More Republican Misinformation On Medicare To Scare Seniors

There they go again. Republicans are again trying to scare seniors by spreading misinformation about Medicare. They have been making the same false claims for the past few years. From Politico:

Republican Rep. Tom Rooney of Florida took aim today at Obamacare’s impact on older Americans, saying that seniors across the country are paying “more money for fewer choices, less access and far less peace of mind.”

In the GOP’s weekly address, Rooney castigated President Barack Obama’s very public pledge that Americans of all ages would be able to keep their doctors under the health law. Since the fall, the president has had to backtrack on that statement, acknowledging that the law was forcing changes in insurance plans that meant some people were losing their physicians.

“Here’s the reality,” Rooney said as he blamed Obamacare for “deep cuts” made to the popular Medicare Advantage program that serves low-income seniors, among others. “Constituents tell me they can no longer see the primary care physicians they have been going to for 10 and every 20 years,” he said. “One woman told me that four of her specialists have already been dropped from her plan.”

The truth is that Obamacare is helping, not hurting, seniors.

Medicare Advantage Plans were set up by George Bush as a way to reward insurance companies for all their contributions to the Republican Party. The initial law establishing the plans provided tremendous subsidies for insurance companies. The idea as initially argued by conservatives was that private insurance companies could provide health care more economically than the big bloated government Medicare program. Instead the government pays private insurance companies substantially more to treat Medicare patients than it costs to care for the same patients in the government plan. Any true Republican should think that private insurance companies should not need this corporate welfare.

The Affordable Care Act is paid for partially by reducing this corporate welfare, saving the tax payers about $136 billion over ten years. Private insurance companies will still receive plenty of money to care for seniors. Why should they need more money than it costs to treat them in the government program?

Medicare Advantage plans have been using limited panels for several years to try to save money. The Affordable Care Act does not change that, except now the insurance plans blame Obamacare for what they would do even if Obamacare did not exist.

The Affordable Care Act has helped seniors in many ways. It makes Medicare more sound financially. The donut holes in the drug benefit are being phased out, saving seniors money on their prescriptions. Preventative studies which previously were not covered are now covered by Medicare, saving seniors yet more money.

It is particularly absurd to expect seniors to turn to the Republicans when they have already voted for a plan which would end Medicare as we know it and force those on Medicare in the future to pay more out of their own pockets for health care coverage.

Cross posted at The Moderate Voice

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How Jed Bartlet Would Handle The Debates

There were many aspects of Obama’s debate performance which were disappointing.  As Zeth Meyers noted on Weekend Update last night, this was an event which Fox could report as it actually happened. The most frustrating was the manner in which Obama didn’t do enough to call out Romney for his many lies. If you watched closely, and manged to stay awake, Obama did point out the truth several times, but not as strongly as is needed for this debate format. Maureen Dowd suggested how Jed Bartlet might provide advice to Barack Obama. Here is a portion:

BARTLET They told you to make sure you didn’t seem condescending, right? They told you, “First, do no harm,” and in your case that means don’t appear condescending, and you bought it. ’Cause for the American right, condescension is the worst crime you can commit.

OBAMA What’s your suggestion?

BARTLET Appear condescending. Now it comes naturally to me —

OBAMA I know.

BARTLET It’s a gift, but I’m likable and you’re likable enough. Thirty straight months of job growth — blown off. G.M. showing record profits — unmentioned. “Governor, would you still let Detroit go bankrupt as you urged us to do four years ago?” — unasked. (shouting) I’m talkin’ to you, too, Lehrer!

WILL (in the other room) I got him, sir!

BARTLET All right! (back to OBAMA) And that was quite a display of hard-nosed, fiscal conservatism when he slashed one one-hundredth of 1 percent from the federal budget by canceling “Sesame Street” and “Downton Abbey.” I think we’re halfway home. Mr. President, your prep for the next debate need not consist of anything more than learning to pronounce three words: “Governor, you’re lying.” Let’s replay some of Wednesday night’s more jaw-dropping visits to the Land Where Facts Go to Die. “I don’t have a $5 trillion tax cut. I don’t have a tax cut of a scale you’re talking about.”

OBAMA The Tax Policy Center analysis of your proposal for a 20 percent across-the-board tax cut in all federal income tax rates, eliminating the Alternative Minimum Tax, the estate tax and other reductions, says it would be a $5 trillion tax cut.

BARTLET In other words …

OBAMA You’re lying, Governor.

BARTLET “I saw a study that came out today that said you’re going to raise taxes by $3,000 to $4,000 on middle-income families.”

OBAMA The American Enterprise Institute found my budget actually would reduce the share of taxes that each taxpayer pays to service the debt by $1,289.89 for taxpayers earning in the $100,000 to $200,000 range.

BARTLET Which is another way of saying …

OBAMA You’re lying, Governor.

BARTLET “I want to take that $716 billion you’ve cut and put it back into Medicare.”

OBAMA The $716 billion I’ve cut is from the providers, not the beneficiaries. I think that’s a better idea than cutting the exact same $716 billion and replacing it with a gift certificate, which is what’s contained in the plan that’s named for your running mate.

BARTLET “Pre-existing conditions are covered under my plan.”

OBAMA Not unless you’ve come up with a new plan since this afternoon.

BARTLET “You doubled the deficit.”

OBAMA When I took office in 2009, the deficit was 1.4 trillion. According to the C.B.O., the deficit for 2012 will be 1.1 trillion. Either you have the mathematics aptitude of a Shetland pony or, much more likely, you’re lying.

BARTLET “All of the increase in natural gas has happened on private land, not on government land. On government land, your administration has cut the number of permits and licenses in half.”

OBAMA Maybe your difficulty is with the words “half” and “double.” Oil production on federal land is higher, not lower. And the oil and gas industry are currently sitting on 7,000 approved permits to drill on government land that they’ve not yet begun developing.

BARTLET “I think about half the green firms you’ve invested in have gone out of business.”

OBAMA Yeah, your problem’s definitely with the word “half.” As of this moment there have been 26 recipients of loan guarantees — 23 of which are very much in business. What was Bain’s bankruptcy record again?

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Republicans Advocate Eliminating Medicare

I’ve frequently seen mention of the Republican plan to end Medicare in various medical newsletters but have been surprised that it has not received much attention in the mainstream media. After all, this is an idea which the Democrats should be able to receive support by attacking. The idea is basically to give people vouchers to purchase insurance instead of going on Medicare in ten years. Presumably the Republicans believe that people more than ten years away from Medicare do not think enough about their personal future to pay attention. There is an outside chance they might be right on this. Republicans are also hoping that seniors will not care if it doesn’t affect them, but seniors would be wise to see this as a threat. If young people are not going to wind up on Medicare, they’d have less incentive to see it protected today. Having a steady stream of new people on Medicare will help ensure that there is political support for maintaining this important and highly successful program.

The idea finally started attracting attention today with Paul Ryan writing about his plan in The Wall Street Journal. Apparently one Democrat did a poor job of criticizing the plan on Hardball but there will be many more opportunities. While the Democrats are frequently beaten by Republicans on the spin war, primarily because not being bound by the facts makes it easier to argue, this is one GOP idea which is so bad that even the Democrats should be able to successfully attack it.

The primary problem is that health care costs will continue to go up and vouchers are unlikely to allow seniors and the disabled to buy health care insurance which adequately covers their needs. Health insurance companies already do a terrible job of covering those over forty on the individual market in their efforts to avoid covering people who actually need health care coverage. The insurance companies do not want to cover people with pre-existing conditions, and this applies to a very high percentage of those on Medicare. The one exception where private insurance companies have insured the Medicare population has been Medicare Advantage plans, but many companies have already left this market after the subsidies to care for these patients were reduced. It costs about twelve percent  more to cover people under private Medicare Advantage plans than in the government plan, showing how the private insurance industry is a poor alternative to the Medicare program.

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Tomorrow’s Right Wing Attack Regarding Health Care

Tyler Cowen, writing in The New York Times, warns that no matter whether the current health care reform legislation is passed we will be seeing more of managed care.

There is no doubt this is true. The financial realities are there regardless of whether or not health care reform is passed. As Cowen concludes, most Americans are in denial of the fact that “our government — or, for that matter, our insurance companies — can’t pay every bill.”

This does have an important ramification for the future spin war. Republicans are already falsely claiming that health care reform will lead to rationing and even “death panels.” They are attacking the proposed cuts to Medicare even though the proposed cuts would primarily reduce the profits of insurance companies which sell Medicare Advantage plans and will not significantly affect patients .

However, while the proposed health care reform bill does not ration care or meaningfully cut Medicare, the economic reality is that we are going to see more rationing and cuts to Medicare in the future. Democrats, who are already losing the spin war, need to be careful if health care reform is passed. It is inevitable that conservatives will blame future changes in health care which have nothing to do with the current legislation on “Obamacare.”

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Republican Ideas on Health Care

The main strategy of Republicans is to block any meaningful health care reform. Their overall plans would do little if anything to help the uninsured, increase the ability of insurance companies to avoid consumer protection laws by operating out of the states with the weakest regulations, and would increase out of pocket expenses for most people. However, when Republicans have made suggestions which could be considered as part of an overall health care reform measure many Republican ideas have already been included.

Newt Gingrich and John C. Goodman list several suggestions in an op-ed in The Wall Street Journal. This hardly represents a meaningful health care reform proposal but many of the Republican ideas are already included in the current health care legislation. The Wonk Room goes through many of these suggestions noting how many are now in the bill. I’ll just add comments on a few of the topics.

The Republicans are trying to portray themselves as the defenders of Medicare  after years of trying to destroy the program. The Medicare cuts being proposed are not serious cuts to the program. Most of the cuts would be to Medicare Advantage programs which use the bulk of the subsidies they receive to increase profits for insurance companies and sometimes use a small amount to provide extra benefits to entice customers. In addition, if there is near-universal health care it will not be necessary to fund as much money for Medicare to pay for added expenses due to cost shifting because of the uninsured.

The article is misleading when it says Medicare pays doctors by the task but  doctors “do not get paid to advise patients on how to lower their drug costs.” No, there is not a CPT code for advising patients on lowering drug costs but Medicare does pay for office calls in which such matters can be discussed, and does pay more when more time is spent counseling patients.

They also write that “Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail.” True, but the same is true of most private payers. This is an area which is just starting to be considered. It could either be added to health care reform legislation or could be added in the future.

Gingrich and Goodman advocate meeting the needs of the chronically ill but one of their key recommendations for doing this will not have this result. They write that “Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start.” The problem is that when people with chronic diseases have to pay for more expenses out of money in their own account they tend to avoid many necessary tests and office visits to save money. In the long run this leads to poorer outcomes and higher costs. There is also the danger of these accounts being depleted leaving patients with chronic medical conditions without sufficient coverage.

They also advocate eliminating junk lawsuits. I agree, but Republicans tend to greatly exaggerate the effect of this. Malpractice suits and the resultant defensive medicine do result in wasted money we should attempt to recover but this is a small part of overall health care costs. The health care legislation does provide for state demonstration tests regarding tort reform. I would be happy to see some actual solutions included in the bill. Perhaps if the Republicans took an attitude of compromising to get their ideas included, as opposed to all deciding early on to vote against health care reform, they might have been successful in having more concrete solutions for tort reform included.

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White House Responds To Howard Dean’s Criticism of Health Care Plan

The White House has been responding to yesterday’s attacks on the watered-down Senate health care reform bill from the left which I also discussed here. David Axelrod appeared on MSNBC:

Axelrod, responding on MSNBC, said: “I have a lot of respect for Governor Dean but he got on the phone with Nancy-Ann DeParle, our point person on the health care issue, went through point by point. She explained why he was wrong. And he simply didn’t want to hear that critique. I saw his piece in The Post this morning, and it is predicated on a bunch of erroneous conclusions.”

Asked his response to progressives who say “kill this bill now,” Axelrod replied: “I think that would be a tragic, tragic outcome. … I guess if you’re hale and hearty and have insurance, it’s fine to say, ‘Kill this bill.’”

Peggy Noonan, the columnist and former Reagan speechwriter, told Axelrod: “On the issue of health care, you are losing the left, you are losing the right, you are losing the center. That looks to me like a political disaster.”

“When you describe what’s in the bill, there’s strong support for it,” Axelrod replied. “We don’t think of the world in terms of left, right and center. We think of the world in terms of small business people, … senior citizens, … Americans who are looking for help on a problem that we’ve been trying to solve for a century.”

The White House Blog has been busy responding, starting with White House Communication Director Dan Pfeiffer:

Recently, a somewhat perplexing new line of argument has emerged about health insurance reform, with some folks suggesting the Senate bill is a “dream” for insurance companies.

If that’s the case, though, it must be news to them. The insurance industry has been leveraging its considerable resources in a ferocious effort to defeat this bill, including producing a report the day before the Senate Finance Committee vote that was so misleading the firm behind it had to walk away from it. And that’s not surprising, because this bill will finally wrest power away from the insurance industry and put it in the hands of American consumers.

  • Among the many provisions to end insurer abuses, lower premiums, and hold insurance companies accountable:
  • Insurance market reforms will prohibit abuses such as denying coverage for pre-existing conditions, charging exorbitant premiums based on gender, age, or health status, dropping coverage when people are sick, and imposing lifetime limits on benefits.
  • Consumer rights will be enhanced by requiring all insurers to provide effective appeals procedures including outside, independent review of appeals
  • New insurance exchanges will reduce premium increases by lowering administrative costs and increasing the leverage of individuals and small businesses in this insurance market.
  • Competition will also be enhanced by providing consumers comparative information on available insurance options giving them the tools to make more informed decisions and drive competition based on value and service.
  • Insurers will be held accountable for excessive overhead costs fueled by unreasonable executive compensation and profits.
  • Insurers will also be required to compete against cost-effective national plans selected by the federal Office of Personnel Management.
  • Wasteful taxpayer overpayments to insurance companies through private Medicare Advantage plans will be eliminated.

Jason Furman, Deputy Director of the National Economic Council, added:

As we move into the final stage of the historic push for health reform, opponents of reform are testing the age old adage that if you only say something enough times you can somehow make it true.  Yesterday, we heard a new version of the old, tired refrain that the health reform bills in Congress would raise taxes on the middle class.

So let’s set the record straight:

  • First, the health insurance reform bill being considered in the Senate does not raise taxes on families making less than $250,000 – in fact it is a substantial net tax cut for American families. The bill being considered represents a substantial net tax cut for middle income families. According to the independent Joint Committee on Taxation, the bill will provide nearly $450 billion in individual income tax cuts over the next 10 years.
  • Second, the excise tax levied on insurance companies for high-premium plans, the so-called “Cadillac tax,” will affect only a small portion of the very highest cost health plans – a total of 3% of premiums in 2013. The vast majority of health plans fall below the thresholds set in the Senate plan and would be completely unaffected by the provision. And those that are above the threshold would only face an excise tax on the generally small portion of the plan that exceeds the threshold. As a result, based on analyses by the Joint Committee on Taxation, only about 3% of premiums will be affected by this provision in 2013. In addition, the Senate plan provides special protections to plans held by workers in high-risk professions – like police and firefighters – as well as by those over 55.
  • Third, for the small sub-set of plans that are affected, the primary impact of this provision will be to increase workers’ wages. Getting a pay raise is not what most people would call a tax increase. Economists agree by taxing the highest cost plans this provision will lead insurance companies to be more efficient and provide quality care to consumers at lower prices (see this endorsement in a letter from a group of prominent economists – including three Nobel laureates and previous members of both Democratic and Republican administrations and this analysis by CBO 2009). Even a report commissioned by the insurance industry’s trade association acknowledged that: “[w]e expect employers to respond to the tax by restructuring their benefits to avoid it.” [PWC, 2009].  As a result, employers will be in a position to increase workers’ take home pay.

Nancy-Ann DeParle, Director of the Office of Health Reform, described the benefits of the measure and the blog also quoted Bill Clinton:

At last, we are close to making real health insurance reform a reality.  We face one critical, final choice, between action and inaction.  We know where the path of inaction leads to: more uninsured Americans, more families struggling to keep up with skyrocketing premiums, higher federal budget deficits, and health costs so much higher than any other country’s they will cripple us economically.  Our only responsible choice is the path of action.

Does this bill read exactly how I would write it? No. Does it contain everything everyone wants?  Of course not. But America can’t afford to let the perfect be the enemy of the good.  And this is a good bill: it increases the security of those who already have insurance and gives every American access to affordable coverage, and contains comprehensive efforts to control costs and improve quality, with more information on best practices, and comparative costs and results. The bill will shift the power away from the insurance companies and into the hands of consumers.

Take it from someone who knows: these chances don’t come around every day.  Allowing this effort to fall short now would be a colossal blunder — both politically for our party and, far more important, for the physical, fiscal, and economic health of our country.”

Ezra Klein also disagrees with Howard Dean’s evaluation of the Senate bill:

What’s so strange about Dean’s objection is that the exchanges in the Senate bill (pdf) do act as “prudent purchasers,” that is to say, they set limits on the plans that can enter in the exchange to ensure that people are getting good choices. The relevant section begins on page 131 of the Senate bill. “The Secretary shall, by regulation, establish criteria for the certification of health plans as qualified health plans.” A couple of pages of relevant criteria follow, including marketing requirements (plans can be disqualified for focusing their marketing in outlets that would bring them uncommonly healthy enrollees), broad provider networks, coverage of options used by low-income folks (community health centers, say), quality measures, quality improvement strategies, consumer ratings, standardized benefit packages, etc.

And then, a couple of pages later, the language gets stronger. On page 143, the exchanges are given power to certify insurance plans based on whether “the Exchange determines that making available such health plan through such Exchange is in the interests of qualified individuals and qualified employers in the State.” On 144, premiums, and premium increases, enter explicitly into the discussion. Any insurance plan that wants to increase premiums has to submit a written justification for their decision. It will have to post that information on its Web site. And if the exchange is not convinced, it can decertify the plan.

Don’t believe me? In his op-ed, Dean names John Kerry as the senator who has been working hardest on this question. This morning, I spoke to Kerry’s staff, who got me a statement from Kerry himself. “The prudent purchasing provisions in the Senate health bill will lower costs and increase affordable options for consumers,” Kerry says. “It’s strong language that will allow the exchange to deliver competitive prices and offer high quality care, and I’m thrilled to see national reform honor the best innovations already succeeding in Massachusetts.”

John Podesta has also made a case similar to the arguments above.

Update: Richard Eskow disagrees with some of the claims from the White House.

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Deal Reportedly Reached on Health Care

It sounds like a deal has been made on health care reform in the Senate after a busy day. The reports are contradictory with some saying that the public option is dead while Reuters reports that Harry Reid denies the public option will be dropped. The proposal is being sent to the Congressional Budget Office for scoring before the details are released.

Earlier there were reports that Olympia Snowe opposed the Medicare buy-in plan which I discussed yesterday but Joe Lieberman was willing to consider it. Both reportedly opposed an expansion of Medicaid. In addition there is more talk of offering further choices modeled along the Federal Employee Health Benefits Program which covers members of Congress and government employees.

As I discussed previously, allowing those between the ages of 55 and 64 to buy into Medicare would be beneficial for an age group which has the most difficulty purchasing insurance on the individual market. It might be better to have such a plan which offers true benefits at age 55 as opposed to a watered-down public option. Once the Medicare age is lowered to 55 there is also likely to be increased pressure to lower the age further if many people find that buying into Medicare is a better deal than purchasing private insurance. I have also seen mention today of the possibility of a trigger to lower the age based upon future costs of health insurance.

Another benefit of this proposal is that it can begin helping those who are unable to obtain insurance as early as 2010. There is talk that those who qualify for high-risk insurance pools will be able to buy into Medicare in 2010 with this to be offered to everyone at age 55 once the insurance exchanges are established in 2014.

Republicans who previously were arguing against cuts in Medicare are now taking the opposite approach and arguing against Medicare expansion. I guess they are channeling George H.W. Bush in arguing to “stay the course,” opposing both cuts and expansions. Actually the Medicare cuts which the Republicans oppose are cuts in subsidies to insurance companies in Medicare Advantage plans.

If Lieberman is aboard, it might be possible to pass a compromise without any Republican support but there is danger of losing the support of one conservative Democrat. Ben Nelson’s attempt to place restrictions on abortion was tabled in a 54-45 vote. Nelson said this makes it harder for him to support the bill. Nelson is one of the handful of Democratic members of The Family, a conservative religious group which believes they were chosen by God to lead.

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Hidden Costs of Medicare Advantage Plans

The Medicare Advantage plans were set up by George Bush to reward the insurance companies for their contributions. The plans pay large subsidies to care for Medicare patients. As a result, it takes from 13 percent to 19 percent more to care for patients in Medicare Advantage plans than in the government Medicare program. Most of this extra money goes to increase profits for the insurance companies. Some  plans use a portion of the money to provide benefits such as health club memberships.

These extra benefits often don’t turn out to be a good deal for patients. Many don’t use the exercise programs, and often patients in Medicare plans do have access to exercise facilities. I’ve had patients who signed up for Medicare Advantage plans which promised dental benefits only to find that there weren’t any dentists in the area who actually accepted the plan.

Health insurance plans should be judged primarily on their health care benefits, but often the extra benefits are offset by higher out of pocket expenses for routine health care. For example, Medicare patients who do not have a secondary insurance pay 20 percent of  Medicare allowed amounts for office calls. Many Medicare Advantage plans have copays of $15 to $30 which exceed the 20 percent Medicare copay. There is no copay for laboratory testing in the government Medicare program but some Medicare Advantage plans do have a copy for lab work.

The Washington Post has an article on the hidden costs of the “free” perks from Medicare Advantage plans:

The trouble is, the extra benefits are not exactly free; they are subsidized by the government. And some of the plans pass their costs on to seniors, who pay higher co-pays and additional fees to get care.

“It’s a wasteful, inefficient program and always has been,” Sen. John D. Rockefeller IV (D-W.Va.) said at a recent hearing. At its core, Rockefeller added, Medicare Advantage is “stuffing money into the pockets of private insurers, and it doesn’t provide any better benefits to anybody.”

President Obama has proposed cutting more than $100 billion in subsidies over 10 years, a contentious component of health-care reform that will be fought in earnest as the bills move through Congress. But unlike some issues that touch off partisan sparring, Medicare Advantage has an unlikely band of bipartisan defenders who have already battled to restore $10 billion of the proposed reductions.

In a health-care debate defined by big numbers and confusing details, the prospect of losing benefits such as a free gym membership through the Silver Sneakers program is tangible, and it has spooked some seniors, who are the nation’s most reliable voters and have been most skeptical about reform.

Medicare Advantage was established in the 1970s (under a different name) when private insurers convinced Congress that they could deliver care at lower costs than Medicare. The program blossomed in the late 1990s when Congress bolstered it with millions in additional federal subsidies to for-profit HMOs. It has proven popular among younger, active seniors who had managed-care plans as workers, and about a quarter of Medicare’s 45 million beneficiaries are enrolled.

Many private plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission.

“The promise of Medicare Advantage and Medicare HMOs was to save the government money, to save consumers money, all the while providing additional benefits and coordinating care,” said Joseph Baker, president of the Medicare Rights Center. “That promise has been unfulfilled overall because the plans are overpaid by the federal government at this point.”

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Hardly A Big Change For A Government Take Over of Health Care

Opponents of health care reform claim that the current plans represent a government take over of heath care. Ezra Klein looks at the Congressional Budget Office’s evaluation of the Senate Finance Committee proposal:

The verdict? It will look a lot like our old health-care system.

Unless you’re uninsured, or on the individual market, this bill is not expected to affect you. CBO estimates that 29 million Americans who would’ve otherwise been uninsured will be covered. That’s a very big deal. Five million Americans who would otherwise have been left to the individual market will find a better option. And 3 million Americans who would’ve otherwise been in employer-based health insurance will be on the exchanges or, in some cases, on Medicaid. The insurance exchanges are projected to serve 23 million people come 2019, and 18 million of the members will be low-income and on subsidies.

That leaves 245 million non-elderly Americans who will pretty much be in the exact place they would’ve been otherwise. As for the elderly, the CBO doesn’t include them because they’re on Medicare. They, too, will be where they otherwise would’ve been.

This is hardly the radical change that opponents claim. As an owner of a small business this matters more to me than it does to the vast majority of people who are protesting against health care reform. I sure hope that they go beyond the current proposal and also give us the choice of a public option.

The key finding in the Congressional Budget Office report is that this would reduce the deficit by $81 billion over the next decade. While reducing the deficit is a good thing (most recently only seen under a Democratic president), I hope we don’t place this over doing health care reform right. Eliminating wasteful government spending (like the subsidies given by George Bush to the insurance companies in Medicare Advantage plans) is a good thing, but sometimes we really do benefit by spending more government money. I’d prefer that the deficit not be reduced as much so that greater assistance can be given to individuals to purchase health care coverage, and to avoid needing to expand coverage by placing people in Medicaid as opposed to real insurance plans.

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Doctors Support a Public Plan Because Our Chances of Actually Getting Paid Are Better Than From Private Insurance

Big Government claims that, in supporting a public plan, doctors are endorsing the largest denier of health care claims. The selected data they cite is misleading and the blog’s argument is contrary to our actual experience. The chances of getting paid is far better from Medicare than most private insurance companies assuming Medicare was correctly billed as primary insurance. Such personal experience is what is going to influence physician support for a public plan–not selective quoting of statistics by conservative blogs.

The post lists a column on percentage of claim lines denied but doesn’t account for the reason. In real world experience, the number of denials is a small fraction of this. Another number which is far more consistent with my real world experience is percentage of claim lines reduced to zero. By this measurement Medicare is far more likely to actually send payment.

When my office does have Medicare claims rejected, by far the most common reason is that the patient was enrolled in a Medicare Advantage plan but is unaware that their coverage was changed. When physicians support a public plan we are supporting a plan based upon the original government Medicare program before it was screwed up by George Bush and the Republicans. I have also seen far more incorrect rejections of claims from Medicare Advantage plans, often taking multiple phone calls and faxes to fix, than I see from the government Medicare plan.

The second most common reason for denials I see is when a patient has Medicare but the patient or a spouse are working and another policy is actually primary. Medicare for All would fix that problem.

There are also situations where Medicare is pickier than other insurances on technical matters, but these rejections are easy to fix. The most common rejection of this type I experience is when an employee makes a mistake in typing in the Medicare number.

When a claim does need to be corrected, it is generally a simple matter to correct and resubmit the claim electronically. In contrast, if many private insurance plans initially reject a claim they will then reject fixed claims as duplicates, making it more difficult (and time consuming for physician offices) to actually get payment.

Medicare also has a number of rules by which they pay for certain services but their rules are all posted on line. It is generally easy to figure out what it takes to get a claim paid, but I’m sure that some physicians fail to pay attention to this and might be responsible for a larger number of rejections. In contrast, private insurance plans often reject claims without providing any good explanation. Often private plans will require prior authorization, taking up more staff time and increasing office overhead.

Private plans reject claims due to preexisting conditions. Medicare never does this. Private plans sometimes also find ways to drop a patient when they become too expensive, but this is not a problem with Medicare. Once a patient is dropped by private insurance plans, no more claims are submitted and this is not reflected in their percentage.

The bottom line is that in general Medicare pays us more reliably than private plans. It is also less expensive to bill Medicare as they don’t play the types of games private insurance plans often do in order to get payment. It is no surprise that so many doctors support a public plan as part of health care reform, with many also supporting Medicare for All.

Update: Another important factor is that there is a fair system of appeals and due process when Medicare claims are rejected. On rare cases where I have had rejections because of Medicare claiming that something was not necessary I have been successful in appealing their decision and receiving payment. If an appeal is not successful it can be taken to an administrative law judge. This is far less likely to be successful with private insurance.

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