17 Medicare Facts:

[kitkat24]

17 Medicare Facts *

* Medicare is essentially compulsory. People who refuse to join Medicare Part A are not allowed to receive their earned Social Security benefits.

* Medicare patients cannot pay cash for care. A 1997 law (the Balanced Budget Act, section 4507) forbids private contracts between patients and doctors. With few exceptions, Medicare recipients cannot pay cash for a Medicare-covered service that Medicare denies.

* Initially refusing to enroll in Medicare Part B leads to costly penalty. Seniors are automatically enrolled in Medicare Part B. Those who refuse and later change their minds pay higher premiums - 10 percent higher for EACH year they were not enrolled.

* Citizens do not have a right to their Medicare contributions (payroll taxes). There is no binding contract between the government and citizens for future payment of Medicare benefits. Congress can alter or eliminate Medicare benefits at their discretion.

* Medicare comes in three parts. Medicare Part A (hospitalization insurance) is funded through payroll taxes. Medicare Part B (supplemental medical insurance for physician services, diagnostic tests, and other services) is funded approximately 73 percent by federal income taxes and 25 percent by Medicare recipients. Medicare Part C (Medicare+Choice) created in 1997, has turned into primarily a HMO managed care option.

* Medicare dependency is growing. While there are about 40 million people now enrolled in Medicare, approximately 77 million babyboomers will begin entering Medicare in 2011.

* Medicare faces insufficient funding. While there are approximately 4 workers/taxpayers for each Medicare recipient today, there will be only 2.3 workers/taxpayer for each Medicare recipient in 2030.

* Medicare is heading toward bankruptcy. According to current estimates, it will be insolvent by 2026.

* Medicare is not a catastrophic health insurance policy. It doesn't pay for hospitalization longer than 150 days, and there is no cap on out of pocket expenses. "Medigap" insurance is often purchased to protect against huge medical bills not covered by Medicare.

* Medicare does not cover the cost of long term care and nursing home care - unless it is related to a hospitalization or other urgent medical care.

* Medicare pays only about half of all health care costs of seniors. In 1997, 39,840 seniors paid an average of $22,124, either in out of pocket costs or through supplemental insurance.

* Medicare frequently denies payment. In 2001, 3.7 million appeals were filed for denial of payment by Medicare Part B. Despite a 2000 law requiring swift processing of appeals, a 2003 report by the General Accounting Office found significant delays in appeals processing.

* Medicare has not significantly decreased out of pocket payments for seniors. In 2000, a study by the American Association of Retired Persons (AARP) found seniors paying an average of $2,510 per year - about 19 percent of their income - on out of pocket costs. This does not include home care or nursing home care. In 1964, a year before Medicare passed, seniors were paying 20 percent of their income on health care.

* Medicare wastes taxpayer money. Over the past 7 years, almost $107 billion in improper payments have been made for services provided to recipients of the traditional fee-for-service Medicare program. CCHC calculated that the $13.3 billion loss in 2002 equals $36.4 million per day.

* Doctors, hospitals and others who accept Medicare patients are at enormous risk. There are over 130,000 pages of Medicare regulations that must be meticulously followed. In 1996, Congress made health care fraud a federal crime - a felony. Even minor billing errors can be considered fraud. Fines start at $10,000 per violation.

* Medicare threatens patient privacy. The federal government requires home health agencies to regularly send private data on Medicare recipients. This is called the Outcomes Assessment Information System (OASIS) In addition, doctors and hospitals that make inadvertent errors in billing Medicare can be forced to hand over the patient's entire medical record for investigation of fraud.

* Scarce Medicare dollars are used to fund medical education. In 1996, Medicare paid $7.1 billion toward the training of physicians.

Information taken liberally from Medicare's Midlife Crisis, (Sue Blevins, Institute for Health Freedom, published by Cato Institute), GAO REPORT: "Medicare Appeals: Disparity between Requirements and Responsible Agencies' Capabilities (September 2003), and testimony to Congress (House Budget Committee) from the Office of Inspector General (July 9, 2003).

Dated: November 7, 2003

[ernurse2244]

When I graduated from nursing in 1975, Medicare was a gravy train. One of my first patients stayed in the hospital for three months with a fairly uncomplicated CVA. Medicare paid for all three months although he could have done ok at home. Through the years I have seen Medicare impose regulations, DRG's etc trying to curb spending, but with the healthcare industry working at finding ways around the system. In 1975, GP's and FP's treated a much greater variety of illnesses and injuries. Now, anything but the most minor problem is shunted to a specialist and the government pays without question (well some questions, but not enough). I know that liability problems and patient expections explain alot of this, but Medicare needs to ask alot more questions. They also need to end alot of their regulations that only cost the healthcare industry money without improving patient care or curbing costs.

Wish I knew someway to change the system.

[kitkat24]

Yes...

And what people do not realize is what a problem that Medicare is, well except for the nurses that are required to work under Medicare regulations, rules, and restrictions.

Medicare is an example of what a single-payer, United States, Universal care system would be. It would cost an enormous amount and provide poor and inadequate care.

Kitkat

[ernurse2244]

I'm not sure Universal Healthcare would equal Medicare for the masses. Some interesting posts at your other thread on Universal Healthcare that contradict that assumption.

One of my arguments with Medicare is the contract MD's must sign saying they won't charge anyone else less than they charge Medicare. This means the MD can't give a discount to someone without insurance, yet, it would cost the MD less if a cash carrying patient walked in.

[ernurse2244]

Another reason Medicare costs are going through the roof is the Pharmcay Industry friendly drug program just added to it. Our "fiscally responsible" Republicon-men made sure their good buddies and benefactors in the Pharmacy Industry would have plenty of money to pass around:

Jan. 28, 2004

Public Citizen Calls for Ethics Investigation of Tauzin

Did Tauzin Negotiate Lucrative Job With Pharmaceutical Lobbying Group While Crafting Industry-Friendly Medicare Drug Bill?

WASHINGTON, D.C. - Public Citizen today called for an investigation into whether U.S. Rep. Billy Tauzin (R-La.), who had a key role in writing the Medicare prescription drug law, broke House ethics rules when negotiating a lucrative job with the drug industry's top lobbying group.

Tauzin has received an offer to represent the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry's main lobbying group, which was heavily involved in the crafting of recently passed legislation to create a prescription drug benefit under Medicare. The legislation contains key provisions beneficial to the drug industry; it subsidizes private insurers to provide prescription drug coverage to seniors - thereby increasing demand for drugs, bars the Medicare administrator from bargaining for lower drug prices and effectively prohibits the reimportation of lower-priced drugs from Canada.

link to the entire article:

http://www.citizen.org/pressroom/release.cfm?ID=1635