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Old 04-01-2019, 12:12 AM
Anonymouse Anonymouse is offline
Join Date: Jun 2010
Posts: 214

Originally Posted by DW View Post
This is a correction to misstatements
... Also CRITICAL to note is that when you join a Medicare Advantage plan, you are WITHDRAWN from actual Medicare and are then covered by an entirely "for-profit" PRIVATE healthcare underwriter - though you can go back to straight Medicare without a penalty any time you wish.
This probably explains the higher co-pays and stuff - they ARE out to make a profit off your misery, afterall.
They get paid on multiple ends - by you, by Medicare for handling your claims, and they cut side deals with big pharma on meds & get discounts from providers for everything else.
Whatever they can chisel out from all sources is theirs to keep, and pad their profits...

Originally Posted by DW View Post
Last I checked the health insurance industry earn an average slim 4% margin which is unfair to portray as greedy. I suspect that is a bargain when the same service is provided directly by the Feds.
As many are, you are mistaken as to what is covered in the term "profit" for private insurers & how that affects how much you pay for that private insurance.
Premiums are divided up into 2 pools;
Expenses - that is to say how much the insurer pays out for goods and services to providers.
If the insurer is honest, any rebates on those goods and services will be shown as deductions from the expenses ledger.
Saying the words "honest insurer" somehow doesn't strike an easily accepted chord, but to each his own opinions on that.
The ACA obliges insurers to spend no less than 80% of premiums on delivery of services - 85% in the case of large pool insurers.
In the first six years of the MLR (Medical Loss Ratio) rule implementation, insurers rebated $3.24 billion in excessive premium charges to consumers.
So much for "honest insurers".

Administrative costs & profits must both come from the remaining 20%/15% of premiums taken in.
Here's where your 4% figure becomes absurd (trust Anonymouse, it's closer to triple that, when all is said & counted on the P&L sheets).
Administrative overhead for Medicare is <2%.
Yes, that's right, as hard as it is for right-leaning individuals who worship the invisible hand of the free market as being the best path to the lowest costs, the gummint actually operates a HALF TRILLION DOLLAR enterprise for 10% to 16% LESS than even the most efficient private health insurance companies - who are busy paying their officers 8 figure salaries - salaries that do NOT show up as "profits".
Indeed, they are not profits for the shareholders (who are being robbed blind by these interlocking BoD 1%ers on multiple fronts), but they sure LOOK like profits for the corporate officers who also hold YUGE chunks of company stock - to this observer anyway.
The point is, even at 4%, taxpayers are paying DOUBLE what gummint employees would cost us to run Medicare if Obama hadn't caved on the ACA and let the foxes into the hen house in the first place.
It's not all that complicated when you figure out a CEO making $20M/year is the same "administrative expense" as 400 gummint employees making $50,000/year in salary and benefits (standard package cost of a Clerk II gummint worker).
Nor is it that complicated to figure out that 20% in administrative costs+profit is still many times the 1.4% Medicare spent to administer the program in 2017.

Originally Posted by DW View Post
It is true that Medicare Adavantage insurance companies assume Medicare responsibility from the Feds, as was intended.
Congress created the Advantage plans to lower Federal costs and risk while improving patient service.
Not only do Advantage plans reduce the Fed costs, but generally reduce patient costs, and in my case by a LOT!
Most Medicare doctor deductibles are 20%. My copays are $10 to $50 depending.
Advantage plans do NOT "reduce" the Fed's costs.
They allow the conservatives in gummint to reduce the size of gummint employee rolls through privatization and cost shifting (at a profit) to "For-Profit" corporations who generally pay substantially less in wages and benefits than gummint employeees receive.
It's a case of personal opinion as to whether we are better served by gummint sending our tax dollars back into the private sector and allowing the 1% to enrich themselves at the expense of those they employ, vs directly paying tax dollars to employees at a somewhat higher rate of remuneration that doesn't have to have "profits" shaved off their income to support the "Leech"...er "Money-ed" class.
On the other hand, large gummint payrolls support the political class, so either way the taxpayer is getting screwed.
It's a choice between whether you want to get screwed by political appointees and elected officials - or Old Man Scrooge, who already owns the entire town.
We THINK we already know which way better supports the actual workers getting stuff done, however, and it ain't by begging Scrooge for a decent-paying job and being told to go suck it up or die.
At least you can vote to rotate the political class and let someone else slurp from the public trough once in a while.

Originally Posted by DW View Post
If you think the Feds do it better, count the number of Doctors who will accept Medicare only covered patients. Not many!
Since 2006, we have not been refused services by any physician, hospital, or pharmacy.
They ALL accept Medicare - and in fact, it is as much as 60% of their annual income, even at the reduced compensation rates.
Medicaid, you might have a slight possbility of a point, though personally we have never heard of anyone on Medicaid being turned away either.
Anonymouse suspects that propaganda is as big a canard as the whole "rationing of service" lie told about Canadian Universal Healthcare.

"However, profits in the health insurance industry have been growing in recent years, fueled in large part by growth in the Medicare Advantage and Medicaid managed care markets.
The ACA's medical loss ratio rules don't apply to the private plans that participate in the Medicare and Medicaid markets, although those plans have to win contracts with the governments (state governments for Medicaid managed care contracts, and the federal government for Medicare Advantage plans).
So they have to provide a net value to the government in order to win those contracts....
{snippty}...Currently, health insurers are the only segment of the health care industry in which profits are directly curtailed.
In the rest of the industry (ie, hospitals, device manufacturers, pharmaceuticals, etc.), a more free-market approach is taken.
There is certainly an argument to be made for eliminating or further curtailing the profits generated in the health insurance industry, but there is a similar argument for reducing or eliminating profits in health care in general."

The point in bringing this to your attention is that administrative costs and amounts spent on paying out for covered services are ONLY as low as they are because the ACA prevents them from totally gouging the consumers - which is WHY Anonymouse specifically spelled out HOW they get around those ACA restrictions on "war profiteering".
It's the side deals that generate all the Benjamins & quite often vertical ownership by healthcare insurers, (of medical device suppliers and pharma intermediary companies - prescription benefits management companies or PBMs), who's profits are NOT restructed by the ACA, generate a boatload of cash for insurance companies operating in the Medicare arena.

Not to disparage in any way your attempt to bring this discussion forward, but if you want to go around correcting the statements of someone, its probably better to look elsewhere for an easy victory than to someone who has spent the better part of the past 2 decades studying the disparities between the U.S. "For-Profit" style of delivering healthcare and the costs and improved benefits of using a Universal Healthcare model operating in every developed and most UNDER-developed nations on Earth.
It's ridiculously easy to demolish ANY defense of the American "For-Profit" system, once you dispense with all the right-wing propaganda presented by those who profit handsomely from it - big pharma, big insurance, & the AMA system of restricting healthcare providers to sustain and even boost their members' wealth.
Do you honestly believe greedy corrupt dictators would be using the universal healthcare model in 3rd world countries if there was a cheaper way to provide at least minimal revolution-preventing levels of healthcare to their peeps?
Heck no, because for all it's vaunted "best in the world" BS, "For-Profit" healthcare in America is delivering worse results than 3rd world countries, to a 1st world population.

Anonymouse congratulates you on being open to discussing this at all, and not locking your mind up and "knowing" only YOUR side has all the answers.
As always, Anonymouse welcomes vigorous debate on healthcare or any other subject in which he is adequately researched and informed enough to now have a supportable opinion.
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Old 04-01-2019, 02:01 AM
DW DW is online now
Join Date: Jan 2004
Posts: 1,817

The folks can see you have it covered.
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Old 04-01-2019, 07:02 AM
Bosshogg Bosshogg is offline
Join Date: Jun 2018
Posts: 11

Originally Posted by Anonymouse View Post
Since 2006, we have not been refused services by any physician, hospital, or pharmacy.
My wife and I spend a great deal of time traveling our country spending most of our time between Michigan, Ohio, Florida, and California. We have never come across a doctor or medical physicality that did not accept Medicare. My wife did come across a rheumatologist that would not accept our secondary insurance (United Healthcare Plan F) albeit we are mystified as of why.
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Old 04-01-2019, 02:48 PM
Anonymouse Anonymouse is offline
Join Date: Jun 2010
Posts: 214

Originally Posted by Bosshogg View Post
My wife and I spend a great deal of time traveling our country spending most of our time between Michigan, Ohio, Florida, and California. We have never come across a doctor or medical physicality that did not accept Medicare. My wife did come across a rheumatologist that would not accept our secondary insurance (United Healthcare Plan F) albeit we are mystified as of why.
Thanks for adding your voice to the discussion, Bosshogg.

Healthcare and it's delivery is the #1 problem facing this nation right now (right before - or maybe BECAUSE of - the crushing interest being paid to bankers on the National Debt).
Annual national debt interest payments alone are approaching $400 BILLION, which would fund 57% of the current Medicare system - and will cost Americans over $7 TRILLION through the next decade.
At projected rates, $7T would pay for about 2.5 years of a Universal Healthcare system.
Over a decade, Americans would save about $2.5T using UHc ($32.5T) instead of the system now in place (Medicare + Private Insurance = $35T).

The biggest hurdle in reaching such a logical decision is that the biggest money interests in the game (pharma, insurers, & the AMA) have nearly unlimited capital to spend on influencing public opinion and they have ZERO compunctions about outright lying to us to keep their cash cow grazing in perpetuity.
As American citizens it is up to each of us to sort the wheat from the chaff and figure out what is true and what is just selfish interests trying to manpulate the system for their own advantage.

The 3 biggest and strongest continuing propaganda myths against Universal Healthcare are;

• 1.) Gummint can never do stuff as efficiently as private enterprise.
That one has been proven false repeatedly, for nearly 2 decades.
Medicare is being run on ONE EIGHTH of the costs of private insurance enterprises & results in cheaper and better quality healthcare delivery for all but the very tippy-top (kudos to AOC for the funny adjective) Unobtainium-level plans costing literally $5,000-$10,000/month.
If you can afford more than $30,000-$100,000/year in healthcare insurance premiums, perhaps you will be better off not using a Universal Healthcare system.
(PS: the gummint also runs the most cost efficient [partial anyway] retirement plan on the planet - Social Security.)

As a side note, guess where the #1 destination for medical care, BY the wealthiest Americans, is.
"Socialist Hellhole" FRANCE - because their socialized medicine is delivering the most cost efficient and highest results in the entire world in "bang-for-the-buck" terms.
It provides almost everything you’d want, and it’s expensive only compared with countries other than the United States.
(Compared with the U.S., it’s a bargain.)
It probably doesn't hurt that you can drink a few bottles of Chateau d'Vinegar for a LOT less than you could in a fancy 5 Star New York restaurant, while you're recuperating.
Europe in general is on the cutting edge of medicine and just about the only place on Earth studying and trying to CURE - not "manage" - orphan diseases.

Cuba (one of those "Socialist Hellholes") has some of the best healthcare & education on Earth - so much so that exporting doctors & teachers are the 2 primary sources of economic income for the country.

India, Brazil, Malaysia, & Thailand, are the top "Medical Tourism" destinations in the world.
It isn't because rich peeps can't afford better healthcare or object to receiving it from a socialized medicine system - so be like Scrooge McDuck and wise up about the private healthcare delivery system in the good ol' U. S. of A.

• 2.) Healthcare will be rationed under a Universal Healthcare model.
(Right up there with "death panels", this is one of the most egregious lies told about foreign countries and their socialized medicine systems.)
In every 1st world country healthcare is NOT "rationed", and in fact, wait times for doctor appointments appear to be shorter than here in the USA.
They do this, in part, by insisting you show up for your appointments or else - you PAY for it if you miss your Dr. appointment, not if you actually use it.
There is probably a little less choice in WHEN to schedule those visits, but employers are a part of the plan and excuse workers for medical appointments without blinking twice.

There are systems where specific specialties have more demand than they can handle at present, but since the gummint ALSO runs the medical education system (instead of the private AMA), they can usually self-correct withn 4-5 years by directing more doctors into those areas of shortage.
The U.S. solves shortages by raising prices, which is a "rationing" tyranny of another color - one fraught with even more terrible repercussions if you have to go deeply in debt to get your care anyway.

Granted "end-of-life" care MIGHT require some hard choices, since 50% of the medical spending in a person's lifetime usually occurs within 2 years of death.
The rich can maybe afford to live forever but us mortals are going to have to accept that sometimes spending more money than a 3rd world country - just to prolong the dying of our loved ones for a few months - is NOT a feasible healthcare delivery system.

• 3.) Americans won't stand for having the gummnt tell them what healthcare they can & cannot have.
ALSO proven false, though OPINIONS on that particular canard have only shifted recently to a 2:1 margin of Americans more than willing to go to a Univeral Healthcare system.
(Between 60% & 70% - depending on which polls you believe)
It's been a long, hard, slog to combat the propaganda and misinformation being fed into the mainstram media by well-heeled lobbyists for the "Big Three" (pharma, insurance, and the AMA), but peeps are finally starting to "get it".

Anonymouse thanks the posters here for being kind enough to let Anonymouse get off on a rant he hasn't done for quite some time now.

Last edited by Anonymouse; 04-01-2019 at 02:53 PM.
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Old 04-01-2019, 04:36 PM
3M TA3 3M TA3 is offline
Join Date: Jul 2005
Location: Burt Lake
Posts: 2,096

Glad to know the guy in green has been studying this topic for more than two decades. Perhaps he can answer this. How much is spent annually on Medicare fraud and how much is expected annually under a nationwide health care system? Are there less fraud events under for profit programs?
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Old 04-01-2019, 06:32 PM
Anonymouse Anonymouse is offline
Join Date: Jun 2010
Posts: 214

Originally Posted by 3M TA3 View Post
Glad to know the guy in green has been studying this topic for more than two decades. Perhaps he can answer this. How much is spent annually on Medicare fraud and how much is expected annually under a nationwide health care system? Are there less fraud events under for profit programs?

Ex-governor Rick Scott from Florida (now the US Senator from Florida) is the expert on Medicare fraud.
His company (CEO of Columbia/HCA) stole more than $2 BILLION from Medicare through fraudulent billing tactics.
He got out 4 months after the Feds opened an investigation that ended up costing HCA $1.7 BILLION in fines ($840M + $881M) - which means they STILL made over $300k in profits from their chiseling.
Hmmm, you have to wonder how Scott, (net worth $500 Million, personally) can afford to run for political office. LMFAO

Current estimates are that about 10% of Medicare's funds are lost to ID theft and fraud.
(2017 Medicare budget was $702 Billion.)
That involves mostly scam chain medical operations that use the homeless to put in inflated claims for services never rendered - most of them in Florida and other southern states.

There were over 75,000 calls made to the OIG fraud tip line in 2017 alone.
Federal officials struggle to keep up because the Congress Critters seem particularly resistant to authorizing any funding for investigation of Medicare Fraud.
Geez, wonder why, when somebody (like Senator Rick Scott) is making hundreds of millions of dollars off it!!!
On the good news front, the ACA actually put a dent in Medicare fraud because it INCLUDES both funding and tools for fraud prevention, that resulted in savings and recovery of more than $2.27 billion for the first half of 2016 alone.

Private insurance companies spend MASSIVE amounts of money on fraud prevention, using everything from investigations to automated systems to cross-check claims, to predictive analysis - but there has still been a 3-fold increase in fraud across all insurance-related industries (not just healthcare) over the past 3 years.
The industry estimates no less than $80 BILLION lost to fraud every year.
While private insurance processes much more of the healthcare expenditures, their fraud rate does appear to be slightly lower, which is driven by their greed.
Gummint prevention & recovery efforts are only driven by a sense of honor on the part of public officials.
Greed beats the honor system every time, hands down.
Bear in mind that private insurance companies handle a MASSIVE proportion of current Medicare billing, so THEY are actually the ones letting the fraud occur, not the actual gummint Medicare administrators.

The answer, of course, is to make the punishment fit the crime.
Instead of letting white-collar criminals skate with fines and some community service, pop their arses in jail for a year for every thousand dollars they steal.
Peeps will go to jail for $50k/year & call it a good living - not so much for $1k/year.
Also, a better cross-checking system for the billing would make it a lot harder to steal from the gummint, but there will always be peeps who try.
You cannot actually reduce fraud to zero.
Experts state that at least a 40% reduction in fraud SHOULD be achievable, with the right tweaks to the current system.

Anonymouse's solution?
Put the tracking down and capturing of fraudsters in the hands of greedy "for-profit" operators, and leave the actual healthcare delivery in the hands of a quite capable (and less expensive) gummint-run system of universal healthcare.
Seems like a very good way to convert the current "for-profit" insurance industry into something able to survive the switchover.
They get a percentage of the money recovered from the crooks they catch - which means they'll concentrate the hardest on the worst and biggest fraud operations, where the most profit is to be had in recovery percentage.
Maybe an escalating scale for the bigger the fraud score nabbed, the larger the recovered bounty percentage will be.
If they can whittle it down, the system can probably withstand the small-fry operators who only steal a few million or so.

Last edited by Anonymouse; 04-01-2019 at 06:45 PM.
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