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ORIGINAL: cadenas



They aren't? I'd call that a top manager of a business is doing nothing but "administration". But in the end, it really doesn't matter what you call it - point is that these items are built into the private health insurance premiums and thus cost the taxpayer (or premium payer - same thing) money. You can play the Heritage Foundation's game all day long, but somebody has to pay these - ajnd that's the tax payer/insured.

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ORIGINAL: tazzygirl

willbe, almost every post you have made has reeked of your ego and need for superiority. you may address any post of mine you wish.

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ORIGINAL: tazzygirl

lol.... forgot to google what selective means?

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ORIGINAL: willbeurdaddy

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ORIGINAL: cadenas
They aren't? I'd call that a top manager of a business is doing nothing but "administration". But in the end, it really doesn't matter what you call it - point is that these items are built into the private health insurance premiums and thus cost the taxpayer (or premium payer - same thing) money. You can play the Heritage Foundation's game all day long, but somebody has to pay these - ajnd that's the tax payer/insured.

No, that isnt what a top manager of a business does, and no, that is not what is meant by "health care administration", which refers directly to the processing of claims, pre-authoriszations etc. Your whole line here is total nonsense, and any health care administration costs that the private sector has so does the government.

And despite your semantic games on the math (they are both correct calculations depending on the context), the point is that medicare does not process A CLAIM less expensively than the private sector process A CLAIM. So if the government should take over A CLAIM currently processed by the private sector the cost will go UP, not down, by 26% or by 87.8%.

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ORIGINAL: cadenas

)

c) Not even the Heritage Foundation claimed that claims processing in the private sector is cheaper *per claim* - and in fact, if you accept their numbers, it inevitably follows that per claim, Medicare does it cheaper (unfortunately, they do not actually come out and give the per-claims cost for either Medicare or private health insurance). That's why they had to make up their own "cost per person" measure. Since Medicare by nature processes more claims per insured, that measure artificially inflates the government's cost.

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ORIGINAL: willbeurdaddy

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ORIGINAL: cadenas

c) Not even the Heritage Foundation claimed that claims processing in the private sector is cheaper *per claim* - and in fact, if you accept their numbers, it inevitably follows that per claim, Medicare does it cheaper (unfortunately, they do not actually come out and give the per-claims cost for either Medicare or private health insurance). That's why they had to make up their own "cost per person" measure. Since Medicare by nature processes more claims per insured, that measure artificially inflates the government's cost.

No, it doesnt inevitably follow, and Medicare doesnt "by nature" process more claims as a percentage of their costs. Most of Medicares costs are concentrated in the final hospitalization at the end of life...one claim.

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ORIGINAL: cadenas


Thank you for confirming what I've been saying earlier: the end-of-life costs generally aren't borne by the for-profit insurance industry, and thus don't contribute to the crisis among young people. lol what crisis?

You are of course misdirecting again when you somehow try to deduct that the NUMBER of claims will be low simply because one of them tends to be particularly expensive. misdirect? A younger person enrolled in insurance incurs them randomly throughout a year, and they are billed as incurred. Medicare final expenses, since the bulk of them occur in the last weeks of life, are billed once.

But in any case, of course Medicare has far more claims per person. A young person in his 40s sees a doctor maybe once a year. An older person often once per month. Even more once the health starts seriously failing. Each claim may only be for $100 or so, but it still needs to be processed. Wrong. A person in their 40s has their medical claims spread over time, and the insurance company is billed each time they occur (and far more than once a year for anyone in ill health..ie the ones that generate claims. Medicare processes monthly or even less frequently depending on the provider, not per expense incurred.

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As costs continue to grow unchecked, however, the impact on Medicare has become increasingly apparent. According to the Congressional Budget Office (CBO), total spending on health care would rise from 16 percent of the Gross Domestic Product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082. Federal spending on Medicare and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025, 12 percent in 2050, and 19 percent in 2082. A s a share of the economy, 19 percent of GDP is roughly equivalent to the total amount that the federal government spends today.

The impact on individuals is no less dramatic. Under projections by Medicare's actuaries, by 2025 over one-half of the average senior's Social Security benefit check would be consumed on Medicare out-of-pocket costs.

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The rising costs of Medicare and Medicaid have been characterized by some as an entitlement crisis. However, according to analysis by the Congressional Budget Office (CBO), if every entitlement in the federal budget were repealed outright – eliminating Social Security, Medicare, Medicaid and other critical programs – but nothing were done to slow the growth in health care costs overall, we would still find ourselves spending almost 70 percent of the nation's wealth on health care by 2082. It is clear America does not face an entitlement crisis; it faces a health care financing problem.

The health care financing problem affects the entire health care system, not just the government programs. And the solution to the problem, both on the government side and for the private sector, is effective health care reform that ensures we are getting the most value for our health care dollars. This is the goal of proposals to provide universal coverage for all Americans and to improve the delivery of health care through payment reforms and investments in comparative effectiveness research and health information technology that enhance the quality of care being provided.

To achieve this reform, it is inevitable that policymakers will look to Medicare – both as a model and as a tool. Medicare is this nation's largest purchaser of health services, and it can therefore have an affect on costs in the private sector. In addition, many of its coverage decisions are adopted by private health insurers and incorporated into their own health care coverage for those under age 65. For example, once Medicare agrees to cover a particular procedure, many private insurers follow suit. In addition, it is much easier to achieve many areas of savings in Medicare because it is run by the government – as opposed to enacting private sector mandates. As private plans adapt, these changes expand to the broader health care system over time. The key will be for legislators to use Medicare as a tool for enacting broad changes in the way health care is provided, not to arbitrarily cut the federal government's commitment to America 's seniors.

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For seniors, the stakes are very high. If overall health care costs are not brought under control, it is almost inevitable that Medicare and Medicaid will face deep cuts, as it is difficult to imagine how our nation can sustain long-term spending at currently projected levels. Unfortunately, putting more pressure on these programs without affecting overall cost growth risks converting Medicare into a second-rate health care system, leaving seniors with expensive but inadequate coverage.

Such an alternative would shift these societal costs to individuals who are among the most vulnerable in our nation. If not for Social Security, fully one-half of today's seniors would be living in poverty. One out of every five seniors relies on Social Security for all of their income, and two out of three rely on Social Security for over half of their income. Social Security benefits are modest – with an average payment of around $12,000 a year. Today this replaces about 40 percent of workers' average earnings, and once the retirement age increases to 67, that replacement rate will shrink further. Among 30 countries with advanced economies, the United States is 5th from the bottom in the generosity of its benefits for average earners, and single older women have the lowest income relative to married couples in cross-national comparisons of Western industrialized nations.

About 70 percent of Medicare beneficiaries have incomes under $25,000 a year and 85 percent have incomes under $40,000. Almost two out of three elderly households have incomes under $20,000, and they are already spending 30 to 50 percent of their incomes on health care.

Arbitrarily cutting Medicare without getting at the root of the continuing upward trend of health care costs is not a hypothetical financial exercise. It would have real impacts on real people – most of whom have nowhere else to go for coverage and limited options for increasing their resources.

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Senate Democratic leaders have been urging the White House to provide more explicit guidance about what Mr. Obama wants to see in a bill. The president apparently did not provide such guidance on Tuesday.