I can speak about an apparently non-scam Medicare Advantage plan that my wife and I are on.
It is effectively a PPO (similar to the Kaiser plan someone else mentioned), so we have access to exactly the same physicians that we had already where we were paying for private insurance. Our annual premiums went from about $85k a year (on the private insurance) to around $10k out of pocket.
We are fairly healthy, though my wife is going to have some major joint surgery. What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. (That stalling finally motivated my wife to make the switch out of the private insurance.)
The downside of our MA plan is that we are not going to be able to move out of the area easily. But you always have that issue regardless -- finding a whole new set of doctors and dentists when you move...
I do get these phone calls asking to schedule a "wellness" check that the article writer mentions. Oddly enough, my wife didn't get any (so far.)
>What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately.
At least one part of the scam seems to have worked here: you use "private" to describe your old plan, to contrast with MA. In reality, both your old and new plans are private.
No, the Affordable Care Act restricts premiums for the most costly insureds (age 64) to 3x the least costly insureds (age ~21).
So the health insurance premiums you see for ACA compliant health plans are very subsidized by younger plan members, but this subsidy ends starting age 65.
In other words, expected healthcare costs for old people are massive.
Edit: also, annual premiums for age 64 are around $20k to $25k, and that is with the subsidy from younger plan members.
As I understand it, the subsidy ends at 65 because at that point the "affordable care" option is Medicare. Thus, there's less motivation to subsidize private insurance.
It is not a health care system, it's a sick and dying payment plan system. They definitely don't want you to die because then you stop paying into the system. But they don't care about quality of life, they want to pay out as little as possible.
> No, the Affordable Care Act restricts premiums for the most costly insureds (age 64) to 3x the least costly insureds (age ~21).
> Edit: also, annual premiums for age 64 are around $20k to $25k, and that is with the subsidy from younger plan members.
This implies premiums for the least costly group are $6500-8000/year, which is substantially more than the price I pay. I dont have employer-provided healthcare, nor a marketplace plan, I pay the cash price for individuals without any subsidy. And I haven't been 21 in decades.
See Omnia BCBS Gold at $731 per month for age 21 to 24. Omnia BCBS Silver HSA would be $423 per month.
Silver plans cover 70% of expected costs, but at age 64, I assume most would want the lower deductible and oop max of a gold plan. Even the insurance company is calculating it needs to charge $300 more per month for that extra 10% of expected healthcare costs they would have to pick up with a gold plan versus a silver.
As another datapoint, my family of four gold HSA BCBS plan is running around $33k per year in premiums for 2 adults in their 30s and 2 toddlers.
That call is because Health Plans are rated by CMS on if you get certain types of services, or skip them. By skipping those checkups you are reducing your health insurance plans STARS rating, which means they lose significant monies from the government. Each .1 of a start equals around 1 million US in government funding to a health plan doing MA.
The insurance was a high end PPO with no lifetime max and $20 copay. My wife is a cancer survivor, and I take drugs to minimize my cancer risk.
Additionally, the premium growth rate accelerated considerably after 65.
We did not actually pay $85k for a year but that was going to be the price. We were told what the new premiums would be, and instead of paying the $85k (paid monthly in installments), I switched immediately to the MA plan and told my wife, let's see how this works out. She held on for six months, then ran into the stalling, and then it took her another six months before she could get on the same MA plan.
The reason our MA plan works is that it's offered by the same medical center we happened to use 100% of the time on our previous insurance. So we didn't need to switch any physicians.
Regarding predatory MA's, my wife's surgeon, who was trying to get the approval for her surgery, told her, "This isn't going anywhere, you're past the time to switch to medicare, get an MA. However, be sure you avoid these companies."
Yes, we switched to medicare late, and we are reminded of that every month when we pay the penalty.
(I should mention our current MA plan is a HMO, not a PPO -- my typo.)
Hmm. It wasn't that we didn't have coverage -- that's a separate penalty instilled by the ACA.
It was that, after 65, you're supposed to be on Medicare. Period. And they way they enforce it is they charge you extra when you do finally get on it (presumably after your private insurance becomes just too expensive...)
I'd be delighted to be proven wrong, but we were told repeatedly, including by Medicare itself, we Shall Be Penalized.
> It was that, after 65, you're supposed to be on Medicare. Period. And they way they enforce it is they charge you extra when you do finally get on it (presumably after your private insurance becomes just too expensive...)
"It’s important to sign up for Medicare coverage during your Initial Enrollment Period, unless you have other coverage that’s similar in value to Medicare (like from an employer). If you don’t, you may have to pay an extra amount, called a late enrollment penalty."
The penalty is intended to stop people from saving money by forgoing insurance entirely, then hopping on when they get sick. Ask your insurer if they can provide a certificate of creditable coverage for the period. I wonder if a quick consult with a lawyer with relevant experience would be of use.
I wonder if 65+ health insurance plans are allowed to price insurance based on the insured’s health, since the Affordable Care Act pricing rules only applies up to age 64.
If so, I can see someone with chronic ailments with high probability of things like heart attack, stroke, and other high cost events cause a premium that high.
I was paying $2700/month 13 years ago for a higher-end family plan when I owned my own business. I'm not surprised then, if I paid $32k/year 13 years ago, that some plan today might be $85k. US health insurance is indeed crazy expensive. You will see some people paying less, but that's because large businesses subsidize costs, some of them only use the big insurance companies for administration, and pool their own funds to pay from. What individual people pay varies wildly.
Socialised healthcare is not a utopian dream and is riddled with problems. However I can’t see how costs of even a fraction of those cited here don’t motivate people to demand change. A heart bypass graft, cancer treatment or a joint replacement every year could be paid for and there would be cash left over (but not in the US obviously).
49 years old, married (same age), six kids, and my ACA plan in my area is $3k/mo for bronze, and $4 to $5k/mo for gold, with $10k deductibles. We have paid cash for five of our six kids.
Thankfully, my spouse and I and kids are healthy, but that's so much money that if I'd carried insurance when building my startup, we wouldn't have a startup today.
The ACA kills the American Dream. One possible fix is that I should be able to buy any insurance I want from anywhere in the country I want; this would mean real competition; currently, I can only buy from a few providers that operate in my local part of my (large) state.
Anyway, I find $85k shocking, but not that shocking given that I'm looking at $60k/year (not including deductibles) at a much younger age. (When I first started in my career, that was more than I made in a year!)
Once I had commercial insurance from out of state. A doctor visit was covered as in-network and all was well. But they did a lab. The lab was in a hospital 100 miles away. The insurance said "ok you have to pay the deductible for this lab", which is like fine, how much can a single lab cost? Single urine sample, easy.
Well didn't you know, the hospital did NOT have a negotiated in-network rate with the insurance company. The hospital insisted that we owed them $650, because that was our deductible.
Other in-state insurance companies cut those stupid bills down by 95-97% with 'allowed amounts', but the out of state insurance didn't have that negotiated rate with them.
In the end I called the hospital and told them I knew from other insurance bills how much it should have cost, and that we can just not pay, and ignoring collectors is easy. I offered them $50 (for a $20-30 lab) and they send me a new bill "writing off" the other $600.
So, you want out of state insurance, well, be careful what you wish for, it just might come true, and you may not like it at all.
Because as a whole, this industry can't actually determine what fair pricing is. There are too many perverse incentives concurrently in play for anyone to realistically make sense of things.
We can easily look north to Canada or east to Japan for context on what services and procedures should cost.
Japan has the health insurers and medical providers engage in structured fee negotiations and standardize prices in systems.
There is no reason in the USA that injecting a Covid vaccine should cost $42.70, while injecting a Mpox vaccine should cost a different price of $67 when self paying at Kaiser. Meanwhile, insurers pay significantly less than this for the same service.
The current version of the ACA (i.e. as subsequently amended) limits your premiums to 8.2% of your household AGI were you to sign up for the 2nd most costly Silver plan in your state.
So no, you're not paying $60k a year unless you have a shockingly high AGI.
You need to look into federal subsidies. You can get them either through the relevant (federal|state) marketplace or as refunds on your federal tax bill.
The subsidies reduced my wife & I (late 50's, New Mexico) premiums by more than 50%.
Not really. The subsidies are provided by the federal, not the state government. If your state isn't making it easy to access them, then just claim them on your federal tax return.
> You need to look into federal subsidies. You can get them either through the relevant (federal|state) marketplace or as refunds on your federal tax bill.
Wondering why I'm just now hearing of this -- can you recall any focused search terms, or web links?
They should automatically get applied on the healthcare.gov site or your states local version. They only apply to the silver level plans, which is why the GGP post talking only about bronze and gold plans quoted such high numbers. Those plans completely skip the subsidies.
That's why the websites ask you your income levels.
It also affects your max out of pocket expenses for the year (total limit of deductibles and copays before insurance has to cover it all)
They are computed from a given state's 2nd-most expensive silver plan, but they apply to all plans. I am on a gold plan and receive them; last year I was on bronze and received them.
The subsidies have no impact on deductibles or OOP - that is determined by the insurance plan itself.
I looked it up, and we are both correct. There is a premium subsidy based on the silver plan but that applies to any plan and a deductibles/OOP pocket subsidy that only applies to the silver plan. They have different qualification levels. It seems the deductibles level has a pretty low income cutoff, and the premium subsidy has changed a lot over COVID (to the point where the income limit was removed, at least temporarily).
The Republicans are generally opposed to these, and they are not permanent.
I would note that I am also opposed to them in principle - I do not like a system that allows insurance companies to continue to overcharge and under-provide by limiting what consumers actually pay (the rest being paid by the government). However, in 2023, this seems to be the best the USA can come up with.
The ACA is what allows small business and individuals to buy insurance in the first place. Without ACA, you would be subject to benefit maximums, pre existing coverage denials, and no requirement that insurance cover proven treatments for your ailment.
> One possible fix is that I should be able to buy any insurance I want from anywhere in the country I want; this would mean real competition; currently, I can only buy from a few providers that operate in my local part of my (large) state.
If anything I think we'd see more consolidation and fewer choices if people could buy across state lines. If enough people in state A buy from a provider in state B, state A's providers could very well close up shop.
Want to see my bills? I don't shred paperwork until 3 years go by, so they're around somewhere. We were able to afford it, though it did take a good chunk of our retirement income away. And it was less in previous years.
The goal was to protect against really bad things happening that would result in hospital bills of a million or more -- and screw up our retirement completely.
(We had private insurance because both of us retired early, and the early premiums were reasonable. Also, my wife had heard that Medicare was a bad insurance to have, and didn't want to take the risk she couldn't get the care she might need.)
https://imgbox.com/OwGh0xwd . That's my wife's. Mine is buried in a box in the garage and it's staying there. I am ~four years older than her so my premiums were noticeably higher.
Please let me know if I failed to anonymize the image.
Are they immediately approving the surgery so you stay on for a year and then are hooked? How long from approval until the procedure takes place? Will they deny future, follow up or other, procedures down the road?
As I mentioned elsewhere, the MA covers the same health center we've used for 40+ years as a HMO. I've had no issues with getting stuff approved. Her surgery was approved in less than a month and it's scheduled in a month. She'll need another later this year, but approval of that must wait until we see how this one turns out.
There's always the possibility the MA will stall. If it's egregious, we'll need to look into legal alternatives.
I don’t like the idea of private Medicare but this article is populist handwaving. Here is an article from real healthcare researchers with aggregates statistics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465897/
Notable:
> Private health insurers in Medicare Advantage must abide by all explicit Medicare coverage determinations including national coverage determinations (NCD) and local coverage determinations (LCDs). In the absence of an NCD, LCD, or other explicit Medicare coverage determination, however, Medicare Advantage insurers can apply additional coverage restrictions if they determine that a service fails to meet the “reasonable and necessary” standard.
It sounds like virtually no claims are denied even under Medicare Advantage:
> Denied services accounted for 1.40% (95% CI 1.39–1.41) of total services (paid and denied services), and denied spending accounted for 0.68% (95% CI 0.67–0.70) of total spending (paid and denied spending).
However, it sounds like MA plans will deny things that the ordinary Medicare rules by themselves wouldn’t deny.
> On average, Medicare coverage rules accounted for 85% of denied services and 64% of denied spending, with Aetna Medicare Advantage coverage rules accounting for the remainder.
It seems like an unaccounted for confouder that LCD/NCD/MUE denials are the bread and butter of a claims clearinghouse and the claims would not be sent to the payer if they failed those tests. My bias may be showing, but it doesn't seem like they accounted for that at all..
It is not a popular opinion but I always thought the tv ads that spam the airwaves in the last few months of the year were harmful to the legitimacy of institutions. In this day and age most of us are so assaulted by spammed scams that we develop a sensitive sense of scamminess and like many of the ads aimed at seniors these ones scream “get grandma away from the tv!”
Certain day parts on tv are dominated by ads for personal injury lawyers and things you can spend government benefits on and are a desert for ads for things you might spend your own money on.
One series of ads that promoted getting some free medical equipment that ran for years and I thought looked scammy turned out to really be a scam.
I’ve always thought these ads promote the idea that some chiselers somewhere are trying to rip off government benefits and they drive people, even the pensioners that these are aimed at, to vote Republican.
I've said this before but it was such a perfect moment that I share it whenever possible, my mother in law is one of these folks and once she said that she'd never support universal health care because there was a chance some immigrant might get free health care on her dime. She followed that statement up by mentioning she was going to Mexico for some dental work she couldn't afford.
In high school, my girlfriend's dad was Mexican born to illegals in the US, and we found it bizarre that he was a huge Rush Limbaugh fan and Fox News fan and regularly ranted about the border. His parents were different than the drug dealers and criminals coming over "now" and they eventually did become citizens was the logic if you asked about his origins.
This is much less bizarre when you realize that Mexicans are, you know, not a homogeneous bloc and have their own divisions that might simply not be visible to you.
Imagine creating a single stereotype for everybody in the US, calling us "Americans" and assuming we have a single set of values and opinions - now contrast it with the reality of our polarizing politics where people have wildly different points of view.
There's no contradiction. Lots of insurance plans and systems, whether in the US or not, don't cover dental or don't make it "free". Let me introduce you to Mosonmagyaróvár <https://en.wikipedia.org/wiki/Mosonmagyar%C3%B3v%C3%A1r#Dent...>, a small town with no fewer than 350 dentists, because so many Austrians and other western Europeans cross the Hungarian border to visit. Dental care is so cheap that an Austrian can get work done on his teeth and take a local vacation for less than what he would pay in Vienna. Dentists even have their own small hotels <https://diamantdent.hu/en/Hotel/> to serve such patients!
If you think those are bad, try looking at the junk mail retirement-aged people get. My parents get "official" looking notices about owing money or being owed a lot of money, offers to reverse mortgage their house for a "retirement nest egg" without using the term reverse mortgage, and for different scam insurance plans that don't cover anything worth covering.
If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year.
They get that kind of junk mail literally everyday.
My in-laws fell victim to this. When they moved they sat us down and started to talk about this "407-B" (not the real name, but I don't remember what it was) and how it's not a reverse mortgage. Then they proceeded to describe it as exactly a reverse mortgage.
Meanwhile I was tap-tap-tapping on my phone. I called them out and said it was a reverse mortgage according this page titled "Everything you need to know about 407-B reverse mortgages". They asked what fly-by-night website it was and when I said "irs.gov" they grumbled and moved on. To this day they refuse to admit that it's a reverse mortgage.
> If they ever went through with the offers they get in the mail, they'd be homeless, without insurance, cashless and asset-less within a year.
Not that quickly, but yeah, they're on that road. They're trapped in that home until they die. They'll be needing hospice care soon, and they won't be able to get it. Nothing we can do to move them off of it now because it's basically irreversible.
Everyone needs to have that awkward "don't trust any unsolicited offers" conversation with their aging parents. They may seem sharp today, but people's mental faculties decline. My folks fell for one or two, and they're a lot more on the alert now. I'm glad they listened and understand not to trust any unknown callers or mail. Feel terrible for some other people I know who can't get through to their parents, who are convinced that "Rajesh" from the IRS needs to be paid $20K through Amazon gift cards.
This generation who told us all to not believe what you read online... now trusts everything they see on Facebook, everything they get in the mail, and every phone call they get.
Hope it works out for them. Not sure though why you're so against reverse mortgages? It seems like it's just one of several options for folks to pull equity out of their home. Especially if a high priority is to stay in their home. I'm sure there are scams, but, for example, in NJ, before signing up, you meet with a government specialist who reviews the terms and the company to confirm that it's legit.
I'm not fundamentally against them, and I don't think they're scams, but it was a poor choice in their case. I also don't think this one wasn't legit, but I think that an objective bystander would not have been able to say it was a good decision.
- They had a $250,000 house that was completely paid off.
- They used the sale of that house as their down payment with a reverse mortgage to buy a $400,000 house, so they effectively didn't pull any equity out.
- It was very clear that they would need nursing home care in 10-15 years due to several health issues in both their backgrounds.
- They had no investments, no savings, no assets, and they were planning on living almost completely off of social security.
- It was clear that they had no basic understanding of what a reverse mortgage even was.
At the time I predicted that they'd need to move to a nursing home or an assisted living facility in ~15 years. They wouldn't have any way to pay for that, and selling the house wouldn't be an option because they'd be completely underwater on it. They'd eventually try to get a nurse to stop by regularly, but when they get to that point it'll be paid by us because they won't be able to afford that and food.
My predictions were off slightly, but not for the better. The house is already underwater due to a variety of factors. Mother in law's cancer is aggressive enough that she won't live long enough to need nursing care. Father in law is right on schedule. We're already paying for food occasionally because we found out that when faced with not being able to afford both food and medicine they were sending cash to one of their kids.
I think the ideal case for a reverse mortgage is a healthy elderly couple that either has no children to leave things to, children who are self-sufficient, or who have sufficient retirement income but they want a bit of splurge.
> My in-laws fell victim to this
The "this" was a reverse mortgage that they had been coached to call "not a reverse mortgage"
It's because they're purposely obfuscating what the mortgages are in order to deceive. There's nothing wrong with them per se, what's wrong is taking advantage of people and deceiving them into making poor choices that can have significant consequences.
In Canada we basically get no medical ads, and it’s great. We find US acceptance of direct-to-patient advertising… ethically problematic. Most developed countries are more like Canada than the US on this.
US ads is such a cultural shock when you visit USA. The biggest surprise was all the lawyer ads, "Did something happen to you? You could get rich by suing them with our help!". So ads like this:
I think the bigger shock is how frequent the ad breaks are. In Ireland, an ad-break 4 times an hour is typical, and often if a movie is showing, it'd be every half-hour or on the hour instead.
In the US it feels like it's every 5 minutes. It's especially jarring watching a show that originally aired on network television in the US, seeing it cut to black or a title card every few minutes where an ad-break would've been.
Wildest of all to me is that some networks add even more ads above and beyond what an older show was produced for, leading to running episodes at slightly faster speeds to fit in that extra ad break.
TBS was infamous for doing this with episodes of Seinfeld, you can find them side-by-side with the original speed airings on youtube.
This is anecdotal, but it feels like there are more ad breaks than there used to be. TV is unwatchable in the USA as a result, and I have little doubt that this was a big factor in the rise of streaming.
Streaming with ads is worse; invariably they cut to the ad 2-3 seconds early, then when you get back it's the last two seconds and then the next segment.
I know ad minutes per hour have increased, because older shows have to be slimmed to air. Sometimes that's fiddling with the credits, sometimes on stations that care less, it's dropping minutes of content; I tried to watch an episode of The Munsters on some sub-channel, and they cut to commercial over the punchline of a joke... which ended up just being omited. Thanks a lot.
but also "structured settlements, annuities, and lottery payments in exchange for a lump-sum cash settlement." After all, it's your money, use it when you need it!
Hollywood celebs peddle public policy they are too rich be affected by during their working years. Selling reverse mortgages and other garbage they're too rich to need targeted at seniors is a perfectly sensible continuation of that income stream.
No, this place would set you up with a knee brace or similar thing out of a catalog, the thing is they did not care if you really needed it. If it did turn out you needed something like that later you’d find that you already wasted your benefit on something you didn’t need.
I just saw a podcast about a startup that was working with Medicare/Medicaid to reduce costs by improving preventative care [1].
They look for people at risk, target them and take a cut of the overall reduced spend.
If Medicare is requiring the same outcomes and disbursing per-person based on the cost to Medicare, then the insurance company's profit would have to come from either selecting for healthier people on the input side, or keeping them healthier for longer. Selecting for healthier people might be hard if it's "all signups allowed".
My dad was on a Medicare Advantage plan offered by a traditional "insurer", and it seemed to be worthwhile - it covered some drugs better than OG Medicare, and had fixed copays rather than anything percentage based. Towards end of life (pre-hospice) they proactively sent a doctor out a few times for housecalls, with the goal of keeping him out of the hospital. And the baseline Medicare rules reigned in a lot of the usual "insurance" company shenanigans. If he had longer term health issues perhaps Medicare plus a Supplement plan would have made sense, but as it was it seemed to work out - had two years of paying the drug coverage gap (paying a few thousand dollars is essentially table stakes for health "care" in this country). I'm not a fan of "insurance" companies in general, rather just reporting my experience.
I kept his phone number (VOIP is like $1/mo), and I still get spam calls from scammers claiming to be "from Medicare" that "have a new card" for him - shamelessly pretending to be part of Medicare itself rather than a private company that's trying to steal his Medicare payments. Many times I'll ask them if their parents know they scam old people all day, or if they would want their parents getting scammed in their old age. Most of the time they just try to get me back to the script and think they'll convert me somehow ("I am not scammer").
I'm ambivalent on medicare advantage as a concept, but the scam companies are really what needs to be reigned in. Given that the benefits of medicare advantage is supposedly better coverage, I think a great way of doing reform would be to make it so people could change back to regular medicare at any time, and doing so would end up yanking back the premiums from the private company for the past year or two, unless they had actually paid them out for bona fide services. In addition to a lot more criminal enforcement against fraud, of course.
> they proactively sent a doctor out a few times for housecalls
The article talks about these housecalls:
"The home health visits are designed to look for illnesses or codings that can increase risk scores. They very much are not looking for conditions that require medical intervention. This “free home health visit” scam is so profitable that an entire industry has sprung up of companies that send nurses out on behalf of the insurance companies."
If I look at it post-hoc and cynically, maybe their motivation was to get him off the "insurance" company's books (electing hospice kicks you back onto vanilla Medicare). But it was objectively needed and they spent time to do the job, on a major holiday even.
I've no idea what the dynamic would have looked like if they came to different conclusions than me and we were at odds, but all I can say is that the quality of care always heavily depends on having an advocate.
Port request. Landline at Ma Bell with the number being in a traditional city exchange, straight to voip.ms. I forged his signature on the landline statement I sent in with the request, rather than adding complexity with POA/executor paperwork (I forget when I actually did this). It worked fine.
And it's really complex so that even if you have the money to navigate it, you might make bad choices. I have two relatives who did that. It could easily have cost them their lives, but thankfully it did not. It was close, though.
Isn't it the opposite? It's a bottomless money pit set up to ensure that everyone is motivated to work themselves to the bone throughout their productive years, since you never know how much money you'll need for healthcare in retirement.
Looting the state via privatization is the core tenet of neoliberalism. Conservatism is really more of a social philosophy than an economic philosophy. If you are in the us both major parties are neoliberal.
Neither party is fiscally conservative in the United States. No politician gets re-elected by cutting services or raising taxes. Each party uses the Federal credit card to buy and retain voters.
Barack Obama's justice department let nearly all the bankers off the hook after the 2008 financial crisis. A largely democratic Federal Reserve accommodated with zero interest and quantitative easing. Losses were socialized in the form of zero-interest rates that penalized savers. Zero interest rate policies and quantitative easing led to massive wealth inequality and eventually the foundation of the inflation we're now experiencing.
Losses incurred by the banking system were socialized. Profits were privatized. Republicans run this same play via the tax system. But the effect is identical.
Bankers got rich. Wealthy people got wealthier. Working people got poorer.
The point I raised is that Democrats are equally complicit in socializing losses and privatizing profits. The mechanism may be different but the outcome is identical: poor people get poorer.
In 2008 and 2009, to remove moral hazard, big banks needed to be temporary nationalized, their shareholders and bondholders wiped out and some of their executives jailed. The loss would have been felt by the wealthiest. Instead, the Obama administration took the path of shoveling billions of dollars into the big banks. Poor people got inflation, the wealthy got richer.
So to answer the narrow question of privatization: in 2008 and 2009, by not nationalizing the banking system when it imploded, the Obama administration in effect privatized it as a hybrid quasi nationalized system. Banks were force fed billions and of taxpayer money. Executives didn't get fired. Guess who still got to collect outsized salaries? Guess who got screwed over? This was a privatization because the financial backstop to the banks changed from the market to the Federal government. Everyday workers got shafted.
The government made money on TARP. Those were not interest free loans, they were preferred shares on which the banks and other companies had to pay a 5% dividend. Also, these programs began in 2008, as you said. Obama was not president in 2008, though his transition team was involved late in that year. TARP had bipartisan support in Congress.
> In total, U.S. government economic bailouts related to the global financial crisis had federal outflows (expenditures, loans, and investments) of $633.6 billion and inflows (funds returned to the Treasury as interest, dividends, fees, or stock warrant repurchases) of $754.8 billion, for a net profit of $121 billion.
Post 2008, bank earnings were effectively subsidized by ZIRP+QE. Pre GFC, banks had to pay interest on deposits to savers who wanted a risk free return. Post GFC, that risk free return went to zero, leaving the banks to scoop up the margins between cost of funding (0%) and the return on lending.
The banks paid back TARP with money that would have accrued to the public pre-GFC. So yes, TARP resulted in a profit for the government, but the organization of the banking system post GFC was a net loss to the public at large - money that savers would have once earned was handed to banks. This government backstop socialized the losses accrued pre-GFC by distributing it across the public; banks were recapitalized at the expense of savers. Of course it wasn't distributed equally. Everyday workers and savers took enormous losses - just spread out over time as the purchasing power of their savings eroded against housing, healthcare and education.
Obama spent his first two years with a Democratic Congress on healthcare - when he should have nationalized, recapitalized and reformed the banking system in favor of workers. Why didn't he? Well, it should be no surprise that the banking industry is one of the largest political donors in any given election year:
I always thought that Medicare & Medicaid are a scam to drain the nation of their wealth, until the nation is dead AND healthcare used to be a great deal more affordable before Medicare & Medicaid got involved in it.
Now, senior folks get on Medicare until they've tapped out its lifetime benefits and then they go onto Medicaid.
This is part of what has created the upteen millions of Medicare scams.
The programs only exist because health insurance became unaffordable for seniors. Healthcare is expensive for the old! I’m not arguing against the idea that the program has fraud issues (Rick Scott made a fortune off of it), but its not going to be cheaper or better for the elderly if we let private companies exploit them individually instead of forcing them to defraud the government.
Profitability of the insurer is tied specifically to claim denial and reducing expenses.
Medical insurance transfers onto Doctor's Offices and Hospitals all the expenses of billing & coding which then also requires the doctor / medical provider spend 20-40% of their time doing billing & coding, and dedicated personnel to interface with the insurance companies and be involved in tracking down outstanding bills, getting pre-authed, negotiating settlements with insurance, getting "in network" etc.
The whole insurance thing is a racket that has massively enlarged the costs of doing medicine.
The whole private insurance is a racket, because private companies don't have many incentives to offer reasonable insurance.
Public insurance, or community driven, is a different matter. Sure, someone can have a non profit racket, but if the insurance pool is communal with relatively low overhead, it can function much better.
Universal care has different issues, but at least it is closer to communal in this sense, so better in that sense at least.
Public insurance is a sure-fire way to grow how much money goes to private healthcare providers. Just like this latest amyloid plaque crap, the whole thing will be aimed at ensuring that the public budget can be directed into something that is politically unassailable: spending as much money on old people as possible. Remember: you should never trade grandma for a dollar.
The US private healthcare system will be inefficient because it tries to apply market solutions across the board for a problem that isn’t well served by the market.
Yet it’s extraordinarily inefficient because the private sector fights against any level of price-of-service transparency, which means even market forces cannot and do not apply.
This problem has been well-studied and the solutions (more than one) are also well-known.
The magic wand here is the blinders that have been pulled by politicizing healthcare.
What? You're talking about two different things: Health insurance vs Long Term Care.
There are no maximum lifetime benefits for Medicare Part A & B (health insurance) that I'm aware of. When you hear about a "Medicaid spend-down", it's all about reducing an elderly persons assets so that the state sees them as poor and Medicaid will pay their Long Term Care (nursing home) expenses. Medicare has almost nothing to do with the Medicaid spend-down strategy that I know of.
> Medicare Part A covers a stay in the hospital for any single spell of illness or injury within a time frame of 90 days. This is known as a benefit period, and there’s no limit to the number of benefit periods you can have. But if you need to stay in the hospital for more than 90 days with the same illness or injury, you have the option of using some of your 60 lifetime reserve days. These allow you to extend your hospital stay for a higher copayment ($608 a day in 2014). You can use these days—one or more at a time, or as you need them—over the rest of your life. Once the 60 reserve days are exhausted, you would pay the hospital’s full daily charge (except for services covered under Medicare Part B, such as physician visits) if you need to stay in the hospital for more than 90 days in a benefit period.
> Medicare covers only 190 days of inpatient care in a psychiatric hospital in your lifetime.
> Medicare limits the amount of coverage you can get as an outpatient for physical or occupational therapy and speech-language pathology in any given year. In 2014 the limits are $1,920 for occupational therapy and $1,920 for physical therapy and speech-language pathology combined.
The first two are interesting, but last one you mention is not a lifetime limit, and so doesn't really belong in the discussion.
And the first one is interesting, because that 60 day "limit" is actually 60 days of extra benefits. If those 60 days didn't exist, if Medicare Part A always ended their coverage for an incident at 90 days (which would be perfectly reasonable), then there wouldn't be a lifetime limit, but I think we can safely say that the coverage is better with those 60 days than without them.
Which is to say, you kinda had to reach to come up with examples of lifetime limits.
In general, 90 day acute care stays are unusual and the reality is that you’re looking at a transition to a nursing home or rehab facilty.
Once you stop progressing and exceed that limit, at that point you’re self-funding your care until you cannot, and then become Medicaid eligible. If you live in a place with beds and have family that can fight to get you into a good facilty, you’ll love out your life there or transition to home care.
All the critiques dance around the fact that the US doesn’t have universal healthcare so there a variety of hills and valleys that people fall off of and waste billions in the process.
> When you hear about a “Medicaid spend-down”, it’s all about reducing an elderly persons assets so that the state sees them as poor and Medicaid will pay their Long Term Care (nursing home) expenses.
Correct.
> Medicare has almost nothing to do with the Medicaid spend-down strategy that I know of.
Basically. Medicaid will pay Medicare premiums for dual-eligible beneficiaries, and many states have special coverage plans for the dual-eligible population, so there is a Medicare-related impact of the spend-down, but it has nothing to do with exhausting Medicare lifetime benefit limits (which do not exist, also, under the ACA, do not exist for other insurance, either.)
Why did you always think that? Doesn’t seem true at all to me. Seems kind of wild that a country as rich and privileged as America struggles to provide healthcare to its citizens without going broke?
My father in law had Medicare advantage. They denied his claims for skilled nursing that was getting him back on his feet. The facility just downgraded him from skilled nursing and left him in an hallway. He had a cardiac arrest due to low electrolytes ended up back in the ER and never recovered. (Pop quiz, how does someone on an IV end up with low electrolytes? Only way I can think is if they don’t fill the bag)
Why did they deny him? No reason. It’s just standard procedure. They deny, get good justification and approve. They do that every 7 days. They prettied up the language but confirmed that this is exactly what they do.
They literally killed him as part of standard operating procedure.
This country is fucked. Y’all better hope you have enough money to go be old somewhere else.
Yep, this sounds like "the whole story...", doesn't it? Nothing missing here:
- FIL has MA,
- FIL (somehow, no explanation given) is in a "facility" (hospital, ER, doctor's office, bus depot, ???),
- FIL is "downgraded" and "had a cardiac arrest... and never recovered...)
...
- "They literally killed him as part of standard operating procedure."
Sounds like quite a few grounds for a lawsuit but I'm neither a lawyer nor a doctor.
Neither am I a fool: this is waaay to iffy a story/description to be useful in judging most anything mentioned in the story, be it MA, the "facility", the FIL, the writer, or the diagnosis.
As for who's fucked, the writer should worry about himself first.
When talk about Medicare they are usually talking about Part A (hospital care) and Part B (provider coverage), and sometimes Part D (prescription drug coverage). You are on your own for everything else, including dental and vision care. Adding dental coverage to Medicare continues to die in committee every year in congress.
So if you know you'll need continued care from your dentist and eye doctor then Medicare Advantage can be a good thing, since most of the highly rated plans provide that coverage as part of their benefits.
You can also get benefits for things hearing aids, and transportation to and from your provider visits, etc.
Yes, if you sign up for Medicare Advantage you'll find yourself back in the world of the In-Network and Out-of-Network care model.
At the end of the day though it's disingenuous to just label Medicare Advantage as solely the privatization of Medicare. The only way insurance companies that provide Medicare Advantage stay in business is if they provide a high standard of care for their members. The payment model set by CMS incentivizes them to do so.
When you sign up for Medicare Advantage, and you shouldn't, you will still have to apply for and qualify for Medicare (65, 40 quarters of work, ...). You will generally pay the Medicare Part B premium ($164.90/mo this year) and any Medicare Advantage premium.
But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage.
With Medicare Advantage, you get to spend the rest of your life fighting health insurance companies. And for the most part, you're stuck on Medicare Advantage. Guaranteed enrollment is only in your first year. BTW, brokers are incentivized to sign you up for Medicare Advantage. Their commission is much higher for Medicare Advantage than for a Medigap plan. Medicare Advantage is vulture capitalism.
Traditional Medicare generally pays 80% and you get a Medigap plan for the other 20%. My UHC Plan G costs $139.28/mo with a $226/yr deductible, no copays, no coinsurance, no restricted network. And you'll need a Part D drug plan. My SilverScript SmartRX PDP costs $4.50/mo.
Bernie is right. Medicare for all would be awesome.
For a contrasting viewpoint, I have MA plan with Kaiser Permanente (HMO). As far as I can tell, it is essentially the same as what I previously had under employer group coverage, which was satisfactory to me for many years. Fortunately I have no major medical issues requiring expensive treatment, but if I do, I'm pretty confident that my coverage won't be so scant that it leads to bankruptcy or anything. The monthly total premium for both Part C (MA) and Part D (drugs) is $70, and the only co-pay I've seen is $10 for each office visit after the first one of the year.
For a contrasting viewpoint to your contrasting viewpoint, I took over my parents' finances as my father was dying from emphysema. He had a number of comorbidities that led him to see a number of specialists, so he was definitely using a large number of health services. After he died, I steeled myself for the dreaded slow drip of medical bills in the ensuing weeks and months. They never came.
Because my father had Medicare and a Medigap plan.
I've been assisting elderly relatives with myriad physical and mental problems, and they also have Kaiser Medicare Advantage plans. For this elderly couple, out of pocket long-term care costs are about twice the US median income and that's sticking to a somewhat modest board and care environment. It's nice that the Kaiser copays and other billings are not significantly adding to that pile.
I can't say every moment has been golden, but I think I will choose the same for myself if the landscape hasn't completely changed by then. I've had to reality-check myself at times, realizing that many of my complaints are about the sad decline of my relatives, rather than any actual problem with Kaiser's care. It can be overwhelming, and you'd wish there was someone to magically fix it. With end-of-life declines, the care outcomes often don't feel very satisfying.
I've seen them through hospitalizations, ER trips, nursing home rehab, and home health visits. The only part that is frustrating is Medicare-induced rules, where they suddenly reach a threshold for transfer or discharge and you have to scramble in a reactive mode. I'm not sure how unique this is to Kaiser, but they can fail to consolidate communications through a care coordinator. So, you get chaotic days where multiple different staff and third party vendors are trying to reach you about the same topic all at once.
> When you sign up for Medicare Advantage, and you shouldn't
Yes you should. The regular Medicare is utter garbage. Medicare Advantage is WAY WAY better.
> Bernie is right. Medicare for all would be awesome.
Bernie is wrong about basically everything. Unpopular opinion, I know. But the thing is Bernie never thinks about the consequences of his ideas. He'll put out some amazing (in his mind) idea, not realizing people will adjust their actions in response, completely ruining his plan. He does this over and over.
His colleagues know this - check his record, he has never even once gotten a bill of his passed, even his own party votes against him, because they are smarter than him and actually think about consequences of things.
I listened to him at first, I don't anymore.
> Traditional Medicare generally pays 80%
And Medicare Advantage pays 100%. And there are Medicare Advantage plans that don't cost anything extra at all - and still pay 100%. It's better than Medigap.
This comment is much like the article, lots of detail about how Medicare Advantage is a terrible deal and yet there must be _something_ enticing about it or at some point it would be common knowledge that MA is just Medicare with an insurance company sitting in front of it. So what’s the appeal of MA then?
They advertise and they sell the hell out of MA. I called UHC about their Plan G Medigap. They sell both MA and Medigap. I was getting the hard sell for MA on the phone right now today. UHC makes more money off MA and the brokers make more commission off MA. UHC doesn’t make this money off better service. They aren’t magically more efficient. But they do make it, a lot of it.
Why is that?
I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or restricted networks. Overall, I think it's a much much better deal than Medicare Advantage.
CalChris says >"I think Traditional Medicare with Plan G is slightly more expensive up front with no ballooning copays/insurance or..."<
What "ballooning copays/insurance" are you speaking of? FWIW we have Medicare Advantage from Kelsey-Seybold. I don't see any balloons in my future that aren't from China.
You are convinced regular Medicare + Medigap is better than Medicare Advantage. Why don't you show us an exhaustive list comparing the two instead of floating balloons past us one at a time to shoot down.
My MA plan with a single provider has been excellent. One of the best "advantages" is that my medical records are centralized and I have a true medical history going back 40 years in silicon (and on paper when I need it). When go into an ER they have it all there in front of them.
I'm open to change, but provide hard arguments and numbers, please.
Kelsey-Seybold Clinic is a healthcare provider (in Houston). A Silver Medicare Advantage plan with them has a Maximum Out-of-Pocket of $3450 in-network, better than I would have thought. I have a $226/yr Part B deductible. That's it. I have no copays, no coinsurance, no preauthorizations and no network. I am paying $164.90/mo for the Part B premium and $139.28/mo for UHC Plan G. Part D is separate but I only take a statin and my Part D plan is $4.50/mo.
In particular, I value no preauthorizations and no network very highly. It means I won't be arguing with health insurance companies for the rest of my life.
Probably the advertised inclusion of dental and vision, and for some, the comfort of staying with the same insurance company you had before retirement. There’s also the confusion/difficulty in signing up for Medicare. Apparently it’s not very straightforward to do that?
> But roughly, the coverage will be the same, anything medically necessary. The difference is that with Medicare Advantage you'll have an insurance company sitting at the table between you and your doctor. Then there are restricted doctor networks, copays, coinsurance, deductibles. But when you get expensive, you become a cost center, and they can delay and deny coverage.
I'm much too young to figure this stuff out now, because it will be drastically different by the time I would need to use it, but ...
If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? Or does medicare not deny or delay coverage? Not all doctors take Medicare either, but I do understand it's pretty widely accepted. I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up?
And doesn't the patient have to pay some portion of some procedures etc? You could get Medigap insurance for the patient pays portion, but does that have limits or judgement, or are they compelled to follow Medicare's decisions?
> If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor?
There are no death panels.
If Medicare covers the procedure (you can look the procedure up in the What's Covered app) and the doctor deems it medically necessary, Medicare pays and then your Medigap plan pays. So cosmetic surgery isn't covered but removing skin cancers is.
In the Medicare Advantage case, you are an account and when your account gets expensive, Allison Janey's company gets very passive aggressive.
Traditional Medicare sets a policy. Medicare Advantage sets a policy AND manages a cost (you're the cost).
> Not all doctors take Medicare either
The vast majority of doctors take Medicare and accept Medicare Assignment, the standard amount that Medicare pays for a procedure. Cedars Sinai takes Medicare.
> I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up?
Yeah, that's nonsense.
> And doesn't the patient have to pay some portion of some procedures etc?
Medicare pays 80% (except for preventatives where it pays 100%). You get a Medigap plan for the 20%. Mine is UHC Plan G which costs $134/mo and includes some extra benefits.
There is no logical way that Blue Cross or Kaiser can sit between you and Medicare (they get paid by Medicare to take your risk) make billions and still provide the standard of coverage that Traditional Medicare offers. That's a shell game.
The overall function of private "insurance" is appropriately labeled a "death panel". In general I find it very odd how so much scare propaganda against changing things is based on describing the actual current dynamic.
Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.
> accepts Medicare and Medicare won't pay for a procedure
Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair.
> Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover
First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. After that you'd have to show me the rule that says a participating dermatologist can't charge what they want for cosmetic surgery.
Medicare has rules for what they cover (What's Covered) and what they'll pay (Medicare Assignment). Medicare Advantage has some rules but it also manages your costs and their profit.
> Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair.
That's not what I'm talking about at all. I don't know where you got "cosmetic surgery" out of that.
A common pattern is that Medicare will only cover a certain service X times per week/month/year. Because their limits are inherently coarse by design, they're not going to be appropriate for all patients. A patient for whom (X+2)/(unit time) or even 2X/(unit time) would be more appropriate can only obtain the additional services from another provider altogether. Which, in plenty of circumstances, may not actually be literally possible.
> First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules.
Incorrect. Non-participating providers can only charge the limiting charge (usually 15% more than the Medicare reimbursement rate, though some states cap it at a lower value).
So we're talking about two different things (and thus in a sense, both right). By non-participating you're referring to Extra Charges as opposed to what I'm thinking of, a doctor who is not accepting Medicare payment at all and is thus unencumbered by its rules.
Yes, the first case is limited by Medicare Assignment. BTW, it's not exactly 15% either. It's a strange calculation. It's pretty rare. Plan G covers it. I think Mayo, Cleveland, ... may charge it. I don't know why a doctor wouldn't charge it but it's uncommon.
That's not really a fair comparison. MACs handle claims processing and payments on behalf of CMS [0]. They don't have an actuarial stake in your care the way a private insurance company would.
The root of the problem is pre-insurance costs. If an average person was able to pay for their and their kids health care out of pocket, the problems of being sicker than average or poorer than average would be solved without much controversy. And to address costs, we need transparency, freedom, competition and more healthy attitudes towards personal health. No payment system will get us out of this problem, it will be high out of pocket expenses, or high taxes, or limited care or some combination of the three.
My daughter required heart surgery when she was 24mo. Overall price billed to insurance for everything was about $250k, including several pre-surgery procedures (MRIs, cardiac cath, etc). I believe we paid about $7k after insurance.
My son is currently on isoretinoin (Accutane generic) for systemic acne. Because of the severe side effects isoretinoin can have, they force you to come in for an office visit / check-in monthly, and only dole out the meds one month at a time (no refills). Thus far, we've received from our pharmacy prescriptions from three different manufacturers, ranging in price (to us, post insurance) from $7 to $120. Pre-insurance prices are in the $500-700/mo range. There seems to be no rhyme nor reason for these dramatic monthly fluctuations ... so if we can't even get something like this to be predictable and simple, what hope is there for treatments requiring complex care?
I agree with the author, but for far different reasons. Anytime taxpayer money is up for grabs by private companies, there is almost no oversight and things get out of hand quickly. This is the wrong way to go about things and it never works.
I don't think the US government is capable of running large programs efficiently. They're universally understaffed, the staff that does work there is under-qualified, and they don't have to answer to anyone because they can't be fired for missing budgets, goals, or deadlines.
I don't know what the right answer is honestly, so I do enjoy ready other people's views in this thread.. but I'm certain its not what we're doing now.
Medicare Advantage is simple - instead of getting regular Medicare (Part A,B and D) through the government (though Part D is always private), you elect for your Medicare dollars to be used as premiums for a private Medicare Advantage Plan that offers similar coverage.
Thats it.
It’s nice because it offers options. For some people with chronic conditions a MA plan might offer better coverage than regular Medicare for your treatment in exchange for less coverage in another area.
And it’s entirely the patient’s choice.
Don't like Medicare Advantage? Good, don't choose it.
The article was a bit of a rant. But the part that stuck out to me was the irreversibility of Medicare advantage, in some cases. That definitely excludes your last statement as a possible choice. If you’re battling a life-threatening disease, and are also facing overwhelming bills, being locked into a choice you made without realizing the full ramifications would make me rant, too.
No it’s not, its the literally the name the government gave those plans.
“What is Medicare Part C?
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.”
> No it’s not, its the literally the name the government gave those plans.
Please re-read the article and my comment. Neither said anything about who named these plans. The fact is that the name itself is misleading people.
Also, the article gives a few examples how the private insurance companies _tricks_ people to think that MA plans are always better. I worked at one of these big insurance companies, and we implemented products and worded things in a way to ensure that we increase the growth of the Medicare Advantage plans. At the time, I genuinely thought the Medicare Advantage plans were always better but that is not the case. It's actually very difficult to choose which one would be better and the fact that it's really hard to change exacerbates the situation.
You don't have to agree with me. You are one of better people who can understand these plans better. Consider people with less education on this subject and have some empathy. You might think this differently.
Ok, if your argument is that making a choice for Medicare isn't easy, I'll agree with you there. There are a very complex set of rules and it's not always obvious what is the best for a given person. It takes a lot of homework to figure out.
Yeah the article spends a very long time ranting about... medical insurance as a concept. Which, yeah, there are lots of problems with medical insurance. The doom and gloom and scare words do a lot to mask some of the more interesting points that the author is making, such as the flaws with the risk score system and its enforcement.
Medicare for All would be great, at the prices being quoted by folks on here. But I bet your premiums and deductibles aren't covering your costs, especially at your age. Over 65 spending is around $18K per year.
Average in the US is $7-12K across age groups and genders (depending on how it's counted).
The problem with traditional fee-for-service Medicare is that there is no mechanism to reign in those costs - doctors get paid pretty much no matter what they order. So they order a lot.
For Medicare Advantage, it's more a capitation model where the insurance co is paid per patient, and their incentive is supposed to be to keep the patient healthy and thus less costly. That's the theory.
Incentives matter, and getting them right in healthcare is a messy task.
The issue with the medical system is that there are a whole bunch of middle men leeching cash out at every possible point. Medicare for all would be one step to cutting back on this waste
This is how most of Medicare works. 10 or so choices of co-insurance or unified Advantage, outsourced to private insurance. Private health insurance should be illegal just as it is in other countries.
As someone who will be medicare age in a few years, I was following the article until it hit the [drat those darn republicans] comment and my attention quickly waned, and not because of age.
Mmmhmm. And who else made it party policy to suggest sunsetting Medicare, Medicaid, and Social Security in five years? Or bring it up for a vote every year? Hint: NOT the Democrats.
I live in a country with socialised medicine and wanted to give some counterpoints to "the grass is always greener in socialist utopia".
1 yes they scam boomers. An actual funded pension system means boomers are the richest people in the country. Everyone wants a slice.
2 healthcare is expensive as fuck so the government is only providing the bare minimum they can get away with. Think "when was the last time my 80 year old mother had a shower".
3 commercials aimed at boomers for private healthcare services: you can get your own private nurse (because the one provided to you by the government only shows up for an hour a week). Obviously most people can't afford such luxuries.
4 community care. Please volunteer in your local nursing home because they are chronically understaffed. They have an entire propaganda campaign on this. The Philippine nurses did not work out.
The "solvency" crisis is one of the dumbest things that has been shoved down our throats.
For decades there wasn't a social security or medicare fund. What was there was taxes. Workers paid taxes, and those taxes went to retired people. There was no fund. Then people freaked out about the boomers and what that would do to retirement. So they created a fund- they started collecting more than they needed, invested it in government debt so it would grow, and used that to get over the bump.
We can easily solve the "solvency" crisis by simply raising taxes. Remove the "cap" that says people are only subject to the social security tax on the first $160,200 of their income and the "solvency crisis" completely disappears. In fact if we completely removed the cap, rather than just raising it, we could afford to pay out more in social security while still extending the life of the "surplus" fund for almost a century.
Anyway, if it is so simple and easy, it raises the question: why hasn’t anyone legislated this yet? You know, during one of those sessions where both houses and the presidency are of the same party (two occasions in recent memory, one for each party) and put all talk of crisis to rest?
Because it's not necessary yet, and the political issue is useful to both parties.
Democrats get to go "we should tax the rich more to fix the gap".
Republicans get to go "look how badly this is run, we should privatize it".
Neither side wants a horde of seniors (who vote, in large numbers) actually losing their Medicare/Social Security benefits, so when the time comes, they'll vote to add funds and celebrate themselves for saving it for another few years.
Probably the same reason the Democrats never legislated abortion rights into law: never let a good crisis go to waste. The priorities of both major parties are:
1. Keep the donors happy
2. Keep getting elected
3. Line up a cushy position as a lobbyist or other government orbiter after retirement
Pretty sure actually serving their constituents is at the bottom of the list for most politicians.
Probably because the majority in the legislative is not filibuster proof, and there are always a few representatives or senators who disagree with the proposal and prevent it from going to a floor vote. Recent examples of such individuals are Manchin and Sinema. Lieberman was another one who managed to get the public option removed from the ACA before it was passed.
It is effectively a PPO (similar to the Kaiser plan someone else mentioned), so we have access to exactly the same physicians that we had already where we were paying for private insurance. Our annual premiums went from about $85k a year (on the private insurance) to around $10k out of pocket.
We are fairly healthy, though my wife is going to have some major joint surgery. What was interesting is that it was our PRIVATE insurance that stalled and stalled over approving the surgery. When she switched to the MA plan, it was approved immediately. (That stalling finally motivated my wife to make the switch out of the private insurance.)
The downside of our MA plan is that we are not going to be able to move out of the area easily. But you always have that issue regardless -- finding a whole new set of doctors and dentists when you move...
I do get these phone calls asking to schedule a "wellness" check that the article writer mentions. Oddly enough, my wife didn't get any (so far.)