Posted on 02/19/2014 10:09:07 PM PST by artichokegrower
With nearly six weeks to go before open enrollment ends under the new federal health care law, more than 1.7 million Californians have signed up for health coverage since Oct. 1, according to the state's insurance exchange.
Through Feb. 14, the number who bought a private insurance plan on the Covered California exchange shot up to 828,638, almost reaching the 830,000 goal it hoped to hit by the March 31 open enrollment deadline.
(Excerpt) Read more at santacruzsentinel.com ...
RE: “I am fairly confident that the number of uninsured will increase rather than decrease.”
I disagree.
I think virtually every low income person will wind up on free Medicaid, or something almost free.
Which raises the question I’ve been asking for 4 years.
Why did we have to destroy the best mass medical system in the history of the world just so we can assign all poor people to Medicaid?
We could have assigned them all to Medicaid with a one page bill and left everybody else with a medical system and health policies they were basically satisfied with.
The cost would have been about $200 billion a year.
Since we’ve been running close to $1 trillion deficits for 5 years, who would have even noticed an extra $200 billion?
They will have to change the law to make that happen. The costs of the expanded Medicaid are paid by the Federal government for three years and then the states pick up 10% thereafter. Under regular Medicaid, the states pick up about 50% of the costs. Obamacare is actually bringing in lots of people who qualify under the old system. The states will see their Medicaid bills rise. Medicaid comprises about 25% of most state budgets now. The revenue will have to come from somewhere. The states can't print money like the Feds so you can expect state taxes to increase significantly.
We could have assigned them all to Medicaid with a one page bill and left everybody else with a medical system and health policies they were basically satisfied with.
Medicaid already has 70 million recipients (including those on CHIPS). Do you think we could add 40 to 50 million on Medicaid and not see huge financial problems? Who picks up the costs for all these additional people? Would you use the same criteria as expanded Medicaid, 133% of the poverty level? And what about the reimbursement rates to doctors and hospitals. 40% of doctors don't accept Medicaid patients now. 12% don't accept Medicare patients. The reimbursement rates don't cover their costs.
The cost would have been about $200 billion a year.
Total Medicaid spending in 2012 was $415 billion.
The federal expenditures on Medicaid in 2013 were $265 billion. $76 billion were spent on long term care alone We have 10,000 baby boomers retiring every day for the next 20 years. Those long term care costs will skyrocket and medical costs are increasing faster than GDP.
Putting more people into an inferior health care system like Medicaid will make things worse, not better. Coverage is not access to good medical care.
Since we’ve been running close to $1 trillion deficits for 5 years, who would have even noticed an extra $200 billion?
I hope you are joking.
In other words, with $200 billion a year in extra spending, everyone gets insurance coverage.
So, I just extrapolated that to Medicaid, and, in theory, left the rest of the health system in peace.
Also, although there may be 50 million people without insurance, the actual number who will require health treatment is much lower, thus, less expensive.
I also assumed the Medicaid cohort would be conspicuously younger, thus healthier, than the general population.
I was not aware that Medicaid paid for long term elder care.
I assumed that was on the Medicare account.
Bottom Line - I'm trying to adjust to political reality without destroying the health system we already have.
Since the Republican Party will never take serious action to repeal O-Care, what is your preferred alternative to this catastrophe?
The CBO estimates on the costs of Medicare were off by a factor of 9, i.e., Medicare costs 9 times more than they estimated initially. The CBO's estimates on the costs of Obamacare have been a moveable feast.
Also, although there may be 50 million people without insurance, the actual number who will require health treatment is much lower, thus, less expensive.
We have an aging population. By 2030 one in five in this country will be 65 or older--twice what it is now. Medicare and Medicaid costs are going to go up regardless. Medicare has been running in the red since 2008. 40% of the costs of Medicare come from the General Fund.
I also assumed the Medicaid cohort would be conspicuously younger, thus healthier, than the general population.
Wrong assumption. And Medicaid is not an insurance plan. The federal government pays for everything. As I indicated, almost one-fourth of the Medicaid costs are long term care. Many of thee elderly are called dual eligibles who get covered by both Medicare and Medicaid. Medicare and Medicaid spend about $300 billion a year for “dual-eligibles. Here’s what that means: Roughly 39 percent of the Medicaid program costs and 27 percent of Medicare costs are going to 15% and 16% of program enrollees respectively - and at the same time. The numbers will go up as the baby boomers retire. Obamacare had a long term care provision (CLASS), but it was dropped because it was too expensive. It's Official: CLASS, Obamacare's Long-Term-Care Entitlement, To Be 'Suspended' Indefinitely
Bottom Line - I'm trying to adjust to political reality without destroying the health system we already have.
The best way to do that is thru a patient centered program that allows the patient to control the resources. Heath care will by necessity have to be rationed. The government or the insurance companies, or the patients can do that. I prefer the patient. Right now people under Medicare and Medicaid don't care that much how much the services cost. They are not paying the bills.
Since the Republican Party will never take serious action to repeal O-Care, what is your preferred alternative to this catastrophe?
We will probably have to drastically change Obamacare to make it sustainable. It will eventually be Obamacare in name only. The Democrats won't allow its repeal because of the political consequences. They need a fig leaf to cover the wholesale fix that will be needed, i.e., it will still be called the Affordable Care Act as amended.
RE: “40% of the costs of Medicare come from the General Fund.”
I had no idea.
I start Medicare next year.
The Medicaid cost for 67.1 million able bodied children and adults is $2,500 per person.
Thus, the cost for 50 million uninsured would be $125 billion, and probably less, since tens of millions of the uninsured are completely healthy.
I'll speculate that very few disabled Americans are not already on Medicaid or Medicare - I believe enrollment is automatic once you are declared disabled.
As to poor elderly Americans in need of long term care, I'll speculate that very few have fallen below the radar of social workers, or well informed families, or church members, or neighbors, or friends.
Yes, I understand your point about the escalating numbers of elderly.
But, I'm talking only about Obama’s 50 million, almost all of whom are able bodied adults and children.
We could have dumped ALL of them on Medicaid, and still had $75 billion left to increase compensation to providers.
Instead, the Republican leadership calmly sat back and watched Obama destroy our health care system, and they have viciously criticized every Republican who tried to stop Obama.
Actually it is 45%. From the 2013 Trustee's ReportFor the seventh consecutive year, the Social Security Act requires that the Trustees issue a “Medicare funding warning” because projected non-dedicated sources of revenues�primarily general revenues�are expected to continue to account for more than 45 percent of Medicare’s outlays in 2013, a threshold breached for the first time in fiscal year 2010.
Medicare is the biggest driver of our debt. By law, the premiums collected for Medicare Parts B and D (SMI) only cover 25% of the costs. The rest is paid by the General Fund. In 2012 the General Fund paid $214.8 billion for SMI.
In January of 2011, C. Eugene Steuerle and Stephanie Rennane of the Urban Institute published an update to their earlier work "Social Security and Medicare Taxes and Benefits over a Lifetime." The chart below illustrates their findings and shows the huge discrepancy between lifetime Medicare taxes paid and Medicare benefits received.
This graph shows that the average man and woman (average defined in the study as average income over their working lives and living to the average life expectancy) who start receiving benefits in 2010 get over 3 times more in benefits than they pay in to the system! Of importance, the study accounts for inflation by calculating all past taxes and future payments in 2010 dollars to provide an accurate comparison.
If the notion that Medicare recipients are simply "getting back what they paid in" is false then where is the money coming from? Simply, the excess received is being borrowed from younger generations and the cost is more than we can bear.
I have been on Medicare for 6 years. I much prefer private insurance. You will find that some doctors don't accept Medicare patients.
Really? Your thesis leaves a lot to be desired in terms of the assumptions you seem to be making.
First, you seem to have no problem providing free health care to people who can afford to pay for their own. Many of the uninsured have elected to be uninsured. If you say that the 50 million uninsured will be added to the single payer Medicaid system, then combined with Medicare, the majority of the population will be on the single payer system, the ultimate objective of Obama and the Dems, i.e., universal health care. And what does that say to the people who are stupid enough to pay for their own insurance?
The uninsured are not a static population. The numbers are changing and increasing all the time--sort of like the food stamp program. Our population will grow by over 100 million in 40 years. And a sizable percentage are illegal aliens who can't be covered by law.
I am sure that Obama would applaud an initiative to put all 50 million of the uninsured into Medicaid. The problem is that someone must pick up the bill.
Second, you are assuming that the uninsured mimic the same demographic profile as the existing population, which is changing all the time as the population ages and the baby boomer generation goes thru the system. The numbers of disabled and elderly will continue to grow and the share of Medicaid they consume will also increase.
The number of people on disability payments is not static. Some disabilities are permanent and others are not. We have witnessed a huge increase in disability claims. There are now 8.9 million workers on disability payments, not including the 2 million spouses and children of the disabled who also receive benefits. 10.9 million in total.
And as the number of Americans collecting disability continues to increase, the number of full-time workers in the United States continues to decrease. In December of 1968 there were 51 workers for every person on disability, today there are thirteen. Some analysts attempt to explain the increases in disability payments by pointing out that the Baby Boomers are beginning to retire and show health problems. However, evidence indicates that the increase is instead a result of Congress dramatically expanding the definition of “disabled,” thereby permitting otherwise able-bodied Americans to receive government paychecks for the rest of their lives.
The SS DI Trust Fund goes belly-up in 2016. From the Trustees Report: DI Trust Fund asset reserves, which have been declining since 2008, are projected to be fully depleted in 2016, as reported last year. Payment of full DI benefits beyond 2016, when tax income would cover only 80 percent of scheduled benefits, will require legislation to address the financial imbalance, possibly including a reallocation of the OASDI payroll tax rate between OASI and DI.
The Medicaid cost for 67.1 million able bodied children and adults is $2,500 per person.
Are you including the state costs in those figures? It appears not. You need to double those figures. And as we go into the future the costs will increase as our population of children increases along with medical costs, which are increasing faster than inflation.
I'll speculate that very few disabled Americans are not already on Medicaid or Medicare - I believe enrollment is automatic once you are declared disabled.
As the disabled numbers increase rapidly, you must factor that in as well. The proportion of the costs they consume will increase along with those requiring long term care. Most Americans have not saved much for their retirement. One third of those over 65 depend solely on SS for their income and for 50% SS constitutes the bulk of their income. When you look at the data for people over 50, it is depressing how little they have in terms of assets. And as America becomes a majority-minorty nation by 2043, the situation will get worse. By 2019, 50% of the children 18 and under will be minorities.
We could have dumped ALL of them on Medicaid, and still had $75 billion left to increase compensation to providers.
Pure sophistry that ignores the real data and shoves more people into a single payer system. If the objective is to have a rolling program for the uninsured so that at age 18 you put people automatically into Medicaid, then you will destroy the healthcare system. 40% of doctors do not accept Medicaid patients now because the reimbursement rate is too low. It costs them more money to treat them then they get back from the government. Wen also know from studies that even if you put more people on to Medicaid, the use of the ER goes up. This stands to reason since people do not want to get second rate healthcare and have less access. They will use the ERs as health clinics, which will bankrupt the hospitals and the taxpayers. One night in the ER can cost $10,000 as I found out personally.
When I say “dump” the uninsured on Medicaid, when I say “add $75 billion to provider compensation,” I completely agree those are not viable long term solutions.
But, they could have been a general political strategy for the Republican Party in 2008, they are excellent political one liners, and they are easily understood political sound bites.
In 2009, John Boehner could have stood up on the House floor and asked Americans why Obama wanted to completely tear apart the American health care system when a simple, affordable solution was directly at hand.
That would have brought O-Care to a dead stop.
Instead, our leadership did nothing serious to stop O-Care in 2005, and they will do nothing serious to stop O-Care after the 2014 election, regardless of how well or how poorly we do.
A couple side notes on other issues you brought up.....
Disability Claims:
Several years ago I noticed that approval for claimants over age 60 is almost automatic.
Then, it occurred to me why the number of elderly claimants is going up so fast.
If you get approved, your SS check will be almost the same amount you would get at age 66.
Thus, if you apply for Disability at 60, and get approved, you completely carve away your 6 year waiting period.
My own strategy has been to continue working and postpone SS until age 70, mostly because my private income will only be in the $1,500/month range.
But, the minority-majority issue is more and more on my mind.
I don't think those folks are going to sacrifice anything in their own lives in order to pay pensions and medical costs for elderly white Baby Boomers.
I think they will solve America's debt issue the old fashioned way:
Default!
When I decided to “die in the harness” my stress level went down. I mean nobody really retires anymore. Quitting a paying job is too scary foe anyone nowadays at any age. I look at social security as a tax cut for older workers and nothing more.
“The only way you can avoid Medicaid is to lie about your income!”
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No so-——just don’t buy insurance through the exchanges.
.
By the way, are you aware that the IRS has no legal authority to collect the ObamaCare “penalty” except by deducting it from your tax refund, IF you have a tax refund?
The law explicitly states that the IRS cannot file a civil or criminal lawsuit against you if you refuse to pay an ObamaCare penalty.
No liens, no garnished pay checks, no jail.
However, there is some discussion about reporting "penalty" scofflaws to collection agencies.
No one, of course, wants that headache, plus it would show up in your credit history if the courts decide that is lawful.
In 2009, John Boehner could have stood up on the House floor and asked Americans why Obama wanted to completely tear apart the American health care system when a simple, affordable solution was directly at hand.
That would have brought O-Care to a dead stop.
Dead stop in 2009? Not a single Rep voted for Obamacare. The Dems controlled Congress including having 60 votes in the Senate. The Dems used all kinds of ploys to push this bill down the throats of the American people. It had nothing to do with health care and everything to do with power and taking over one-sixth of the US economy.
I don't think those folks are going to sacrifice anything in their own lives in order to pay pensions and medical costs for elderly white Baby Boomers.
Regardless, by 2030 there will be just 2 workers for every retiree. The welfare state is unsustainable. We have over $100 trillion in unfunded liabilities.
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