There's a lot of noise out of DC these days about the future of Medicare. The current Republican plan would convert Medicare from an insurance program to a voucher program. It would give future seniors a set amount of money to go out & buy their own insurance. This idea is a disaster in the making. First, once you involve for-profit insurance companies in the process, you increase cost radically. Seniors will be forced to spend their own money way beyond the amount of their vouchers for their basic coverage. Since the elderly are the biggest consumers of health care, their insurance premiums will be enormous. Second, the administrative costs of the current Medicare program are about 2 --3% of total expenditures. The administrative "costs" of private insurance companies? 22%. In other words, health insurance coverage will automatically cost 20% more under this plan. Third, there is power in numbers when it comes to insurance. A large group (e.g., a business) can negotiate for better, cheaper coverage with an insurance company, and can even make deals with care providers for the benefit of their insured. Individual old people won't have this leverage. Finally, the proponents of the voucher plan, the Republicans, are determined to repeal the Affordable Health Care Act (AKA Obamacare). the AHCA requires insurance companies to sell coverage to everyone, and prohibits the exclusion of preexisting conditions. (Good luck reaching age 65 with no preexisting conditions). If these Republicans succeed in eliminated the protections of the AHCA along with Medicare direct coverage, old people will be out of luck. Yes, I know that this won't affect current old people, but we're all going to be old sooner or later, or so we hope. Future codgers will be forced to choose between health care or other basic necessities, or may not even be able to get coverage at any cost.
So how do we solve the problem of the increasing costs of Medicare? I can tell you. Mainly, it will involve reducing the costs of ALL health care.
The first thing to do is take health insurance out of the private sector and, in effect, give everyone Medicare. Remember that extra 19-20% going to "administrative costs" (profits) for private insurers? that will go a long way towards reducing everyone's costs. This would not be an easy thing to do, given the level of political cowardice which is epidemic in Washington. While the politics of the issue are complicated, the solution is not. Don't let anyone tell you differently. If "government run health care" is such a terrible thing, why do Medicare consumers love it? There is no logical reason why it would work less well for those under 65 than it does for seniors.
I don't want to hear any whining about "socialism". the socialism label just doesn't make sense. ALL government is a form of socialism. I think the real definition of socialism is "anything the government does that I don't like". The simple truth is that there are some things that the private sector does better and some things that the public sector does better. I don't hear anyone calling for the privatization of police departments, for example. The private model for health care insurance has failed us. Time for something different.
The second part of the solution is more complicated. we need strict regulation of medical expansion. What do I mean? West Virginia provides some important examples. The state is not heavily populated, but every hospital has state-of-the-art everything. West Virginians don't need as many MRI machines as we have, for example. Once a hospital buys the latest thing, they have to justify the costs so more people suddenly "need" an MRI, or whatever the new thing is. Every unnecessary use of the new thing costs money; much of that money comes from Medicare. If someone really needs the new thing, they should be sent to larger hospitals in larger cities. West Virginia is not so large geographically that we would need more than 2 or 3 of the new things. Oncde you put the new thing in Logan county, for example, the need for the new thing for Logan County residents suddenly doubles and triples.
We do have something in WV called HCCRA which stands for soemthing like Health Care Cost Something or Other. This agency is supposed to stop "unnecessary" medical expansion, which leads to unnecessary medical costs. as far as I can tell, the only restrictions HCCRA places on medical expansion is to prohibit any new nursing home beds. This is because the State ends up paying for almost everyone who ends up in a nursing home long term. The costs of nursing home care is so high that everyone ends up eligible for Medicaid, for which the State has to pay about 20% of the costs. Other than keeping the Medicaid costs depressed by creating a shortage of nursing home beds, HCCRA does nothing to reduce the medical empires our hospitals are becoming. Rural hospitals that should only offer basic care are using thier lobbying clout to make sure they get everything they want, and they keep locals on their side by claiming that the extra costs are necessary to provide care that is needed. Folks, if you want to live near a state-of-the-art medical facility, don't live in the sticks! That may seem harsh, but there is no justification for people in need of highly specialized medical care to expect to get it without leaving the farm. An hour drive from Logan or Beckley to Charleston is not unreasonable; nor is a drive from Clarksburg to Morgantown. All this unnecessary crap is costing West Virginians more & more, and this is going on all over the country. We need HCCRA to start doing its job and to stop worrying about political pressure to do nothing, and we need a national equivalent of HCCRA to stop runaway growth nationwide.
A related problem is doctor offices that also own the nearby lab, physical therapy clinic, or other facility to which they can refer patients. Studies have shown that doctors with this confict of interest order a LOT more use of their other facilities than are needed. this costs Medicare and other insurance companies a lot of money, which of course is passed on to us. These relationships need to be outlawed.
Even if all these things happened at once, it would not solve the problem of increasing health care costs completely, but guess what? The costs of EVERYTHING keep going up! What these recommendations should do is keep the rate of medical cost increase roughly equal to the rate of inflation. None of this is very complicated but it would require politicians to start confronting reality, which they will only do if the alternative is losing the next election. If such pressure could be brought to bear, and these changes enacted, our Medicare and other health care cost issues would become a small deal rather than a big one.
You're welcome.
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