The American Dilemma and How We Can Fix It

Posts tagged ‘Medicare’

MEDICAL HUMOR

A friend sent this to me and I must admit that I roared out loud when I read it.  Then I kicked myself for not thinking it up myself.  Enjoy!

 

This is really a good option!

Medicare – Part ‘G’— Nursing Home Plan

You are a sick senior citizen and the government says there is no nursing home care available for you.

So what do you do? —–

Our plan gives anyone 65 years or older, a gun (part G) and 4 bullets. You are allowed to shoot four Politicians. This means, of course, that you’ll be sent to prison where you’ll receive three meals a day, a roof over your head, central heating & air conditioning, cable TV, library and all the health care you need.

Need new teeth? No problem. Need glasses? That’s great. Need a hearing aid, a new hip, knees, kidney, lungs, sex change or heart? They’re all covered.

As an added bonus, your kids can come and visit you at least as often as they do now!

And who will be paying for all of this? The same government that just told you they can’t afford for you to go into a home. (And you can get rid of four useless politicians while you’re at it!) And because you’re a prisoner, you don’t have to pay any more income taxes.

Is this a great country or what?

Now that we have solved your senior financial planning, enjoy your week!

IS THE RIGHT MAN ON TRIAL?

By now you know, or at least should, that Maj. Nidal Hasan is being tried for his involvement in murdering thirteen soldiers and an unborn child at Ft.. Hood.  After four years of continuing to collect his salary (approaching $300,000 that we have paid him); preparation of his special halal meals – at four times the cost of what we spend to feed those who guard him; paying for his medical expenses; and the cost of about $5 MM to prepare for his trial, we taxpayers have run up a small tab.

Of course, this is merely chump change in view of the big picture that has all of us on the hook for nearly $17 Billion.

Over the weekend another story broke – this time in Michigan.  Apparently an oncologist/hematologist by the name of Dr. Farid Fata  is accused of bilking Medicare out of $35 MM for services which he never provided.  (The amount of fraud could have gotten even bigger but because of the lack of speed with which Medicare pays its providers, another $50 MM had not been sent out to the good doctor).  There is something to be said for government inefficiency.

Now what struck me was the similarity between these two men.  They are both doctors – in Hasan’s case a psychiatrist.  They are both of Middle Eastern ethnicity.  And they appear, at least to my untrained eye, to look as though they might be twins.  Below are pictures of the two – in Hasan’s case the one shown was taken before the Army decided that, not to offend his Muslim sensitivities and have him conform to the Army’s clean-shaven standards, they would allow him to grow a beard.

hasan

Dr. Farid Fata

Well, maybe it’s just me.  You know, all those Middle Easterners look alike to me.  But I was thinking that in what appears to be a defense strategy on Maj. Hasan’s part of essentially not having a defense, he might pull a ringer out of his bag and claim to be Dr. Fata.

In today’s America, anything is possible – and likely to happen.

THE FISCAL CLIFF AND APPLE PIE

The negotiations on the fiscal cliff, if I may use that term to describe the posturing in government that is underway, drag on at their same slow pace as before the election.  We’ve all heard about it – and some of us have taken the time to understand its implications.  Probably just a few of us.  Perhaps the reason so few of us concern ourselves with the matter is that, as I review today’s “Trending News” on Yahoo, the subject didn’t make it into the top ten.  We have higher priorities.

Of the top five items on that list of what Yahoo viewers found important, four were concerned with “celebrities” and their activities which included one law suit; one romantic breakup; one engagement and one speeding ticket.  Rounding out the list just in time for the next $500 Million Powerball drawing was a seven time lottery winner’s advice on how to increase your chances of winning in the random game – a subject which he covers in a book which has sold thousands of copies.

Of course, none of these has anything to do with our subject – but in reviewing the list of today’s news items, there were two entries which I found that did pertain.  These were stories about whether doctors should prescribe the “morning after” pill to teen girls without parental consent and a report about the CDC’s engaging in a three year program to educate minority gay and bisexual men about AIDS prevention.  Whoever said, “Money is the root of all evil” must have lived before the time of our sexual liberation.

According to the CDC report they estimate that 1,000 “young people” whom they define as being between the ages of 13 and 24 are infected monthly with HIV.  The cost of drug therapy to control the virus is approximately $400,000 per person over their lifetime.  This report focuses strictly on people in that age group and does not address older people who are similarly infected.

Since most people in that age group don’t have the benefit of a trust fund from Grandma to pay for the drugs they will need, the taxpayers, monthly are incurring an ultimate liability of an additional $400 Million to add to the amounts we are already spending on Medicaid – which will no doubt be the provider of the drugs that they will require.

Now I don’t want to sound like one of those stodgy old conservatives who is merely concerned about his or her own welfare and that of their family.  Actually, I think of myself as a warm and caring person who generally makes decisions based on logic, tempered with compassion.  But I do become mildly rankled when I read stories like this.

At the heart of the fiscal cliff discussion is the issue of “entitlement” programs which include Social Security, Medicare and Medicaid.  While those three are lumped together under the same heading, I believe that the only one of them which actually qualifies as an “entitlement” is Medicaid – the healthcare program for those who cannot afford treatment because of their limited financial circumstances.  The other two, Social Security and Medicaid are funded by the working taxpayer and by their employers who pay into both funds in similar amounts.  In the latter two cases if people receive benefits it is because they are entitled to do so because they paid for them.

As we know, Social Security and Medicare are nearly bankrupt.  That is because the Federal government has regularly engaged in financial chicanery and pillaged the funds which taxpayers paid into them to use them for other purposes.  One of those purposes has been to fund Medicaid – to which no one has every directly contributed a dime.

If you read through Obamacare, it is clear that health services will soon be rationed.  A panel of fifteen as yet unnamed bureaucrats (who may or may not have any medical background) will determine what services you and I are “entitled” to receive.  In the absence of any realistic, soundly based principled attempt to cut waste and fraud and the overhead costs engendered by a bureaucracy to administer these programs (and now we will be adding to that, digging ourselves yet deeper in debt) it had to come to that.

So with my empathetic view toward life I theorize that I am one of those fifteen people who will have the responsibility for determining who shall receive and who shall be deprived of health benefits and two cases come before me.  There are only enough funds to treat one of these patients.

The first is one of these young, newly-infected HIV patients.  He is in his present situation because he was uneducated or careless or unconcerned about the consequences of his liaisons.  The second is your grandmother who has worked all her life, paid her taxes and raised a family.  She got into her condition through the natural process of getting old.

I don’t mean to sound heartless but I’m sorry HIV “victim,” you’re out of here.  I made my decision based on the “greater good.”

Grandma makes a terrific apple pie.

THE AARP AGENDA

I was approaching one of those milestone birthdays – you know, one of those ending in a zero.  It happened to be my 50th and several months before the actual day I had a new friend who didn’t want the day to go by unnoticed.

The American Association of Retired Persons as it was formerly called, began sending me solicitations to become a member of their organization.  A number of my friends were members and the cost to join was inexpensive, so I returned my invitation together with a check.

AARP efficiently returned an informative membership packet and I began receiving a copy of their bi-monthly magazine.  As it turned out, I was already getting the travel and hotel discounts that they offered from other sources, their offerings for Medicare health insurance supplements were not available to me because of my age and I found I could do better shopping on my own for auto and homeowner’s insurance.

The magazine which AARP publishes is very informative and I highly recommend it to people who do not have the time or are unwilling to make the effort to do their own research.  I have always preferred learning things on my own, comparing several sources so that I get a variety of views and then drawing my own conclusions.  So after perusing several issues, the remainder of my subscription went into the recycling bin unread.

At the end of my year’s membership, AARP sent me a renewal form which also went into recycling as have many solicitations that I received from them over the following years.  I have chosen not to renew my membership in AARP.

If you’ve watched any television recently, you will certainly have seen some ads for “AARP endorsed” Medicare supplement plans.  That is because the period between October 15th and December 7th is “open enrollment season” when seniors on Medicare can choose to switch or change their supplemental coverage for the following calendar year.

I admit that with my sometimes twisted sense of humor, when I hear “open enrollment season” I think of hunters going after our senior population, armed with bazookas to bring down their targets.  There is big, very big money in selling Medicare insurance supplements – a fact that is not lost on AARP.

As part of our regulatory system, both “for profit” and “not for profit” organizations must file financial statements with the Federal government.  What is required of “not for profits” is less than for their counterparts.  But reviewing these statements can still be informative.  So that’s what I did.

In the year ending December 31, 2011, AARP received more than two and one half times the amount of revenue from “endorsing” insurance products than it did from its membership fees – a rather staggering, $704 Million.  By anyone’s standard, this could hardly be considered chump change.  The vast majority of this income was derived from royalties paid by United Health Group based in Minnetonka, MN, but some of it was derived by its “affiliate programs” with other insurers who provide auto, homeowners and life insurance to AARP members.

If you can recall any of United Health’s ads for Medicare supplements, to promote sales of their products they include the phrase, “the ONLY Medicare supplement endorsed by AARP”.  The implication, of course, is that AARP wouldn’t “lend” its name to a product that it hadn’t thoroughly checked out in much the way that consumers used to look for the “UL” label on an appliance to make sure that Underwriters Labs, an independent organization, had thoroughly tested the product before passing on its safety.

There is a big difference between the UL seal on a product and the AARP endorsement of a Medicare insurance supplement.  Underwriters Labs provides an independent assessment of each product it reviews.  It is not compensated by any company for passing or rejecting their products.  AARP has a significant vested financial interest in promoting products by United Health because they receive a royalty for each one of these supplements which are sold.

United Health Group is a fine and reputable company.  It owns the largest portion of the Medicare supplement business with a 30% market share.  I am not suggesting that their products are in any way inferior to those offered by their competitors.  In fact, if I may cite one example in which government regulations have actually proven effective, it is the Medicare supplement business.

Our seniors can choose a “lettered” supplement which will pay part or all of the costs which Medicare does not cover.  The government has standardized these different options and each insurance company which underwrites them must offer the same government-specified coverage for that particular contract as does its competitors.  The only difference between them is the cost that a particular insurer charges and the service that the insured receives from the underwriter.

Considering that fact, an AARP endorsement, or lack of one, makes absolutely no difference to the consumer when they select a Medicare supplement.  It all comes down to the cost of the product and the service that they will receive should they need to file a claim.

According to the financial statement which AARP filed for calendar year ending December 31, 2011, of its $1.35 Billion in income which the organization recorded, more than 50% of it was derived from royalties from insurance contract sales.  In other words, AARP has a vested interest in making sure that there is no threat to its primary source of income – the royalties it receives from the sales of insurance contracts.

And that brings me, together with another item in its financial statement, to question its motivation in criticizing the Romney campaign for statements that they have made regarding Medicare and Obamacare.  Are these criticisms that have been leveled by an independent organization whose mission is to defend and protect our senior population?  Or are they self-serving statements made by a business, intent on protecting its own interests?

The other item in the financial statement which stood out to me was the income the AARP received from “grants”.  The amount that it recorded was $101 Million, and of this amount $92 Million came from the Federal government.

My friends in academia used to sweat bullets when it came time for their “grants” from Uncle Sam to be reviewed for renewal.  Although they may have lived in ivory towers, they realized that the individual who made the determination of continuing or stopping their grants had the power of financial life or death over them.

I would suggest that AARP is in much the same position as my academic friends.  If you combine the royalties it receives from the sale of Medicare supplements and the money it receives in grants, AARP is dependent on the Federal government and its programs for over 60% of its income.

Is it, therefore, any surprise, that AARP took Mitt Romney to task for challenging the administration on its healthcare programs calling his statements “false and misleading?”

As I head out with Gracie for our morning visit to the dog park, the old adage comes to mind.

“You don’t bite the hand that feeds you.”

HOW OBAMACARE IS AFFECTING REAL PEOPLE ON MEDICARE

If you are on Medicare you have probably received (or will shortly) your Official Guide to Medicare, sent to you by your friends in Washington.  It’s a large and informative book which does a good job of explaining what you need to know.

For those people who are considering the merits or deficiencies of a Federal health care system but are not currently on Medicare, allow me to give you a brief overview of how the system is structured.

If you are Medicare eligible (generally you either have attained the age of 65 or are younger but have won a disability case with the Social Security Administration) then you are automatically enrolled in Medicare Part A.  This portion of the program provides for payment to hospitals for their services.  There is no premium associated with this coverage.

Part B of Medicare is optional coverage which pays about 80% of the negotiated fee for services such as doctors’ visits, doctor ordered tests including MRI’s, blood work, etc.  The premium for this coverage ranges between $100 – $320 per month dependent on income.  Medicare pays 80% of the charges which a patient incurs for these services – the balance being the patient’s responsibility.

Typically, people who have significant medical conditions or want to avoid incurring such charges should they contract a new infirmity will purchase a supplement from a private insurer.  Depending on the plan, they may get private insurance coverage which may pay the balance that Medicare does not pay.  Premiums for these plans typically range between $200 – $1,000 per month depending on the insurer and their underwriting determinations based on an individual’s specific health profile.

Excuse the skip in lettering but we will now go to Medicare Part D.  This is the prescription drug portion of Medicare and is also optional.  The cost of participating in Medicare Part D is also determined by income.  Most plans require a monthly payment ranging from about $20 – $60 a month.  Plans have an annual deductible which range between $0 – $325 before making any benefit payments.  All require an additional co-pay for any prescription drugs a patient takes.  Most plans do not cover all drugs which a patient might be prescribed or will only pay for certain drugs in non-generic form.  They all contain a cap on the maximum amount of benefit they will pay annually and are underwritten by private insurance companies.

Medicare Part C is known as “Medicare Advantage”.  This is also underwritten by individual insurers at no monthly premium cost to the patient and include a prescription drug plan.  These plans include an annual physical exam at no charge.  For all other services including doctors and hospitalizations and drugs the patient must make a co-payment which varies depending on the service that is involved.  Of course, for an individual who is generally healthy, doesn’t make frequent trips to the doctor or takes a limited amount of medication, this is the most attractive supplement since there is no monthly premium – merely the co-payment which must be made for each service or prescription.

The reason I went into such detail on how Medicare works in its various components is because of a conversation I had with a friend the other day.  She is a young 66 year old, active and healthy and living on Social Security for the majority of her income.  She was covered under a Medicare Advantage plan but was informed by her insurer, Sierra Health Systems that they are discontinuing their plans in Clark County, NV in 2013.  Anthem (which is Blue Cross) also underwrote this coverage and they too are discontinuing their plans.

So my friend was advised by her insurance agent that she can expect to obtain similar coverage for next year, but instead of paying no monthly premium, she can expect a premium of at least $30 a month with a new insurer for the same coverage.  The reason which the agent cited – Obamacare.

This is a real person with an income from Social Security of about $1,100 per month who is currently paying $100 per month to Medicare for insurance coverage.  That is 9% of her income.  That cost (assuming that her Medicare Part B premium doesn’t increase at all) will now escalate to $130 per month – a 30% increase in the amount she must spend for insurance – thanks to the Affordable Care Act which the Congress passed and President Obama signed into law.

So for whom is the “Affordable Care Act” affordable?  Apparently not for the members of Congress who, without reading the law, were wise enough to exempt themselves from being subject to it.

Tag Cloud