[pickledpepperRN]

How about letting people choose to buy into Medicare at any age?
It already covers those over 65 years old and the disabled.
Why not let people choose what plan they want including Medicare?
At the same cost seniors pay for it?

We could choose Part "A", Part "B", or any combination.
Medicare would have to compete with the commercial insurance plans.

[ZASHAGALKA]

Originally Posted by spacenurse

How about letting people choose to buy into Medicare at any age?
It already covers those over 65 years old and the disabled.
Why not let people choose what plan they want including Medicare?
At the same cost seniors pay for it?

We could choose Part "A", Part "B", or any combination.
Medicare would have to compete with the commercial insurance plans.

Because, while social security won't be bankrupt until 2017, Medicare will be bankrupt in the next few years.

We already spend more than 1 trillion dollars on Medicare and Social Security, alone. That is 1/3rd of the entire budget. How could we triple that coverage and not triple taxation, as well?

How are you going to get the average MIDDLE CLASS taxpayer to agree to triple his/her taxation?

These programs aren't sustainable. Don't believe me? FINE. Here is what YOUR Medicare TRUSTEES have to say, in their 2007 summary report:

http://www.ssa.gov/OACT/TRSUM/trsummary.html

Medicare

"As we reported last year, Medicare's financial difficulties come sooner-and are much more severe-than those confronting Social Security. While both programs face demographic challenges, the impact is greater for Medicare because health care costs increase at older ages. Moreover, underlying health care costs per enrollee are projected to rise faster than the wages per worker on which payroll taxes and Social Security benefits are based. As a result, while Medicare's annual costs were 3.1 percent of GDP in 2006, or about 72 percent of Social Security's, they are projected to surpass Social Security expenditures in 2028 and exceed 11 percent of GDP in 2081."

At the current rate, and without expanding it, Medicare will surpass Social Security spending in 2 decades. We currently pay 7.2% SS tax and 1.5% Medicare tax, and NEITHER is enough to fund the programs, as they exist. Within 2 decades, we will have to cut expenses on both programs, or raise the taxation OF BOTH programs to above 7.5%, each. That's 15% of payroll before any income tax is taken out. And, since costs are passed on by employer, it is, in effect a 30% tax (your employer matches). Within 2 decades, the current liabilities will exceed 30% of your salary, for these two programs alone.

How do you expect to expand them?

~faith,
Timothy.

[ZASHAGALKA]

http://www.ssa.gov/OACT/TRSUM/trsummary.html

Medicare

"The outlook for Social Security presents a fiscal challenge that pales in comparison to that posed by Medicare. The big news in this year's report is the triggering of the "Medicare funding warning." While the warning is new, it simply reflects the same dire financial outlook for the program we have been reporting for years and which was exacerbated by the recent addition of the Part D prescription drug benefit.

Projected Medicare costs are even more sensitive to population aging than Social Security's. But they are also projected to grow faster than those of Social Security over the entire projection period for a far more important second reason: the expectation that per capita health care costs will continue to grow faster than per capita GDP in the future, as they have in the past. As a result, this year's report-as did last year's-projects overall Medicare expenditures to increase from their 2007 level of 3.2 percent of GDP to 6.5 percent by 2030, and to 11.3 percent by the end of the 75-year period. In the absence of reform that greatly restrains these cost increases, taxes on the working age population and out-of-pocket payments by beneficiaries will both have to rise far faster than incomes in the decades ahead."

. . .

"On a cash-flow basis, last year's general revenue transfers to Medicare were equivalent to 12.3 percent of Federal income tax revenues. To fully fund currently projected Medicare costs would require-in addition to currently dedicated sources of income from payroll taxes, premiums and the like-the equivalent in such transfers of nearly double this percentage of Federal income tax revenues (again, projected at their historical average share of GDP over the past four decades) within 15 years and more than triple in 25 years. Such transfers would require that over the next 25 years either Federal spending on government programs other than Social Security and Medicare fall by almost 25 percent, or that income tax revenues increase by more than 25 percent from their historical shares of GDP."

http://www.washingtonpost.com/wp-dyn...050101448.html
Medicare Will Go Broke By 2018, Trustees Report

~faith,
Timothy.

[Nurse4years]

Originally Posted by Jolie

We assist them in obtaining the tools necessary to be responsible for planning, budgeting, making care decisions for themselves and accepting the consequences of those decisions, just as employed and insured citizens do every day. Those tools include lessons in budgeting, saving and financial planning, as well as tax breaks and vouchers to assist with establishing healthcare savings accounts and purchasing healthcare services and/or coverage for themselves.

So, the insured are the "we", and the uninsured are "them".
Isn't this assuming that uninsured are all irresponsible, unemployed people?

Until individuals of every economic status are responsible for their own expenses and budget, healthcare costs will never be brought under control.

Ouch. those darn poor, working poor, and middle class. Aren't the poor being irresponsible just by being poor?

[Jolie]

Isn't this assuming that uninsured are all irresponsible, unemployed people?
(Quote from mschrisco above)

Absolutely not! My belief is that those of low income and limited financial means are far more capable of managing their own healthcare than any government program will ever be, just as middle and upper income families are. I believe in the capabilities of my fellow citizens. I absloutely do not believe that poor equals ingorant or incompetent, which is why I believe that we need to empower low-income Americans to manage their own financial and healthcare affairs. This can be accomplished by providing them with the tools necessary to do so (education, tax breaks, vouchers, medical savings accounts, etc.) not by rounding them up into a doomed government mandated healthcare plan.

Ouch. those darn poor, working poor, and middle class. Aren't the poor being irresponsible just by being poor? (Quote from mschrisco above)

Those are your words, not mine, and an attitude I don't share.

[jjjoy]

Isn't the reason that Medicare costs are rising is because health care costs overall are rising? There are ever more and more wonderful, yet expensive and on-going treatments and diagnostic techniques out there. And people are living longer with chronic disease and thus racking up health care costs. And fewer businesses are offering health insurance benefits to retirees.

UHC could theoretically reduce some costs by simplifying the reimbursement system. But of course, it would likely increase costs because more people would access it, some because they could now afford to and some because of the sense that "I paid for it, so I should use it whether I really need it or not." In regard to the latter, such behavior isn't a problem exclusive to government assistance programs. Private insurance companies also have to deal with this mentality as well. Either way, measures must put in place to minimize abuse.

So back to the point, it's true that UHC wouldn't have an infinite budget and would quickly run up against financial constraints. Private health insurers are also running up against this problem as well. So premiums keep going up, especially for those unlucky enough to have extensive health care needs.

Thus, I don't see UHC primarily as way to keep costs low. I see it as a way to spread the costs for expensive health care across all groups. I see it as way to insure everyone from the fear that if they get ill, they may end up having to spend down all of their assets. And then they end up completely dependent upon public assistance. So how is it more cost-effective to NOT protect against this?

Yes, individuals could attempt to insure against catastrophic health care costs. But to fully protect oneself from the kind of astronomical, on-going costs that certain illness can accrue, the cost for such insurance would be prohibitive to the average person, at least as things currently stand.

Personally, I'm not all gung-ho about UHC. But I don't think it's evil either. I'd like to see health insurance be *insurance* and not some kind of all access membership fee. I'm all for the consumer paying for services directly. However, how could we go about dismantling the current system? And it would seem we'd still want some kind of regulation in case there are some vital services that aren't profitable enough to offer at prices affordable to the average person. I know currently if I had to pay out of pocket to take care of a UTI, it would cost well over $200. It would be a lot more affordable to self-diagnose and get some meds from Mexico. So would we then need to reconsider our current system which would usually require an office visit and a lab test in order to treat a UTI?

"Free market" and "choice" and "personal responsibility" are great ideals, just like "affordable health care for all" and "social insurance" and "public services." It's not all or nothing.

[jjjoy]

I don't see how HSAs and tax breaks help those with low incomes manage health care costs better. When you're not making much, your medical expenses could easily outstrip the taxes that you owe. HSAs mean having to estimate your health care costs ahead of time. The money comes out of your paycheck, buffered by the tax benefits. So instead of getting a paycheck for $800 every two weeks, you get a paycheck for, say, $750 with $80 going to your HSA. Now you have to pay your health care bills out of pocket... let's say $150... and send the receipt in for reimbursement from you HSA. For a low-income worker, it's an awful lot of work for not much savings. For any substancial expense, there's no way they could put enough aside into an HSA to make a difference. Tax breaks have the advantage of not having to guess how much one's future health care expenses will be. Still, they don't help you if you're faced with an $1,800 bill now. You have to wait til next April to deduct the expenses. And again, for those in a low income category, expenses can quickly run over whatever taxes are owed, meaning a rather low limit on the assistance such breaks offer to low income people.

[ingelein]

Originally Posted by jjjoy

Thus, I don't see UHC primarily as way to keep costs low. I see it as a way to spread the costs for expensive health care across all groups. This concept of risk shifting or spreading the costs, is what is causing so much disagreement here on these UHC threads, some simply will never accept this concept, despite the fact that it makes a lot of sense.

"Free market" and "choice" and "personal responsibility" are great ideals, just like "affordable health care for all" and "social insurance" and "public services." It's not all or nothing.

Despite all the uncertainty regarding health care reform, it will have to happen, we cant sustain our current system for much longer.

[lindarn]

Originally Posted by spacenurse

How about letting people choose to buy into Medicare at any age?
It already covers those over 65 years old and the disabled.
Why not let people choose what plan they want including Medicare?
At the same cost seniors pay for it?

We could choose Part "A", Part "B", or any combination.
Medicare would have to compete with the commercial insurance plans.

Tricare, the military insurance for military members, is also a good option. They are now letting reservist buy into Tricare for medical insurance for themselves, and their families. There is also Tricare Dental Insurance that reservists can also buy into.
Tricare also has Pharmacy benefits, that we can use. I pay a $9 co pay for name brand prescriptions at a neighborhood pharmacy, and $3 for a generic. These are programs that are already in place and can be extended to the American public. If they can make the command decision to cover reservists they can make the command decision to cover the American public.

Lindarn, RN, BSN, CCRN
Spokane, Washington

[ingelein]

Tricare is a GREAT option. Its good insurance, my daughter gets excellent care in the Navy.

http://www.tricare.mil/