Comparing Medicare rollout with ACA rollout

[eridani]

Medicare’s Rollout vs. Obamacare’s Glitches Brew
http://healthaffairs.org/blog/2014/01/02/medicares-rollout-vs-obamacares-glitches-brew/

The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare.

As of March, 2013, federal grants for Obamacare’s state exchanges totaled $3.8 billion. Spending for the federal exchange is harder to pin down because funding has come from multiple accounts, including: the $1 billion Health Insurance Implementation Fund; DHHS’ General Departmental Management Account and General Departmental Management Account; CMS’s Program Management Account and the Prevention and Public Health Fund. CMS estimates fiscal 2014 spending for the federally-operated exchanges at $2 billion. So it’s safe to say that the costs of getting the exchanges up and running, and (hopefully) enrolling 7 million people in the program’s first year will exceed $6 billion.

Bear in mind that the exchanges won’t actually pay any medical bills, just sign people up for coverage. So billions more in overhead costs will show up on the books of the private insurers and state Medicaid programs that will actually process medical claims.

Back in 1966, Medicare started paying bills for 18.9 million seniors (99 percent of those eligible for coverage) just 11 months after Pres. Johnson signed it into law. Overhead costs for the first year totaled $120 million (equivalent to $867 million in 2013). But that figure includes the cost of processing medical bills, not just the enrollment costs.

Signing up most of the elderly for Medicare was simple; they were already known to Social Security Administration, which handled enrollment. To find the rest, the feds sent out mailings to seniors, held local meetings, and asked postal workers, forest rangers and agricultural representatives to help contact people in remote areas. The Office for Economic Opportunity spent $14.5 million to hire 5,000 low income seniors who went door-to-door in their neighborhoods.

Obamacare’s byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers. And private insurers will exact a steep ongoing toll. Medicare’s overhead is just 2 percent, vs. an average of 13 percent for private plans (on top of the Exchanges’ costs, roughly 3 percent of premiums). A single payer plan that excluded private insurers could save hundreds of billions in transaction costs.

PNHP oress release
http://www.pnhp.org/news/2014/january/medicare’s-1966-glitch-free-rollout-a-sharp-contrast-with-obamacare-health-affairs

“Obamacare is a giant workaround crafted to keep private insurers at the center of the health care system,” said co-author Dr. David Himmelstein, a primary care physician, professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School.

“The simple single-payer, Medicare-for-all approach would save more than $400 billion annually on bureaucracy, enough to give every American first-dollar coverage. But to get those savings you have to break private insurers’ stranglehold on health care and on Washington,” he said, adding, “The glitches in Obamacare’s rollout don’t come from government incompetence, but from political cowardice.”

[Demo_Chris]

1. The POINT of the ACA was the Mandates. It was Obama's gift to insurance companies. nt

[kelliekat44]

9. Johnson didn't face the same kind of opposition by private sector. Obama had to give them something

or there would be no ACA at all.

[pnwmom]

11. It was Joe Lieberman's gift to the major insurance companies, which all happen

to be based in his state of Connecticut -- not Obama's.

Lieberman's was the vote that prevented any chance of getting the 60 votes necessary for a public option. He had switched parties to Independent by then and was beyond the Dem's control.

[jeff47]

13. No, the point of the ACA is to apply a band-aid to the existing system

while setting up a framework that moves the battle for single-payer forward.

Congress has a Republican bias - low-pop red states have more power than high-pop blue states. Implementing single-payer at the federal level in 2009 was not going to happen - too many Republicans, too many Liebermans.

The ACA provides some short-term relief, while moving the battle to the states. "Red" states will do nothing - they can't make the healthcare system worse.

"Blue" states are going to go single-payer, or de-facto single-payer via public option. Successes there will destroy the FUD the Republicans have been spewing. After that, it becomes possible to win the battle at the federal level.

Just because the ACA passed doesn't mean the fight is over. The fight is never over. It took decades for Social Security to cover as many people as it does today. And we're still fighting to expand it, while the Republicans are still fighting to shrink it.

[truebluegreen]

2. Exactly right.

As I've been telling the wingnuts of my acquaintance, the government/Medicaid expansion part is going smoothly and the exchanges/private exchanges are not.

[jtuck004]

3. Invest it in health care, vs pay rich insurance company executives more money?

Who do they think we are? Cuba?

http://www.democraticunderground.com/110824785

[yurbud]

14. nothing gets done in Washington these days unless it makes the already rich richer

and insulates them from risk.

[mdbl]

4. Gotta keep that efficient privitization in the insurance biz (Sarcasm)

Obamacare’s byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers. And private insurers will exact a steep ongoing toll. Medicare’s overhead is just 2 percent, vs. an average of 13 percent for private plans (on top of the Exchanges’ costs, roughly 3 percent of premiums). A single payer plan that excluded private insurers could save hundreds of billions in transaction costs.

I guess 13 percent is better than the 22-26 percent that insurance companies have been taking from the sick. Oh wait, we are back to the lesser of two evils again!

[Sunlei]

5. we need to get rid of the middlemen profiteers, they're the reason everything costs so much!

[KG]

6. the usual 'uniquely american' solution = make sure the right people make a fortune while everyone

else takes it in the kiester.

[MannyGoldstein]

7. Ah, geez not this divisive bullshit again.

Ugh, I just read ANOTHER post calling for single payer

Go back to Karl Rove and tell him to call me when Americans actually WANT single payer.

What next? CommieCare? You people are never happy.

Regards,

Third-Way Manny

[JoePhilly]

8. Maybe we should repeal it?

Some one should give John Boehner a call, he might be interested.

[ProSense]

10. This is

"The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare. "

...pure fantasy, and what's with the RW-style attack on the cost of the program?

Medicare Had Messy Rollout, Too
http://www.bloomberg.com/news/2013-10-15/medicare-had-messy-rollout-too.html

When Medicare launched, nobody had any clue whether it would work
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/17/when-medicare-launched-nobody-had-any-clue-whether-it-would-work/

[eridani]

15. So doctors threatened to boycott it, but didn't

Southern hospitals threatened to stay segregated, but didn't. This compares to Obamacare how? Remember, Medicare did not only enroll people, but also promptly started paying medical bills.

[Egalitarian Thug]

12. But technology! Jesus! Republicans! Helpless! Not a Dictator!