Haven't you heard? Americans are lazy. If you give them healthcare they won't be forced to work any more. They will all go on welfare and drive Cadillacs.
2
It is astonishing how any party can publicly support this unequal and unfair reimbursement by medicare to practices owned by hospitals - shame on you democrats . In this instance Trump has clearly taken the lead in getting rid of pork and excess fat . Democrats are, in this instance, clearly more beholden to the hospital lobbyists than to their own country. I applaud the NYT for this article showing once again how professional they are.
3
Why blame Repubs, This is where NYT is in 2019. So why we talk about "aspirations" like Medicare4all etc.?
1
I wish they'd cut mine out (along with medicaid!) and pay me the $ they give the garbage insurance co's like humana! I literally HATE them!
3
The Times editors are sounding more and more like Fox News.
9
But wait...Didn't an NYT Op-Ed the other day tell us that the savings and structural changes to our HC, that M4A would institute didn't really save us money?
Yet here the NYT Editorial Board says savings and change are possible and necessary.
Seems like someone's pockets bulge with silver pieces more than others in that newsroom.
Regardless, our gov. was enjoined to "promote the general welfare" of We The People. It is the only sentence repeated twice in that good screed. If HealthCare isn't in our general welfare of The People I don't really know what is.
M4A~! It's time.
2
Says the rich newspaper Editorial Board. Yes, thank you media millionaires, PLEASE do tell the rest of us what to do with our lives--ruin your own, don't vaccinate your children, who cares--but leave poor people's rights alone--Jesus, you have EVERYTHING else.
5
Now. Let's have the NYT Editorial Board wax poetic about the obscene profligate Defense budget: Trillions here- trillions there and no one knows what it's for. But-of-course, any discussion about trimming the fat would be seen as unpatriotic: We've got imaginary wars to fight and provocations to milk.
5
Trump following Obama's lead just like keeping the Obama economy jugging along.
Just say you want poor people to die. You didn't have to write 2000 words, you could just say what you mean which is poor people should be eradicated. This is despicable, and all of you should be ashamed. I'm cancelling my subscription.
8
Democratic proposal good; Republican proposal bad. Republican proposal good; Democratic proposal bad. Does anyone believe by now that there's any other kind of thinking going on in Congress - or elsewhere for that matter.
4
Just call the US healthcare industrial complex what it really is; legalized extortion at all levels of the system. There is an unholy trinity eating all healthcare consumers alive, not just Medicare. It is comprised of Big Pharma, then the even bigger health (denial of) insurance companies and the biggest Kahuna of them all, those oh-so-angelic people in white coats; the medical profession itself, tugging at your heartstrings with tales of compassion, care and cure.
Simply put, at every level of the healthcare racket (which pretends, very disingenuously, to care,) is a rapacious money-hungry behemoth. It charges eye-watering, unjustified prices, which cannot be challenged as price-gouging in court, for reasons nobody has ever explained convincingly to me.
It's really simple. Anyone worth their salt in any aspect of the medical biz, who is not wealthy is a loser to their peers. This government-sanctioned, daylight robbery of its citizens by these leeches on productive society, that prey upon ill-health, is nothing more nor less than appalling. It is a sad indictment of America's social values.
8
MEDICARE FOR ALL! Both parties have been wrong on this for eternity. While the rest of the developed world enjoys universal coverage and better health, the richest country in the world languishes while some get rich off of other's ill health and death. We should be ashamed!!
32
@Terri The rest of the developed world doesn't have our government or our political system. That's the reason in a nutshell.
4
So, pretty much the whole roster of Democratic presidential candidates is absolutely clueless, or worse, mendacious about the actual reasoning behind, and foreseeable effects of the proposed budget changes. Either way, we neither need a liar nor an idiot in the White House in 2020, and whether he/she is a Democrat makes no difference.
2
Ask the distinguished Senator from Florida, Rick Scott, how to fix Medicare. He's an expert.
https://www.politico.com/states/florida/story/2018/08/30/democrats-medicare-fraud-is-fungus-scott-will-never-get-rid-of-573155
"And the indiscriminate attacks by Senate Democrats are a reminder of how hard it has become for Congress to perform even the most basic kinds of prudent housekeeping in the public interest." I just spit out my Wheaties when I read that. Coming from this Editorial board. That's rich.Seriously after all your partisan and inflammatory editorials you really have the nerve to write that? What do you expect to happen?
4
@Rob Who eats Wheaties at 5 in the afternoon?
1
Current projections state a physician shortage of over 100,000 doctors in less than 10 years. That’s 2,000 doctors that are needed but not available in each and every state! Rather than focus on the relentless pursuit of cheap healthcare, better focus on how to create/keep physicians around to see patients. Medical care without doctors is like eating without food.
4
Pursuit of CHEAP healthcare??? I a country that spends over 17% of its GDP on it but gets nothing but a mess and rich doctors whose summer office hours are Tue to Thur (coz they spend their 4-day-weekends in the Hamptons? These days, unless you pay a 5k a year (and up) retainer for "medical concierge service" you get worse service than at the US Post Office.
It is simply not working for middle to upper middle class patients. I am always trying to schedule my medical appointments on trips to Europe (France, Germany, Switzerland, Netherlands). They save my sanity there, and my cost is barely more than my US copays would be.
3
@Beyond Repair
Yes, doctor’s lives are so cushy, that explains why we have the highest suicide rate amongst ANY white collar worker in the country. And it explains why the doctor shortage is worsening daily. Not.
2
Medicare pays only 80% of "usual and customary" medical bills. But it also sets a limit on doctor's charges, so the initial charge, that paid by the uninsured, can be far higher than what Medicare pays.
We could save substantial amounts by reining in fraud, but Medicare has never had enough staff to investigate fraud as thoroughly as it might.
Where I live, many psychiatrists do not accept payment by Medicare. The same was true in another state where I lived.
My main concern is that we don't cut payments to the point that doctors drop out of the program.
1
Anything short of pushing for universal health coverage will guarantee Trump's re-election. Squabble over the details at your peril.
Not all military cuts are bad. Why don't you examine that budget, instead? We could save a billion dollars just by eliminating five RQ-4 drones. Would Americans miss those as much as they'd miss a billion dollars worth of Medical care?
6
@Peter "Anything short of pushing for universal health coverage will guarantee Trump's re-election. Squabble over the details at your peril."
Might be true except for the Electoral College. It's very doubtful that the Democrats would lose a single state because of a failure to push for universal health coverage.
In any case, push or no, it's not happening any too soon.
What we are doing is providing healthcare and the structure that supports that provision is important. In large or even not so large conurbations competing healthcare systems should be established to the detriment of independent doctors and practices. There is much corruption between these systems and independents and it needs to be weeded out. The best way is through price competition and transparency.
A single player system and regulation of the industry throughout the supply chain is needed so we can join the rest of the 1st world.
4
Doctors are leaving medicare in droves because they are not paid enough. The program is being killed off in small increments so nobody will notice.
6
So the "Mueller" report comes out which is really the Barr interpretation and suddenly everyone turns to the right. Really?
4
Apparently an echocardiogram in the US costs from 1.000$ to ?????$$$$$.
In France it is less than 60 $ part of which is paid by the National Health System.
Same thing for the procurement of insulin.
Dear NYT, do, do,do, please, check this out.
Mind you, I am one for more real and useful health services in the US.
Curbing the greedy abuses of insurance companies
and hospitals would go a long way to accomplish that;
But then, are not these greedy people who decide who will be our political "representatives" by spending millions and possibly billions on" lobbying" and "contributions"?
4
Too true. One of the greatest examples of thievery is the medical appliance industry. The annual cost of a rental wheelchair (for example) can be upwards of $1000.00 from Medicare's "authorized provider." That wheelchair can be purchased on Amazon for $100.00.
The durable medical equipment appliance industry has lobbyists who write the regulations for appliance rental/purchase. They then pay off the members of the HHS subcommittee by donating to their campaigns.
6
As a cataract surgeon, I am very familiar with the expensive HOPD "loophole" --where it costs the system double when I do surgery at a Hospital Outpatient department vs. an Ambulatory surgery Center. I am paid the same either way for my services, but the facility fee allowable is dramatically higher if a surgery center is owned by a hospital. Makes no sense. In fact, our local hospital tried to buy our ASC years ago. If that had gone forward, I could bring the same patient to the same facility with the same nurses and same machines, under a new HOPD banner, and their insurance would be on the hook for double the facility fee. Perfect example of an easy way to save serious money. Democrats should not have a knee jerk response to all cuts. Some actually make sense.
9
If the Times wanted to side with Trump on something, I wonder how in the world it came down to Medicare cuts. It is not entirely accurate to say Medicare services have not endured cuts. There have been cutbacks on basic services so much so, there is a loss of doctors in certain specialties, just like there was a while ago in primary care physicians. The deductible is ever increasing and that there is even a deductible is troubling for health care. Then we've got the issue of the cost of prescription drugs. If the government let Medicare negotiate like everyone and his brother says, a whole lot of money would be saved, plus just SAY NO to advertising. Big Pharma doesn't need to promote every single drug on the telly. I could go on but so many comments touched on it, like booting ill people out of the hospital before they really should be, etc. Wow, NYT, wake up. Is this your way of atoning, for example, for writing about the Russia meddling?
5
Well-written, well-argued and a near masterwork of disingenuousness, the Times' fallback position of bothsiderism with a fine array of cherry-picked facts and innuendo. Make sure to mention this to Trump next time he complains about your coverage. In the meantime, I look forward to the work the Democratic House is doing on the ACA to actually fix the problems in the health care system.
4
The separate rate systems for similar services provided in hospital outpatient departments and physicians offices has its origins in cost accounting. Hospitals' institutional overhead cost is spread among all service lines, with outpatient services picking up their allocated share. Physicians' offices, being much simpler to run than a hospital, have much less overhead and require much lower rates to maintain a going concern. It's true that hospitals gamed the system by buying up doctors' clinic practices and turning them into offsite hospital departments but the 2015 law was a partial remedy.
It seems like a common sense move for Medicare to pay the same rates for the same service regardless of the setting but there could be an unintended consequence. If hospitals see that they are losing money by providing treatment in the outpatient setting, they may start to reverse a long-term trend and move more services back to the higher cost inpatient areas. Overall, it could actually drive health care expenditures up.
"Nobody knew healthcare was so complicated".
3
Is there any reason why hospitals should be for-profit? Is there really any need for the insurance company middlemen with their fleet of doctors ruling on patient care without ever seeing them?
We lived in the US 10 years ago with what we considered gilt-edged insurance. It cost $1000/month for the two of us. But when my marathon runner husband was diagnosed with a rare blood cancer, the insurance company tried to cancel.We fought it. Short story: his doctor applied 10 months in advance for stem cell transplant-- knowing that if chemotherapy didn't halt the aggression of stage 4 cancer application then would be too late. Insurance approval came just in time(with another attempt at policy cancellation ).Stem cell transplant is exactly the same in Canada, but without the anxiety of insurance approval.There was simply no time to return. Initial treatment had to begin immediately.
We returned to Canada for after-transplant care. During the waiting period for coverage we paid out of pocket for blood testing. The "negotiated rate" the US hospital billed for a blood test was $680. The very same test in Canada was $40 out of pocket.
And that is why Canadians may grouse about a few inconveniences, but scream blue murder at any suggestion of privatisation. Canada spends less, but gets a better outcome overall.
6
I'm not a senior, but my office visits went up 1.5 times what it was after the local IDN (integrated delivery network, nice name for questionable service) bought my doctor's office. That was in 2008, long before the ACA.
But after the ACA, my costs tripled. That's because the insurance industry always follows the lead of Medicare and Medicaid rules. That increases the 'retail' price for care for those without insurance.
The ACA has many flaws, but none were fixed even though Congress knew them. The HHS also has far too much leeway under the ACA. The can do just about anything, and tend to make rules based on national data, vs. recognizing that there are significant differences between regions, states, and even within a state. Standards of living, wages, housing, taxes, etc. all differ greatly. The one size fits all never works, but is the method of choice for Federal agencies.
Trump is right to cut the fees that hospitals have been enabled to charge when one visits a doctor's office. I'd like to see all non-providers of care to the patient see fees cut. Sadly, in this virulent anti-Trump environment we live in, the Dems will never consider it, or will propose cuts to the military instead which also has dire consequences for those in the service.
Wouldn't it be fabulous if both parties spent like it was their own money, money that they had to really justify or cut? If cuts were made based on need vs. want instead of red vs. blue?
3
The presumption in the report is that as hospitals aquire more physician practices those practices will be billing as hospital outpatient departments rather than as individual physicians. This is a dubious statement. There are some additional payments to Federally Qualified Health Centers, but these come with additional controls on quality and accessibility, especially for underserved populations.
13
@SRW
Hospital owned practices can bill a professional fee and a facility fee which is equal to or greater than the professional fee. This has nothing to do with the office being a federally qualified health center or treating underserved populations.
11
@Paul
Exactly correct!
2
Dear @SRW
I am afraid you have no idea how predatory the hospital owned practices are.I can assure you that not only do they acquire practices partly for that reason,they are very aggressive as far as their billing is concerned compared to private practices.
5
First can we remove the law that prohibits Medicare from negotiating prices with Pharmaceutical Companies.
139
@Raj Sri
There is no such law.
Medicare medical services are subject to a price controlled system. Where those prices are below the cost of care, hospitals and other providers shift the costs to other consumers, or limit access to the services to Medicare patients.
When Medicare part D, prescription drug coverage, was being developed, Democrats wanted to have the same rule applied to Medicare. Republicans, in the majority, wanted to provide coverage to retirees, but where also aware that under price controls, the most expensive drugs would either not be available to Medicare patients because the price offered was too low, or the extra cost would be shifted to everyone else. The Republican designed program did not result in drug prices exploding. Until the Democrats "fixed" it and drug cost rose both for retirees as well as everyone else. Medicare part D prices are negotiated by insurers, instead of price controlled.
Medicare part A drug prices are negotiated by hospitals. Interestingly enough, the hospitals are not required to pass along their discounts to Medicare, and patients are charged the full 20% co-pay [no out-of-pocket maximum] on list price, rather than the price the hospitals actually pay. That is one of the items in the Trump budget proposal. It saves Medicare money and also saves Medicare patients out-of-pocket costs. The Editorial Board did not see fit to detail this provision because it points to Democrat cronyism.
9
Incorrect - Congress passed legislation which did not allow CMS / Medicare agency to negotiate standard prices for pharmaceuticals. This was done by Republicans. This has led to runaway prices on even generic medicines , making the task of physicians harder and risking health of patients. I am in the health care field .
34
@ebmem
As far as I know, you are incorrect. Congress invested the power to negotiate Medicare D prices in Pharmacy Benefits Managers (PBMs), for profit companies with limited negotiating powers. This was done on the theory that private companies could negotiate more efficiently than government.
That Americans continue to pay much higher prices than countries whose governments negotiate with big pharma directly puts the lie to this assertion.
8
This is a truly astounding NYT editorial, looking at the merits of a Trump proposal instead of calling it heartless and racist. Maybe even the NY Times has learned something from the Trump - Russia fiasco that it peddled for the last two years. For once I say, hooray for the NY Times.
25
@Alex
Or maybe they're not as rabidly biased as, say, Fox.
4
@Alex Maybe you should read the Times more often. They've given Trump the benefit of the doubt far more often than they should have.
6
@Alex if you have read the Times over the years you will see it IS a newspaper and not a flunky of the left or the right.
4
The first line that caught my eye when I clicked on this piece (before I began at the beginning) was, "But some cuts to Medicare make sense."
And I thought for an instant I bumped a wrong key and skidded off onto some right-wing ecosystem rag.
Are you nuts? Aren't you listening to us? We're out here talking healthcare for every human being in the U.S. supported by our taxes. And you're blabbing about our inadequate-as-it-stands healthcare costing too much?
I'd be sick about this if I weren't so sure that I couldn't afford to pay for treatment.
4
@Rea Tarr
Many of us do not want to pay more taxes for healthcare.
If people want health insurance. they need to fund it themselves.
2
@Rea Tarr
So you’re saying that there are no areas at all that could be examined and produce cost savings through greater efficiency, elimination of duplication, smarter payment rules and standards, etc? Savings that could allow us to spend more where it would be more useful? That every government expense is reasonable, justified and can in no way, ever be cut or money (note, the taxpayers money, not the government’s) saved?
2
Pushing the collusion theory for two years with no evidence will contribute mightily to Trumps reelection. Thanks NYT. Now pump him up some more by telling how great his budget is. If you're going to be partisan, could you at least be smart about it?
NYT, I am having an internal debate with my husband and 2 adult children to keep our subscription. Your slant lately in so many ways is so odd. The headline on the Mueller report when it was really the Barr report is what started our latest debate.
But, when the sub-title in the editorial "indiscriminate attacks" - a loaded phrase indeed and not what I have seen. In fact even your quotes from Harris and Warren don't raise to that level, (IMO). They are actually accurate, but stated in politic sound bites as they are politicians. Also, this money isn't being redirected from savings you suggest might work (needs debating) to other areas of Medicare, but taken out of the Medicare budget.
But then in the third paragraph of an editorial you inject snark: "the rare Democrat who is not running for president". Why? This is just snark for snarks sake. In fact out of just the 284 Democrats in the 116th Congress 17 (depending on if you count and that includes non-Congressional candidates) have said they are running. Not including state democrats and those from business and other endeavors, that is still only 6% running, using a very inadequate denominator. So Senator Schatz is hardly rare, he is the majority.
Get better NYT or I am going to lose the debate and I will probably agree with them.
2
If the GOP is in favor of it - how can any responsible person be for it? Oh yes, it must be buried somewhere in that great new medical plan we were all promised?
More GOP lies!
I believe your opinion page has been hacked. An opinion article appeared today that sided with Prez Trump on some suggested Medicare changes. In fact, the same piece said the Democrats were just being contrary and political. Clearly this was not written by the Editorial Board. If it was, it's the first one I can remember that didn't toe the line on Democrat orthodoxy.
1
"When Americans with Medicare visit a doctor’s office, the federal government pays a higher fee if that office happens to be owned by a hospital. This bonus payment serves no obvious purpose."
I know this isn't the place, but...
So, one the one hand our government finds it foolish to pay extra for doctor's services connected to a hospital, yes?" Even you find the idea worthy.
Yet on the other hand, represented by the crows at SCOTUS, that same government is likely soon to find that women cannot manage their own bodies unless the clinic they attend is attached to a hospital, because safety.
So, 'sup?
I refuse when at all possible to have medical tests done at the hospital or a hospital owned clinic. Where I live there are independent testing facilities that are much less expensive. Don't be afraid to ask for prices before obtaining medical services and do not feel obligated to use the testing facilities recommended by your doctor. At a minimum, request that the doctor give you a good reason why you should pay more for testing at the recommended facility. Often the answer will be that there is none.
I live in an area that has had a multitude of doctors and hospitals. To much competition resulted in the doctors forming group practices so as to cut costs. Hospitals merged, creating large medical systems which lowered their costs. Now these large medical systems are buying the group doctor practices and smaller medical practices of doctors ready to retire. We seem to be getting capitalisms form of socialized medicine. Hospitals getting paid a higher rate for the same care that doctors in private practice. A decade or so from now and hospitals will be the sole source provider of health care.
w
Good grief, NYT! This editorial is short-sited. Unless if you're prepared to say hospital profit margins are too high (they aren't, and are more often too low), then reducing reimbursement from a public payer means private payers have to make up the lost revenue.
But private payers already subsidize public payers; reducing Medicare would make it even more expensive. And answer me this, NYT - what should the safety net hospitals that are using Medicare to subsidize low Medicaid reimbursement rates do? Offsetting lost revenue from private payers isn't much of an option. They already have a low private payer share (hence the term, safety net), and even if they did, they don't have the bargaining power.
Hospitals are held together with a wacky quilt of revenue streams - mess with one of them and it all comes tumbling down.
2
We just keep talking about the wrong thing. Sure, who pays for care is a big deal. The bigger deal is the reasons for care, chronic conditions that are not prevented or properly treated, and the complete lack of price or quality transparency.
1
In my mind, a cut in Medicare is when my out of pocket for medical care goes up. If it does not go up, then there is no cut in Medicare even if Uncle reduces what he spends.
2
I hope they pay regular doctors more, I’m having a heck of a time finding a primary care physician who even accepts Medicare patients. Even when they’re accepting new under-65 patients, they have an endless waiting list for new Medicare patients. Since virtually everyone over 65 has Medicare, this is also age discrimination.
6
@John Jachetta Bingo! This IS age discrimination and discrimination against people who have paid for Medicare all their lives.
1
@me
This isn't age discrimination. Don't use your insurance and pay the doctor cash. Doctors do not have to treat you just because you are ill.
1
@Driven. You'd only be right about the age discrimination part if people under 65 also had to pay extra for basic services. You're unfortunately absolutely correct that they don't have to see you.
1
The healthcare system in this country is so complex and expensive that it will take more than a yearly budget plan to resolve its problems. And with the Republican administration in place at the moment, there's little hope for any process that will actually improve the situation; already the right-wing politicians are ripping at the shaky structure of Obamacare again, determined to destroy the Affordable Care Act even though they never had any intention of replacing it, and never will. As the lifespan of the population increases, more and more citizens will be using Medicare, so a serious, permanent system must be developed and supported by the government, not the for-profit hospitals and insurance corporations. Yes, that takes taxes; but we wouldn't be paying for the confusing and unexplained procedures that are making our current system the most expensive (but one of the least efficient) in the world. This is the time to be working out a "Medicare for All" single-payer system that will put us on a par with the rest of the world--though the politics are against it while the Republicans rule.
1
@carrobin Not only our politics, but also the caliber of our government and the structure of our economy, work against our being on a par health-care-wise with the rest of the (industrialized) world regardless of who's in charge in Washington. For better or worse, "Medicare for All" is a delusion, at least for a long time into the future.
1
Democrats aren't debating the details because Trump isn't offering details.
Trump has stated he wants an austere budget because we can't sustain high deficits, a deficit that he and the GOP added $1 trillion per year to with the tax cut and huge budget.
Trump is using a sledgehammer so the Dems are pushing back with sweeping statements. And good details a meaningless.
1
I'm engaged in this industry in that my business constructs a variety of medical facilities from physician's offices to imaging centers, to out-patient centers with surgical capabilities. What capabilities are included in such facilities is predicated upon the knowledge that if a procedure (by numerical code) remunerates a private physician $200, that same procedure allows for a "facility charge" of $1000 if performed in his own (or shared) surgery center. And can result in a facility fee of $3000 or more if done in an out-patient (walk-in) ward of a hospital. So hospitals are incented to buy private practices, and then refer patients to their out-patient clinics for things as mundane as ingrown toenails.
Put simply, if you are a medicare patient and go you your podiatrist for that procedure, and he performs it in his own treatment room (as was nearly always the case just ten years ago), Mwdicare will pay him a few hundred dollars (the surgical code, the anesthesia, the disposables, etc.). This fee includes a follow-up visit. If that same procedure, is done in a surgical center ( in which your podiatrist is a partner or not), Medicare will likely reimburse $2500 or $3000. And if done in the out-patient clinic of the hospital next door, as is permitted if the podiatrist thinks it's necessary, Medicare will reimburse as much as $10,000 (or even more) for that same ingrown toenail.
6
Hospitals are experts on billing and ballooning administrators . Remember when the cry was why are hospitals run by doctors. They should be run as businesses. But medicare should take a very hard look at how much is being paid for little or no value things.
5
I “love” the phrase, “the efficiency of health care SPENDING”.
As opposed to “efficiency of health care”?
Of course, if we as a nation are concerned about spending, perhaps we would implement universal essential disease care, and look at reducing expenditures for military NONdefense and increasing expenditures for infrastructure, infant and child care, education and envronmental “care”.
1
None of this deals with the uninsured. Compare this cost savings with one of the many single payer plans now being promoted instead of promoting an Obamacare scenario where Republicans and Democrats work together to improve it. How ridiculous - on its face - is that premise? Citing cuts that need to be made to make Obamacare more efficient? This could have been done over the last decade instead of trying to obliterate Obamacare, couldn't it? Can we be realistic please in dealing with such important issues? Cover everyone, then get our the carving knives for efficiency.
4
Finally a factual non partisan article about proposals to cut Medicare funding for hospitals
I would like to add that in recent years hospitals have pushed for interventional radiologists to perform bedside procedures (thoracentesis, paracentesis, spinal taps etc) that were part of basic training for residents. In doing so they rob residents of their right to learn necessary skills, and manage to increase their revenues by hundreds of dollars per procedure. What a scam
2
Ok, let's go over it again, what history has taught us, you can pervert motherhood, apple pie and charity and all at some point have been perverted.
Add to that list medicare. Although it is the gold standard for seniors that they all love including republicans and is light yrs. better than the pre ACA de facto criminal general republican health policy of be rich, don't get sick and/or don't have a bad life event, it too can be perverted.
In addition to or included in the technical points mentioned here, the main perverters of medicare are.
1-Hypos, mainly women who go to doctors every other minute for imagined sicknesses costly trillions of dollars over time
2-Macho neurotics, mainly men, who never go to a doctor and then their health go downhill and costs trillions of dollars over time.
3-Outright crooks who scam the system.
To a a lesser degree unlike our general health care system, big pharmaceutical and big HMO who make trillions of dollars off the sicknesses and pain of Americans in general.
3
If President Obama had suggested these changes, who actually said no to it? Wouldn’t that be the republicans? This is exactly what we’ve been saying. Anything and almost everything President Obama and the democrats requested to policies, the republicans blocked at every turn. They wouldn’t even let him nominate a SCOTUS! Now suddenly the tables are turned. The republicans have owned Congress for a long time. McConnell is the leader of the cult. He’s the one that made final decisions on killing any request Obama made. Again, he’s the one making the final decisions on getting anything the democrats suggest, request, or recommend. So, he’s STILL blocking democrats. Why can’t there be bipartisan agreement? Trump won’t listen, McConnell won’t pass anything the democrats say through to trump.
2
@LI Res Obama's IPAB was rationing/limiting access to health care for seniors, because it did cut off care for Medicare patients at a certain age/point.
1
The IPAB was tasked to achieve savings in Medicare without
affecting coverage or quality. And, Congress was to be given
the power to overrule IPAB’s decisions through supermajority
vote.
It's attitudes like this which makes one realize that the desire for "Medicare for All" or single-payer or some such "free" version of health care is DOA. When we cannot even define any of it, and cannot ever, apparently, even make adjustments to programs (which are only allowed, like most of the federal budget, to increase, never decrease no matter how wasteful) then how will we ever afford and manage even more widespread and expensive systems.
This is not unlike the phenomenon famous is Washington where a budget "cut" is one where a federal program grows "only" 4% instead of 7%. It still gets more money, but is immediately portrayed by opponents as a cut. Insane. And with the massive costs involved in any health care or social program, it gets even worse, as we see here. Phrases like starving government, killing seniors, letting children die, and all the rest of the overheated blather makes us look like the fools we at times are.
As long as the public buys it, however, we will not be able to manage our fiscal house, which is on pretty shaky legs as it is.
1
For clarity your title for this article could easily have been "2020 budget Proposal Seeks Large Cuts To Medicaid Payments for Lower Income and Disabled" INSTEAD of the more provocative "Not All Medicare Cuts are Bad".
In your list you cite democrats are engaged in "indiscriminate attacks" on proposal yet nothing in the list was in error according to your article. WHY THE EXAGGERATED LANGUAGE? It's not helpful. Just the facts would be nice.
Your views on the issue of the cuts would have been much more informative than your views on how the Dems/Repubs are responding.
2
I think they should go after fraud, and go after it aggressively. All you need to do is watch the back brace ads on cable TV, and see what they're selling. Same thing with the doctors; a dishonest practice can easily be picked up by computer algorithms, and the government has all the data.
The Democrats won't even object....well, maybe one local senator will have a problem with this.
1
Thanks NYT for helping pay for Trump's tax cuts for the wealthy. With his cuts to Medicare and Medicaid he can now further cut taxes on the richest.
4
The writer is obviously not dependent on Medicare. For those of us who are cuts on what is covered and at what ?? amount may simply force us to do without or buy expensive supplemental insurance.
Look at the DOD, Trump’s trips to his properties, his kid’s frequent jaunts, and thousands of other wasteful expenditures
At current Medicare rates of dr’s and hospital reimbursements it is difficult enough to find care. A very silly proposal.
4
How about the bloated Military budget spending 2.2 million on lobster and crab in one month. Try doing a story on how the military can't even account for any of their spending even when they try.
Republicans screamed bloody murder about Democrats cutting Medicare during the Obama administration to scare the American public into not supporting the Affordable Care Act. It worked, Republicans gained control of Congress and the White House, and we came within one vote of the gutting of the ACA.
There might be a few decent ideas in this current administration's plan, but does anyone seriously doubt which party really cares about ensuring adequate health care for all Americans and which one would sell their grandmother to an insurance company to make a buck? Let the Democrats pillory the Republicans all they like. Turn about is fair play in this case, and if it works to get Democrats fully back in power to get this system fixed once and for all, so be it. I don't usually believe in 'the ends justify the means' but it's time for Democrats to play just as hardball as Republicans do.
1
Defrauding Medicare remains a huge drain on resources needed to provide for the real needs of enrollees and to fairly compensate those who provide those real needs. I'm 72. Rarely does a day go by that I do not get at least one spam phone call urging me to stay on the line to learn how I can get my "free" motorized cart, my "free" back or knee brace, my "free" this and my "free" that. All that I need do is recite my Medicare # and we're already half-way there!! Wasn't that easy?
And snail mail, even in this digital age, still provides plenty of opportunities to avail myself of this or that product or service, all "free" to me, of course.
When (If?) Congress really ever does get serious about improving Medicare, the elimination of scammery will result in huge savings, allowing services that do benefit us oldsters to be covered that currently are not, like dental care. We're not all wearing dentures.
I have no idea how funding for Medicare is handled. I do know that there are more people over 65 annually .. and will be for a while and that people live longer. I also know that I don't necessarily think that using hundred thousand dollar drugs to extend life a few months is a great idea. In fact, end of life spending probably should be monitored so useless and expensive procedures on terminal individuals are avoided; e.g. surgery that will accomplish nothing. Been there done that.
Otoh many, many people make their living from $$ related to healthcare expense; the $$$ spent in fact go to the living including shareholders in drug companies!!;- (Make a list of everything used in a medical care situation!) In some towns in the USA the local hospital is biggest employer and that is just one tip on the iceberg -- outlay in the medical industry.
If the Times wanted to support a more efficient system the editorial board would be writing pieces about supporting Medicare for All, which even the Koch-back study showed saved $2 trillion over a ten year period. However, virtually every day there is an opinion piece about why that shouldn’t be done or why people like private insurance. If private insurance is the answer, then could the Times explain why Medicare shouldn’t be converted into a private system? They can’t because it doesn’t make sense. Save money = Medicare for All.
1
850 billion savings over ten years. You wonder how much more they could save if there was a desire. But why would the Democratic hopefuls be against this "centrist" position? They could get out the message Evil Trump is at it again but are the the voters that dumb? The details have to be worked out and if this could become a bipartisan effort I would gain some new found faith in my party.
Good for the nytimes for standing up for the American people for once instead of playing partisan politics. It would be nice if you took a hard look at NATO, trade deals and Europe instead of always taking their side. High tariffs on American cars seem unfair don't it.
Hey New York Times
All these "moderate" proposals are meant to distract the public from the real facts and problems solutions .
Enough .. We had enough ....moderation ....
Just send a team to Sweden or Norway and they will tell you what to do to create Medicare for all.. in fact almost every other country in the developed world made it paying less money than the US..
Does Sweden and other countries have more money for its citizens ? Are they wealthier?
They just tax the wealthier classes , and they don't overspend on military,
Not a rocket science .
1
"Obama Loots $716 Billion from Medicare | Americans for Tax Reform" I guess since Trump is proposing the cuts it's now Ok. I guess in today's America things can only happen if it's done by the white, male dominated political right?
Cost-cutting for Medicare should absolutely begin with drug prices. The sickest patients and those with lifelong lethal diseases, such as type 1 diabetes, pay more. Drug managers, middlemen, negotiate their own rebates. It is a corrupt system.
People die as a result.
Big pharma is getting away with murder.
It would be beneficial to not just cut out the hospital-owned clinic differential (which was a scam from the day the hospital lobby had it put in) but in an anti-trust sense, force the hospitals to disgorge the thousands of practices they purchased. Many will want to rid themselves of the practices voluntarily - the financial model for purchase demands the differential be in place. Along with ending Certificate of Need (meaning at the state level - it is largely done at the federal level) and ending government meddling into electronic medical records design, costs would come down in just a few years. Add a serious restructuring of drug pricing and elimination of TV and similar advertising, something both parties should agree is long overdue, and there would be enough money in both the public and private health care pots to pay for all the uninsured without a massive overhaul.
1
In recent years I have had a major health issue for which Medicare is my primary coverage. My treatment plan introduced me to the "web" that is health care coverage in our country.
Yes, I had successful treatment, for which I had co-pays. But I was troubled by the somewhat cavalier attitude toward the costs of some aspects of the treatment.
Did I really need these braces? Could I have obtained them at a lower cost from a local supplier? Did I really need the treatment plan that was prescribed?
Some years ago my late husband was "discharged" from a rehab center on a Friday. However, he could not leave the facility until Monday morning because, as the Social Worker explained, the supervising doctor had left for the day without signing off on the discharge.
When I responded about the waste and cost of several unnecessary days in the facility, her response was "Why do you care? You're not paying for it?" My response to her?
"I am indeed paying for this unnecessary stay because it is covered by Medicare and I am a taxpayer who is paying into the Medicare system through bi-weekly deductions from my paycheck."
This lack of accountability disturbs me. We are indeed all of us paying for such a disregard of financial realities.
2
Payments to hospital-owned physician practices are low-hanging fruit for sure. The biggest trouble with Medicare solvency, though, is that the amount the average worker pays in Medicare taxes throughout their working years contributes only about half of the Medicare benefits they are expected to use.
Every time someone says they are owed Medicare benefits because they paid all their working lives should learn how much we're using in our old age.
2
@DC Doesn't that kind of depend on the individual? Not everyone uses an enormous amount of resources, so your statement is not true.
@me
@me
"Average worker." There is data looking more closely at some demographics, but the bottom line is still that we generally get more than we pay.
https://www.politifact.com/truth-o-meter/article/2013/feb/01/medicare-and-social-security-what-you-paid-what-yo/
Before approaching cuts in Medicare, how about some talk of investigating fraud and exploitation by Medicare providers? Where's the news about an aggressive investigation into that?
You can't swing a cat without seeing "providers" pop up like mushrooms to zero in on Medicare reimbursement or watch TV without seeing ads for any kind of equipment or medication that can be squeezed out of Medicare. Check out the abuse before cutting legitimate use.
1
This is one of the sanest Editorial Board pieces I have read in a long time. Kudos for making an important distinction between "cutting care" and "cutting spending". Both parties need to stop pandering to their respective voting blocks and get serious about containing health care costs, before they bankrupt our country.
2
"Both parties lately have taken a more relaxed view of the government’s borrowing capacity, in part because apocalyptic predictions about the current level of federal debt look rather silly in retrospect." Oh, come on. Democrats have long realized that the facts don't support urgent demands to lower the debt. Republicans, on the other hand, have a long history of ignoring economic reality and then squawking about the debt when Democrats are in power and running it up (far more than Democrats) when they are in control.
Republicans haven't suddenly realized that apocalyptic predictions about the debt look "rather silly." They are just doing what they have always done — using the issue when it suits them and dropping it when it comes to paying off the 1%, their only real constituency.
2
Fraud and waste in Medicare, really? In 2017, the top sixty-five health insurance CEO’s made $1.7 billion in compensation and $83 million of that went to the head of United Health alone. The largest pharmaceutical companies made a grotesque $50 billion in profits last year! Americans pay more for drugs than any country in the world, isn’t that wasteful spending? Instead of squeezing the doctors and hospitals that serve Medicare patients, we should cut the earnings of greedy health insurers and implement a single-payer system so that Wall Street investors no longer earn profits from our sickness.
2
You’ve got your moral indignation confused with the financials; yeah, that’s a heap of money and one wonders, and no, that’s not the main reason (or even close to it) that health care’s so expensive.
Look at the actual numbers. This is nothing.
The Dem elites running the show are just as bad as any Republicans. They attempt to distract and divide while doing the bidding of their corporate and banker masters. If we want real change, we need to eradicate them root and branch, and put people in charge who care about normal society, and who are willing to try new ideas. Even if stuff doesn't work, you can learn from it, and keep moving forward.
To @L on removing limits on income taxed for Medicare and Social Security.
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At present the limit on income taxed for Social Security is $132,000 - taxed at 6.2% for both employer and employee. For Medicare the tax rate is 1.45% for both the employer and individual.
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It looks like I was wrong about Medicare. The income limit on tax for Medicare was reomved last year. So Medicare is NOW a welfare program. The high income people are paying a disproportionate part the Medicare expense for the rest of us. That proportion will increase over time.
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With people such as yourself becoming more vocal and expressing your your opinions at the elections, it won't be long before the income limit on Social Security is removed as well.
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I know you are going to win. We will both be stripped of our dignity.
@HH You're way behind the times; the income limit on the Medicare tax was removed 25 years ago. You can't say that this is a "welfare program" or that anyone is contributing "disproportionately", since there's no way of knowing in advance how much or how little one will make use of Medicare benefits, a fact totally unrelated to income level. That's very different from the guaranteed income of Social Security.
And as for Social Security, we're long overdue to raise the cap on the payroll tax to at least $174,000 - the base salary of members of Congress.
It's unfortunate if some consider these pillars of the social safety net undignified, but that's a reflection on them, much more than on the programs.
3
Actually way not true. SSI tax is capped at a little over eight grand. As for one’s dignity, that’s hard to come by when you’re sick and living in a shack.
1
The sad reality is that most any cuts to Medicare will harm the patients. Today, many doctors in so-called "rural" areas refuse to take Medicare patients. I live in one such area, which is not "rural," though Medicare has deemed it such. (It is also not a huge metropolitan area.)
If doctors in practices affiliated with hospitals lose their connection, they, too, undoubtedly will begin refusing to treat Medicare patients. Of course, the hospitals still will have to treat them, but some hospitals and doctors are outsourcing their billing services. And, trust me, these companies are very nearly predatory in their efforts to wring every penny out of patients.
The system may be rife with problems, but any changes have to be very, very carefully thought out. Careful thought is not a skill set utilized by this particular president, or by many members of Congress.
3
Not all medicare cuts are bad? Not all subscriptions need to be renewed.
3
Is it just me that expects that any savings that result from Medicare budget trimming by this administration will immediately flow into cronies' wide open pockets?
By this time most everyone but all those temporarily embarrassed millionaires waiting for the lottery view all contact of trump and his gang with government funds to be a potential scam.
This being said, the editorial is correct that savings can be achieved without detriment to the program, but this administration cannot be trusted to do it.
2
The editorial correctly points out that medical care prices, including those paid by the Federal Government through Medicare and other programs, are a very confusing and inconsistent mess. Unscrupulous insurance companies and medical services providers love this system because it makes finding their excessive charges very difficult and allows the US to pay twice as much as any other advanced country for health care with much worse overall results. The whole system needs a complete overhaul, and the best option appears to be a move toward Medicare for all where all of the spending can be examined and brought under control in a single system subject to government review by appropriate experts from medical to legal personnel.
1
I don't like many aspects of President Trump's policies, but I also feel that in some instances he is defending the nation's interests correctly. For instance some Medicare cuts he proposes are to the advantage of the insured. Other examples are: his calling on Nato allies to share more of the common defense expenses or to take China's unfair support of its industries to task. It is harmful to us all to indiscriminately attack him on everything. If he is granted credit for policies that are reasonable, he can be challenged with more strength on the many policies that are not.
3
It is quite unfair to expect the democrats to have to be the only ones having to repeat the facts. The editorial board may be correct about these particular cuts but they are being naive if they think the GOP is only intent on making reasonable cuts. These examples actually help make the case for the broader cuts that the GOP intends, because the majority of US citizens will accept whatever their cult tells them is necessary. So this content will end up being talking points that help the GOP make far more substantial cuts to the program.
The editorial board is expecting the truth from the democrats, and only from the democrats.
Let's also not pretend that Trump has proposed these cuts. Trump doesn't know anything about this.
The Times could just as easily been critical of all the other cuts proposed to medicare, rather than hammering democrats for opposing any cuts. The main story here is that the GOP is proposing major cuts to medicare, not that democrats oppose the few cuts that may make sense. I guess this is part of how the oligarchy rules.
This editorial is misguided. As a Medicare recipient with a Medicare Advantage contract, I am consolidating as many of my outpatient needs - and my medical record - within the facilities of a major teaching hospital. My reasons for doing this are two-fold. First, my digital medical record is readily available to any practitioner I visit within the hospital network - critically important to anyone taking medications regularly and dealing with the chronic conditions associated with aging.
Second, and more important, the hospital network assumes the entire administrative burden associated with claims, pre-authorizations, and cost-share. I followed my internist into private practice when she left this network. It proved to be impossible. Her office objects to dealing with insurance companies; doesn’t understand the difference between direct Medicare and Medicare Advantage and threw all the complexity back on me. My initial out of pocket costs increased, too, because the one claim they filed was mis-coded and they insisted I pay a considerable sum that I knew was a covered service. I spent hours on the phone sorting it.
Services provided by hospital networks improve patient care and efficiency. Hospital networks staff up to provide this support. Those costs alone justify additional payment.
I’d like to know how many members of the Editorial Board are on Medicare and how many of those have Medicare as their primary, not secondary, insurance? I’m serious, really.
4
Well written. I recently had a short hospital stay that started in the ER. I was admitted and discharged 2 days later. I received a 70.00 copay bill for the ER, which should be waived since I was admitted. I called the hospital to question it, and I was told Medicare claimed it was not medically necessary. What bothered me was why was it considered not medically necessary, and who pays the cost of the ER expenses that they’re not getting paid for. This includes the doctor, cat scan, medications, etc.
1
Why should anyone wonder the reason behind so-called "non-profit" hospitals plowing their tax exempt windfall profits into buying up individual and group physician practices. The artificial higher fees apply to many other outpatient services.
3
How about Medicare for All, or drop the age to 55 the first # of years while simultaneously raising the age at the other end 2-3 years so the younger and older meet in the middle.? Adjustment can be made as the process progresses.
At the same time drop the hideous War budget 7-10% per year until we get down to only 3 times the output of the next non-allied countries combined. We will still have enough firepower to destroy Earth many times over.
2
This is just another reason for a single-payer insurance system. As long as money is the primary motivator for all healthcare providers, those providers will find ways to work the system or work around it to increase their take-home pay and profits. Patients have very little power in the current system over how they receive care, its quality and cost so there is no great threat to patients from handing the reins to a government agency to pay providers. What we need is administrators whose primary motivation is healing the sick and doing no harm to the people whose lives depend on them.
1
For a period of some years, increase the personnel, and software, that roots out fraud. Medicare/Medicaid fraud/phony billing/inflated billing/etc. costs us mega billions, and every dollar saved reminds us who is ultimately footing the bill-the taxpayers. Plus, a percentage of the fraudulent billing may actually hurt seniors/the disabled who fall prey to unnecessary procedures/treatments. Medicare also needs to change the way it reimburses, and determine beforehand whether the biller is passing off a ludicrous amount of hours, or treatments, that are clearly abnormal. Trying to get money back afterwards is not the way to run this system.
1
Is everyone as shocked and dismayed at this editorial as I am?
My parents have Medicare pay $1600 a month for the two including co pay on their meds, and if their hospital didn't get more money I doubt that hospital would offer the program they do. None of the "good" doctors" in a large city take Medicare because of the pittance they pay or they ask for a large "concierge fee" yearly to supplement.
Most importantly until Congress the only group in the who can keep their group insurance and opt out of Medicare when they turn 65, use it, and try living on lower incomes we will never get
the lobbied politicians to examine what public needs.
4
With unstoppable population aging Medicare will be the only pillar to support the health of the elderly .
No private insurance will be available for the chronically sick elderly patients , this is the reason why we have to protect Medicare from the various predators ready to make huge profits .
Charges for “ anything medical “ in America are stratospheric in comparison with the rest of the industrialized world and so much money is wasted in red tape and bureaucracy.
With Wall Street in control of most medical fields , ranging from Big Pharma to hospitals , American healthcare system will continue to deteriorate until the final step towards universal single payer health insurance will be taken .
2
There are already many doctors and hospital who do not accept Medicare patients due to such low reimbursements from the government. Mayo Clinic does not accept Medicare. There are many others as well. If there are continued cuts to Medicare soon many more doctors and hospitals will not accept Medicare patients.
5
If hospitals are paid more than doctor's offices for the same type of visits why isn't the answer to pay doctor's offices more?
A majority of Americans under the age of 65 seem to think that Medicare is free and provides comprehensive coverage. The average couple I know on Medicare pays about $700 per month for Parts B and D premiums, and of course Medicare does not cover dental care, eye glasses, hearing aids, etc., the things that most, even healthy "seniors" ultimately need. Am not complaining, but healthcare is still very expensive for even we old folks.
11
The doctor's office in the hospital payment has angered me for years. My mother's doctor's office said Medicare pays this extra fee. My argument has always been that rent is the doctor's responsibility. I could never understand how this obvious cheating was ever written into the law. Do we have too many doctors in Congress? Medicare should also pay more attention when a patient points out that a bill was padded by saying it was a long visit when it was 5 minutes and a procedure was done when it wasn't. My mother complained all the time to Medicare about false charges and nothing was ever done. Just paying attention to false billing would save a fortune.
4
I am a senior citizen. Every time I see a full page ad for some gadget directed at Medicare patients I know it's probably unnecessary, and definitely costs a lot to taxpayers. The scammers know how to get things approved by CMS and then convince seniors to buy it because it costs a little or nothing to elderly.
Many doctors, particularly those who serve immigrant communities, create phony need for visits, over testing, and over treatments because uninformed people trust their physicians. These frauds are much more common than known to general public.
Entire private health care industry is robbing us. Unfortunately it's impossible to reform it, and too late to abolish.
2
The physicians and eye doctors we visit are all located in a hospital complex - the dentist's clinic is in a separate location by itself, because the dentist charges his or her own exorbitant fees and they are not covered by Medicare. The huge complex of hospitals in our city all house doctors' offices. It's possible that the rental charges for these offices may be more affordable for practicing physicians, then setting up independent rental places where they may have to pay higher rents. The administration may be wise to poll the physicians before they make these drastic cuts in medicare charges.
This is just plain wrong. Where I live there two choices for almost all outpatient medical care if you have Medicare , either UNC or Duke hospital physicians . The physicians who work for them have to accept Medicare. Doctors not working for hospitals can't afford to accept Medicare because reimbursement doesn't even cover their costs.. The reason they can't take Medicare is quite understandable when a neurologist is reimbursed $90 for an office visit, ten dollars more than my PCP.
Private doctors not on salary with the hospital system can not afford to take medicare patients. In the Triangle(over 1M people) area of NC I know of 3 gynecologist who accept Medicare.These doctors lose money if they see Medicare patients. Can you think of any business model set up on losing money on every customer !
This also means Medicare patients have long waits to get in to see Physicians which of course sends them to the emergency rooms when they can't wait 3 months for an appointment.
The system is broken because Medicare reimbursements are so low that few doctors can afford to see these patients. If we want to save money pay more for office visits so more doctors can afford to see these patients . That will keep them out of the ER and hospital beds because by the time they get treatment they are seriously ill.
Health care in USA is dangerously broken.
2
When I helped my parents die, and now with my own health problems, I have seen hundreds and hundreds of pages of medical bills in the hundreds of thousands of dollars, mostly for hospitalizations. Medicare sends you a tally of charges and amounts covered by Medicare, with the notation that you won't pay anything for services they cover. At the end of virtually all bills the notations was: the patient owed nothing. Sometimes there was a charge of a hundred dollars. The amounts shown as paid to the physicians was generally a pittance of that charged, at a rate where I couldn't see how the doctors could afford to provide the service. Medicare works smoothly - you give the doctor/hospital your Medicare and supplemental insurance cards (thank you AARP) and that's it. No need to fight with a hospital or insurer, you are covered. It is a great system, one of the few government systems you can actually use and directly benefit from. If anything it should be better funded.
Where I see possible fraud in claims for Medicare is the hospice charges that may not be warranted. Two years ago my stepmother, who is in a memory care facility, was deemed hospice-worthy because she had edema. That was improved nearly two years ago through use of medication. However, we are told she still needs hospice care so the government continues to pay 5,800 a month for “daily visits” even though we already pay 3,400 a month for her care at the facility. My inquiries about this are met with a shrug.
@MF I thought there was a 6 month limit on hospice stays.
While I am not opposed to cuts that make sense, I'm not sure that these do. This editorial takes for granted that the proper rates are those paid to independent physicians and groups, and hospital affiliated groups are gouging. This ignores the reality that doctors all over the country are dropping Medicare completely due to the pitiful reimbursement rates. In average cities they are simply not serving older patients, while in wealthier areas they are going concierge and serving a few. This is not around the edges. A large number of doctors are dumping Medicare and there are worsening shortages as a result.
The perspective of the Times further illustrates why single payer healthcare wouldn't work in the U.S. as it does in a few other countries. Physicians here expect to make a good living and be rewarded for their years of extra school and training. They expect, and deserve, to live solidly upper middle class lives commensurate with their expertise, not be civil servants as is common elsewhere.
5
Well, you got almost all of that wrong.
Doctors aren’t refusing Medicare patients in large numbers. There are no shortages. Universal (not necessarily single-payer) healthcare works — at lower cost and to better effect — in every other wealthy country, not a mere few. Doctors in Europe have training on par with Americans, and live upper middle-class lives. They’re not civil servants.
5
Currently any hospital that has an emergency department must provide care to emergency cases and to patients in active labor regardless of the prospect of payment. This additional cost has to be paid somehow.
Talk to me about this when everyone in this country has the means to pay for medical care.
1
Trump's obscene tax cut act which decided that billionaires needed even more money, his tariffs, and his tendency to believe that he can make better trade agreements than anyone else (a confidence that seems to be unfounded) - these economic decisions do not help me trust that 'Trumponomics' is a sound basis on which to base the future of the American economy.
My doctor already is drastically underpaid by Medicare and if this continues it will be almost impossible for seniors to find doctors willing to take them on as patients. Once funds are cut from a program they are rarely restored. And as far as a man who hates to read actually making surgical cuts to a complicated plan 'forgettaboutit'. Our president is also a man who likes to appoint people to cabinet positions who are "hacks" as Paul Krugman tells us this morning on this same opinion page. We can spend wisely and make well-considered cuts when we have a government who can do actual math.
1
Your defense of cuts to Medicare to create parity between payments for visits to doctors’ offices outside hospitals versus inside misses a significant point: Cost shifting. Cancer patients and survivors frequently have no choice but to see a doctor who practices in a hospital setting. Under private insurance, those patients frequently are subjected to so-called facilities charges, which are not covered or reimbursed and are substantial. Johns-Hopkins, for example, charges a “facilities charge” of almost $100, which is not reimbursed by insurance. Are cancer patients supposed to meet their physician in the parking lot to avoid such charges? The fair parity and “reasonable” cut to Medicare that you suggest, would just shift more costs to elderly patients, in the same way that private insurers already have done. This is not the answer.
1
One of my friends in our local, private medical group, also works part-time for the hospital owned medical group. Both offices are in the same building, but when he walks across the hall to the hospital group, his visits are billed to the people he cares for for at twice the rate of the private group. When hospitals buy the practice of private physicians, rates for their visits and tests double overnight. This drives up the cost, but it does not improve the quality!
5
A private physician owned medical office charged $X for an office visit. The next day the medical practice is purchased by a hospital, The cost of the office visit now includes aa 'facility fee' and costs $X + x. The service rendered by the same physician is unchanged
Also the county health department which offers 40 hr/wk availability also charges $X + a facility fee
And some actually wonder re the reasons for increasing cost of medical care in the USA
4
I'll believe the propriety of this editorial, if and when this legislation is passed, AND it is ultimately implemented as to what your editorial in fact states. Further, if it is neither altered legislatively, or subsequently changed, administratively.
However, the head of Medicare, has administratively decimated many reasonable items, since Trump was elected in 2016. This has been been ongoing since then.
For instance, Medicare is cutting nursing home health safety fines in half, which was just published by the March 22, 2019 Friday Alert of the Alliance for Retired Americans.
And recently before that, Medicare has been administratively relaxing health safety in nursing homes, before this latest move.
Further, what about the recent Congressional hearing in the last week or so, with big phamra's lack of verbal response to the incredible rising costs of meds that many individuals, which the public cannot afford!
Even AARP is running ads on tv about this.
A nd, Congress has been proposed that they must put their med prices on their tv ads, which they are refusing to do.
Respectfully, I would suggest that you respond to some of these ongoing matters, as well. And if you have, and I missed them, I apologize.
2
A wise public policy would take all the monies saved from rational cuts to Medicare and re-invest it in increasing reembursement to primary care providers, docs, physician assistants, and nurse practitioners. Thus monies saved would immediately bolster the system and protect the improvements from partisan rhetoric.
2
When I was healthy 45 year old and sick, I'd go to my regular doctor for a strep, bronchitis, etc. test, and be out of his office in 20 minutes.
Like so many people my age, my oncologists' appointments are more frequent, with blood tests to assess whether my meds are working, for chemo infusions, radiation treatments. And, yes, I chose the institution with oncologists who had the greatest expertise for my care. Is it expensive? Yes it is and it is why we have medical institutions with this level of expertise. Just an FYI to the NY Times editorial board, those very same institutions are developing treatments that you may need in the future.
Sorry to tell the Editorial Board at the NY Times, but getting old is expensive. My bet is that each and every one of them would make the very same decision I did in seeking the best care possible when they experience an unexpected health crisis. These people are not wise, insightful, or empathic in their assessment; they are merely too young or lucky in their healthy lives to understand.
This is just the beginning - the tsunami of baby boomers are reaching their senior years. At every level of our lives, this generation has had an impact on society. This final chapter is going to be very expensive. My suggestion is to end the endless wars and cut the tax breaks for the uber wealthy. But, please, leave seniors who are just trying to deal with very serious and painful health conditions out of this budget process.
4
It is difficult to reduce health care spending....without actually reducing health care spending.
An entire industry and lobby have built up in the interest of preserving the higher payments for "hospital-based" ambulatory facilities. That gig should have been up years ago.
3
I could't wait to finally turn 65 and have good health insurance. I, like many others, neglected to address numerous health issues due to excessive co-pays demanded by health insurance companies. In the event that you can't afford the high co-pays demanded by private insurance companies you find yourself with a stack of collection agency bills that lead to poor credit scores due to your inability to pay. It's all about profit for hospitals and private practices that the AMA promotes and supports. I can only imagine that the early death of average citizens who can't afford health care will provide more room for the 1 percent to escape environmental devastation by traveling on their space ship to Mars.
3
I live in an area that is stuffed with doctors and hospitals. But, in contrast to the way supply and demand are supposed to operate, the prices never come down, there is no rhyme or reason to the costs, and because most of us are not physicians or knowledgeable enough to discern the difference between one procedure and another we cannot bargain to get lower prices.
If this country is serious about improving health care for all the first thing that needs to be addressed is the complete lack of transparency on bills. Prices need to make sense and patients, since we are expected to pay a sizable amount of the bill, should know why we're being charged for the mucus recovery system and what that is.
We have reached the point where health care in America is now a luxury item. Who knew that one has to make over 6 figures to afford the cost of a simple broken arm?
253
@Jackson, how many employers are shifting their employees to high deductible health insurance plans? The premiums are ostensibly lower, but I doubt that. So, with out of pocket costs and premiums, health care can cost thousands of dollars of year. Even for minor procedures, such as a broken arm.
61
@Jackson
Those "employer funded plans" are often actually paid for by deductions from the income of the employee. Even when my daughter worked for a non-profit hospital, money was taken from her wages for her medical plan. The only benefit is being in a group rather than having to buy individual coverage!
59
@Jackson Employer funded is a gross exaggeration. It is rare for an employer to pay the bulk of the insurance premiums. Co pays for procedures are significant for most employees and you are expected to pay up front. I had a friend I worked with, with company insurance, who had a cyst on her brain. The day of surgery, before they wheeled her into surgery, someone from the business office came to her room to collect the co-pay. She hadn’t brought her purse, so her family had to use their credit cards to pay several thousand dollars before she was taken to surgery.
39
This editorial misses the forest for the trees. Of course, any program can improve services per dollar if scrutinized. But anyone with any direct experience (as I have with my Mother) using Medicare can see that, if anything, Medicare needs more rather than less spending allocated. The large donut hole causes millions of American seniors to spend what little money they have on hand, thousands, in fact, before Medicare picks up the tab on necessary medications. Patients are routinely forced out of the hospital before they are truly well enough to be sent home or to rehab, often leading to a quick return to the emergency room. And the compensation for doctors (especially primary care physicians, the front line of health-keeping) is so low that fewer and fewer doctors are accepting such patients. Not to mention the fact that, when you do need a physician who actually knows your medical history to be present upon admission to a hospital, this is not possible but instead you are seen by a “hospitalist” who doesn’t know you from Adam. Reforms and oversight are always a good idea, but Medicare needs more, not less money budgeted. Just a portion of the tax cut to corporations and wealthy could pay for this. Shameful opining from the New York Times!
173
@David Parrish
I think you missed the section where the Board says private practitioners not affiliated w/ hospitals should get the bonus rather than those affiliated w/ hospitals.
I also think the Medicare recipient plays a role in the decisions made about Medicare financing, including the knowledge that not all procedures are necessary and that the money available is not limitless.
4
@Jo
You are telling me that I: a) should decline some procedures because they might be unnecessary; 2) should forego those tests or surgeries, etc., that cost a lot because, after all, available money is not limitless.
Even though I have no training in medicine -- and don't think I'd have time enough (at 81) to get through med school -- you want me to play a role in decisions about my Medicare financing.
Thanks for today's laugh.
25
@David Parrish. You’re missing the point of the article. One of the proposed cuts is to stop paying hospitals more than independent practices for the same treatment and office visit. Why do you think hospital groups have been so aggressively acquiring practices? That up payment doesn’t buy better care or more access. It just makes everything more expensive.
15
While I am all for saving money, I'm against the proposal to move those savings to the general fund. That money could be used to reduce the cost of prescription drugs, or reduce the size of the "donut hole" for example. That money was earmarked for healthcare, and should remain within the healthcare system to benefit those who have had money withheld from their paychecks for 40 years.
133
@Joan Puma I don't think you understand how it works. Medicare is in the red. HHS has been cutting reimbursement to try to make up for the shortfall, but doing a very bad job at deciding what and how to make those cuts. There isn't a bunch of money sitting in the budget where we just need to figure out how to best spend it. We spend more than we take in because of the baby boomers getting Medicare (rest of world seeing this) and the government took excess funds back in the 60s and 70s and spent it. In the general fund.
3
Whoever wrote this editorial isn't functioning in the real world of health care delivery. The category of "independent doctors ( general practitioners particularly) offices is nearly extinct. Hospitals have gobbled them up.
Although the editorial mentions that fact- it treats this reality as an afterthought. Rural clinics are also owned by hospitals and most doctors are affiliated with those too.
The entire editorial is nonsensical and contradicts itself on too many levels.
64
@Candlewick. Most people are completely unaware of how hospitals have bought private practices. Medicine has become corporatized and just as an individual has little power in the business corporate world they have little in the medical corporate world. This column is nonsensical and offers no real solutions to the problem of medical care costs.
5
@Candlewick No, the reason that they bought the offices was to be able to upcharge the office visits as the ACA allows. That is what needs to change. It's not about stopping doctors from being bought, although that would be welcomed, it's about paying more for the office visit because they are hospital owned. Yikes, there are 41 likes on your comment that shows no one gets what is really happening.
3
Acknowledging that the cost of providing medical services can vary across the country, decisions on reimbursement should be a function of the actual cost of providing those services. Do we even know the cost of providing the elements of services and their effectiveness? I utilize a combination of the VA and non VA related medical services. The VA and hospital affiliated providers use more automated systems, which allow me to check test results, check appointments, and reorder prescriptions electronically. I even do pre-checkin for appointments online. I usually get test results back in 24 hours or less without another visit to an office or clinic if further follow up is not needed. Such systems are much more efficient, convenient and I would suspect less error prone. My wait times have been reduced substantially. To provide such services certainly requires a critical mass of patients to justify the costs of providing such services. The VA and the hospital chain I use both provide local outpatient clinics for more basic services, with more specialized services done at the hospitals. It works. Rural areas will be a challenge as patients are spread over a wide geographic area. Reimbursement programs must have flexibility as "one size fits all" programs will not satisfy anyone. Base reimbursement rates on the real costs of providing services. Things like universal broadband which may seem medically unrelated will help reduce the cost of providing medical services in all areas.
3
It is a shame that we have become so partisan that common sense cuts cannot be supported across party lines. I thank the Times for supporting these cuts.
5
My medical group was swallowed up by a health system a couple years ago. Equalizing payments to hospitals and medical groups, if it comes, will be too late to save thousands of independent doctors. My buddy, a neurologist in California, will earn an extra hundred thousand this year because his practice was bought by the health system. He would gladly give back a big chunk of that to be independent and not have to answer to a turnip-brained MBA.
The businessman have won. We are their serfs. You are their cattle.
275
@vbering
100% correct. People long complained that the political power of the medical profession was the problem and that physicians needed to be brought under control. That has been done. The profession is one in name only. It is broken and under corporate control.
The political power of the corporate masters is however, far greater. Their pockets are much much deeper and there are fewer impediments to concerted action to drive the law for their own soulless ends.
33
@vbering
If memory serves the AMA was adamantly opposed to medical care for all as early as the late 1940's or early 1950's. Corporate America was using anti-communist rhetoric calling it socialism to maintain their profit from illness position. Seems the chickens have come home to roost. It will take great courage to bring power back to the people.
15
@Charles Hayman
I'm not an AMA member.
Glad you're enjoying the Schadenfreude, but remember people are paying double what they should be paying for a simple echocardiogram because of the MBA's.
It's bad to be a serf. It's worse to be cattle.
14
Maybe today we should have "Money-Power-Ins" and "Be in the Elite Ins" and "I'm A Top Schooler Ins." Perhaps chaging the ins every decade or twoo to reflect American liberal values is in order.
I actually used to work, years ago, for the federal agency mentioned in this article. And I think it's a shame that nobody in this discussion appears to understand (or acknowledge) how those payment rates were set. If one did, one would realize that Medicare is perfectly justified in equalizing the rates but has no justification for cutting overall hospital reimbursement because of that.
Here is the Federal government's argument, in a nutshell.
1) The Federal government imposes rates on physicians, using one accounting methodology.
2) The Federal government imposes rates on hospitals using a completely different methodology.
3) Those two sets of Federal rates don't match, item-by-item.
4) So both hospitals and physicians own the Federal government money.
On 4), people discussing this forget that the Feds already used this trick to cut physician payments for imaging and other services.
The reason 4) is just-plain-wrong when it comes to hospitals is that the hospital rates -- the "OPPS" -- are based on hospitals' costs, allocated to individual services. All the cost is allocated. In theory, no costs get ignored or overstated. So, if Medicare is overpaying hospitals for some services, it is, as a matter of logic, underpaying them for others.
Equalize the payment rates by site, sure. That's reasonable. But there is no justification for cutting total hospital payments on the basis of that.
Statements 1-3 are true. Statement 4 is a fiction.
Put it in context.....Hospitals are no saints, by any means. But you leave out one tidbit of information. Hospitals are required to provide services regardless of ability to pay. Doctors can say "We don't accept Medicaid" or if a private pay patient doesn't pay their bill, the doctor's office can refuse to see them. Hospitals cannot do that. Eliminating increased payments to hospitals for hospital based services, wherever they are located, will mean premiums will go up. People think the uninsured will simply go away. The system wipes their hands of them. In fact these people wait until they are very sick. Then they take an ambulance to the ER. And, make no mistake, you will foot that bill. One way or another.
8
I am an advocate of both programs. Good health must be available to everyone regardless of income. Yes, both systems are in need of a better system of spending oversight, and it should begin with the escalating intragovernmental debt.
This debt includes money the federal budget borrows from Peter to pay Paul, one of which is the Medicare program we pay for. Another place to find hidden cash to pay for health care for all could be found if someone would work on finding the trillions of dollars unaccounted for in the defense budget.
1
Medical services should be provided by not-for profit institutions and businesses. Yet in the US both hospitals and insurers are for-profit entities. Changing this situation would greatly reduce costs and increase overall health.
5
I am very pleased that this editorial clarified at least one of the proposed Medicare cuts. Last year, following a routine chest X-ray, the billing for the procedure as well as my copay were charged as if it had been performed in a hospital, not at an office suite in a local medical building of offices where the procedure was actually performed. This enabled the practice to bill far more than they should have. This is a ripoff of Medicare and Medicare recipients, a profitable loophole for hospitals that should be closed off.
4
>50% of healthcare is under government control. As such, politics and special interests abound. There is no free market. Why is the average dermatologist paid 3x what a pediatrician is paid? Because historically the specialities lorded over the reimbursement setting. Why are their doctor shortages when there are 2x the number of qualified applicants to medical school? Because the AMA+Medicare (residency slots) limit the number of medical schools slots. As the editorial pointed out, hospitals have absorbed thousand of physicians practices to game the system. The Democrats promote "access" without regard to cost (2x that of any other industrial nation). The Republicans fail on both cost and access. There is literally no reason we cannot cover all Americans at 1/2 the cost we are charged today while still allowing individuals to pay to access their own healthcare alternatives. It will however require lower costs from hospitals, doctors, insurance, drug companies and a Congress that actually cares to act
4
Here we go again. My rural critical access hospital system would not survive without the boost we get for serving a population who would otherwise not get any care. Most are on Medicare and Medicaid and as it is we are barely hanging on.
There is virtually no private practice left here and we all are employed by the hospital system. Our mere existence and abilty to serve a population in need depends on our getting a bit more for what we do from Medicare,etc. I get a salary and do not get paid fee for service.
Wake up NYT. There is a whole other country outside the bubble you exist in.
6
Thanks for an informative piece - the NYT doing its job well. It is very hard for the average American to hear beyond the sound bites and political posturing to understand exactly what is happening or what is being proposed. It is also hard, IMO, for many of us who loathe Mr. Trump and his posse to look at what he is doing thoroughly enough to see that something might actually be reasonable. Thanks.
2
Not everyone has Medicare. And there are problems with Meducare. Thanks for pointing some of them out.
Everyone deserves to have access to quality affordable healthcare as a right because they are a human American. While the cost of prescription drugs is immorally inhumane and outrageous.
6
Growing healthcare costs are eating up this nation and will bring it down if they are not cut. It is simple math. They will be cut in a deliberate and controlled manner or by the chaos of collapse. Can we be adults and face the facts of necessity to avoid more pain later?
2
The hospital lobby will never let this common sense proposal happen, ever.
3
What gets me about this and about the ACA, when it was passed, so that there is always opportunity for amendment as conditions and understanding change.
But noooo, politicians always have to have the knee-jerk reaction. That’s such an overwhelming condition that it needs its own medical code now.
Maybe we should call such modifications by some other term, but that sort of finesse won’t fit a news cycle.
1
"Maintaining tight control of Medicare spending is good government in its own right."
Yes, ensuring Americans hard-earned tax dollars are spent on things we really need and in a prudent manner is a good thing and not paying big medicine more than individual doctors seems like a good idea. However, the article claims this would save as much as $28.7 billion over 10 years or 2.87 billion a year. The US spent $3.5 trillion on healthcare in 2017. The proposed savings is 0.08% of our healthcare spending. Also do you trust a president that believes he has the power to shuffle funds approved by congress for one purpose to any other purpose he likes better to handle even sensible adjustments to Medicare or SS? I don't.
19
The legislation discussed in this article is so common sense that I cannot see it ever passed. In that same vein, I do not understand why publicly supported health plans of Medicare and Medicaid pay taxpayers' money to for- profit institutions. These institutions have to get funds from somewhere to pay dividends to their stockholders. Where does that money come from? I suggest that Congress formulate and pass legislation to stop the lining of stockholders pockets at the public and patients' expense.
11
@Janet
I am a doctor. I own a practice. I provide services to patients insured under Medicare, so I bill Medicare for these services. I spend less to provide these services than I take in in Medicare reimbursements. Therefore I am a for-profit entity. Tell me what part of that you would change.
5
@Janet
The government provides foodstamps to low income Americans. They use these funds to buy food at for-profit grocery stores. Do you think they should be prohibited from shopping at grocery stores?
The ads are out there again for Medicare Advantage plans that pay for superficial benefits such as health club memberships ("Silver Sneakers") which is a travesty while other Americans do without health care at all. What a kick in the teeth it must be to young famijlies who can't afford care for their children to see these happy seniors cavot around in their fancy gyms. Is this an insidious way to pit generations against each other until the social safety net is entirely dismantled? Maybe. Medicare Advantage plans are still subsidized by all who pay into Medicare. And not to mention that the very idea of an "advantage" is antithetical to fairness and equality since it is the wealthier Medicare recipients who can afford to buy these "advantages" while others have to settle for having Part B taken out of their meager social security payments. Let's start with getting rid of "Advantage" plans and move on to making all health insurance companies non-profits that are government- regulated along with hospitals so that charges are equal and fair for all Americans. Or even better, take all the money companies pay for employee insurance, add individuals pay for overpriced insurance, add a reasonable, graduated tax and have Medicare for all, then employ oversight and regulation of drug prices and hospital charges.
17
@fg
Silver Sneakers provides opportunities for senior citizens to participate in exercise programs usually at modest gyms such as YMCAs. This type of preventive health care proved to be extremely cost effective in helping seniors avoid and/or control illnesses such as heart problems, diabetes, chronic pulmonary disorders, osteo-neuro conditions, depression and many other costly medical problems. Participating gyms also pay into the Silver Sneakers programs and many seniors are required to pay part of the membership fee.
A little research here by the commenter could have gone a long way.
8
@fg. You are overlooking the fact that by encouraging seniors to exercise, lowering blood pressure, weight control which eases arthritis are also benefits. There are many other conditions that exercise helps avoid, like falls which cause all sorts of problems that Medicare would pay to address. So your view is short-sighted. By the way, gyms that offer Silver Sneakers are hardly fancy. And supplemental plans also offer Silver Sneakers. Those are plans that are purchased along with Original Medicare. Please educate yourself before you comment on such issues.
1
@J. Benedict I don't disagree with the benefits of exercise and healthy living but even local YMCA membership fees are expensive for those living on social security and you cannot argue with the elitism exhibited in these "silver sneakers" ads or miss the fact that the lower the income the lower the health of poeople in this country. It would be better use of health care dollars to cover all Americans and for communities to provide opportunities through senior centers and local efforts that are more cost-effective than diverting crucial healthcare dollars to those who least need help and in fact it is a travesty that a chunk of Medicare dollars go to insurance companies through Medicare Advantage plans.
Excellent article. I'm a self employed hospital based physician. I was not aware that private self employed physicians whose practices were taken over by hospital systems started seeing a substantial increase in their reimbursement rates from Medicare for the exact same service. It's no surprise that there are hardly any independent private physician groups left in our county.
So, my question is, what did Medicare, by paying much more for the exact same service by the same exact provider, succeed in doing?
On the other hand, those physicians that stayed independent saw decreases in their Medicare reimbursement through unreasonable enforcement of EMR penalties, HEDIS and other doubtful measures of quality.
No wonder that most residents out of training are opting to work for hospital systems. It's extremely hard to hang up your shingle in a system designed to penalize you if you're private and independent, and in admire those that still do it and succeed...
16
@Shahbaby got it exactly right. I'm a private practice urologist in Manhattan - getting paid 20% less than my "academic" colleagues who work at the hospital or at affiliated practices. Medicare payment cuts and increasingly outrageous requirements will likely force me to close my doors within the next 5 years - as treating Medicare patients, many of whom are retired (or working) Manhattan millionaires, are now my "charity" cases. Meanwhile, Medicare patients find it nearly impossible to find internists who will see them in Manhattan. And my own party is now playing politics while supporting the huge, expensive hospital systems? Shameful. Retirement here I come!
5
@Shahbaby
If you're a private practice doctor, good luck competing on the uneven playing field a local "vampire squid" hospital system creates. Due to the site-of-service differential in payment, hospitals have a whole lot more disposable income and debt finance available for lavish facilities and ancillary staff salaries. Do you know how much a single one of those guest chairs cost in a hospital waiting room? $800-$1200. Consider their armies of staff, with their high salaries and generous benefits too. This raises the bar for every private practice in the community. We have to make due with older facilities and fewer staff that need to work harder to keep us afloat. By all means, please level the playing field.
1
In this rural area it is impossible to stay private. It simply does not exist. We are all employed and salaried.Our FQHC and critical access hsopital would not exist without the boost we get in fees. We are barely hanging on and this population would other wise get NO care.
2
The cuts would mean more dr's refusing to take medicare patients and hospitals surprise billing. Surprise billing is when the non network dr charges thousands above what Medicare will pay.
9
We are now arguing about which party bankrupts us all first. Novel, isn't it? Ross Perot was simply way ahead of his time. I voted or him, so don't blame me.
1
More baloney. Clipping here, trimming there, just ways of continuing our collective denial of the failure of our healthcare mess. I recently left this mess, after almost half a century. Reacting to healthcare payors' relentless demands for documentation and data pushed me to the brink. It's total cacophony, a Tower of Babel of metrics. The costs for responding to these demands fall on healthcare providers. Bonuses for exceeding goal metrics include constantly moving goalposts. Only fundamental and sweeping changes in the financing and management of healthcare will improve this mess.
10
If cuts in medicare are offset by waste in Medicare. What is not to like as long as granny is not thrown under the bus. The fact that health insurance companies managing medicare are thriving beyond all expectations is indicative of the government spending way too much to take care of Americans above 65 who are receiving medicare benefits. If only the government managed medicare efficiently it could have saved the tax payers billions and cuts in medicare would not affect the quality of care.
The health insurance industry takes the lion's share of medicare and those democrats engaged in indiscriminate attacks on president Trump's 2020 budget proposal are not just ignoring some worthy ideas, they are in the pockets of the health care industry doing their bidding.
3
@Girish Kotwal Granny WILL be thrown under the bus. That's the hidden agenda/goal here.
I work as a physician in a busy, renowned academic hospital where we take care of all kinds of complex patients many of whom don’t have insurance. They show up in the ER and we take care of them. I cannot think of any other industry where one would show up, get a service ( life saving in this case) and leave without paying. And yes if something bad happens, get sued for a million bucks. We teach medical students and residents and nurse practitioners and PAs and prepare the next generation of healthcare providers to take care of your next generation. Is that factored into the cost of healthcare? Not at all! I can go on and on about the shortsightedness of politicians and the general public and the press who seek to vilify whole sectors that try to do good. The greatest medical education and healthcare system in the world that attracts the most talent from all over the world and created the most scientific innovation the world has ever seen is getting slowly unraveled and it’s articles like this that are complicit. All the best America!
22
@Dr Patriot
I agree Dr. Patriot. I hope it all falls apart and then the public can wail about waiting in line for years.
@Dr Patriot
A Congressional Research service bulletin published last month estimated that Medicare paid hospitals $16 billion in 2015 for medical education training.
1
@Dr Patriot
Thankyou
How about taking that savings they want to make and returning it to seniors. Start with a lower lower Medicare part B premium or provide dental and vision care for Medicare recipients. That would be a proposal I could get behind. But instead the money will find its way into our already bloated defense for more $10,000 toilets.
31
Again and again it has been proposed to greatly increase the cut-off salary (now around $130,000) for medicare contributions. Again and again this is ignored. People earning c. $130,00 to, say, $5,000,000 should contribute in proportional kind throughout their earning years. This would contribute greatly to the so-called problem of medicare funding.
22
@Vinnie K, that cutoff is for Social Security, not Medicare. You are correct that the cap should be raised or eliminated, but it has nothing to do with Medicare.
2
Medicare only pays 80 percent. So my private policy picks up the rest. Any charge, like doctors associated with hospitals, may come off of Medicare, but they fall onto my private insurance and eventually to me through higher co-pays or higher premiums. It may seem like a good cut on the surface, but all it does is shift the burden to the patient.
Those hospital-related offices generally cost more because they have their own testing and scanning equipment, whereas a regular doctor writes you a prescription to get the test at the hospital. In fact, the tests in the hospital-related office are cheaper and benefit the patient with less transportation costs and rapid results.
10
@Patty Funny how those advocating doing away with the plans that help pay the Medicare deductible NEVER advocate for increasing SS benefits, isn't it. US SS benefits are the fourth LOWEST relative benefits of their kind in the world, and every advanced country has a system similar to SS.
I have private health insurance right now but will be eligible for Medicare in a few more years. When I get a doctor's bill or a hospital bill I look at the bill to see how the doctor, hospital or other provider charged, how much was discounted by the insurance company, how much I have to pay in coinsurance, how much went towards my deductible, how much the insurance company paid for each procedure, how much they paid the doctors, etc.
It's a mystery as to how these parties negotiate the fee schedule for the procedures. I do know that the hospitals in Manhattan, NYC get a higher fee than my local hospital.
Medicare has a completely different fee schedule which I haven't seen yet since I don't have Medicare but it would be interesting if someone wrote an article about how what Medicare pays differs from a private insurance company. And explains why a CT scan costs around $4,000 in a hospital ER but costs much less in a free standing facility, etc. If you're visiting an ER for example you are paying for that hospital's costs of being available 24 hours a day, their location and other factors.
4
@Sam C.
Medicare has a bizzillion billing codes, and the insurance industry shares the coding structure. Insurers negotiate an upcharge on the Medicare prices.
If you have an appendectomy, Medicare pays "X" for the surgery and "Y" for the anesthesiologist if it is a "simple" appendectomy, and Medicare has a different billing code if it is for a "complex" appendectomy like your appendix had ruptured.
If you have a cat scan at a hospital the hospital gets a higher fee than a standalone imaging center. Even though the imaging center is not located at the hospital and five years ago was a standalone imaging center.
The fee for each procedure is adjusted for location. Politically powerful states like NY have persuaded HHS to assign them higher Medicare reimbursement rates than less well connected states across the river from them.
The hospital has a list price for each item, which has nothing to do with cost of care but is used as a reference price for various purposes.
All of the prices, insurer upcharge percentages, hospital costs and anything that might be of interest to a motivated consumer are trade secrets.
Five patients are billed for the same 25 Medicare codes, hospital calculates: A, the Medicare patient, received $10,000 in services. B with one insurer received $14,000. C with another insurer received $18,500. D and E, uninsured, are billed $50,000. E pleads poverty and arranges to pay $23,000 over time. The hospital claims $27,000 in charity care.
28
@ebmem Thanks for your answer and The NY Times should write a detailed article about this subject in order to educate people.
The bottom line issue for our medical care system is that it costs too much. In our capitalist system, the price of anything is determined by supply and demand, with the potential exception of monopolies which are supposedly removed by government action. With the continued aging of the US population, medical care costs will rise for that population demanding increased services and the only way to contain costs is to increase the supply of medical care. That means more doctors and more medical schools, more rights for nurse practitioners, more over the counter medications, more rights for patients to treat themselves, and as well, stronger government action to prevent monopoly practices in medical care businesses. If you want to treat a disease, you have to use the correct medicine.
3
@lester ostroy
We do not have a capitalist system in health care, we have a socialist system. Capitalism requires a willing seller and a willing buyer, as well as transparency with respect to cost and quality.
Many will argue that when someone is having a medical emergency, capitalism doesn't apply because the buyer is desperate and the seller can charge anything. People in a capitalist society would be expected to purchase insurance, so they would have a powerful insurer to stand between the patient and the all powerful provider.
That said, most medical spending is not consumed under emergency circumstances. If there were transparency in quality and pricing, women would be able to determine that if they get their mammogram at imaging center A [out of network], it will cost their insurer $250 less their $50 copay and if they go to center B [in network], it will cost their insurer $150 less a $20 copay and if they go to the in network hospital imaging center, it will cost their insurer $275 less their $20 co-pay. They could then choose the most convenient location balancing their out-of-pocket costs and well as the costs that will ultimately be reflected in their insurance premiums.
Even under emergency circumstances, if we had a capitalist system, an educated consumer would know that if they were having a heart attack the best place to have the ambulance take them is to hospital A, while if they have severe burns or gunshot wounds, the county hospital is right.
3
@lester ostroy Unfortunately, "supply and demand" does not work with physician fees. Doctors finish Medical School with an income expectation, and 95% of them meet that expectation during the first year of practice. Add more doctors and you simply add more expectations. There is a reason the largest single component of the maligned "top 1%" are orthopedic surgeons. Add more such surgeons and you will simply add more of them to the top 1%, not reduce costs.
1
@lester ostroy
The US medical system is like visiting a store where the salesman tells you what you need and the bill is sent to your uncle.
2
Surprised to see this editorial in the Time, one supporting an idea from President Trump. First thing I checked was my calendar to make sure it wasn't April 1.
12
Yes it is good to be aware of institutions-- especially for-profit, but non- profit as well, gaming the system. But why,then,take the money out of the program? Redistribute it in a more appropriate way. There is certainly a lot of unmet need. By the way, this is a built-in feature of Single Payer/MC4A! Contrary to your inaccurately cast dispersions, better fiscal control and cost savings is always one of the points made by MC4A advocates.
14
@Stephen Vernon
Medicare For All advocates ignore the fact that Congress refuses to control costs for existing Medicare benefits. Do this first before you create a massive program that bankrupts the country.
1
@Stephen Vernon
Democrats are not noted for their excellent plan design. In 2010, Americans were spending 18% of GDP on health care. Today we are up to 20% of a larger GDP. Hospitals are getting higher payments because of changes Obamacare made to Medicare part A. Drug companies are getting higher prices because of changes made to Medicare part D, along with changes for everyone.
Medicare [AKA single payer] for all would increase profits for hospital and drug companies.
How in the world can Democrats trust anything that the Trump Administraton is proposing with regard to cutting entitlement spending, when they know the end game is to get rid of it all? Today the DOJ indicated that it will join a lawsuit to kill the ACA in its entirety, including protections for preexisting conditions. When we know that the Republicans wish, in the end, to simply make healthcare a right for the wealthy and a corporate system that is allowed to maximize profits without regard for our well being, then the status quo should be protected at all cost.
33
@Rich D
How can anyone believe that any change they would make would do anything other than enrich big medicine, like Obamacare did. Everyone is paying higher premiums, co-pays and deductibles and not getting any better service.
There are ways to protect people with pre-existing conditions without increasing the wealth of big medicine.
Prosperous hospitals and other big med are going to fight before they are giving up their crony socialist largesse.
I'm sure that there are savings that could be found in the Medicare budget, but forgive me if I'm skeptical that the right savings would be identified, as opposed to politically-driven ones, putting the onus on seniors who have almost no power to defend themselves. It's clear even in this article that both Democrats and Republicans are calling for cutting Medicare, but for their own political purposes. Why do average Americans, and especially seniors, have to be the political football?
If they want savings, let's start cutting - no hacking away - the bloated Defense budget! Or how about giving back those ridiculous tax cuts to Corporate America and the wealthy that were supposed to help everyone, but are only pushing up the taxes of the middle class, and exploding the budget?
Before they start cutting benefits for Americans who have worked their whole life, and who should be able to feel somewhat secure in their latter years, they need to look elsewhere to fix the deficit they caused by their own politics and greed.
77
@Kingfish52
Healthcare costs are the single biggest driver of the deficit. Overall Federal tax revenue went up (slightly) after the tax cut was implemented. I agree the defense budget should be cut, but the real deficit driver is healthcare.
@Joe Public
The Federal tax revenue's loss of the great tax cuts to the wealthy, raising our national deficit by trillions makes health care only a drop in the bucket. A lot of us on Medicare will die off, but the tax break for corporations and the ultra wealthy will go on forever if the republicans have a say in the matter.
2
@Joe Public
You are correct, but the revenue increased because more people were working not because the rich got a tax cut.
If you want to raise revenue here is some suggestions to reduce the tax gap:
Raise high-end tax rates. ...
Stop favoring one type of income over another. ...
Raise the estate tax. ...
End “step-up basis.” ...
Cap deductions on high-income taxpayers. ...
Minimum foreign earnings tax. ...
Financial transactions tax. ...
A tax on carbon.
from: https://www.investors.com/politics/editorials/trump-tax-cuts-federal-revenues-deficits/
My brother just got a medical bill and it showed the difference in the insurance companies payment and the cash payment. There was a 25% difference.
So Medicaid is being cut in a way that will reduce health care for low income and disabled individuals. This is very cruel to people who lack other options. No one seems to care about this or how political meddling will affect any single payer/universal health care plan in the future. So-called Medicare For All as described is actually Medicaid For All. The current healthcare plan that covers people regardless of age and has no premiums or co-pays is Medicaid, not Medicare.
10
@Lynn in DC
Literally the first 4 paragraphs state whom and which party is upset and speaking out about these cuts.
1
@Lynn in DC Good point. We really should be saying Medicaid for All.
Cuts in Medicare must not be made by people who have the often-covert aim of phasing out or substantially reducing the program, but see nothing wrong with making sure powerful interests keep a piece of the action. Medical equipment has makers and users who have powerful lobbies, so it will be purchased and used extensively for people with good health insurance but not for people with no health insurance.
Cuts in Medicare should fall on the wealthy and powerful who furnish the care and not on the end recipients or relatively low-tech first providers such as general practitioners. In themselves they are a good idea, but not when carried out and administered by the present administration. Suggesting them as practical or possible now is playing into the hands of those who have been driving up our deficits to justify cuts in the program.
As an establishment vehicle, the Times shares the establishment's desire to save money by snipping away at our safety net while pretending not to do so. But once the programs are no longer sacred, cuts will be negotiated that will do real harm to our society's losers.
6
Some of the best doctors have their offices in hospitals or practice at hospital clinics. If the amount Medicare pays them is reduced they may stop accepting Medicare altogether. Many top doctors already do not accept Medicare because Medicare pays less than private insurance.
17
@Judy, There has to be a different solution to the very real issue you identify.
Doctors who don't accept Medicare patients "because Medicare pays less than private insurance" are in medicine for the Big Money, nothing more. It's all the more galling when one considers how much tax-payer money was spent on many of their educations (Medicaid and Medicare spending foot much of the bill for medical-residency programs in the US).
Today's Medicare patients planned and paid for their Medicare coverage, in good faith, over lifetimes of work. In this context, and in practical terms, refusing to treat them now amounts to age-discrimination. These are not necessarily "top doctors" -- they're greedy doctors. What's needed are incentives to make them less greedy; or to go away.
16
Those doctors do not get the extra facility charge - hospitals pocket that . Essentially , no difference .
5
@RR
Today's Medicare patients use far more in services than they ever paid for over a lifetime of work.
3
It is all well and good to criticize the Democrats for not jumping at the opportunity to move some spending around and save billions of dollars. Do you notice how ridiculous that sounds?Healthcare is a huge business. Where I live, there are three hospital systems that are in heated competition. This does not bring reduced costs, but unfettered building of hospitals, clinics and centers. These systems would never work together to even share data or reduce costs. They are all not for profits, which only means call your profits something else. I recently transferred from a pretty good insurance plan to Medicare. Blood tests that were considered necessary twice a year under my insurer are only reimbursed once a year under Medicare. Interesting, my health hasn’t changed.
16
@F B Duchene In raising the issue of non-profit hospital systems, you have pointed out one of the least talked-about and perhaps least-known reasons for the continuing rise of health care costs.
In order to maintain its non-profit status, an entity supposedly must end the year---the moment before midnight when a new year begins---with its P&L sheet balanced out at zero. Non-profit hospital systems make lots and lots and lots of money---profit. In order to zero out their books, they must find a way to spend those outlandish profits. Hence, they build new and often unneeded buildings, buy new and unneeded equipment, buy out doctors' practices and medical testing clinics, etc., and, most egregious to me, give enormous bonuses to their highest execs. All of this incentivizes filling those buildings, utilizing that new equipment and doing more and more unneeded testing.
I've put it simplistically but, as simplistic as it may be, it is exactly what happens. These non-profits are only non-profits in terms of their end-of-year fiscal statements.
3
@Rusty Inman, Non-profit doesn't mean the books must be balanced at zero at any point. It means there aren't any "owners" to distribute profits to. And that's pretty much the only real difference between for-profits and not-for profits - non-profits can save/invest excess revenues (at least to a point) , they can raise salaries, give bonuses, spend on buildings and equipment.
@Rusty Inman It's possible that you are misinformed.
Look up the financials of a nonprofit hospital and you'll see that they are not limited to their income y - to - y. In NYC, NY - Presbyterian is one of the largest NFP hospital systems in state.
For the YE 2018, they ended the year with over 320M in additional assets. Over 500M the year before.
So while some of your understanding about nfp hospitals may be true, this part is not.
Link attached for your convenience. https://emma.msrb.org/ES1194379-ES933433-.pdf
Well, I hate to say it, but on the narrow question of paying more for doctors who conduct office visits under the umbrella of a hospital, the Board has a point. My primary care physician does have such a practice, in a normal office setting, but because it's seen as "outpatient care," the charge is about twice as much as a regular office visit. I've made this observation to the business manager of the "practice." The "facility" fee is not entirely bogus: nurses and clerical staff are necessary. But other practices run without the additional fee.
This doesn't justify cutting Medicare. First, I would eliminate Medicare Advantage plans. They waste a lot of money in administrative fees to private insurers. I would also pay per patient, not per service. And Medicare should be able to negotiate drug prices. The resulting savings might be put toward better or extended care to people beginning at age 50.
20
@Wiltontraveler
A third of Medicare beneficiaries elect to use Medicare Advantage plans because they do not have the 20% copay and no out-of-pocket maximum as traditional Medicare. If someone elects a MA plan and doesn't like it, they do not have to wait until the open enrollment period to switch to traditional Medicare, although the reverse is not true.
It is a Republican design that reduces gravy to hospitals, drug companies and other big medicine cronies. No wonder you have been convinced it should be eliminated by Obama, who already defunded it by $0.5 trillion.
Particularly in competitive urban markets, they offer additional services, frequently with no additional premiums over traditional Medicare drug coverage so no part D premium is required, health club memberships, eye and dental care have been available since the MA plans were introduced. This year, some plans are offering free transportation to doctor's appointments and spending accounts for personal care products like vitamins, over the counter drugs like aspirin, medicated shampoo and incontinence products that Medicaid participants get for free.
Despite providing more services for lower cost, MA plans cost Medicare less per capita than traditional Medicare. Somehow, despite administrative costs, advertising and profit, a third of Medicare participants select Medicare Advantage plans even though it means less out-of-pocket expense.
It gets paid per patient, not per service. You want to end it.
Cuts?
What about the opposite? As in actually investing in healthcare?
What about at least adjusting for inflation?
Like everything else in the economy, overhead costs in healthcare keep going up, but all we hear is even more cuts.
Somehow people are shocked when hospitals and clinics close or no longer accept Medicare for certain procedures in order to survive.
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@Tony S
This was obviously written by a person with a financial dog in this fight.................
How about Sen. Rick Scott's HCA Healthcare, Inc. racket of a business. It easily paid the government a fine of over four BILLION dollars to settle over-billing the Medicare system.
As a retired physician who knows how medical organizations try to game the system this change in billing makes perfect sense.
If I practiced in an outpatient clinic that was associated but not owned by a hospital my billing for the same service would be increased if the clinic suddenly owned the hospital and then charged based on the hospital's overhead. This makes no sense.
As a life long Democrat who believes everyone should have health insurance, Warren and Harris are wrong to oppose this fraud.
There is only a finite sum available for patient care and it should be used wisely.
If the next budget included substantial more funds for rooting out Medicare and Medicaid fraud we would all benefit.
43
The small rural Colorado town where I live had an independent medical clinic until about 4 years ago. They closed because they could not see enough patients per day to meet their overhead with all the time required for physicians to do their record keeping on the computer in real time. The county does have a regional hospital 25 miles away that runs a local clinic. All the medical staff of the independent clinic either moved to the hospital owned clinic or just quit. So, if Medicare starts paying less to hospital owned clinics, what kind of medical services will be available to our town?
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@Margaret Butler
Under the Obama administration, all electronic medical record keeping was introduced. Yet all I've seen is the back of my physicians' heads while they type endlessly into their computers. I wonder whether the time it takes plus the lack of patient interaction are enough justification to change or improve the system now?
9
@Ellen. From the perspective of many well trained physicians it is not because as you point out the doctor has his nose to the computer screen and not to your chest or the color of your skin or the shites of your eyes. They cannot look at two places at the same time, nor do,the thinking required to figure out your problem.
I'm having a hard time believing almost a trillion dollars in cuts to medicare can be made merely by rearranging fee schedules between doctors and hospitals.
And to the extent this reduces services to beneficiaries, then it IS a cut to beneficiaries.
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@Paul It doesn't reduce services to beneficiaries! It stops the hospitals that have bought the doctors from making more for every procedure conducted at the doctor's office; sometimes (in my case) that charge increase 2.5 times!
So frustrated with people that react with no facts, no understanding of process, and no desire to think beyond their emotions.
@
I was replying to what was in the editorial. Chill!
Pragmatic, Neutral and honest proposal from NYT.
Democrats, Its time to STOP talking about Russian Collision, accept the 2016 defeat, and build on 2018 success by focusing on improving Health Care even if it meant supporting some of Mr.Trump's proposals.
Prove to the American Public that Democrats are focused on solving people's issues instead of wasting time on useless conspiracies ("Obstruction of Justice")
10
As a strong proponent of Medicare for All I found this sentence at the end of particular interest: “The case for such an expansion would be strengthened if proponents showed greater concern not just for broadening the availability of health care, but also for managing the cost of care.”
As a consumer that pays thousands in premiums, copays and deductibles I am also concerned about containing costs and one way that could be accomplished would be to eliminate some of the profit motive. It makes me angry everytime I read stuff like “how are they going to pay for something like a Medicare for All plan” and “people stop supporting Medicare for All when they are told “their taxes will go up”. Why is it that Americans currently pay something like twice as much as any other country for healthcare and still millions have no coverage? What if we stopped using those healthcare dollars to build health insurance company CEO’s third houses and actually use that money to pay for healthcare. Our system is unsustainable, inefficient and evil. Let’s definitely talk about bringing healthcare costs down. Let’s start by seeing how much savings we get if we eliminate the profit motive.
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@Susan F.
Two years ago I had a stroke while visiting Poland. I was in a state hospital for 9 days (all tests were done on the first day), then in a residential rehabilitation facility (lodging, food, therapy) for 18 days. I had to pay for everything in full and it amounted to about $4000. The care and outcome were excellent. However, the other patients were sorry for me, since they did not pay anything (belonging to state healthcare system). There are also private hospitals
(more luxurious) and many doctors have private practice (a visit costs ~$25), for those who prefer it.
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@Susan F.
I totally agree with you. My first job in a hospital was in the business office. It was a NON-Profit Hospital as all the hospitals were in the area. When I started to work as a nurse in 1983, all hospitals were NON-Profit. One by one after that, the hospitals that were owned by the cities were sold to Profit Groups. This is one of the big reasons hospitals charge so much. If a hospital room is $250 per night, the insurance companies pay around half. The insurance companies have bargaining power. The individual doesn't. This discrepancy has to stop. Hospitals have to be NON-Profit again. It is not fair to charge, like I was charged, $275 for a lab test and my insurance paid $55.00 and I was charged nothing.
5
@Susan F.
Read today's Times. (D) have given up on M4A.
https://www.nytimes.com/2019/03/25/us/politics/house-democrats-health-coverage.html
IMHO, with smokers, illegal drugs, and heavy drinkers causing $100000000000s in costs, M4A was unworkable and unrealistic -- another Flint Water crisis in the making. That's why AARP never endorsed M4A
Whatever positive ideas that improve Medicare, by not hurting deficiencies are welcome.
But Pedigree counts.
Picasso paints 2 pictures, signs one, gives you one to sign.
His signed Picassso is worth $100 million.
Your signed Picasso is worth $10,000.
That and stopped clock is right twice a day - all do not mean that there is any SINCERITY or INTEGRITY that in an otherwise normal politik-verse would be properly recieived.
1
@George Jackson I don't understand your comment, if I signed a painting Picasso painted it would still be a Picasso and worth millions of dollars. If I painted a picture and signed it "Picasso" it would be worth nothing.
Doctors affiliated with teaching hospitals should get higher reimbursement.
7
Incorrect.
Doctors affiliated with teaching hospitals already have a slew of unfair benefits:
—resident labor to do a huge portion of their work
—non-profit status (ie, pay no property tax or corporate taxes)
—receive federal research funding
—receive alumni and community donations as a tax write-off
—receive a higher reimbursement due to being owned by the hospital (the subject of this article)
—have no personal risk/ownership in the facility providing the care
—have drastically reduced risk of malpractice causing a personal financial loss, due to the way institutional coverage is arranged
If anything, academic physicians should receive far LESS than private practice physicians, per service provided.
14
@turbot
They do. Doctors working in solo practice should get higher reimbursement. Or better yet....all doctors should get the same government salary and benefits.....we do that with firemen and police officers and other public safety workers. Why not doctors? It made no sense in the past because doctors were thought to be small businessmen like the local attorney. But now that we have more healthcare options than 75 years ago and now that most doctors cannot afford to run a private practice and now that the government one way or another is paying the bulk of health care costs nationally the time is coming when this will need to be addressed. Firemen, for example, in California make as much as primary care doctors and have a better retirement and benefits already. Firemen are now trained as paramedics. What is the difference when the patient enters the ER?
1
@as
You would never be able to afford the physician pension as well as benefits in their retirement. We can’t afford the pensions for current government employees.
1
In essence we are talking about arithmetic. Smartly trimming Medicare leaves resources available to where they are needed most and in the lung run will save the program from fiscal ruin.
2
In reply to @L proposing to remove limits on income taxed for Medicare:
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So not only are there proposals to remove limits on income that is taxed for Social Security, now we are getting similar proposals for Medicare.
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SS and Medicare were designed to be paid for by employers and the workers who eventually receive benefits from those programs. There was always a sliding scale to make the programs more affordable to lower income workers.
.
These proposed changes would turn SS and Medicare into welfare programs. The changes would fold Medicaid into Medicare and fund them from General Revenues. It will be difficult for politicians to not continuously increase payments and increase the national deficit and debt.
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Furthermore, the programs currently give us who participate a sense of dignity. We are getting what we pay for. It is not given to us.
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We are currently not in a position of having to thank our elected officials for our benefits. These proposals would put us in the position of supplicating them at each election.
1
@HH: You are making the commonest of mistakes in saying that taxing every dollar earned somehow makes Social Security and Medicare into "welfare"! It certainly DOES NO SUCH THING!
Further, the more people who participate more fully (meaning the rich ones whose income goes way past the current cut-off amounts for payroll deductions), the more we ALL can get what we pay for!
I've paid into the system since the late 1960's, and I want my ENTITLEMENTS (which are absolutely NOT welfare!) to be available to me now and going forward.
Maybe if Congress had only Medicare coverage for its members, instead of platinum-health-care, the system would be more carefully considered.
50
@L
What is platinum health care? The health care that corporate execs and rank-and-file receive?
Any way, if members of Congress are over 65, they may enroll in Medicare. Younger members purchase their health insurance in the marketplace, typically DC Health Link, or the exchanges in their home states.
2
@Lynn in DC
How about REQUIRING any members of Congress who are over 65 to have Medicare (and pay out of pocket for Medigap and Part D), as is done in most private industries?
1
No, it's a lousy idea to penalize hospitals and best practices to save a few dimes.. All of my university hospital specialists and my PCP c are the best in their field and train future subspecialists and Primary care physicians. Medicare/Medicaid invests indirectly in these programs by covering those like me who are permanently disabled. we also face a major cut to the Medicaid state care waivers under Money Follows the Person funding that provides home care support by for those seniors and permanently disabled who can to return to independent living after discharge from nursing homes. TBI centers of excellence programs are also on the chopping block .
6
Tough issue, trying to preserve but update Medicare, so to best serve seniors, and yet avoid waste or corruption. Finances are, by force, limited, hence the need to find not only what's efficacious but also effective. That way will guarantee affordable quality health care. But this ought to be applicable to all sectors, especially the poor, children, women, and of course the elderly.
As long as the bulk of the USA's healthcare industry and including insurance companies, "big pharma", and for profit hospital/clinic conglomerates etc. is driven more specifically by unbridled capitalistic greed for profits that mostly go into the pockets of shareholders and CEO cliques at the top of these companies, where they show up as inordinate amounts of salary/bonus and perks -- the US's healthcare system cannot be repaired and will continue to have costs spiral. The diminution of the common man's income, living standards, and wherewithal -- does not appear to be a factor in the minds of those that are the lucrative chief beneficiaries of this wholly broken system. Medicare and Medicaid are also highly and deeply impacted by this greedy mess. Our country would do better to work first towards proper rationalization through rate regulation of this out-of-control money mongering monster before picking apart Medicare and Medicaid.
24
WHY is there no mention of one straight-forward and important way to keep Medicare affordable to senior citizens, namely: REMOVE the cap on earnings that are taxed for Medicare purposes.
This is so obvious an item that I question the Editorial Board's intelligence in excluding it from the discussion.
110
@L There is no "cap" on earnings which are taxed for Medicare, I am taxed from the first dollar I earn to the last dollar I earn. I think you are referring to the cap on social security which stops somewhere around $138,000 and adjusts upward every few years.
Social security and Medicare are two different programs.
31
There is currently no cap for earnings for Medicare taxes. You must be thinking of Social Security, for which there is a cap.
17
@L ?? Are you thinking of the cap on earnings taxed for Social Security? There is no cap on earnings taxed for Medicare, indeed there is a Medicare surtax for highly-compensated wage earners. See
https://www.shrm.org/resourcesandtools/hr-topics/compensation/pages/fica-social-security-tax-2019.aspx
6
Medicare and medicaid should not be lumped together Medicare is not an entitlement. It is a benefit senors have paid for their entire working life and continue to pay for after they retire. The IRMAA adjustments adds significant dollars to the premiums of many seniors. Medicaid is an entitlement. The government should concentrate on decreasing medicaid spending by sharing the cost of care with recipients. Making a medicaid recipient pay even a dollar for a doctor visit will curb unnecessary usage. Something that is free has no value. The current system is doomed to be an expensive failure.
19
@sues
It’s worth mentioning, however, that on average, retired Medicare recipients will receive roughly TWICE the dollar amount in services that were paid in by them (the research on this can be found online). Medicare is not, as many seem to think, a set of personalized savings account filled by payments- it’s a revolving door system in which recipients are not literally relying upon their earlier pay-ins- and its current use IS going to saddle future generations with greater debt. So yeah, Medicare in (current) action actually IS partly an entitlement program.
13
@artikhan More than that, it's approaching bankruptcy. The amount coming in is quite a bit smaller than the amount going out, and it's propped up by a dwindling trust fund.
3
@sues, Medicare is an entitlement program. For some reason, people think that :entitlement" means welfare. It does not. It refers to programs where if you are eligible, you will receive the benefits.The opposite of an entitlement program is one with a specified budget . With those programs, people who are eligible will not receive benefits once the funding runs out - section 8 is an example of this sort of program.
1
Good for the NYT for pointing out a couple of good ideas for the Medicare budget. Please give a similar, careful analysis of the gigantic military/"defense" budget, which is scheduled for yet another increase. These are our tax dollars, too.
221
@Ellen
Read NYT more frequently -- already done.
https://www.nytimes.com/2018/12/01/opinion/sunday/pentagon-spending-audit-failed.html
1
‘...apocalyptic predictions about the current level of federal debt look rather silly in retrospect.‘ This sounds like something a baby boomer could write (though perhaps it’s not the case).
As the ratio of retired Medicare and Social Security recipients to younger taxpayers keeps increasing, will the generations immediately to come feel as sanguine about the national debt and its effects, which will put an increasing strain upon them?
4
As a Gen Z-er, I am concerned with the outsize influence the older generations have on politics. They have continually kicked the cam down the road on issues like climate change and the federal debt. They will be long gone by the time my generation is done paying the price for their irresponsibility and profligate spending.
Medical care and pensions are an important resource for many elderly, my grandparents included. However, with birth rates dropping, the ratio of workers to retirees decreasing, and life expectancy increasing the CBOs predicts that the social security trust fund will be depleted by the mid-2030s. Even completely eliminating the cap on wages excluded from the payroll tax cannot fill this gap. The program requires a long term reform. Please don’t throw away my future because it’s convenient or easy to rely on a system that is nothing more than a Ponzi scheme
5
@ZaneY
The cost of just one of Trumps golf weekends at Mar-a-Lago would cover a lot of health care for those of lower income!
8
@ZaneY - Removing the SS cap on wages resolves over 70% of the funding shortfall. Increasing Full Retirement Age from current 67 years to 69 years by adding one extra month per birth year to the FRA schedule solves the remainder of the shortfall. The math is simple; the politics not so much.
6
"But a president’s budget is just a list of ideas. It's up to Congress to pick the good ones."
And you make this statement in all seriousness? When you know that the Republicans have hated Medicare since its inception?
"But the government's ability to borrow money is not justification for the wasteful spending of tax dollars."
Perhaps it would have helped if Trump and the Republicans had not rammed through a tax cut that primarily benefited corporations and the richest among us.
74
@Annie
With or without Trump tax cuts, Medicare and Medicaid expenditures are eating up the future.
1
@Annie Um, did you know that the costs of healthcare have exploded under the ACA? Tax cuts have nothing to do with that fact that Medicare spends too much on waste.
"Maintaining tight control of ------ spending is good government in its own right." I ask the Times to give the same attention elsewhere. The savings to be found in the Defense Department are no smaller than those reasonably obtainable from Medicare, and the auditing is a bad joke. Do we only audit and constrain spending that is good for us?
243
@Thomas Zaslavsky -
"The savings to be found in the Defense Department are no smaller than those reasonably obtainable from Medicare,..."
In fact, they are arguably much greater. And this editorial fails to mention that Trump's budget proposes increasing military spending by almost 5%.
126
@Thomas Zaslavsky
Actually, under the non-Democrats, DoD has had more financial audits.
https://www.nytimes.com/2018/12/01/opinion/sunday/pentagon-spending-audit-failed.html
Facts -- they're fun. And the work makes you smarter! Yay!
1
@Annie
Yes, and thanks. I was deliberately conservative.*
* In the true sense.
"Ms. Harris, Ms. Warren and other Democratic presidential candidates — including Senator Kirsten Gillibrand of New York, Senator Cory Booker of New Jersey and Senator Bernie Sanders of Vermont — have become vocal proponents of expanding Medicare eligibility."
This is a deeply disingenuous paragraph. One of those candidates has not "become" a proponent of expanding Medicare eligibility, he's been talking about expanding Medicare for his whole career, and is one of the main reasons why this has become such a widely covered issue.
18
Bravo, NYT! This is the kind of reasoned perspective that our shattered nation so desperately needs right now. May it be listened to by the countless Democratic aspirants for the Presidency. Wouldn't it be a wonder if the Congress would try to have a conversation among its members and work for the good of the country? Will a truly admirable, smart, dedicated nominee please offer us an alternative to DT in 2020?
12
@PATRICIA - Too bad that you don't seem to realize that a number of " truly admirable, smart, dedicated" individuals have already announced their candidacy.
Great editorial from the NY Times. I never thought I would say that. Congress has shown time and time again, regardless of which party is in control, that they have exactly ZERO interest in implementing any kind of meaningful cost controls on healthcare. Until they do, I will never support any tax payer funded expansion of coverage.
11
October 29 NYT reported community hospitals are closing. "Since 2011 more hospitals have closed than opened..." seems like an important counter argument to be very careful about limiting further Medicare income to hospitals. The follow up story is what about the health of urban hospitals? Without that estimate, advocating for further cuts to medicare reimbursement is premature.
25
@michael doherty
That is a big problem that needs separate attention. I guess the hospitals that are closing are small hospitals without the resources to buy up private practices to collect bigger Medicare payments. Instead, they will take the brunt of the reductions, if no better care is taken of them than has been recently.
5
If Medicare for all would become law, our heads will spin with the number of hospitals that close.
The disparity in payments to services done in hospitals rather than private or sisters has hurt me as a private practitioner. It is long overdue that this disparity be corrected. However, the way this article is framed, it appears that you are supporting overall cuts in Medicare. Medicare money should be spent wisely but not cut. There are many areas that can be improved by careful use of limited funds.
49
@LAM NYT is an extremely ageist publication. They DO advocate spending much less on Medicare, and have in the past come very close to saying that patients beyond a given age should be denied any access to health.
@LAM - Exactly. The NYT has unfortunately set up a straw man.
1
This is a good start. An editorial educating the senators and the rest of us about how, exactly, prices are set for procedures would be helpful. Or an editorial explaining why there is so much unwarranted geographic variation in price. Have had it, NYT. We all have a lot to learn.
11
As a taxpayer, diminish healthcare insurance for Congress instead of cutting Medicare benefits. While we’re at it, start making Donald Trump and his family pay for their own weekend getaways. That would save literally millions. If Melania Trump decides to have an outpatient procedure again, kick her out of the hospital as would be a normal outpatient stay rather than staying a week.
These are a just few hints to save Medicare from being cut. Seniors have paid into Medicare for a long time - then cut their benefits? That’s just plain wrong.
142
@MIMA
Yeah, that's why AARP never endorsed the alleged "Medicare For All."
Because the pro-M4A crowd never mentioned that "boomers" have paid into Medicare for 50 years. IMHO, they'd never allow BoyNee to get within 200 miles of the Medicare Trust Fund. Never.
1
@MIMA
You could entirely eliminate health insurance benefits for congressmen but the savings applied to the Medicare budget would be like adding a drop of water to the ocean.
@MIMA. But you’re okay with transporting Pelosi and her family to California every weekend?
If politicians weren’t constantly fund raising and campaigning for the next election, they might actually have time to read, digest, and make intelligent remarks about things.
38
Thank you. We need more careful analysis, such as this article, and less blind, vitriolic partisanship from either party.
43
@MLB - This is not "careful analysis". It ignores the problems affecting our entire health care system, ignores the role of the Trump tax cuts, and completely fails to mention that Trump's budget doesn't seem to have any problem proposing to increase military spending by almost 5% while proposing cuts to Medicare.
65
Conceding anything to Trump’s budget, its shameful prioritizing of an arms build up over funding for any human services, seems like a dereliction of duty for the paper of record. Pushing for cuts to funding for hospitals is not something I would ever expect the Editorial Page to pontificate about at such length. This overburdened public hospital MD is now officially taking a break from caring about what the Editorial Board thinks about anything.
1
@Annie I agree with you that this article does not provide a detailed analysis of the US budget, health care system, and defense spending - this is not even a comprehensive report about the situation of the health care system in the United States. ( For that kind of analysis I recommend this article, which compares health care systems in several countries comparable to the US: https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html }
This article draws attention to the fact that not every point of the proposed budget is necessarily detrimental. We are all throwing out the baby with the bath water. Oh, and thank you Dan McGonigle for illustrating my point.
1