Forbidding first dollar coverage for Medicare beneficiaries

[eridani]

Proposals To Forbid First-Dollar Coverage For Medicare Beneficiaries
Kaiser Health News
http://www.kaiserhealthnews.org/Stories/2011/August/02/different-takes-080211-vladeck.aspx

The usual laundry lists of proposals for Medicare savings are already being circulated throughout official Washington. Most of these ideas have been around for years, and have never gotten past the talking stages because of political opposition or because they are simply bad ideas. But one especially pernicious proposal appears to have increasing traction among both politicians and policy analysts: the prohibition of first-dollar coverage in Medicare supplemental insurance, whether purchased in the individual markets or provided as a retiree benefit.

This proposal is based on a simple and seemingly self-evident syllogism. Medicare beneficiaries with supplemental insurance that provides them with first-dollar coverage by paying their deductibles and co-payments use more services than the small minority of beneficiaries without such coverage. Hence, forbidding such coverage would reduce use, thereby saving Medicare a pile of money.

American policymakers, and the health economists who enable them, are obsessed with issues of consumer demand, and the notion that health care is so expensive because Americans are so eager to consume it. In fact, insured Americans already have the highest out-of-pocket liabilities in the developed world, and use fewer services initiated by consumers. In the absence of supplemental coverage Medicare beneficiaries would have still higher out-of-pocket liabilities than other insured Americans, which is why essentially every beneficiary who can afford it seeks extra coverage. But while overuse of some services in some communities is inarguably a part of the Medicare cost problem, there is no compelling evidence that consumer-generated demand is a significant part of the problem. Whatever thepolitical rhetoric, Medicare beneficiaries simply aren?t banging down the doors of physicians' offices demanding extra MRIs and surgical procedures.

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The reason health insurance exists in the first place, after all, is to relieve individuals who are not medical experts of the need to figure out whether they can afford any particular medical service. In a rational world, policymakers worried about unnecessary or inappropriate use of specific services would just refuse to pay for those services. But in the contemporary American political environment, they might be accused of "rationing" or "death panels," so they stay away. Instead, they appear to be willing, once again, to impose the consequences of their inability to control costs on those least able to bear them.

Comment by Don McCanne of PNHP: Unreasonable consumer demand is not a significant source of our high health care spending. Measures that deprive patients of beneficial health care services by imposing penalties designed to suppress consumer demand are not only inappropriate, but are truly heartless.

My comment: We use fewer services, and pay twice what every other developed country pays. End this with improved Medicare for all!

[amborin]

1. somewhat relatedly, there's a program in place to rationalize medicare

further...newly using 'efficiency' as a rating criterion of hospital quality

[Mimosa]

2. The big money interests said America can't have advanced health systems like France, Canada, NZ, +++

Our politicians don't care what we want to pay for. Somebody is paying them to deprive US.

[demosincebirth]

3. I think part of the high cost of medicare/medical care is that we

have many doctors who do nothing but refer patients to specialists. What happened to the ol' doctors of past who used to take care of all your needs?

[eridani]

4. They have medical school debts so high they can't afford to become GPs n/t

[indurancevile]

5. that started in the 80s (or at least that's when i started noticing it). it was supposed to save

money. or at least that was the rationalization. but what it seems to have done was fragmented care to the point where you have to drive all over hell & gone to one specialty facility or another.

one of the most horrible things, imo, is making medically fragile people drive long distances to get, e.g. chemo or other special treatments. i have an acquaintance who's elderly and half blind & has to drive 100 miles at least once a month to keep what little sight he has left. he's poor, no kids in the area, & if he didn't have a kindly neighbor he'd be sol.

[demosincebirth]

6. There are many, like your acquaintance, who are in the same situation. I remember

when you'd go in for a physical and it would last, at least, a half hour. They would ask you all kinds of questions about your health and even look at you hands and finger nails. Doctor told me, one time, that you can spot some health conditions by looking at your hands and finger nails. Now, I go for a physical and I'm out the door in ten minutes. Thats how much its changed for the sake of expediency.