--Than Adults With Private Coverage
Summary by The Commonwealth Fund:
July 18, 2012
Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage
By Karen Davis, Kristof Stremikis, Michelle M. Doty and Mark A. Zezza
The 2010 survey results indicate that compared to people who are privately insured, Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home?a primary care provider who knows their medical history well, is accessible, and helps coordinate their care. Studies show that patients with medical homes are less likely to report medical errors or gaps in the coordination of their care and are more likely to be up-to-date with their preventive care.
Given these findings, it is not surprising that Medicare beneficiaries are far less likely than privately insured adults to give their health insurance plan a fair or poor rating, while being far more likely to report excellent quality of care.
Among Medicare beneficiaries, those with Medicare Advantage are more likely than adults with traditional Medicare to give their insurance a fair or poor rating. Although Medicare Advantage enrollees are less likely to spend 10 percent or more of their income on premiums and out-of-pocket expenses, they are more likely to report cost-related access problems than adults with traditional Medicare. This may in part reflect beneficiaries? experience with private health maintenance organization plans that offer lower premiums in return for limited access to a smaller network of providers.
The evidence reported here from surveys now spanning a decade shows that Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.
Comment by Don McCanne of PNHP: One of the goals of the Affordable Care Act was to protect private, employer-sponsored health plans - a sector that was considered to be functioning well. In so doing, a less expensive Medicare for all model was rejected. So how do the private plans compare to Medicare?
According to this report, "Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home - a primary care provider who knows their medical history well, is accessible, and helps coordinate their care," and are "far more likely to report excellent quality of care."
Medicare is not perfect and does need improvement, but it performs far better than the best of the private plans - the employer-sponsored health plans. Individual and small group plans have an even worse performance.
Above all, "Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection."
Right now, efforts are being made to convert Medicare into a market of private plans. Why should we pay more for less health care choice, greater risk exposure, and poorer quality? Any sane individual who is paying attention should realize that we should be doing the opposite - improve Medicare and then provide it for everyone.
It is very clear from the way the founders used the term "well-regulated militia" in contexts other than the Constitution that they intended that such a militia was to be used for defense of the country INSTEAD OF a peacetime standing army. Given that guns were widely available and used for self-defense and getting dinner, all that was neccessary for a defense force was that citizens get together occasionally for drills. A navy to protect shipping was a different matter, to be handled separately.
What, sir, is the use of militia? It is to prevent the establishment of a standing army, the bane of liberty. . . Whenever Government means to invade the rights and liberties of the people, they always attempt to destroy the militia, in order to raise a standing army upon its ruins.
Elbridge Gerry, of Massachusetts during a debate in U.S. House of Representatives, August 17, 1789
That a well-regulated militia, composed of the body of the people, trained to arms, is the proper, natural and safe defense of a free state; that standing armies, in time of peace, should be avoided as dangerous to liberty; and that, in all cases, the military should be under strict subordination to, and governed by, the civil power.
Virginia Declaration of Rights 13 (June 12, 1776), drafted by George Mason
Whenever people entrust the defense of their country to a regular, standing army, composed of mercenaries, the power of that country will remain under the direction of the most wealthy citizens.
A Framer, in the Independent Gazetteer, 1791
None but an armed nation can dispense with a standing army.
large and permanent military establishments which are forbidden by the principles of free government, and against the necessity of which the militia were meant to be a constitutional bulwark.
James Madison, Fourth Annual Message, November 4, 1812
A standing army is one of the greatest mischief that can possibly happen.
by David Himmelstein and Steffie Woolhandler
Its good the Supreme Court decided to follow the Constitution rather than play politics. But, from a medical point of view, theres little to celebrate in its upholding of the Affordable Care Act.
The health reform will leave 26 million uninsured even when its fully implemented, and force tens of millions to buy lousy coverage from private insurers. Instead of cutting out the insurance middlemen who caused the health care crisis, Obamacare hands them a trillion-dollar windfall from federal subsidies, mandated premiums and Medicaid managed-care contracts.
Because of this sweetheart deal with the insurance industry, the ACA offers no relief from spiraling health care costs.
The results are predictable. Twenty-six million uninsured means 26,000 deaths each year from lack of coverage. Soaring health costs and ever-skimpier insurance mean financial ruin for more and more Americans; already 800,000 middle-class families are driven into medical bankruptcy each year.
In Massachusetts (where Mitt Romney enacted the model for the ACA in 2006) the number of uninsured has fallen by half to 5.6 percent, but costs have skyrocketed. The premium for the cheapest mandated coverage for a 55-year-old is $5,000, and the policy has a $2,000 deductible thats $7,000 out of pocket before insurance kicks in.
Little wonder that medical bankruptcies havent fallen in Massachusetts, and surveys have found little improvement in how easy it is to get or afford care.
The unrelenting health crisis in Massachusetts has led doctors there to support more radical reform single-payer national health insurance by more than 2 to 1 over Romney/Obamacare; even fewer want to go back to the pre-2006 system.
Labeling would tell them that the group was designed and created by and for political backs from both parties, who scrupulously hide their funding sources but are associated with people like anti-Social Security billionaire Pete Peterson.
The Slick No Labels Plan to Duck Debate, Cut Social Security and Coddle The 1%
Why won't you publish your list of donors?
What's wrong with having legislators debate the issues publicly? Isn't that how representative democracy works?
How can you call yourself 'centrist' when so many of your ideas are unpopular, and in fact are too conservative for most Tea Party members?
He might have another question, too:
What's wrong with labels? Don't they let us know what we're buying?
No Labels is just one small cadre in a great army of mercenaries pushing the austerity cause. Their brigades have colorful (that is to say, silly) names like Americans Elect, I.O.U.S.A, the Committee for a Responsible Federal Budget, and my personal favorite, Budgetball - which I like to think of as 'The Fountainhead' Meets 'Deathrace 2000'.
Even if every one of these groups fails individually - which so far they all have - the hope seems to be that they'll have the cumulative effect of making it look like there's a tidal wave of support for Simpson Bowles austerity.
These programs uniformly attempt to stigmatize the majority's opinions and interests as extreme. These front groups always try to stigmatize the popular goals of protecting Social Security and Medicare benefits and fighting Simpson Bowles austerity as those of a tiny minority which ruthlessly punishes those who step out of line.
There's a word for a political system where politicians face dire consequences for defying the will and interests of the people. That word is democracy.
A conservative Christian moves to Canada
When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canada's Universal Health Care, I was somewhat disgusted. This meant we couldn't choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom.
When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted. So imagine my surprise when I discovered that midwives were not only covered by the Universal health care, they were encouraged! Even for hospital births. In Canada, midwives and doctors were both respected, and often worked together.
I started to feel differently about Universal government mandated and regulated Health care. I realized how many times my family had avoided hospital care because of our lack of coverage. When I mentioned to Canadians that I had been in a car accident as a teen and hadn't gone into the hospital, they were shocked! Here, you always went to the hospital, just in case. And the back issue I had since the accident would have been helped by prescribed chiropractic care which would have been at no cost to me. When I asked for prayers for my little brother who had been burned in a camping accident, they were all puzzled why the story did not include immediately rushing him to the hospital. When they asked me to clarify and I explained that many people in the States are not insured and they try to put off medical care unless absolutely needed, they literally could not comprehend such a thing.
I started to wonder why I had been so opposed to government mandated Universal Health care. Here in Canada, everyone was covered. If they worked full-time, if they worked part-time, or if they were homeless and lived on the street, they were all entitled to the same level of care if they had a medical need. People actually went in for routine check-ups and caught many of their illnesses early, before they were too advanced to treat. People were free to quit a job they hated, or even start their own business without fear of losing their medical coverage. In fact, the only real complaint I heard about the universal health care from the Canadians themselves, was that sometimes there could be a wait time before a particular medical service could be provided. But even that didn't seem to be that bad to me, in the States most people had to wait for medical care, or even be denied based on their coverage. The only people guaranteed immediate and full service in the USA, were those with the best (and most expensive) health coverage or wads of cash they could blow. In Canada, the wait times were usually short, and applied to everyone regardless of wealth. If you were discontent with the wait time (and had the money to cover it) you could always travel out of the country to someplace where you could demand a particular service for a price. Personally, I never experienced excessive wait times, I was accepted for maternity care within a few days or weeks, I was able to find a family care provider nearby easily and quickly, and when a child needed to be brought in for a health concern I was always able to get an appointment within that week.
Im 27 and was diagnosed a year ago with Multiple Sclerosis, an autoimmune disease I will have for life. I got it despite my youth, resources, education and mostly healthy lifestyle. Its a complex disorder, and potentially disabling. But I get to be sanguine about my future: I know that whatever comes, I have a safety net, a growing range of treatment options and the care of a first-class specialist. I have these things because I happen to be a UK national. Constitutional ambiguities aside, Americans should rejoice in a move towards a European healthcare model. Here's why.
Without access to the National Health Service or private insurance, I would be (and was, for a time) spending about $2000 a month on medications alone; along with consultants fees, ancillary imaging and testing, the disease could easily cost $40-50,000 a year. My best-case scenario would be a choice between health and a comfortable existence.
I moved to the UK to take advantage of my NHS eligibility, exhausted and angry after months grinding my fingers trying to wrest health out of an engine geared foremost to produce profit. Fragile and afraid, I had banged at the door of a fragmented, incoherent healthcare industrial complex, and even with ready money found only the frustrations of bureaucracy, and healthcare providers at every level whose interest in my case evaporated the moment the check cleared.
I came to the NHS steeled for similar challenges, only cheaper. Instead I found a different world. A de-monetized doctor-patient relationship has made a tremendous difference to my experience of care. With no incentive for hasty patient turnover, primary-care physicians learn about you and have time to fight your corner within a system they know intimately. A central data-sharing system obviated my stressful, hyper-vigilant legwork, accounting and record-keeping.
Many employers are quietly considering a move away from traditional defined benefit plans and toward defined contribution plans, which set aside a fixed amount of money each year for employees to use toward health care costs.
Under the structure of defined contribution plans, companies hand an employee a set amount--say $9,000--and employees use that money to buy or help pay for a health insurance plan they choose themselves.
At the heart of the shift is a desire of companies to reduce their exposure to health care costs by shifting the risk of unpredictable expenses to their workers.
Few employers, particularly large companies, are eager to discuss their internal deliberations on the issue because they don't want to raise concerns among employees before final decisions are made, said Paul Keckley, executive director of the Deloitte Center for Health Solutions, the health care research arm of consulting firm Deloitte LLP.
"The only thing that's certain right now is (companies are) doing everything that's legal to shift cost to employees," Keckley said.
Comment by Don McCanne: Just as they did with employee pension plans, employers are now gearing up to convert employee health benefit programs from defined benefit to defined contribution. What does that mean?
Over the past few decades, employers passed on the risks of their pension plans to their employees by switching from a defined benefit (a guaranteed dollar amount that employees would receive monthly in retirement) to a defined contribution such as 401(k) plans (a set dollar amount contributed to the pension account, but with no guarantee of the amount received in retirement - the employee thus bearing the full risk of the uncertain investment returns on the pension funds).
Now many employers plan to do the same with their health benefit programs. They intend to pay a set dollar amount for the premiums, whereas the employees will have to bear the the costs of health care inflation plus the costs of any benefits in excess of the basic program to be offered by the employer.
This will be disastrous. Employees are already being stuck with higher deductibles in order to slow the rate of premium increases for the employer. With defined contribution, premiums can be contained further by limiting the benefits covered, by further increasing the out-of-pocket cost sharing of deductibles, copayments and coinsurance, by tiering cost sharing of different levels of products and services, and by further restricting the panels of approved health professionals and institutions.
My comment: This is exactly what Paul Ryan wants to do to Medicare. An excellent way to get better at bankrupting and killing off sick people than we already are.
(Jack Bernard is a retired health care executive who formerly worked with Kansas hospitals on planning and cost containment issues. He is now a Republican county commissioner in Monticello, Ga., a suburb of Atlanta.)
Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The "government takeover" catch phrase scared them off.
Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems.
Medicare For All can be paid for through payroll and employer taxes, just like Medicare and Social Security are now. It is affordable because private insurance marketing and administrative costs (30 percent of the premium) are eliminated for employees and the firms employing them. Costs can be controlled through the Independent Payment Advisory Board, an independent panel set up under Obamacare. And, just like those programs, it would find immediate acceptance by the American public after implementation.
For more information on costs and benefits, please go to the web site of Physicians for a National Health Program at www.pnhp.org/.
Comment by Don McCanne of PNHP: This op-ed is of special significance for us for two reasons: 1) Medicare for All is not only a liberal/progressive issue as these are the words of a Republican health care executive, and 2) The efforts of PNHP to communicate the single payer message are gaining traction as he cites us as an authoritative source.
Jack Bernard is to be commended for his persistent efforts to inform the public on a better health care alternative. We need to renew and expand our important work on behalf of health care justice for all. It's working.
My comment: Intermittently, a website for Republicans for Single Payer appears. Lots of hits today, but I can't find the website that was up a couple of years ago.
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About eridaniMajor policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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