dagblog - Comments for "Generational Divide Colors Debate Over Medicare’s Future; Benefits Cost Far More Than Is Paid In"

I liked your idea immediately

artappraiser — Wed, 06 Apr 2011 19:16:36 +0000

In reply to VA for everyone Or everyone

I liked your idea immediately the first time I saw you suggest it. It is a way out the money-driven medicine mess that really could work. Working like this--as more people signed up, they would hire more doctors and it would eventually get better and better, both drawing newly minted docs not in it for the money and more people signing up. Private insurance and practice continues to escalate in cost, more people opt for it. We end up most people in a National Health system with wealthier people opting out or people buying extra plans if they want fancier services , just like in the UK

Big glitch: the government has to have a desire to fund its growth. The GOP would be attacking it all the time, every day in every way. It would be a great help if it got into doctor/practitioner training, too, so all new docs are not money-driven maniacs because of their debts (and a pony.)

Still, it really is a good solution to the Medicare fee-for-service mess that drives money-driven medicine. It's going to be hell trying to get people to give an inch of that up. A VA competitor to it for the under 65 would acclimate those folks to a NHS type scenario before they retire, and also if successful, draw more and more practioners out of the open market, so that Medicare's "free choice" doesn't look so swell any more. Where people would start thinking what good is choice of things like brand name drugs and MRI's for every sprain if you can't get an appointment without waiting 6 months and the big name specialists won't accept your Medicare payment any longer? But it would have to be funded well as it grows, there's the problem.

P.S. I liked it especially as a counter-narrative to the cries of" Medicare for all." Without reforming Medicare first, I saw that as people knowing not of what they spoke. That would be a disaster in the making. Not the least of which a lot of people would have sticker shock at what the rates would be for non-retired unsubsidized.. As you can see from the Times' chart, fee-for-service is very very expensive. But it could also end up killing all government involvment in medicine as costs skyrocketed to crazy levels. That's because it's the main thing causing money-driven medicine. For profit insurance follows Medicare's lead, i.e., if Medicare refuses to cover Provenge, they can too, if Medicare covers Provenge, they get grief if they don't. A VA type system hopefully just says--we don't cover Provenge, it you want it, go pay for a private health plan.

VA for everyone Or everyone

jollyroger — Wed, 06 Apr 2011 10:32:36 +0000

In reply to Medicare will pay $93,000 for

VA for everyone Or everyone who wants it, anyway. Let states contract their medicaid block grant to the va for coverage and Ryan can have his Medicaid dissolution and Medicare destruction act.

Medicare will pay $93,000 for

artappraiser — Wed, 06 Apr 2011 09:46:31 +0000

In reply to Generational Divide Colors Debate Over Medicare’s Future; Benefits Cost Far More Than Is Paid In

Medicare will pay $93,000 for Provenge: A Big Win for Wall Street
By Maggie Mahar, Healthbeat.org, April 04, 2011

Summary: Last week, Medicare made the decision to commit to paying $93,000 per patient to cover Provenge, a cancer drug that promises to give the average patient suffering from end-stage prostate cancer an extra four months--though it doesn’t appear to affect the progress of the disease.

For Wall Street investors who had put their money on the Dendreon, the drug’s manufacturer, this represents an enormous win. Cancer researchers also may have reason to cheer: Provenge could mark a small step forward, opening another door in the long quest to find a cure using a patient’s own immune cells. But it is not at all clear that the government should be paying for the treatment outside of controlled trials. For today’s patients, the danger is that Medicare coverage will give them false hope. After all if the government is willing to pay $93,000, thieir must be a chance that Provenge will save lives, right? Wrong.

The drug offers absolutely no promise of cure; at best it may extend life for a few months--or lengthen the process of dying, depending on your point of view. Meanwhile tax-payers and other Medicare recipients are the losers. If Medicare is paying for yet another $100,000 cancer drug that offers only a marginal benefit, it will have that much less to spend on other, more effective, if less exciting treatments....CONTINUED @ link

The High Cost of Care in a Sellers Market
By Maggie Mahar, Healthbeat.org, March 25, 2011

....In this post, Spero explains why “free market competition” doesn’t work to bring us affordable health care. Quite simply, the seller has too much power. Drug-makers and device-makers set their own prices, with little push-back from public-sector or private sector payers. Lobbyists have managed to push through a law stipulating that Medicare cannot negotiate for lower drug prices. As for private insurers, they have found that if they don’t cover all of the drugs advertised on TV, they lose customers. So for the past ten years they have been shelling out whatever the manufacturer demands, while passing the cost on in the form of higher premiums.

In the case of doctors and hospitals the situation is more complicated. As I explain in a note following Spero’s post, total reimbursements to providers have been spiraling--though some physicians and medical centers have enjoyed the lion’s share of the gains, while others have watched their income drop....CONTINUED @ link

Graphic with above (link to

artappraiser — Wed, 06 Apr 2011 09:23:16 +0000

In reply to Generational Divide Colors Debate Over Medicare’s Future; Benefits Cost Far More Than Is Paid In

Graphic with above (link to full size):

Medicare: Reaping More in Benefits Than Paying in Taxes (unlike Social Security)