July 23, 2009

• Health Insurance & Medicare

  During the past several decades, medicine and its delivery systems have certainly changed - mostly for the worst IMHO.
  My wife and I have been on medicare for many years and find that system generally pretty good. There is little or no restriction on what MD or hospital you use but it does suffer from two problems: As it was originally set up it was supposed to be self-funding - sort of part of the Soc sec system, but the inclusion of medicaid and the lack of oversight has led to problems both in funding and in payments. For example, the 80% of MD bills we pay costs each of us $96.40/mo. taken out of our soc sec. The so-called drug benefit (actually a pharma goldmine) costs an additional $32.50 - also taken out of soc sec each month. Not bad, really. The additional 20% coverage (we use AARP health ins.) costs us a total for both of $380.50. You can see how unbalanced the system has become - $96.40 for 80%, $190.25 for the additional 20% - and that's with AARP negotiating the best price.
  Apparently any shortfall in the medicare part of our insurance is paid out of soc sec revenue - which may be why that system is in fiscal trouble. Medicare payment schedules ( generally about half what the MDs charge insurance) are supposed to be set by a board of MDs, bureaucrats and just plain folks - how it actually works is difficult to determine.
  The President's idea of some kind of non-political oversight board made up of MDs and other interested parties to set rates and suggest/mandate procedures which work - not enrich the medical establishment - is a very good one and may well be the making of any reform passed.
  Here' a personal anecdote: Our personal doctor (A nice, attentive, skilled young MD) was talking costs with me last year - he is quite open about such things. He was complaining that he billed patients over $450K last year but received only about $320K in actual payments. Apparently the discrepancy was in refused insurance payments and the reduced payments he gets from medicare (They pay 80% of their pay schedule - not his) and the payments, which are handled at the state level are often delayed. He like the AARP insurance - they pay much faster than any other that he sends claims to.
  Bottom line: No one , patients, doctors, hospitals, most other providers like the present system- I think secretly many practitioners would like to see a single-payer system emerge. Then they would know where they stand and be more able to predict income.

  • 2:15 pm
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