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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 1 of 46

rker321 wrote:

john258 wrote:

t of forms. The VA has one, and the Indian Health Service has one. Both work. Single payer like Medi Care and that works. The experts could put one together quickly if all they had to worry about is what is good for the people. I would strongly look at Medi Care for all. You need people who understand the system not just how to read about the system.

One problem with Medicare for all. I have said that Medicare has ties with our very bad immigration laws.
I am sure that you realize that we cover elderly people that come to this country under the family immigration rules and are receiving SS and Medicare and have never made any contributions?

I don't think that medicare for all is the answer. at all. Canada has a different immigration laws, so they don't have that problem I wonder as to how they absorb their new immigrants.


Not a problem and never has been. They go to the ER as I said in a previous post and they will be treated. ER care the most expenseive there is so we save money by doing it another way.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 2 of 46

GailL1 wrote:

rker321 wrote:


One problem with Medicare for all. I have said that Medicare has ties with our very bad immigration laws.
I am sure that you realize that we cover elderly people that come to this country under the family immigration rules and are receiving SS and Medicare and have never made any contributions?

 


NO they don't -

1.  Possibly they can BUY into Medicare if they have enough money and have been legal immigrants (residents) for the stipulated amount of time, cost are

over $400 per month for Part A ,currently $134 per month for Part B or it could be more for them, I don't know, and then whatever their D plan cost.  Then they would have to get a supplemental if they stayed in original Medicare or pick a MA plan to get their benefits.

 

2.  Once a legal immigrant has been in the country for (5) years, they can apply for Medicaid if they are income eligible.

 

3.  If they don't want Medicare and aren't eligible for Medicaid, they can buy an Obamacare policy even if they are 65 years old or older. 

 

 

 

 


Or they can go to the ER and be treated. This is a red herring. They can get medical services now, and have always bee able to. It is the same way in all non 3rd world country. The quality does vary.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 3 of 46

gruffstuff wrote:

 

 

Don't you think we should begin to put in some tried and true cost saving healthcare measures, get cost down and then begin thinking about the system we might want.  We seem to be trying to just mess around with some of these measures now.  Like dropping Plan F and C from the Medigap choices so that beneficiaries have some skin in the game.  Like paying doctors for some procedures based on an all inclusive price and not fee for service.  Like paying for more procedures done as outpatient rather than inpatient.  Like getting rid of a lot of healthcare infrastructure in certain areas and increasing the number of them in other areas.  Yes, and Medicare or the country as a whole, negotiating drug prices even if that means that some meds will not be covered.

 

National health care plans do that sort of thing, they manage resources better, they negotiate prices better, the price of drugs is a good example of that.


We need more cost saving measures now.

 

Which systems are you referencing in "National Health Care"'because in many of the systems, the federal government delegates all the running and managing to a Sub-government entity - like a state, a province or a territory.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 4 of 46

rker321 wrote:


One problem with Medicare for all. I have said that Medicare has ties with our very bad immigration laws.
I am sure that you realize that we cover elderly people that come to this country under the family immigration rules and are receiving SS and Medicare and have never made any contributions?

 


NO they don't -

1.  Possibly they can BUY into Medicare if they have enough money and have been legal immigrants (residents) for the stipulated amount of time, cost are

over $400 per month for Part A ,currently $134 per month for Part B or it could be more for them, I don't know, and then whatever their D plan cost.  Then they would have to get a supplemental if they stayed in original Medicare or pick a MA plan to get their benefits.

 

2.  Once a legal immigrant has been in the country for (5) years, they can apply for Medicaid if they are income eligible.

 

3.  If they don't want Medicare and aren't eligible for Medicaid, they can buy an Obamacare policy even if they are 65 years old or older. 

 

 

 

 

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 5 of 46

john258 wrote:

t of forms. The VA has one, and the Indian Health Service has one. Both work. Single payer like Medi Care and that works. The experts could put one together quickly if all they had to worry about is what is good for the people. I would strongly look at Medi Care for all. You need people who understand the system not just how to read about the system.

One problem with Medicare for all. I have said that Medicare has ties with our very bad immigration laws.
I am sure that you realize that we cover elderly people that come to this country under the family immigration rules and are receiving SS and Medicare and have never made any contributions?

I don't think that medicare for all is the answer. at all. Canada has a different immigration laws, so they don't have that problem I wonder as to how they absorb their new immigrants.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 6 of 46

Your taxation plan to pay for any such new healthcare system is amusing since we have such a large group of citizens who pay nothing in taxes now and I doubt they can come up with it either.

 

That is why a basket of taxes should be used, not just an income tax, but yes some people will be so poor they just can't pay. We just pretent that doesn't happen and tell them to use the hospital emergency room.

 

That's just stupid, it's a huge waste of money, better to insure them and have them use a primary care doctor.

 

Don't you think we should begin to put in some tried and true cost saving healthcare measures, get cost down and then begin thinking about the system we might want.  We seem to be trying to just mess around with some of these measures now.  Like dropping Plan F and C from the Medigap choices so that beneficiaries have some skin in the game.  Like paying doctors for some procedures based on an all inclusive price and not fee for service.  Like paying for more procedures done as outpatient rather than inpatient.  Like getting rid of a lot of healthcare infrastructure in certain areas and increasing the number of them in other areas.  Yes, and Medicare or the country as a whole, negotiating drug prices even if that means that some meds will not be covered.

 

National health care plans do that sort of thing, they manage resources better, they negotiate prices better, the price of drugs is a good example of that.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 7 of 46

rker321 wrote:

It would be extremely beneficial for all of us, that do not have the knowledge like you both have. to at least see consistency in your words.

What I mean is where are the solutions. ?  Frankly we are  all waiting to see solutions and not, what and why we cannot function differently in this country.

It is becoming frustrating To see that apparently we have such a horrible system and no one can come up with a reasonable plan that will benefit all Americans.
From what I have seen in the posts of both of you, is that everything that we have done and are doing is really bad.

So, is there hope in this country for all citizens to have a system that will work for at least the majority? 


Coverage for all. It can take a lot of forms. The VA has one, and the Indian Health Service has one. Both work. Single payer like Medi Care and that works. The experts could put one together quickly if all they had to worry about is what is good for the people. I would strongly look at Medi Care for all. You need people who understand the system not just how to read about the system.

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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 8 of 46

GailL1 wrote:

john258 wrote:

GailL1 wrote:

No rker321, it is because we have really had a very open ended system and exerting some cost saving processes has its down fall.  Somebody is gonna lose something.  How would you feel if something that you need, something that you get now was not covered anymore?

 

Just one case in point - Medicare Negotiating Drug Prices For Its Beneficiaries -

KFF 01/23/2017 - Searching for Savings in Medicare Drug Price Negotiations

 

Figure 1: A majority of the public favors allowing the federal government to negotiate drug prices for Medicare beneficiaries

 

Well that is all just fine until you get down to just how negotiating will save money -

 

From the link -

What has CBO said about the potential for savings?

CBO has said that giving the HHS Secretary authority to negotiate lower prices for a broad set of drugs on behalf of Medicare beneficiaries would have “a negligible effect on federal spending.”   It based this assessment on its view that the Secretary would not be able to leverage deeper discounts for drugs than risk-bearing private plans, given the incentives built into the structure of the Part D market, where plan sponsors bid to participate in the program, compete for enrollees based on cost and coverage, and bear some risk for costs that exceed their projections.

 

CBO has suggested that savings could potentially be achieved under a defined set of circumstances. For example, in addition to simply removing the non-interference clause and allowing the Secretary to negotiate drug prices, CBO has said that in order to obtain price discounts, the Secretary would need authority to establish a formulary that included some drugs and excluded others and imposed other utilization management restrictions, in much the same way that private Part D plans do. And yet, CBO has questioned whether the Secretary would be willing to exclude certain drugs or impose limitations on coverage, as private plans do, “given the potential impact on stakeholders.”

 

Read the whole link it is informative -

 

In Austrailia International Profiles of Health Care Systems May 2017 - Australia

Out-of-pocket pharmaceutical expenditures are capped. In 2016, the maximum cost per prescription for low-income earners was set at AUD6.20 (USD4.00), with an annual cap of AUD372.00 (USD242.00). For the general population, the cap per prescription is AUD38.30 (USD25.00), which reverts to the low-income cost cap if a patient incurs more than
AUD1,476.00 (USD958.00) in out-of-pocket expenditure within a year.
 
That sounds real good,  doesn't it - but here is the clencher - it only covers the ones on the list -
 
Pharmaceutical subsidies are provided through the PBS ( Pharmaceutical Benefits Scheme ) 
To be listed, pharmaceuticals need to be approved for cost-
effectiveness by the independent Pharmaceutical Benefits Advisory Committee (PBAC)
and. . . . .
 
Consumers pay the full price of medicines not listed on the PBS.   Pharmaceuticals provided to inpatients in public hospitals are generally free
 
In Austrailia as well as many other countries, the approval of a medication going on the formulary list includes the cost effectiveness of the medication - we do not do this here.
 
So what I am saying is that as far as Medicare goes, Part D has a wide range of drugs - brands, generics - in fact, in certain classes of drug essentially all of them are offered under one insurer or another.  If we begin to negotiate the cost of drugs by HHS, the list is gonna get a whole lot smaller.
If we begin to use cost effectiveness in our approval of drugs - the list is gonna get a whole lot smaller.
 

Bad support material. The VA does it and saves money. There is a large group and for drug to be offered it is done at the National level like VA. The Insurance Cos do this and get discounts. They would not be able to do this for Medcare and Medicaid as they would do it for themselves. These articles are not golden and not correct quite a bit of the time so lets do it and see, I and experts say lower drug prices.

 

The VA works similar to the way the CBO says the Medicare drug benefit would have to work if drugs were ever negotiated by HHS - that is to say limit the formulary list for those where the best price could be achieved.

 

The VA has a formulary.  On the formulary are those medications for which they get the best price and does the whatever job effectively.  The VA system does not have all drugs on the fheir formulary.  VA doctors use the formulary list to prescribe.  In fact, the VA also has clinical guidelines as to what to prescribe for specific conditions.

 

They have their own pharmacy benefit manager to do the negotiating and set the clinical guidelines.

 

The VA goes a step further in their use of generics - they will ALWAYS use a generic drug on their formulary in place of any brand.  And since sometimes there are several generics for the same medication made by different generic manufacturers, the one that gives the VA the best price gets used.  Sometimes this might mean that the Veteran receiving a generic medication, for which there is more than one generic, will get the same medication in generic form but the medication might look different from time to time because it is coming from a different generic manufacture.

 

A doctor can request a medication to go on the formulary but it is a long process before it MIGHT go on the formulary.

 

VA.gov - Pharmacy Benefits Management Services

 

What do you mean by bad support material? 

You consider Kaiser Family Foundation, the CBO, the Commonwealth Fund's International Profils of Health Care Systems bad support material?

 

Yes, the VA does cover a large number of medications on their formulary especially generics but NOT as extensive as the required medication coverage under the Medicare Prescription Drug program.  The Medicare Prescription Drug program formularies from insurers must include drug classes covering all disease states, and a minimum of two chemically distinct drugs in each class. Part D plans are required to cover all drugs in six so-called “protected” classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics.

 

 


Another article that tells about many parts of the subject but has no bearing to the full subject. Drug cost will be lower if Medicare and Medicad can deal with the drug producers. Stop using the CBO. The CBO can only answer questions it is asked, and no where does it tell what it was asked. It does say the Fed. govt would not save that much and that is true since the Indv. pays for most of the drug cost in Medicare. My guess is the CBO was asked how much the Feds would save on this. When you say an Insurance Co can get just as good a deal as Medicare would that is crazy. Have you ever been part of getting discounts on drugs for a group of people? From what you post you have not and that is a difference between you and I. The gold standard for a discount would be Medi Care. Yes they will use a formulary as does just about every Insurance Co has been doing for years. It can bet set up so drugs not in the formularies are approved if needed, and this has been done for years. Fact is I have had it done for me in about 15 minutes over the phone. You do not understand this area and how it really works. You only understand how to find articles as you have done here.

Kaiser has articles covering all areas and are good. Just in the past week they had one out trashing Medicare Advantage programs, and they offer them. The article was a good one for the areas it covered. You have to know how to use the articles correctly. That means when applying it to a problem make sure it covers the full problem not just a sliver. That you have not learned todo yet.

 

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Treasured Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 9 of 46

rker321 wrote:

I am glad to see that someone else besides myself sees the fact that the system that we have in this country is not only not efficient but unsustainable.
I have said that before but I have not found individuals that will offer reasonable solutions to this very inefficient system.
They simply blame many times the American people because they say that we demand too much. and therefore there is no solutions to this problem
Because, we will not accept anything that offers less.
Yes, other countries have different approaches to health care, and I am sure that they are not perfect. but they actually cover their citizens, with whatever amount is reasonable to have.
One of the things that they don't want to talk about, is that most of those systems have private insurances that will provide what the Government can't or won't
Therefore,that disparity will always exist and there is no perfect system but a system that will be beneficial to a majority.


@rker321

Things will change regardless of what anyone wants. But I am tired of hearing about how bad it is to have employer subsidized healthcare.  Before the Unions fought for benefits there were no benefits.  The companies provided contracted benefits to the plant workers and included the offices in fear of further unionization.   We accepted benefits in place of a portion of wages and have absolutely no reason to feel bad about that.  Things have been changing back the other way for several years now. Less company money more employee money and less coverage. But no one who has worked for 40 years and now uses more and more of their health care benefits is going to want to change their coverage now.   It will be up to the next wave of voters/workers to make that change. 

 

 

Life's a Journey, not a Destination" Aerosmith
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Valued Social Butterfly

Re: Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind

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Message 10 of 46

gruffstuff wrote:

When all those employers pay their employees those faux-wages better known as employee health benefits, neither are thinking about what is being denied our government systems of Medicare or Social Security.  There is NO income tax paid on those faux-wages and NO Medicare or Social Security payroll taxes paid - neither by the employee or matched by their employers.

 

We have a lot of different health care provider systems in the US. On one extreme some people don't have any health care provider and no health insurance, on the other some people have what is effect a government run and government paid health care insurance.

 

There are going to be a lot of disparities in that kind of patched together system.

 

Naturally the people with no health care provider and no health insurance are going to want a health care provider and health insurance, and the people who have government run and government paid health insurance at very low cost will want to keep that low cost insurance.

 

This is why we need Medicare for all, everyone gets the same insurance, everyone pays the same percentage of their income, based on all income, not just wages, to pay for it.

 

That is a simplistic way to put it, I think the reality would be a basket of different taxes across different types of ecomonic activity targeted at different lifestyles, with what should be everyone pays the same as a percentage of income as a goal. I'm sure there would be an ongoing debate about what is fair, productive, counterproductive and so on.

 

I think what we're doing now is not sustainable,  just saying don't insure the poor won't fix it, because no one is saying don't treat the poor when they show up at a hospital, they're just saying don't tax me to pay for it.

 

However those cost just don't go away like magic, they get passed on.

 

I think it's a really dumb and inefficient way to run health care, it causes a lot of harm, and that harm in the end is expensive. I think that is one of the reasons America is falling behind on lifespan even though we spend more per capita on health care then most other countries.


The stupidity of the system goes much further than paying for it or who and how people get access.

 

Other than the FDA approval on the medical effectiveness of new drugs or treatment, we never compare the cost of such new products to their effectiveness nor do we compare the price and effectiveness of such a new drug or treatment to what might be already in the marketplace.  We can do a lot here to instill some competition.

 

The FDA now has a streamline way of approval - well that's great but if price is not a consideration all it is going to do is increase healthcare cost.

 

Olderscout66 often shoots down pharmaceutical companies advertising their drugs on public media - that's right it is not just TV.  To me, it is not the fact that they can do this but the real problem is that a person can demand such from their health care provider and get it.

 

We use too much care - doctors have become scared of lawsuits so they order more and more diagnostics and care to cover their a* *.

 

We are now beginning to spend BILLIONS on drug addiction treatments but we really don't know what the best treatments are or whether the patient has to exert some willingness to succeed.  How many times will we pay to treat one person?

 

Medicare, last year, approved a program after investigating it for about 5-years - now we can enter hospice, you know the palliative care which you can get if you are predicted to have less that (6) months to live - we are now adding curative measures to hospice.  I think this is going to escalate healthcare cost.  And personally, I would rather have the right to have help in self-destruction if I have less than (6) months to live and my quality of life has declined.  I would like this to be covered in pre-planning.

 

rker321 is right, there is no system in the world where everybody is treated the same.  But unless we begin to control healthcare cost, there is no system in the world that will help us.

 

When somebody else is paying for or helping to pay for something that you need, they have a say in what, when and how.

 

Your taxation plan to pay for any such new healthcare system is amusing since we have such a large group of citizens who pay nothing in taxes now and I doubt they can come up with it either.  Those plans like Medicare for all out there already - well, I don't know about Bernies since I haven't seen his funding description or any analysis from those who count - but Congressman Conyers' H.R. 676 plan put a lot of the funding on employers.

 

Don't you think we should begin to put in some tried and true cost saving healthcare measures, get cost down and then begin thinking about the system we might want.  We seem to be trying to just mess around with some of these measures now.  Like dropping Plan F and C from the Medigap choices so that beneficiaries have some skin in the game.  Like paying doctors for some procedures based on an all inclusive price and not fee for service.  Like paying for more procedures done as outpatient rather than inpatient.  Like getting rid of a lot of healthcare infrastructure in certain areas and increasing the number of them in other areas.  Yes, and Medicare or the country as a whole, negotiating drug prices even if that means that some meds will not be covered.

 

We are now paying for Home and Community based care for some people rather than them going into a nursing home.  Many times this does save us a lot of money however, cost need to be watched on a per person basis and if those cost rise to a place where it is above the nursing home rate, we have to be able to switch them to the place which is cheaper for their care.

 

Where do those involved in this discussion think we could save on health care cost?

 

 

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