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By Roz Rogoff

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About this blog: In January 2002 I started writing my own online "newspaper" titled "The San Ramon Observer." I reported on City Council meetings and other happenings in San Ramon. I tried to be objective in my coverage of meetings and events, and...  (More)

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Obamacare or Medicare?

Uploaded: Feb 12, 2014
Now that Tim Hunt and Tom Cushing have weighed in on the pros and cons of Obamacare, I want to take my shot at it.

I confess I'm a registered Republican. However, I consider myself a Pragmatist first. I lean towards whatever makes sense and works. In my opinion Obamacare doesn't, but at least I understand the rationale for it.

I have been in favor of a single payer medical plan for at least five years now. That's because I'm on one and I like it. Yes, it is Medicare. Ask almost anyone 65 or older if they prefer Obamacare to Medicare? I'm sure (no research here), most would say they want to keep their Medicare.

I have two big concerns about Medicare – continued funding as the population ages and finding Doctors willing to accept the lower payments. There are solutions for both of these.

Private insurance is available for the difference between what Medicare pays and what Doctors and other services charge. It's called Medigap insurance. I buy Medigap insurance from Humana now, which I like better than the AARP policy mentioned in my 2009 blog.

The other problem is that the aging population on Medicare requires ever-increasing medical coverage, which could be offset by adding all those younger people who don't need as much medical care. That's the purpose of requiring everyone to buy medical insurance under Obamacare, to spread the costs around.

That's the way insurance works. Those who don't use it pay for those who do. I paid for auto insurance for 50 years and never used it, but when I needed it after my accident last year (which was not my fault) I was glad I had it.

That's why Obamacare forces everyone to buy medical insurance, but this isn't something that can be forced on people. The Federal mandate, "Thou shalt buy medical insurance or else," leaves the "or else," which is to pay the fine, as a viable option for many Obamacare opponents.

Clearly I don't like Obamacare and I don't believe it will work to solve our accelerating medical costs. Obama tried to use a Republican plan to appeal to Republicans in Congress but they wouldn't cooperate. So he had to push this plan down Democrats' throats to get it passed. Why do you think it was so difficult to get Obamacare passed when he had a majority of Democrats in the Congress at that time?

Rather than forcing the Democrat majority in Congress to vote for a plan most of them didn't like, Obama had a perfect opportunity to expanded Medicare for all. This would have saved Medicare for everyone 65 and up like me and extended coverage to everyone under 65.

No one would have to go out of his or her way to sign up for Medicare either. Medicare is tied to your Social Security number; so anyone from age 1 and up could be put onto Medicare almost immediately with no need for state-run Insurance Exchanges.

Medicare isn't free. About $105 is deducted from my Social Security each month as my Medicare premium. Combine that with $49 for Humana and $22 for my dental coverage, my total "premium" costs me $176 a month for excellent local and regional care. Medicaid would be available, like now, for people who cannot afford even this small monthly expense.

There's already a payroll tax deduction for Medicare. If everyone was on Medicare, the payroll tax could be increased to an amount similar to what is deducted from my monthly Social Security. Medigap and Supplemental plans are helpful but are not required. Employers who already offer health insurance as a benefit could save a bundle by offering the Supplemental insurance instead of the higher cost plans they have to under Obamacare.

For the poster who asked if Kaiser is available under Obamacare, I don't know. But I do know Kaiser is available as a Supplemental plan with Medicare. I'm happy with Humana and don't want to change my Doctor or Dentist and start over again with Kaiser, but if you've got it you could keep it under Medicare and that's no lie.

I can see no downside to Medicare for all. The only complaint, and there's always someone who will complain, is it is the dreaded "Socialist Medicine." Oh GROW UP!

Comments

 +  Like this comment
Posted by David Bynon, a resident of another community,
on Feb 13, 2014 at 2:28 pm

Hi Roz,

I blog about both Medicare and Obamacare. From my point of view, they both have monumental problems. However, in at least one regard, Obamacare fixes an issue that Medicare does not.

The tax credit component of Obamacare ensures that all Americans under the age of 65 have fair access to quality healthcare. This is no longer true of Medicare.

As you mentioned, you purchase a Medigap supplement to cover the cost difference between what Medicare pays and the actual cost of care. However, what about the millions of seniors that can\\\'t afford a supplement? Do they have fair access to treatment and coverage? The common wisdom for the past decade was to switch to a Medicare Advantage plan if you can\\\'t afford a supplement, but these plans are feeling the squeeze due to ACA cuts on Medicare.

So, we\\\'re back to a gap in coverage between those who can afford insurance and those who can\\\'t. If you can afford a Medigap policy your home and other non-retirement assets are safe and secure. If you can\\\'t afford additional coverage, a single illness can wipe you out. This should be a serious concern for all Americans.

David


 +  Like this comment
Posted by Roz Rogoff, the San Ramon Observer,
on Feb 14, 2014 at 1:59 am

Roz Rogoff is a registered user.

David,

You make a very good point. But this could also have been done by offering Medicare for All and providing financial assistance to those who cannot afford the supplemental policies the way it is in Obamacare now. The difference is that Medicare is already established and it would be easier to expand it than start over again with a similar but separate system.

I was in an auto accident early last year. It wasn't my fault but I ended up in the hospital for three days with four broken ribs. My hospital bill, without the Humana supplement, would have cost me almost $25,000. I would have had to take taxable money from my IRA to pay that amount. The "negotiated" price for Humana was a little over $8000. My co-payment was $200.

Insurance companies get better deals from Hospitals and Doctors than individuals without insurance can. That's why people without insurance can go broke from a serious illness or accident.

Medicare is a base from which to work up to better coverage. Any benefits that are in Obamacare now, could have been added to Medicare when the law was voted on by Congress. Medicare for All would have been better than Obamacare and Medicare are separately now.


Roz


 +  Like this comment
Posted by Martin Shenk, a resident of Danville,
on Feb 18, 2014 at 9:28 am

What you may not understand is that the Medigap insurance you have only covers the difference between what Medicare pays and what Medicare allows. That difference is 20% of Medicare's allowable charge it is NOT the difference between what the doctor charges and Medicare allows. That difference must by law be written off by the doctor. The only amount that can be collected is the 20% that Medicare doesn't pay. That 20% can be substantial when you are talking about cancer chemotherapy drugs, etc.

The beauty of Medicare is that they are very good at pricing care, and if the doctor's claim is filed properly they pay in 14 days, which is about twice to four times as fast as private insurance. The real issue with Medicare for all is paying for it. I believe that could be accomplished by eliminating the current cap on social security payments which now cap out at about $110,000.00 of annual income. Eliminating that cap would accomplish one of Obama's stated goals, taxing higher income folks (currently at 5.65% tax on the employee and a 5.65% tax on the employer). The best part is that the system is already in place and the reimbursement rates are already set.

Lastly the insurance companies do not have to get out of the business entirely as they already serve as the claims processors under Medicare and they could continue in that role. The problem is that it is just too straightforward a solution and therefore there is no money in it for anyone so it will probably never happen.

Martin Shenk


 +  Like this comment
Posted by Roz Rogoff, the San Ramon Observer,
on Feb 18, 2014 at 1:18 pm

Roz Rogoff is a registered user.

Martin,

My Humana insurance seems to cover everything like full-fledged medical insurance. It's an HMO, so I guess it is more than Medigap, but it is very cheap at $49 a month. I don't even pay a co-payment to my Doctor. I don't know how it works, but it sure works for me.

Roz


 +  Like this comment
Posted by Roz Rogoff, the San Ramon Observer,
on Feb 18, 2014 at 1:21 pm

Roz Rogoff is a registered user.

I'd like to add another point on eliminating the cap on Social Security. I agree the salary cap should be removed, but it should be kept for the employer's contribution. Otherwise businesses would say it is too much and move their plants back to China or Indonesia, and Obama would never (not that he ever has) get any Republican support for it.

Roz


 +  Like this comment
Posted by Martin Shenk, a resident of Danville,
on Feb 20, 2014 at 9:40 am

You have a Medicare Advantage plan and Obamacare is trying to kill them off. See WSJ editorial today. Obamacare has funding restrictions built in to reduce payments to the insurance companies that offer these plans. Funding is set to be reduced 6-7 per cent in 2015. So you may start to see reduced benefits or elimination of these plans. There were 48 of them a few years ago and we are down to 20 or so now. Basically, for a flat monthly payment from Medicare they act as an HMO with full benefits with none of the co-pays or deductibles that exist in traditional Medicare. Most also include drugs so they eliminate the need for Part D coverage. You may see premium increases if Medicare continues to cut the payments or even elimination of the plans.


 +  Like this comment
Posted by San Ramon Observer, a resident of San Ramon,
on Feb 20, 2014 at 11:04 am

San Ramon Observer is a registered user.

Martin,

Yes that's what I have. It's more than Medigap. Is Obamacare going to kill it? Oh No, Mr. Bill. Now I have more reasons to oppose it. I didn't vote for Obama in 2012, but I didn't vote for Romney either. Obamacare probably can't be repealed now, but it sure needs some fixing.

Roz


 +  Like this comment
Posted by Roz Rogoff, the San Ramon Observer,
on Mar 1, 2014 at 2:39 pm

Roz Rogoff is a registered user.

Unlikely source prefers "Socialist" Medicare Advantage over "Conservative initiated" Obamacare. Web Link

So why gut Medicare and Medicare Advantage when it could simply replace Obamacare with Medicare for all? I will vote for any Presidential Candidate who promises to do that.



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