, smarter, or somehow “better” than my competitors?  From a client’s point of view (or a Medicare patient),  the question isn’t important — they’re getting a service at the best available price.

    However, is that the end of the story?  No.  Because I’m NOT  really  more efficient, smarter, or somehow “better” than my competitors. I’m just running up my credit card, going deeper into debt, and that can’t last.  Nor is it business smart. It’s a recipe for eventual failure.

    Now, maybe I need to factor in these subsidies to the private plans you’re talking about to see the whole picture, but I’m not sure what those are or how they work. 

  17. 17
    Fritz says:

    Ron, why do you put quotes around the word coercion.  When the government is involved, that’s how it works.  That’s government’s metier. 

    I agree that expanding Medicare will fix some of its problems.  Most clearly, it will fix the problem of physicians not being willing to take on Medicare patients at government rates.  If Medicare is expanded, physicians will simply not have a choice.  (Oh, yeah, that’s that coercion thing).

  18. 18
    Ron Chusid says:

    Fritz,

    You also used quotes around coercion. I also wanted to point out the irony that the less coercive way (private plans) also results in less fee choice for most individuals as well as physicians. Besides, polls show a majority would be willing to pay more in taxes for health care reform, realizing this will save them money.

    The days in which Medicare pays less than private insurance are long gone. There are many private plans that many doctors do not take because of paying worse than Medicare. It also costs more to handle many insurances.

    If we had Medicare for all, physician overhead would be reduced tremendously. If we removed the physician overhead of dealing with multiple private plans, along with removing the problems of uninsured patients and insurance plans which fail to pay claims, most primary care doctors would come out ahead financially under Medicare for all. Some subspecialists and surgeons would come out behind, but they will still be making very high incomes.

    From an economic point of view, Medicare for all would be the most economical way to provide health care nationally, while still paying doctors well. There are other arguments based upon choice to preserve the option of private insurance, but this will also cost more. The argument that Medicare is going broke is a fallacious argument against health care reform.

  19. 19
    Ron Chusid says:

    Christopher,

    The analogy to web design doesn’t hold. The insurance companies are not actually providing health care–they just handle the payment to physicians. They are paying physicians around the same amount of money for the same health care, but it costs 13% more to care for them. (People also have the option of having additional coverage, but they have to pay extra for this). I don’t have time to look for the link for the previous post now, but it has been found that this extra 13% goes to higher profits for insurance companies, not to provide health care. My last post on Medicare Advantage includes links to earlier posts.

  20. 20
    Fritz says:

    Ron, whether Medicare is going broke is a different issue than whether it provides good standards of care.  I thought the revenue gap was pretty clear for Medicare as we look forward to baby boomer retirement.

    And I know doctors who don’t take Medicare patients because of payment differences, so I have some trouble believing that those issues are long gone.

  21. 21
    Ron Chusid says:

    Fritz,

    The quality of care from Medicare is as good or better when compared to any private payers. Medicare does not provide medical care–it handles the payment. The same people provide the care regardless of the plan. The only difference is that some plans besides Medicare are so restrictive that they negatively impact quality of care.

    There are doctors who don’t take Medicare patients. This may or may not mean it is on rational grounds. There are also doctors who do not take many private plans. The above study shows that  Medicare patients have less problem with access to care.

    I actually deal with reviewing the plans and their fee schedules so I know first hand how they compare. Of course I also take into consideration factors such as how reliably they pay and what additional costs are brought about due to participation in a play. I care about first hand information–not whether you know people who say they don’t take Medicare patients.

    I should also point out that this study compares Medicare patients to patient in employer-paid plans. Employer-paid plans, with all their problems, generally have far less problems than plans obtained thorough the individual market. Include that in the mix and Medicare would come out even further ahead.

  22. 22
    vulcanhammer says:

    “Health care has problems when covered by the private sector. The motivation by health insurance companies to make money often conflicts with actually delivering health care. They found a much more profitable business model in denying as opposed to providing health care.”

    And government run health care doesn’t deny care? Governments strictly ration care in order to reduce the explosive growth of health spending.
     
    Health care in the U.S. is dominated by the federal government…it is a canard to say that there is a “free-market” in health care when nearly a third of the federal budget gets allocated to the federally mandated programs like Medicare. If any other industry had that much government intervention, perverse price distortions and poor quality would also be the end result.
     

  23. 23
    Ron Chusid says:

    This is comparing Medicare with private health care in this country. With the systems we have, as is seen in this poll, private plans are more restrictive than the government plan.

    The Canadian plan is not under consideration in the United States but if we must bring it up at least everyone there has health care coverage. In this country even if you have private health coverage you are basically playing Russian roulette with all your money. If you get seriously sick your insurance might cover you, or you also have a very real chance of winding up in bankruptcy. That doesn’t happen in Canada.

    Medicare is a large percentage of health care spending because the private market is not able to handle providing care to the elderly or the disabled. Our current system barely works for those who are employed. It does not work for those who cannot receive insurance coverage through an employer.

  24. 24
    vulcanhammer says:

    Everybody has health care coverage with government mandated RATIONING which is why the landmark case by the Supreme Court of Canada striking down the ban on private health insurance displays the real shortcomings of ANY government run health plan: Benefits are determined not by individual choice but through the political process–If you need a hip replaced, get on line, take a number, and hope that the bureaucrat handling the load of cases that your file is in is having a good day–Russian Roulette, indeed. You may not go bankrupt in Canada but you might have to live with excruciating pain for quite a long time like Mr. George Zeliotis. Of course, a Canadian frustrated with his/her government health care could just head south to the U.S. for quick treatment. We won’t have that choice.

    “Medicare is a large percentage of health care spending because the private market is not able to handle providing care to the elderly or the disabled.”

    When Medicare was enacted in 1965 by Lyndon Johnson for his “Great Society” agenda, Medicare essentially destroyed a large and growing market for retiree health insurance–the private market was doing just fine before 1965: Johnson knew then what Democrats know now–a sure fire way to garner support and votes is to tell people that getting “free” health care is better for everybody even though as we have seen over the four decades, Medicare has become a bigger burden on our economy than anyone could have ever imagined and with less desirable results.

    “It does not work for those who cannot receive insurance coverage through an employer.”

    —Another example of how government intervention has created an unintended consequence: It was the federal government that tied health insurance to employment (during WWII); tax breaks are provided for employers who provide health insurance for their employees–but if you want to get health insurance on your own, you will not recieve the same tax incentive. This is not the fault of the private or free market.

  25. 25
    Ron Chusid says:

    Despite all the scare stories from the right–which generally turn out to be anecdotal incidents which turn out to be misrepresenting the actual plan–few Canadians would give up their coverage compared to the number of Americans who would love to have their coverage.  Fortunately this isn’t an issue because, despite the love by the right to obfuscate the issue with scare stories about Canada, such a system is not on the table here.

    If you don’t want rationing, you are making the case for expanding Medicare as this rations health care far less than health care is rationed in this country. Medicare restricts care far less than private plans which are looking at the bottom line. The worst rationing in this country is seen by the 80 million plus people in this country who are either uninsured or seriously under-insured (with this number likely to be much higher next time it is counted due to the large numbers of people who have lost insurance in the last several months).

    The federal government might have tied health insurance to employment, but this is the only thing which kept private insurance going for so long. The individual market does not work at all. Health care is one thing which the free market is not able to handle.

    Medicare did not destroy a “large and growing market for retiree health insurance.” This did not exist. The market was not able to handle care for the retired, and this was based on 1960’s medical technology. It could never handle today’s health care

  26. 26
    vulcanhammer says:

    “…scare stories from the right–which generally turn out to be anecdotal incidents which turn out to be misrepresenting the actual plan–few Canadians would give up their coverage compared to the number of Americans who would love to have their coverage.” —–If waiting for a year for hip replacement (a case that made its way to the highest court–no small affair) or any other rationed procedure is to be dismissed as a “scare story” by advocates of a government run health care plan, then it is no wonder why many Americans remain skeptical. You may be right about Canadians, in general, “loving” their government run health care. But if you grow up in a country where there was never another alternative or choice, is that really much of an endorsement?

    And as far as, “such a system is not on the table here;” It needn’t be exactly as the Canadian plan to be a health care plan that is by hook or by crook a government run/mandated health care system. You can call it whatever you want to and you can argue the minute differences but if it reduces the role of private companies, subsidizes, mandates care, and permits price controls (all of which Medicare does) then they are essentially just different ways of skinning a dead cat.

    “If you don’t want rationing, you are making the case for expanding Medicare as this rations health care far less than health care is rationed in this country. Medicare restricts care far less than private plans which are looking at the bottom line.”
    —Medicare has a bottom line too—It’s set by Congress (you don’t think that politics plays a factor, do you?) and taxpayers are the ones that fund this “bottom line.” And because there isn’t an infinite amount of “bottom line” that taxpayers can pony up to cover the costs of Medicare, it DOES indeed ration care: Medicare routinely restricts seniors’ choice of providers and sets prices for health services–this all reduces quality of care. If Medicare were expanded as you suggest, Congress would have no choice but to ration care in some fashion because the cost would be insurmountable:  Medicare spending is expected to increase dramatically in the future due to the retirement of the baby boom generation, rising longevity, rising medical prices, and new medical technology. In addition, these cost pressures will be exacerbated by a smaller number of workers paying taxes to cover a larger retired population. Expanding Medicare or creating a public option as Obama wants is a short term chimera leading to very harsh economic realities in the future.

    “The federal government might have tied health insurance to employment, but this is the only thing which kept private insurance going for so long. The individual market does not work at all.”—The point is that the federal government should not have created any incentive one way or another. If private insurance was going to die off then fine but the feds instead created an unintended consequence that today has made matters worse.

    “Health care is one thing which the free market is not able to handle.”—Nonsense. The free-market can handle anything and everything from the simplest to the most complex:  food production, high technology, manufacturing—there are things that are taken for granted every day that is brought to us by the free-market capitalist system.

    “Medicare did not destroy a ‘large and growing market for retiree health insurance.’ This did not exist. The market was not able to handle care for the retired, and this was based on 1960’s medical technology. It could never handle today’s health care.”—Yes, it did exist and although the private medical market is currently towered over by the federal government, it still has produced some very noteworthy breakthroughs in medicine and medical technology over the last forty years.

    BTW, the Commonwealth Fund survey is hardly definitive or even trust worthy since the Commonwealth Fund is hardly a disinterested party. Their questions to the survey population reek of data fishing or better yet resorting to a “leading question.” I’ll wait for a disinterested third party survey before taking any of their data points seriously.

  27. 27
    Ron Chusid says:

    It is amazing how the right wing manages to sell its propaganda to people like you who clearly have zero idea of how health care works.
    There is simply no relationship between the reality of the system and what you have been brainwashed to believe. You are simply repeating right wing talking points which are pushed to sell an agenda.

    There are horror stories in Canada. There are also many horror stories in the United States, along with far more people who fail to receive needed health care. I know as I’ve worked in the field for well over twenty years and have seen the types of lies which are told to try to preserve the system, and I’ve far more horror stories here than are being told about Canada. Note that today doctors are among the strongest proponents of changing the system. That’s because we see how the system actually works, see how it is collapsing, see the horror stories right here in the United States, and we are sick of working in a system which in many ways has become around the worst in the industrialized world.

    Before you talk about Medicare you should learn how the system really works. “Medicare routinely restricts seniors’ choice of providers.” False. Medicare is essentially open to any willing provider (assuming they haven’t been kicked out for something like fraud). In contrast it is common for private plans to have such restrictions. There is some form of rationing everywhere but there is far less under Medicare. This is why the poll came out as it did. You might decide to simply ignore facts which contradict what you have been brainwashed to believe, but the results in the Commonwealth Fund survey show the same attitudes about health care showed in other polls and most importantly they reflect what is actually happening.

    The free market can do many things better than government, but there are some things it cannot do, such as providing health care. It never was able to provide care to seniors, which is why Medicare was necessary. Writing about make believe plans for retiree insurance does not change reality. Medicare currently provides care at a lower price than private insurance while preserving more choice for both doctors and patients. Health care costs are expanding for everyone, with Medicare coping with this far better than the private insurance industry. Medicare can’t simply say it will stop paying to care for people once they get an expensive medical problem as many private plans do. This makes it look worse on paper, but in reality it is coping far better. Expanding Medicare would be one of the most cost effective ways to provide universal care.

  28. 28
    Fritz says:

    Ron, maybe you can tell me if this is wrong…  Back in the day, I believe that Medicare would not allow a physician to have any Medicare patients if that physician also treated people over 65 outside of the Medicare system.  Is that still true?  If so, I think that would absolutely count as Medicare restricting the ability of seniors to choose their provider.

  29. 29
    vulcanhammer says:

    Ron, what I find amazing is that liberals simply dismiss real, hard economic consequences and facts to sell their agenda. Almost every time and anywhere in history that a government has imposed a price ceiling on a desired resource–this has led to an over consumption of said resource (low prices drive people to consume, high prices drive people to conserve) and it has led to shortage. In the case of a government run health care plan, it will be extraordinarily expensive and it will inevitably lead to some sort of rationing. Every country that has a government run/mandated health care system has run up against this very real economic fact. You can not change the laws of physics or economics with wishful thinking or decree.

    “Note that today doctors are among the strongest proponents of changing the system. That’s because we see how the system actually works, see how it is collapsing, see the horror stories right here in the United States, and we are sick of working in a system which in many ways has become around the worst in the industrialized world.” —I’m not against dismantling this dreadful system that has been created and fostered by the federal government. I want a decentralized, price coordinated health care system—A system that doesn’t depend on the whims of politicians or their desire to please one interest group over another.

    “Before you talk about Medicare you should learn how the system really works.” I’ve dealt with Medicare plenty with my great-grandparents and grandparents. And there are restrictions.

    “There is some form of rationing everywhere but there is far less under Medicare. This is why the poll came out as it did.”—Yes, there is some form of rationing everywhere, in all systems. The big difference is that in a government run health care system the rationing is decided by a bureaucrat, while in a price coordinated system the rationing is done by the individual. Five or ten years from now, I don’t want a bureaucrat deciding how many hip replacement surgeries are allowed under the congressional budget. That type of health care may cover more people but it will, in some form or another, ration care though bureacracy.

    Medicare’s costs has been rising faster than inflation for years, so when you say that “Medicare currently provides care at a lower price than private insurance,” you’re avoiding the fact that Medicare doesn’t really provide care at a lower price because it 1)dictates prices to providers who have to accept them or get kicked out of the program. 2) Since it has a monopoly on retiree care, it has lower costs because it doesn’t need to compete with other competitors–it’s the only game in town so advertising is free and if you don’t like it–tough. 3) Government programs are notorious in how they hide costs from public scrutiny for fear of reprisal—that’s never happened, right?

    “The Commonwealth Fund survey show the same attitudes about health care showed in other polls and most importantly they reflect what is actually happening.”

    —Aside from the fact that the Commonwealth Fund is an organization that supports the expansion of Medicare or government run health care–not an unbiased organization–their poll questions are rigged to cast Medicare in a postive light. I noticed that they grouped all private insurance companies together—the good ones and the bad ones: If you poll Mercedes owners on how satisfied they are with their cars versus Suzuki owners, the difference will be quite obvious. If you lump both data together, the overall results will be far lower. If the Commonwealth Fund wants people to take their survey without skepticism, they should compare Medicare to the best private insurance since being the best and being measured to it should be Medicare’s goal. Their statistical slight of hand really is laughable.

    Long term, expanding Medicare would be an economic albatross that would burden our economy for decades. It makes no sense.

  30. 30
    Ron Chusid says:

    Fritz,

    That is not true. Virtually all seniors are in Medicare and there are not restrictions on who they can see. If someone decides not to join Medicare, then the Medicare rules do not apply to them and they can see any doctor who will take them.

  31. 31
    Ron Chusid says:

    Vulcanhammer,

    “what I find amazing is that liberals simply dismiss real, hard economic consequences and facts to sell their agenda”

    You have it exactly backwards. I was a hardcore supporter of Austrian economics. Over the past 30 years I found that advocates of such conservative economic theories, while right on some points, typically ignored any facts which contradicted what amounted to their religion. I’ve gone with the hard economic facts, including the facts which show that the free market is not capable of handling health care. I’ve changed my view based upon the facts. You are ignoring the facts.

    “I’ve dealt with Medicare plenty with my great-grandparents and grandparents. And there are restrictions.”

    Of course there are restrictions. The point is that the restrictions are much less than under employer paid health care, as the above poll showed. Dealing with the system with some relatives is hardly the same as working in health care every day with a wide variety of plans. Your comments here demonstrate that you do not understand how Medicare works.

    “Yes, there is some form of rationing everywhere, in all systems. The big difference is that in a government run health care system the rationing is decided by a bureaucrat, while in a price coordinated system the rationing is done by the individual.”

    What total bullshit! You say an employee of the government is a bureaucrat while an employee of an HMO or insurance company is an individual?? They are both individuals and in many ways both bureaucrats. The difference is that Medicare policies are based upon medical justification. Insurance decisions are made based upon their bottom line–they can deny paying for something just because they feel they can save money that way. If Medicare denies something there is due process. Insurance company decisions are generally up to the insurance company.

    “Medicare doesn’t really provide care at a lower price because it 1)dictates prices to providers who have to accept them or get kicked out of the program. 2) Since it has a monopoly on retiree care, it has lower costs because it doesn’t need to compete with other competitors–it’s the only game in town so advertising is free and if you don’t like it–tough. 3) Government programs are notorious in how they hide costs from public scrutiny for fear of reprisal—that’s never happened, right?”

    You are wrong on all three points.

    1) Medicare has fee schedules, but so do most if not all employer-paid plans.
    2) Private companies can also provide health care to retirees in Medicare Advantage plans. These plans pay from the same fee schedule as Medicare but it costs from 13% to 19% more per person to treat them in the privately run plans as opposed to the government plan, despite the fact that the private plans try to cherry pick the healthier patients.
    3) Medicare costs are a matter of public record. While Medicare would have a tough time trying to hide things, we do know that private insurance companies have often been caught playing games with their books.

    You can make excuses to deny the results of the poll, but the fact remains that the opinions they received with regards to comparing Medicare and employer-paid health care gives an accurate view of where Medicare out-performs employer-paid health care.

  32. 32
    Fritz says:

    Ron, while the complexities are painful, some of this seem to contradict your statement:

    http://www.ama-assn.org/ama1/pub/upload/mm/399/medicarepayment08.pdf

    It seems like if a doctor is in the Medicare system then he can’t choose to see some (eligible) patients outside of the Medicare system.  I think.  Sure, the restrictions are on the provider not the customer,  but that still restricts the market.  You can’t very well say “they can see any doctor who will take them” if the government rules make sure that is close to a null set.

    Programming is easier.  Just sayin’.

  33. 33
    Ron Chusid says:

    Fritz,

    You are misinterpreting what this says–which is understandable considering how complex the rules get. This is about whether a doctor participates in Medicare or not, which is not the same as whether they see Medicare patients. Doctors can see Medicare patients as either participating or non-participating providers. A doctor cannot both sign a participation agreement and see some Medicare patients under the rules for non-participating doctors.

    I don’t think you really want to get into all the details of this, but the bottom line with regards to your question is that if a patient is not in Medicare none of this really applies and the doctor can see them.

  34. 34
    vulcanhammer says:

    “I was a hardcore supporter of Austrian economics.”

    —LOL! Now you’re being funny, Ron! You obviously don’t understand basic economics but you were a supporter of Austrian economics…Hah, ha!

    “Of course there are restrictions. The point is that the restrictions are much less than under employer paid health care, as the above poll showed.”

    –First off, the poll is flawed propaganda; it is completely irrelevant and tells us absolutely nothing regarding the state of Medicare or Private insurance. And no, there are not less restrictions with Medicare than under employer paid health care or even that it provides better care as you claim. But even if it did all those things, it wouldn’t do them for very long because there is simply not enough money in the U.S. (Present population about 300 million) to pay for such a program under our current budget for 20, 30, 40 years. For someone who claims “the hard economic facts,” you haven’t explained how this is all going to be paid for without there being some harsh restrictions/rationing when the federal budget meets fiscal reality.

    “Dealing with the system with some relatives is hardly the same as working in health care every day with a wide variety of plans. Your comments here demonstrate that you do not understand how Medicare works.”

    —Ron, I don’t have to work in the Medicare industry for 30-40 years to come to understand that it doesn’t work properly; just like I don’t need to work at an auto plant for 30-40 years to know which company makes a crappy car or a reliable one. You seem to think that because you worked in the Medicare industry that it somehow gives you untouchable “expert” status and that the rest of us just have to acquiesce to “experts” like you because you know what’s best for us or what the proper form to fill out is for a certain medical procedure. (A little bit elitist, don’t ya think?) Sorry, but that’s not going to fly: Prove your argument with sound conclusions and spare me the platitude. Please.

    “What total bullshit! You say an employee of the government is a bureaucrat while an employee of an HMO or insurance company is an individual?? They are both individuals and in many ways both bureaucrats.”

    —No, they are NOT both bureaucrats, Ron. Medicare benefits are not a matter of individual choice, but are instead dictated to seniors through the political process–Congress or in effect, bureaucrats. Bureaucrats set prices and decide on how or what service is to be rationed to meet it’s budget. Now here is where basic economics comes in, Mr. “Austrian economics”—-individuals or employees of an HMO or private insurance company DO NOT SET PRICES and therefore DO NOT DO THE RATIONING: Prices are set by the open market and therefore self-rationing is done by the individual consumer who either decides to consume or not to consume according to their personal preference. If you don’t understand what I mean, try going on Ebay to sell a music CD that routinely sells for $3. You could list the item for $300 but I seriously doubt that anyone is going to purchase the CD from you. Why? Because the market on Ebay has set the going price and not you–even though you might think you have. In this case the “rationing” is done by the individual consumer who decides how much to spend on the CD. Medicare bureaucrats and private insurance employees operate on very different planes and the “rationing” that occurs with them are very, very different.

    “The difference is that Medicare policies are based upon medical justification. Insurance decisions are made based upon their bottom line–they can deny paying for something just because they feel they can save money that way. If Medicare denies something there is due process.”

    —Whether Medicare turns you down for a certain procedure via due process or if a private insurance company turns you down to “save money” amounts to the same thing. You are just trying to dress it up in moral melodrama.

    “Insurance company decisions are generally up to the insurance company.”

    –And Medicare decisions are generally up to Medicare.(?)

    Medicare should be overhauled to subsidize seniors directly, to give them true choice among competing private health plans, and to allow today’s workers to prefund Medicare’s obligations through personal accounts. The federal government should get out of the health care industry so that it stops creating price distortions, price inflation, and poor quality care. (Walk into your doctors office and ask her how much for a certain procedure–9 out of 10 times she won’t know what it costs. Why? Price distortions created by the federal gov’t mandating prices and imposing its monopoly.)

    With the country facing a serious economic test that may last years, it’s only fair to ask about expanding Medicare or adopting a government run universal health care plan–How are we going to pay for it without going broke or raising taxes until it weighs down on the economy? Ron?

  35. 35
    Ron Chusid says:

    vulcanhammer,

    “you obviously don’t understand basic economics but you were a supporter of Austrian economics”

    Spoken like a true religious zealot when their beliefs are challenged. I’ve studies Austrian school economics and also committed the heresy of comparing what the theory says to the facts, and rejecting the portions of the theory which are contradicted by the facts. You just assume that anyone who rejects your religious views on economics does not understand.

    “And no, there are not less restrictions with Medicare than under employer paid health care or even that it provides better care as you claim.”

    There you go again, ignoring the facts when they don’t fit into your religious beliefs. Sorry, no matter what you claim I deal with restrictions from both Medicare and private insurance companies every day. I know first hand which plans place more restrictions upon me and my patients, while you are just making up your facts without any knowledge.

    Before you comment further (and if you do not I will not bother to put though any more of your ignorant nonsense) read what I actually said and do not say I’ve claimed things opposite to what I’ve said. I did not claim that Medicare provides better care. I pointed out how this is a nonsense comparison. Medicare and health insurance plans do not provide medical care. Us doctors do, regardless of the plan. While there might be some exceptions as in closed-model HMO’s, for the most part we are providing the same quality medical care regardless of who is covering the patient. In some cases insurance restrictions, which are frequently far worse than with Medicare, do negatively impact the care we can provide. The biggest difference comes when private insurance plans cut off someone’s care because they have become too expensive. Medicare patients never have this problem.

    “I don’t have to work in the Medicare industry for 30-40 years to come to understand that it doesn’t work properly…”

    You might not need to work in the industry, but you do need to have some basic idea as to how Medicare and insurance works. You clearly do not. I have already made many major factual errors. It is not elitist for people who actually understand something to be discussing it and trying to correct the misconceptions that people like you spread so that people can have more choices in their health care, and make intelligent choices. This is not about knowing which form to fill out. I’m speaking of providing total medical care to people in both private and government plans and seeing first hand how each works. I’m speaking of spending hours every month reading both the medical literature and non-medical literature on health care for further information. In this blog I have multiple posts which present some of this material for non-professional readers so that health care reform can be considered based upon the actual facts, as opposed to the type of misinformation you are repeating.

    “individuals or employees of an HMO or private insurance company DO NOT SET PRICES and therefore DO NOT DO THE RATIONING”

    Again, you are showing complete ignorance of how the health care industry works. Private insurance plans and HMO’s do set their payment schedules, just as Medicare does. They decide how much they will pay, what they will cover, and are often more restrictive than Medicare. They ration as much, if not more so, than the government. Of course the ultimate rationing comes to the over 80 million people who either have no coverage or are seriously under-insured.

    “Whether Medicare turns you down for a certain procedure via due process or if a private insurance company turns you down to “save money” amounts to the same thing. You are just trying to dress it up in moral melodrama. ”

    Again you are showing you have no understanding of how health care works. It does not amount to the same thing when Medicare pays because of utilizing due process but an insurance company refuses to pay. I’ve recovered thousands of dollars from Medicare by arguing before an administrative law judge that payments which were denied were medically necessary. The decision was made purely based upon medical necessity under Medicare law. Private insurances can not be forced to pay on claims in this manner. Instead they get away with arbitrarily denying claims with no justification in order to save money. I can go before an administrative law judge, if other appeals measures fail, with minimal expense to receive payment. Taking on the insurance companies in court is tremendously more difficult.

    “Walk into your doctors office and ask her how much for a certain procedure–9 out of 10 times she won’t know what it costs.”

    Again you are showing your ignorance of how heath care works. The point is that the office does not determine what anything costs. Each insurance plan, HMO, and government plan has its fee schedule. Third parties, not doctors offices, set prices. Taking the government out of this would not change this one bit.

    “With the country facing a serious economic test that may last years, it’s only fair to ask about expanding Medicare or adopting a government run universal health care plan–How are we going to pay for it without going broke or raising taxes until it weighs down on the economy?”

    We are not calling for a “government run” health care plan however costs is a poor way to make an argument against health care reform. There is really no controversy if you look at the numbers that Medicare provides health care much more economically than private plans. If you are making decisions purely based upon cost the most sensible thing to do would be to go to a single-payer system. There may be other reasons not to do so, and this is not what is being proposed, but this would be the most economical way to do it.

    The individual market is even worse than the employer-paid insurance market. As people get past 40, especially if they have medical problems, they have a very tough time finding affordable care as private insurance companies do not want them. Why not expand Medicare and allow people to buy into the system at 55, or even younger if they want? You might not believe the facts about Medicare showed in this poll, but I would love the opportunity to drop my private insurance plan and buy into Medicare based upon first hand experience with both private insurance and Medicare. Why not give employers ways to save money such as buying into the health care plans offered to members of Congress and employees of the federal government? I would love to have such options for my employees. Why are you so opposed to giving people more choices so that they can obtain affordable medical care when there are so many problems with the current system?

  36. 36
    Petra Machar says:

    Has anyone out there noticed that TWO new co-sponsors for HR 676 have been added this month (May 20, 2009). The total is now 77!
    The BEST and most up-to date co-sponsor list is found on pnhp.com (Physicians for National Health).
    Google pnhp+HR676+111th congress
    It’s updated daily.

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