NYT: Private Plans Costing More for Medicare

[DeepModem Mom]

Private Plans Costing More for Medicare
By ROBERT PEAR

Published: September 17, 2004


WASHINGTON, Sept. 16 - Members of Congress expressed concern on Thursday about new data indicating that Medicare pays private health plans more than it would cost to care for the same patients in the traditional Medicare program.

Lawmakers of both parties raised questions about the payments, which were increased under the new Medicare law to entice more private plans to participate in Medicare.

About 4.7 million of the 41 million Medicare beneficiaries, or 11.5 percent, are in health maintenance organizations and other private plans, now known as Medicare Advantage plans.

"The majority of seniors in traditional fee-for-service Medicare should not subsidize the minority of seniors in private plans," said Senator Olympia J. Snowe, Republican of Maine.

Senator Jeff Bingaman, Democrat of New Mexico, said that "large overpayments to H.M.O.'s were built into the bill" that Congress passed last year, and he asked why people in traditional Medicare should bear the cost of such "subsidies."...


http://www.nytimes.com/2004/09/17/politics/17medicare.html

[tlcandie]

1. This just sounds WRONG!!!

What a waste of time and money! IMO, this isn't fixing the problem isn't contributing to the problem!

[ClintonTyree]

2. Who would'a thunk it?

It's all part of the Resluglican's master plan to privatize every governmental program that doesn't meet with their approval. Bankrupt each system one by one and replace them with private insurers that OF COURSE can do the job much more cheaply and efficiently. Of course the Slugs will be heavily invested in all of these private corporations, stealing eve more of the taxpayer's money, but that's another chapter.

Have I stated lately how much I despise that particular political party? Well, in case I haven't, I HATE THE FREAKING GOP!!!!

[skooooo]

15. really. big shock here...

not

[Dem2theMax]

3. I NEED this article. I'm not registered at NYT and bugmenot is not

working, which is bugging me. If anyone has access to this article, would you please PM the entire thing to me? I'd really appreciate it. My parents live in a 'seniors only' community. I already have some things on Medical printed out. Want to use this as well. Gonna blanket the whole community. :evilgrin:

Hey, hit em' where it hurts. The $$$$ and their health insurance. Bet I get some votes to go to KERRY! :)

[DeepModem Mom]

4. Check your messages, D2tM -- nt

[teryang]

5. No kidding

And when you enroll in one of these so called Medicare plus choice plans (medicare HMOs) you are opting out of medicare coverage. In other words, if you leave the plan area, which in many cases is only a county, you have no medical coverage whatsoever. When and if you ever get dropped or drop the plan, and want a medicare supplement, you will have be medically underwritten and pay much higher rates.

Don't believe it? Check your plan. Call them, ask them. Check on their web site. Check with medicare.

These plans always lowball their rates and then later drop coverages.

[The Zanti Regent]

6. Wait till the Pill Bill kicks in!

If you think folks are screaming NOW, wail til Jan 2006 when they wind up paying an additional $40 for the Pill Bill (on top of another 20% Part B increase)!

Wait till they scream when they get in the donut hole (between 2,230 and 4,000 when the Pill Bill pays NOTHING!

[dmr]

7. This is outrageous

I became eligible for medicare this year. I didn't know what to do, so I opted out of an HMO because I don't trust them.

My mother was with Cigna in Florida. When she became ill in the 90s, she was treated, then released, for CHF in a Cigna approved hospital. She was very ill and was in horrific pain that wasn't being addressed. I just could not understand why the hospital released her.

I knew something else was wrong with my mom. I prearranged to sneak my mother into the emergency room of the county hospital I was working for. I used the guise that we were out for a drive and she began to have chest pains. My hospital was the closet hospital in which to take her. <wink> <wink>

In the emergency room, the doctors while doing the inital work up, said she needed to be admitted. My hospital called Cigna for approval. They refused, initially, but they finally agreed, but once mom was "stable" she would have to be moved to a Cigna approved hospital.

My hospital found that mom had advanced lung cancer - and when they reviewed her medical records from the Cigna approved hospital, those records indicated the cancer had been diagnosed a year earlier! They just never told mom, or the family! They had no plans to treat my mother. They decided to just let mom suffer and die.

Once Cigna got caught in their playing God, they couldn't do enough to help mom. She chose to fight the cancer with chemo. But, it was really too late, she died five months later.

How many lives do HMOs throw away?

Big business and money.

[DeepModem Mom]

8. OMG, dmr -- that is a medical horror story -- I am so sorry...

that happened to your mom. Is there any recourse when something as awful as this happens?

[teryang]

9. yes, it's called medical malpractice

But according to JebFRAUD, Chimp and Frist it could only a "junk lawsuit against medical providers." Ever seen a repuke get concerned about their legal rights? It happens when an HMO or a corporate product kills or maims one of their loved ones. Then they want to know how the legal system "got so f..ked up" that no one wants to file their suit. Slam dunks only please.

Better check your statute of limitations. Medical lawsuits must be brought within a very short period of time in some states and require onerous pre-suit investigations.

They are trying to reduce attorney's fees in contingency fee lawsuits to $150,000.00. Also trying to limit general damages to $200,000. A medical malpractice lawsuit can easily cost more than that to bring. Another bill is trying to "fine" personal injury lawyers for bringing "frivolous" lawsuits, as if someone would wager tens of thousands of dollars of their own money on a frivolous matter. When you lose a lawsuit, you are responsible legally for the adversaries' costs. Aren't these large losses enough?

Most insurance company lawyers and medical provider lawyers refrain from this penalty and give it up in the release agreement. They really don't want to put their adversaries out of business. With no personal injury lawyers left, they will eventually put themselves out of work. It's happening.

[DeepModem Mom]

11. I've a friend who can confirm from an attorney's view --

Fought for cases like Edwards's cases throughout a legal career (made some money, granted), but then was blindsided by Republican-driven state legislation limiting lawsuits. The top award is now pocket change for any corporation, citizens are unprotected, and my friend's work, and income, perhaps gone.

[dmr]

12. I wanted to do something

I didn't care about money. I just wanted them exposed. I wanted to shout out to the world what they did to mom, and I'm sure they are doing to others, past and present.

Mom made me promise not to pursue it. She made us all promise. Mom thought it would hurt me professionally. She didn't understand, and was in no condition to discuss it further. But, oh, how she suffered.

It is shameful that the doctors and medical staff colluded with Cigna. I will never forgive them.

My hospital did file complaints with the state agencies, though I don't know what or if there was an outcome.

[Rose Siding]

10. So it's all working out as planned.

Some portfolios will be enhanced and all truth about deficits has been almost completely discredited. Dems warned it was a boondoggle.

[struggle4progress]

13. No surprise here. Under Bush, "privatization" means "rip-off." eom

[Princess Turandot]

14. Actually, I think it ultimately means..

that there would be less & less funding of the Medicare. Ultimately,
Republicans have wanted to eliminate all of the entitlement programs.
Medicare & social security are tricky though, since they cannot just blame the recipients for being lazy and thus poor, which they do with Medicaid & welfare programs.Everyone is entitled to 'Care & SS so you need to be more devious to get rid of the programs.
First they'll pay more to HMO's but then insist that the HMOs can provide care for less cost. They'll push people into HMOs by charging even larger premiums & deductibles for traditional Medicare. Then, they'll cut what the government finances, pretending that the difference will not have to be paid for by the individual, when of course it will be. Except that most Medicare recipients won't be able to pay that difference.

The article mentions that studies have shown that "Medicare HMOs are somewhat less costly" to the government than traditional Medicare.
What it doesn't mention is that the Medicare HMOs often have 'cherry-picked' the elderly who are less likely to need a lot of services, because they've received adequate preventative medicine/nutrition/living conditions for all of their lives.In NYC, when HMOs signed up to provide Medicare services, a lot of them limited their catchment area to Manhattan, and perhaps Long Island, avoiding the boroughs which have more poor elderly, who generally use more services. I'm sure that happened in other parts of the country. If you only enroll the healthiest elderly, of course you will spend less to care for them.

[Eye and Monkey]

16. "Republicans have wanted to eliminate all of the entitlement programs."

Not really. Republicans have always favored entitlement programs that favor the wealthy - such as FEMA's underwriting the rebuilding of luxury waterfront vacation homes after a hurricane.

Republicans have also consistently favored entitlement programs from corporations - which roughly translates into favoring the wealthy.

Entitlement - it's not just for po' folks anymore. Matter of fact, it's not for po' folks AT ALL anymore.