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>Medicare is one of the most successful government programs ever. I guess it depends on how you define successful. It’s the single largest budget item (>$1T/y

>Medicare is one of the most successful government programs ever. I guess it depends on how you define successful. It’s the single largest budget item (>$1T/year), it’s largely wasteful, and our populace is only getting sicker (more chronic conditions and medications). We don’t aim to treat chronic illness in Medicare patients either we aim to manage it...it’s broken. And if you don’t believe it’s broken, all you need to do is look at the current transition from pay per service to outcome/managed based reimbursements to see even CMS has waived the white flag. Care will only decline as your Medicare insurer will own your primary care doctor, your specialists, the local hospital and your pharmacy under this system. >Social Security would be a disaster if done by different jurisdictions or privately. Have you received your SOcial Security Administration Statement? I don’t know about yours, I guess it varies by retirement age, but the last one I got informed me I should expect to receive $.42 for every $1 I put in...that is a broken system.

r00fus 8y ago
Medicare is more efficient than private insurance even given its only providing services to the most vulnerable (and costly) population. If the risk pool were to expand to the entire age set, it would probably completely outcompete any private options.
- will_brown 8y ago
  >Medicare is more efficient than private insurance even given its only providing services to the most vulnerable (and costly) population. That’s what makes it so inefficient. In the 70’s, private insurance got into Medicare. In 2003 the flood gates opened with Medicare “Advatage Plans” which are private insurance managed care. The numbers of patients opting for Medicare Advantage is growing every year and now accounts for 1 in 3 Medicare patients...and they’re often the chronic care patients (most vulnerable and costly). This has directly lead to market consolidation (lack of choice in plans, networks, doctors). It has also lead to outcomes based reimbursement while the market leaders are reinventing HMO so they can get paid for a managed care system and not be subject to outcomes based payments. I’d be all for a system like you’re talking about, a single payer system, but that doesn’t exist, and private insurance is running amuck with the $1T+ Medicare budget.
  - r00fus 8y ago
    So you're complaining that Medicare sucks because it got privatized, so you want to abandon or not pay for it? Do you have a link to the 70s history? Wikipedia got nothing. As to Advantage and the Donut hole for Part D - who should we blame for that?
    - will_brown 8y ago
      >So you're complaining that Medicare sucks because it got privatized You said it was successful and efficient. I don’t agree. You said it’s more efficient than private insurance. I don’t need to disagree, because that’s not even close to a realistic picture, it’s quasi-privatized, with 33% of Medicare patients opting for private insurance for their Medicare and more joining every year. Bush enacted Medicare Part D because millions of patients couldn’t afford their drugs (millions getting free care and no drugs is broken and Bush tried Part D as a proposed fix), the fix failed and Obama tried to gut part D in its entirety because of the runaway waste and inefficiency but his party stopped him because it’s not politically advisable for the left take away benefits, so Part D was amended (still being rolled out) under the ACA (Obamacare). Just one example under the changes, doctors are incentivized (paid bonus’s) to keep electronic records of patients and another bonus to turn patient records over to the government and if they don’t they get penalized. It’s a gross and broken system, most people don’t even know Medicare patient records are turned over to the government. Want to see the problem with managed care...look at HMOs, which under Obamacare have been rebranded to ACOs. Basically the private insurance opts out of outcomes based payments (which are failing anyway and no one wants a part of that, because it’s insruance dictating how you treat patients) and the insurance owned networks do managed care get paid $x/patient per year and they water down services to ensure they turn the max profit.

r00fus 8y ago

Medicare is more efficient than private insurance even given its only providing services to the most vulnerable (and costly) population. If the risk pool were to expand to the entire age set, it would probably completely outcompete any private options.

will_brown 8y ago
>Medicare is more efficient than private insurance even given its only providing services to the most vulnerable (and costly) population. That’s what makes it so inefficient. In the 70’s, private insurance got into Medicare. In 2003 the flood gates opened with Medicare “Advatage Plans” which are private insurance managed care. The numbers of patients opting for Medicare Advantage is growing every year and now accounts for 1 in 3 Medicare patients...and they’re often the chronic care patients (most vulnerable and costly). This has directly lead to market consolidation (lack of choice in plans, networks, doctors). It has also lead to outcomes based reimbursement while the market leaders are reinventing HMO so they can get paid for a managed care system and not be subject to outcomes based payments. I’d be all for a system like you’re talking about, a single payer system, but that doesn’t exist, and private insurance is running amuck with the $1T+ Medicare budget.
- r00fus 8y ago
  So you're complaining that Medicare sucks because it got privatized, so you want to abandon or not pay for it? Do you have a link to the 70s history? Wikipedia got nothing. As to Advantage and the Donut hole for Part D - who should we blame for that?
  - will_brown 8y ago
    >So you're complaining that Medicare sucks because it got privatized You said it was successful and efficient. I don’t agree. You said it’s more efficient than private insurance. I don’t need to disagree, because that’s not even close to a realistic picture, it’s quasi-privatized, with 33% of Medicare patients opting for private insurance for their Medicare and more joining every year. Bush enacted Medicare Part D because millions of patients couldn’t afford their drugs (millions getting free care and no drugs is broken and Bush tried Part D as a proposed fix), the fix failed and Obama tried to gut part D in its entirety because of the runaway waste and inefficiency but his party stopped him because it’s not politically advisable for the left take away benefits, so Part D was amended (still being rolled out) under the ACA (Obamacare). Just one example under the changes, doctors are incentivized (paid bonus’s) to keep electronic records of patients and another bonus to turn patient records over to the government and if they don’t they get penalized. It’s a gross and broken system, most people don’t even know Medicare patient records are turned over to the government. Want to see the problem with managed care...look at HMOs, which under Obamacare have been rebranded to ACOs. Basically the private insurance opts out of outcomes based payments (which are failing anyway and no one wants a part of that, because it’s insruance dictating how you treat patients) and the insurance owned networks do managed care get paid $x/patient per year and they water down services to ensure they turn the max profit.