Medicare is USA's Golden standard of public health care

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Supposn, Sep 19, 2009.

  1. Supposn
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    Supposn Senior Member

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    This begasn with an inquiry to the U.S. Centers of Medical Services, (CMS) headquartered in Baltimore Maryland, as to Medicare part B health care providers’ compensation. That is the portion of Medicare that patients ELECT to pay for insuring 4/5ths of their doctor bills.
    We can suppose the compliance officer that replied has much more to do rather than answering my questions but informing citizens of how their government operates is not of insignificant value. I’m posting this letter wherever I can so we all receive the most value for his government paid time.
    I'm not very familiar with other nations' public health services. The letter he wrote helps explain why I believe that until we can devise something superior, Medicare is the USA’s golden standard for the delivery of public medical services.

    Respectfully, Supposn

    “This is in response to your inquiry concerning how Medicare Part B and the Medicare HMO program reimburse providers.
    Payment to physicians and other individual health care providers are made in accordance with a prospective fee schedule that is updated every year. Each service that is provided has a predetermined value, referred to as a Relative Value Unit (RVU). While the RVU for the service is the same throughout the country, a geographic adjustment is made in order to account for the differences in the cost of living. This cost of living adjustment is called the Geographic Price Cost Index (GPCI). The country is divided into 89 localities and each one has a different GPCI value that is used to determine the actual Medicare allowed charge for the service.
    The Medicare program does allow payment for specific preventative medical and screening procedures that have proven to be worthwhile to insure the health of beneficiaries. These services include screening mammography and pap smears, diabetes training, glaucoma screening, prostrate screening, bone mass measurement, flu, pneumonia and hepatitis B inoculations and the initial Welcome to Medicare screening examination.
    Physicians and other health care providers have the option to either participate in Medicare or be a non-participating provider. If one participates, they will be reimbursed based upon 100% of the fee schedule amount. As part of the participation agreement, they must accept the Medicare fee as payment in full which means in most circumstances, they can only bill the beneficiary for the applicable co-insurance (usually 20%) and any outstanding annual deductible. A non-participating provider is paid at 95% of the Medicare allowed amount but can charge the beneficiary up to an additional 15% above the Medicare fee. While this might appear to be more advantageous to be a non-participating provider, Medicare provides additional services to participating providers including direct payment from Medicare, automatic cross-over to secondary insurers and individual listing in the Medicare directory. These additional incentives have resulted in the Medicare participation rate to be over 95% of all providers in the country.

    In regard to HMO services, Medicare pays each contracted Medicare Advantage plan a monthly capitation rate, or set amount, for each Medicare enrolled member. The rates are actuarially developed using a wide number of factors including historical expenditures under Part A and B, age, disability, and various other risk-adjustment variables. The rates are not determined by whether an individual Medicare Advantage plan has profit or non-profit status. Rates are adjusted periodically to reflect changes in costs and data corrections to account for prior year estimates.

    I hope this explanation satisfactorily answers your inquiry. If you have any additional questions, please do not hesitate to contact me at the listed office address; (U.S. Division of Financial Management & Fee for Service, Operations & Integrity Branch, 26 Federal Plaza, room 38-130, NY, NY, 10278).
    Sincerely, Steven Lisker, Compliance Officer”.
     
  2. Supposn
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    Supposn Senior Member

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    I’m an advocate of government administered basic healthcare insurance. My second choice would be government subsidizing all qualified primary basic healthcare insurance.

    The term qualifying is critical. Health insurance contracts and insuring entities are not a homogenous group with attributes of equal merit. You cannot reasonably compare insurance costs without also considering what the contract covers, will the insurer fully comply with the contracts (they write) and do their contracts promise reasonably adequate insurance.

    The federal government’s Central Medicare & Medicaid Services, (CMS) is a superior administrator of medical insurance services and its clients receive q services that are certainly competitive or superior to any other healthcare insurer providing services to all but boutique sized or extremely geographically limited or greatly comprised of “cherry picked" clients and patients.

    If in the future we cannot achieve entitlement of federal healthcare for all legal U.S. residents, my second choice would be government subsidizing all qualified primary basic healthcare insurance.

    I’m also an advocate of a federal sales tax to fund net federal healthcare costs.

    Respectfully, Supposn
     
  3. Supposn
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    Supposn Senior Member

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    I’m opposed to employers bring legally mandated to pay for their employees healthcare insurance. Such a government mandate is unnecessary intervention within what should be for the most part a non-government relationship. Such a mandates are not likely to induce universal seamless insurance coverage for all legal USA residents.

    It is less feasible and practical for laws to mandate individuals be required, (if they or their guardian are deemed to be financially capable) to pay for their own uninterrupted healthcare insurance. The courts may conceivably find such a mandate illegal.

    On the other hand any lapse of healthcare coverage exposes the individual to serious financial risk. When it’s impossible for the individual to cover the risk, it becomes a public burden upon taxpayers. That’s the problem integral to dependence upon individuals’ making direct payments for their individual basic healthcare insurance contracts.

    A single payer method’s practical and absolutely legal. All individuals' contributions to their basic healthcare insurance can be funded through taxation. I’m an advocate of a federal sales tax to fund all net federal healthcare expenses.

    Respectfully, Supposn
     
  4. CrusaderFrank
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    CrusaderFrank Diamond Member

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    This is trillions better than ObamaCare/Medicare

    John Mackey: The Whole Foods Alternative to ObamaCare - WSJ.com

    • Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

    •  Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

    • Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

    • Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

    • Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

    • Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

    • Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
     
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  5. Meister
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    Meister VIP Member Supporting Member

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    Golden standard? Just how much in the red is Medicare? :eusa_whistle:
     
  6. Oddball
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    Oddball BANNED Supporting Member

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    If the bankrupt Medicare/Medicaid scam is the "golden standard", then socialized medicine has no standards.
     
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  7. boedicca
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    boedicca Uppity Water Nymph Supporting Member

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    Indeed. If Medicare is the Gold Standard, it must be Fool's Gold.
     
  8. Supposn
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    Supposn Senior Member

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  9. Supposn
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    Supposn Senior Member

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    Meister,
    . . . I participate in the discussion thread “Health Plans Must Provide Some Preventive Tests at No Cost“ that's posted on the economic forum board.

    With regard to the not yet enacted laws mandating that middle and large scale employers provide healthcare insurance plans for their employees, Rabbi wrote:
    . . . *Once employers think they can get away with dumping the liability on the government they will do so. Especially in a recession when there are many qualified workers for those jobs”. I agree with that analysis.

    Respectfully, Supposn
     
  10. Supposn
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    Supposn Senior Member

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    Dude,
    . . . you’ve chosen an incorrect label. It is certainly not “socialized medicine”. I would hope that it will finally evolve to be socialized or at least federally subsidized basic primary healthcare insurance.

    Respectfully, Supposn
     

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