Thursday, February 18, 2010

It's Alive

Time to grab the pitchforks? Are the torches ready? No. No. No. The monster is not at our gates. For the moment, it is but a rumor.

Once again, Keith Olbermann is touting the Public Option. Eleven, count ‘em, eleven US Senators want to put the Public Option back on the table and then pass it by reconciliation. Who are these eleven senators? Please, you already know.

Which US Senators make up the reliable left, the team that can always be counted on to see only one side of every issue? Let’s say them together in alphabetical order:

Michael Bennet (D-CO)
Sherrod Brown (D-OH)
Roland Burris (D-IL)
Diane Feinstein (D-CA)
Al Franken (D-MN)
Kirsten Gillibrand (D-NY)
John Kerry (D-MA)
Pat Leahy (D-VT)
Jeff Merkley (D-OR)
Bernie Sanders (I-VT)
Sheldon Whitehouse (D-RI)

To be fair, there are an equal number, or possibly even more, US Senators who are incapable of seeing anything but the other side of every issue. The reliable right is just as much a problem as the above group.

Mr. Olbermann and guests quickly delineated the problems with our current health care system. There are a large number of uninsured and underinsured Americans. All problems would be resolved with the Public Option. Can’t you just imagine it? As it is currently designed, the Public Option will lower the deficit, cover the masses, cure cancer, and guarantee that your home team will win the World Series.

Cue the movie clip. Details? We don’t need no stinking details. OK, enough fun, back to work.

There are no details, no real numbers, no real world plans. My past post provided a comprehensive explanation of the specific benefits of Medicare, a program designed to pay most, but nowhere near ALL, of the costs of medical care. A plan that does not cover prescriptions, a senior citizen with just Medicare is woefully underinsured. Yet with all of these holes, Medicare is still underfunded. Before we create a new Public Option, shouldn’t we first fix the current one?

The Rachel Maddow Show follows Count Down with Keith Olberman on MSNBC. Her thrust was that there was no reason to worry about the Republicans. The other party is simply not going to help. Unfortunately, she may be correct. One can spend all day listing the flip-flops of Senators as esteemed as Orrin Hatch and Charles Grassley. The reconciliation issue doesn’t bother me.

I don’t mind the use of power. My concern is what the use of power gets us. Ms. Maddow’s guest last night was Senator Bernie Sanders. He was almost frothing at the mouth at the prospect of passing this massive change to our health care system by a simple majority. He was shouting out his wish list for other reforms that could be attached to the bill. Why stop at health care? In less than two minutes he offered education reform (more $), housing reform (more $), and, well you get the idea.

What was never discussed, two shows in a row, was a single detail about this mythical Public Option. Can such a plan really work? Who knows? But if it would guarantee an Indians World Series victory, I want to hear more.


Friday, February 5, 2010

The One Year Anniversary of Health Insurance Issues With Dave, and yes, Anthony Weiner Still Hates Me

Today marks the first anniversary of this blog. Please allow me to again thank Brad Kleinman and David Toth of WorkSmart for teaching a class on eMarketing and social networking for the Beachwood Chamber of Commerce last January. Their motivation and the wonderful feedback I receive from you, my readers, keep me excited about producing these posts.

On September 21, 2009 I posted an article entitled Anthony Weiner Hates Me. Mr. Weiner is a Congressman from New York City who is entirely convinced that insurance companies are an unnecessary drain on our system. He has preached from the alter of single payer government run health plans on the Rachel Maddow Show, Countdown with Keith Olbermann and the Huffington Post. Mr. Weiner even shows up on the Sunday morning shows every now and then. His extreme views make for good television. Congressman Anthony Weiner was on the Daily Show with Jon Stewart last night.

Anthony Weiner and Jon Stewart have been friends for a long time. How long? Half the interview was dedicated to the threat of exposing incriminating photos from the 1980’s each still had in his possession. That was the interesting part of the interview. The rest? Nothing terribly new.

Realizing that he didn’t have a lot of time, Mr. Weiner spoke in bullet points.
• Medicare is a single-payer system that works.
• We should extend Medicare to people 55 and older. Why start at age 65?
• We should extend Medicare as an option to recent college graduates who are no longer covered by their parents’ policies.
• We should extend Medicare as an option to people who have lost their jobs.
• Medicare has a 1% overhead vs. the insurance companies at over 30%
• We should cap what insurance companies can charge.

Somewhere in this tangle of talking points, Mr. Weiner stopped to take a breath. And here is where the friendship, or the pictures from the 80’s, paid off. Jon Stewart didn’t challenge any of his friend’s assumptions. He allowed this fact-free, totally unsupportable, completely unrealistic presentation to proceed. Jon Stewart, someone unafraid to confront, intellectually, Jim Cramer and Keith Olbermann, devolved into the Memphis Grizzlies defense and watched LeBron James drive to the hoop. Mind you, I wasn’t looking for a hard foul (continuing the basketball metaphor), but I would have appreciated an attempt to protect the basket, or truth.

This blog has dealt with the good and bad of Medicare numerous times. I’m not sure you have the patience to reread much of that. It is still vitally important to note that Medicare does serve a purpose. Medicare is an important part of our current mish-mosh of payers. And of course, anytime the government is involved in writing checks, a lot of what services are, or are not, available are determined by Washington. But Medicare was never designed to pay all the costs of health care for anyone.

Let’s talk about the specifics of Medicare. It wouldn’t be fair, easy but not fair, for me to cherry-pick this. So this is what Medicare really does and doesn’t cover.

PREMIUM – $110.50 per month, assuming you make less than $85,000 per year.


Semiprivate room and board, general nursing, and miscellaneous services and supplies:
First 60 days - You pay $1,068
61st day through 90th - You pay $267 per day
91st day and after while using
Your 60 lifetime reserve days - You pay $534 per day

Skilled Nursing Facility Care
You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days - You pay $0
21st day through 100th day - You pay $133.50 per day
101st day and after - YOU PAY EVERYTHING

First three pints - You pay everything
Additional amounts - You pay $0

Hospice Medicare pays for all with very limited coinsurance
For outpatient drugs and inpatient respite care


Medical Expenses – In and out of the hospital and outpatient treatment such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment,

First $135 of Medicare approved amounts - You pay $135
Remainder of Medicare approved amounts - You pay 20%

Part B Excess Charges, the amount above
Medicare approved amounts YOU PAY EVERYTHING

First three pints You pay everything
Next $135 of Medicare approved amounts - You Pay $135
Remainder of Medicare approved amounts - You pay 20%

Clinical Laboratory Services - You pay $0

Home Health Care
Medicare approved services
Medically necessary skilled care
Services and medical supplies - You pay $0
Durable medical equipment
First $135 of Medicare approved amounts - You pay $135
Remainder of Medicare approved amounts - You pay 20%


Sorry, there was no way easy way to explain this policy. Above are the basics, the shell. What does this really mean?
1. There is no prescription coverage.
2. There are huge gaps as to what is and isn’t adequately covered.
3. People who rely strictly on Medicare are woefully underinsured.

How underinsured? A study released today at the fifth annual
Community Oncology Conference in Scottsdale, Arizona clearly states that “Medicare covers only 56% of the actual costs of administering chemotherapy and providing related infusion room services to seniors with cancer”. We have already discussed how Medicare has reduced the payments to medical providers. According to the report, Mr. Weiner’s favorite single payer has reduced the payments for cancer drug infusion room services by over 25% since 2004. Are the doctors silently bearing these reductions? Are you and I paying more for these and other services as the cost for care is shifted, more each day, to those of us with private insurance?

There were lots of other holes in Congressman Weiner’s presentation. I appreciated that he has now reduced this imaginary overhead expense for Medicare from the unlikely 4% that he had claimed last summer to the impossible 1% of last night. But I know that this is already too long.

There was one saving grace to Congressman Anthony Weiner’s appearance on the Daily Show. When asking Mr. Weiner about his Mayoral ambitions, he wondered aloud whether Michael Bloomberg could have been defeated. Without hesitation Mr. Weiner opined “I would beat him like a rented mule”. See, I’m not the only person Anthony Weiner hates.