Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services.
Stephen, I agree. The system is just weird. I think there are two big factors at play here that make the system what it is.
First, when I look at what is billed for a routine physical exam, then see what is approved, and then...see what the doctor actually gets paid (a small fraction) you can see that the doctor's company (and they are mostly now companies) is simply playing the game. It's a silly mess. It's no wonder some physicians don't want to accept Medicare patients.
Second, I am sure that there is a staffing issue at Medicare. To ask the agency to carefully evaluate every little item or service on a thorough and systematic basis is probably unrealistic. It should and could happen. But an organization that does its job using only 4% of the funding available has its limitations.
We buy a supplemental plan that handles the deductibles - as the VA does for you. I am relieved to hear you have that coverage. I think it should be automatic for anyone who has put on the uniform and served.
The Medicare subject is mind boggling in its complexity. And I could write a whole letter about the confusion for elders with Medicare Part D (aka part dumb) and the many scams with "Advantage" plans.
And I could write several letters as to why every American should be on something like Medicare. We just had a "non-binding" ballot question in Massachusetts. "Should the Commonwealth establish a state run universal health insurance plan and make illegal all private health insurance companies?" The question passed with a healthy majority saying YES. Keep an eye on MA. The new Democratic governor and Democratic legislature just might set the pace for the US. We will see.
I think unless you are a millionaire you should be required to purchase a Medicare supplement insurance policy, otherwise, the state is going to have to pay for that supplement. As far as the VA is concerned, I have a real problem with the amount of people that the VA gives 100% disability to. Most of the people that have 100% are given that rate because they are unemployable, not because they have disabilities related to their time in service. I explained how hard it is to get to 100% if it is based on your disabilities. In my opinion, if you are 100% based on disabilities and not unemployability you should be paid more!
Welcome to the world of Medicare/Medicaid, Stephen. From December 1989 through January 2021 I was involved, first as a County employee Department of Social Services then from December 1989 until December 2003. Then from December 2003 to January 2021 as a business analyst/consultant for many different States. If any agency can release a full blown SNAFU it is Medicare/Medicaid. In 1974 Medicare (in their august wisdom) decided that $600/month was sufficient to support any elderly person, anywhere in these United States AND $600 was so generous it never had to be re-negotiated. My clients receiving what was then called MediCal (because they were so poor Medicare would not cover their needs. So we (Eligibility Workers) were required to take their gross income (usually Social Security) and deduct $600. Everything over that became their share of cost. Every January Social Security would have a modest increase. Every December the Department of Social Security would notify every Social Security Recipient of their increased benefit beginning January. Every County would then notify every MediCal/Social Security recipient that we were using every penny of that increase to increase their share of cost. And my phone would ring off the hook with elderly people irate or more often sobbing about how they couldn't feed themselves (you've probably hears stories of elderly people eating dog food - they're true) because the cost of their rent and medicine exceeded the amount of their Social Security checks. And I would sympathetically agree with them. explain again that this was a Federal rule over which neither I nor the County or State had any control. I would advise them to contact their Congressperson and explain the situation. I worked in a very conservative rural county, I was their "token liberal", so fat chance of any action from their dimwitted Republican Representative. As a County Worker I was forbidden to contact Congress on behalf of my clients. As to the $44 difference between what that company charged and what Medicare was billed is probably lining the pockets of whatever Consulting Agency was hired to do the Negotiations. Why do you think the Republicans and Manchin are so set against negotiating directly between the Government and the Pharmaceutical manufacturers? If you had the time, financing and ability to follow the money you'd see how much profit is made. PS Medicare/Medicaid so disillusioned me that I traded off all my MediCal only clients for cash and food assistance and became a subject matter expert which in turn gave e the knowledge and ability to stay employed until I was 6 weeks shy of 88 LOL. BTW, a Sacramento Congresswoman once took the challenge to live on $600 per week, she made it from Sunday until Tuesday
So you should have been paid like a psychotherapist, apparently. OY.
We experienced a brief period of Medicaid coverage between retiring (for health reasons) and being old enough for Medicare. To call it a nightmare is way too generous.
A handful of Americans have $100 trillion in assets. We could solve the problems of poverty, denied healthcare and clean up a lot of bureaucratic nonsense if we had the political will and the guts to take on the "consultants" and "middlemen". And if we clawed back a bunch of that stolen national treasure that pays for the Bezos yacht and the Musk toys.
True, Bill, and this fits into the "if Only" .....politicians had the courage to stand up to wealth and say "I don't need you. I can learn to live on $174,000 + benefits, and expenses a year. [I worked and lived in a hotel in Washington, DC for 15 months on $68000 + expenses, and lived quite well.] Then if those same Congress persons would pass a fair income tax bill where everyone in the Country paid a fair share of taxes to support all. And, if only, it could pass the Senate.
Stephen, I agree. The system is just weird. I think there are two big factors at play here that make the system what it is.
First, when I look at what is billed for a routine physical exam, then see what is approved, and then...see what the doctor actually gets paid (a small fraction) you can see that the doctor's company (and they are mostly now companies) is simply playing the game. It's a silly mess. It's no wonder some physicians don't want to accept Medicare patients.
Second, I am sure that there is a staffing issue at Medicare. To ask the agency to carefully evaluate every little item or service on a thorough and systematic basis is probably unrealistic. It should and could happen. But an organization that does its job using only 4% of the funding available has its limitations.
We buy a supplemental plan that handles the deductibles - as the VA does for you. I am relieved to hear you have that coverage. I think it should be automatic for anyone who has put on the uniform and served.
The Medicare subject is mind boggling in its complexity. And I could write a whole letter about the confusion for elders with Medicare Part D (aka part dumb) and the many scams with "Advantage" plans.
And I could write several letters as to why every American should be on something like Medicare. We just had a "non-binding" ballot question in Massachusetts. "Should the Commonwealth establish a state run universal health insurance plan and make illegal all private health insurance companies?" The question passed with a healthy majority saying YES. Keep an eye on MA. The new Democratic governor and Democratic legislature just might set the pace for the US. We will see.
I think unless you are a millionaire you should be required to purchase a Medicare supplement insurance policy, otherwise, the state is going to have to pay for that supplement. As far as the VA is concerned, I have a real problem with the amount of people that the VA gives 100% disability to. Most of the people that have 100% are given that rate because they are unemployable, not because they have disabilities related to their time in service. I explained how hard it is to get to 100% if it is based on your disabilities. In my opinion, if you are 100% based on disabilities and not unemployability you should be paid more!
Welcome to the world of Medicare/Medicaid, Stephen. From December 1989 through January 2021 I was involved, first as a County employee Department of Social Services then from December 1989 until December 2003. Then from December 2003 to January 2021 as a business analyst/consultant for many different States. If any agency can release a full blown SNAFU it is Medicare/Medicaid. In 1974 Medicare (in their august wisdom) decided that $600/month was sufficient to support any elderly person, anywhere in these United States AND $600 was so generous it never had to be re-negotiated. My clients receiving what was then called MediCal (because they were so poor Medicare would not cover their needs. So we (Eligibility Workers) were required to take their gross income (usually Social Security) and deduct $600. Everything over that became their share of cost. Every January Social Security would have a modest increase. Every December the Department of Social Security would notify every Social Security Recipient of their increased benefit beginning January. Every County would then notify every MediCal/Social Security recipient that we were using every penny of that increase to increase their share of cost. And my phone would ring off the hook with elderly people irate or more often sobbing about how they couldn't feed themselves (you've probably hears stories of elderly people eating dog food - they're true) because the cost of their rent and medicine exceeded the amount of their Social Security checks. And I would sympathetically agree with them. explain again that this was a Federal rule over which neither I nor the County or State had any control. I would advise them to contact their Congressperson and explain the situation. I worked in a very conservative rural county, I was their "token liberal", so fat chance of any action from their dimwitted Republican Representative. As a County Worker I was forbidden to contact Congress on behalf of my clients. As to the $44 difference between what that company charged and what Medicare was billed is probably lining the pockets of whatever Consulting Agency was hired to do the Negotiations. Why do you think the Republicans and Manchin are so set against negotiating directly between the Government and the Pharmaceutical manufacturers? If you had the time, financing and ability to follow the money you'd see how much profit is made. PS Medicare/Medicaid so disillusioned me that I traded off all my MediCal only clients for cash and food assistance and became a subject matter expert which in turn gave e the knowledge and ability to stay employed until I was 6 weeks shy of 88 LOL. BTW, a Sacramento Congresswoman once took the challenge to live on $600 per week, she made it from Sunday until Tuesday
So you should have been paid like a psychotherapist, apparently. OY.
We experienced a brief period of Medicaid coverage between retiring (for health reasons) and being old enough for Medicare. To call it a nightmare is way too generous.
A handful of Americans have $100 trillion in assets. We could solve the problems of poverty, denied healthcare and clean up a lot of bureaucratic nonsense if we had the political will and the guts to take on the "consultants" and "middlemen". And if we clawed back a bunch of that stolen national treasure that pays for the Bezos yacht and the Musk toys.
True, Bill, and this fits into the "if Only" .....politicians had the courage to stand up to wealth and say "I don't need you. I can learn to live on $174,000 + benefits, and expenses a year. [I worked and lived in a hotel in Washington, DC for 15 months on $68000 + expenses, and lived quite well.] Then if those same Congress persons would pass a fair income tax bill where everyone in the Country paid a fair share of taxes to support all. And, if only, it could pass the Senate.