Why is Medicare the way it is?

Uncategorized 7 Minutes

The purpose of government is to improve and protect the lives of the governed.

Is the Medicare Advantage plan an admission that Medicare itself is unnecessarily incomplete?

Rolls-Royce Phantom Prices, Reviews and New Model Information
Free, but with strings.

A story: You receive a call from the wealthiest man on earth. He owns an infinite amount of money.

He tells you he’s in the mood to do a good deed.

He has picked your name randomly, not based on anything but the luck of the draw, and he is giving you a free, no-strings-attached, Rolls Royce automobile.

Well, actually, there are two small strings. You must choose between two Rolls.

One has no heater. The other has no air conditioning.

And you must wait until you are 65 years old before you pick your car.

This puzzles you, so you ask him, “Why would someone having infinite money decide that when does his good deed, he gifts you a car that is missing either a heater or air conditioner?”

And why must you wait until you’re 65?

What’s his purpose?

While you ponder that question, consider this: The federal government, being uniquely Monetarily Sovereign, has infinite dollars. It never can run short of its own sovereign currency.

The government provides you with Medicare, which comes in two basic “models,” Original Medicare and Medicare Advantage.

And you typically must wait until you are 65 to join (with certain exceptions).

But Medicare and Medicare Advantage have different options depending on many of your personal factors.

WHY? Why doesn’t Original Medicare simply cover all medical conditions for everyone?

The American Association of Retired People (AARP) published “8 Reasons to Change Medicare:

1. My prescription costs have jumped.
That happens usually due to one of two scenarios: You’ve been prescribed a new drug your Plan D policy doesn’t cover, or your current medicines have fallen off your Plan D’s formulary (list of covered medicines), Neuman says.

Each September, Part D prescription plans will send out a list of changes to drug coverage, giving you time to make sure your medicines are still covered.

If not, you can shop around for another plan or ask your doctor to apply for an exception in covering your favored medicine.

WHY? Why must a person pay extra for Part D, and why must that person shop around for a plan that covers all his medicines?

2. I’ve decided to spend my winters (or summers) in a different state.
Advantage plans typically charge more to go to doctors outside of their networks; in some cases they won’t cover any charges if it’s not an emergency.

So a Midwesterner might have to pay more to see out-of-network doctors while in Florida.

You need to read the details of your plan, or talk with a representative, to know where you stand. If you’ll be living a dual-residence existence for years to come, you might consider a switch to original Medicare, with the usual caveats.

WHY? Why the “in-network, out-of-network” rigamarole?

3. I need surgery and prefer a specific doctor.
Original Medicare allows patients to choose any doctor or hospital that accepts Medicare.

But if you’re in a Medicare Advantage plan and its surgeons don’t meet your needs, you may need a different MA plan or to switch to OM.

The people who really need to focus on whether doctors are in network are those who’ve suffered major problems like cancer and heart attack, says Joseph Antos, health care expert at the American Enterprise Institute.

“A specialist may be key to their treatment,” he says.

WHY? Why does one Medicare plan cover any doctors or hospitals that accept Medicare and the other plan doesn’t?

4. I’m super healthy and rarely need a doctor.
If you’re in original Medicare, all should be well: As a “pay-for-service” arrangement, not seeing the doctor isn’t costing you anything extra beyond your mandatory parts B and D monthly insurance premiums.

If you’re in an MA plan in which you’re paying a monthly premium on top of your standard Part B premium, that may be for a plan that offers lots of extras , such as gym memberships.

Consider switching to a lower-cost MA plan that doesn’t offer services you don’t plan to use in the coming year.

WHY? Why are there any premiums, and why does one plan not cover the “extras?

5. I’ve been diagnosed with a chronic condition.
A serious medical change should trigger a full review of your Medicare coverage. Make sure your Plan D policy pays for new prescriptions.

Consider the care you’ll need . If you want disease-specific programs, find an MA plan that offers them.

But if you will need lots of specialists, there’s an argument for OM. Making critical changes early can “really affect your pocketbook and save you money,” says Gretchen Jacobson, a vice president with the Commonwealth Fund.

WHY? Why the difference in plans? Why doesn’t one plan cover everything?

6. My income has dropped sharply.
If you are in original Medicare, your Part B monthly premium is locked in, but your Part D drug plan isn’t.

And there’s a chance you can find a lower-cost policy that covers the medicines you are on.

If you’re in an Advantage plan, consider a switch to a plan in which there is no extra payment on top of the mandatory Part B premium.

And you might qualify for help. Ask your state Medicaid office about Medicare Savings Programs. Find the state offices here or call 800-MEDICARE (800-633-4227).

WHY? Why is there a monthly premium? Why does one plan not even lock in premiums? Why the difference in costs?

7. My former employer is changing its retiree health benefits.
Some companies provide retirees with Medigap supplemental insurance, which covers many health costs not covered by OM.

If you have changes to your retiree benefit coverage, or for some reason that coverage no longer is offered, contact Medicare’s Benefits Coordination & Recovery Center (855-798-2627).

Someone can tell you whether you fall in the window in which Medigap insurers cannot deny you coverage based on preexisting conditions.

WHY? Why are some retirees not covered by Medigap supplemental? Why is there even a need for supplemental?

8. My regular doctor is no longer in network for my plan.
If you deeply want to stay with a doctor, ask directly whether he or she is moving to a different MA plan, accepting OM patients or dropping out of Medicare completely.

If you decide to make a change, make sure a short-term decision won’t affect your long-term coverage (for example, switching to original Medicare to temporarily stay with one doctor but sacrificing Medigap coveragefor the long term).

It might be safer to ask your doctor to recommend a colleague in your current plan.

I’m in need of serious dental care. Original Medicare doesn’t cover routine dental care costs, but many Medicare Advantage plans do.

If you don’t have your own dental insurance and can’t afford dentistry costs out of pocket, consider finding an MA plan that will cover a portion of the costs of your needed work.

Antos warns that figuring out what portion of your dental bills an MA plan will cover is complicated, so it helps to know what services you will use in the coming year.

WHY? Why does a person need to consult a crystal ball to guess what medical coverage will be needed at some unknown time in the future?

WHY?

HERE IS WHY: Our Monetarily Sovereign government has infinite funds. It can afford any expense, even without collecting a single dollar in taxes. It has ultimate control over the value of the dollar, i.e. inflation.

Thus, the federal government has the unlimited ability to fund comprehensive, no-deductible Medicare for every man, woman, and child in America. There is no financial reason why you, your family and everyone you know does not have free, total healthcare protection.

But . . . 

At the behest of the very rich, who run America, our information leaders promulgate the Big Lie that taxpayers fund federal spending, and that the federal government is in danger of running short of dollars if spending increases without tax increases.

You have been sold the bill of goods that “there is no such thing as a free lunch,” and that federal spending causes inflation, and that the phony Medicare “trust fund” is running short of money.

The rich do this to widen the Gap between the rich and the rest, for it is the Gap that makes them rich. The wider the Gap, the richer they are.

Better “Medicare for All” plans have been proposed, but they have been rejected supposedly because tax dollars are needed to pay for it. 

They aren’t. It’s the Big Lie, the sole purpose of which is to make the rich richer.

There is no other purpose.

Rodger Malcolm Mitchell Monetary Sovereignty Twitter: @rodgermitchell Search #monetarysovereignty Facebook: Rodger Malcolm Mitchell

……………………………………………………………………..

THE SOLE PURPOSE OF GOVERNMENT IS TO IMPROVE AND PROTECT THE LIVES OF THE PEOPLE.

The most important problems in economics involve:

  1. Monetary Sovereignty describes money creation and destruction.
  2. Gap Psychology describes the common desire to distance oneself from those “below” in any socio-economic ranking, and to come nearer those “above.” The socio-economic distance is referred to as “The Gap.”

Wide Gaps negatively affect poverty, health and longevity, education, housing, law and crime, war, leadership, ownership, bigotry, supply and demand, taxation, GDP, international relations, scientific advancement, the environment, human motivation and well-being, and virtually every other issue in economics. Implementation of Monetary Sovereignty and The Ten Steps To Prosperity can grow the economy and narrow the Gaps: Ten Steps To Prosperity:

  1. Eliminate FICA
  2. Federally funded Medicare — parts A, B & D, plus long-term care — for everyone
  3. Social Security for all
  4. Free education (including post-grad) for everyone
  5. Salary for attending school
  6. Eliminate federal taxes on business
  7. Increase the standard income tax deduction, annually. 
  8. Tax the very rich (the “.1%”) more, with higher progressive tax rates on all forms of income.
  9. Federal ownership of all banks
  10. Increase federal spending on the myriad initiatives that benefit America’s 99.9% 

The Ten Steps will grow the economy and narrow the income/wealth/power Gap between the rich and the rest.

MONETARY SOVEREIGNTY

Published by Rodger Malcolm Mitchell

MBA Northwestern, business turnaround expert, economist

Published

27 thoughts on “Why is Medicare the way it is?”

  1. Our country didn’t start with health insurance. Most of history is about people living their lives, taking care of their own, and if a doctor is nearby, they seek the help. Health insurance, as I’ve read thus far, correct me if I’m wrong, is a relatively new thing. But there’s more. Many were against the government having more and more control over our lives, and this is one of them. But there’s something else. The government has nooo money. Not a dime. Their money, if you call it their money, is our money they take from the working man, woman, and young people working. The reason we have so many monetary problems in our country is because the “government” keeps spending our money, which they package as “their” money, and they have to borrow because there isn’t enough of our money. But the money they spend on medicare and other programs you, I, and other workers will have to pay back, more likely your children and grandchildren. That’s the reality.

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    1. You have just expressed the big lie, that federal finances are the same as state/local government finances, where taxes fund spending.

      But the federal government is Monetarily Sovereign while state/local governments are monetarily non-sovereign. Do you know the difference? See: https://mythfighter.com/2010/08/13/monetarily-sovereign-the-key-to-understanding-economics/

      If the government has no money, where did the original dollars come from?

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  2. If there were no government medical care program, other than emergency if you got hit by a car or had a heart attack, then costs of services would drop dramatically, and people would go back to paying out of pocket, but not nearly as much. Private insurance, not backed by the government, and that would cost much less.

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      1. That’s the problem with many people in this country, but it’s been put into education and the media promotes as propaganda. That kind of thinking early in our history and America would never have happened. Had the founding fathers and others thought that way, they would have continued living in slavery over their minds, lost to dictatorships. The freedoms we have are because of people who thought for themselves with responsibility. *This, I’m saying to the readers for I can see the article writer doesn’t want to think for himself. To the readers: really study your history, but not what’s been taken over by the pc group. Truly read the U.S. Constitution. If the writer of this article is really serious, you have to educate those around you so they don’t fall for all this. Think for yourselves. Follow the rabbit of reason down the trail of understanding.

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        1. I notice that you claim, in multiple ways, that the article is wrong, but you provide zero facts to support your claim. Just saying “wrong” again and again doesn’t show much. Specifically what is wrong and what are your facts?

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      2. Think you blocked or deleted my last comment. That’s okay. Your article. An article that seems to us dishonest or seriously without understanding. It seems very selfish. But glad you demonstrated what a serious lack of credibility looks like.

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  3. I’ll leave it here: The article writer is one of three things: 1) A propaganda promoter, either bought out or only thinking of him/herself, 2) A person who doesn’t really believe his/her own words, but is having fun, but irresponsible fun, or 3) Wholly unaware. I think not a lick of honesty.

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  4. Moving towards an NHS with massive economies of scale [if it was truly national for once without fifty states messing it up fifty or five hundred different ways] would be a huge disinflationary event. Just saying since inflation is the big boogeyman right now.

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    1. Mark, yes, it relates to arbitrary definitions. The CPI is calculated from a “basket of goods and services” purchased by an “average CONSUMER.” Government purchases aren’t counted.

      So, you are correct that if the government assumed financial responsibility for medical care (or for food, or clothing, or housing, or education, or entertainment, etc., etc.), the inflation rate would drop like a bolder.

      In short, when the federal government pays some or all of the cost of anythings consumers previously paid for, that mitigates against a rising inflation rate.

      And to some degree, that’s not a bad idea.

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  5. Is it not the policy of the Fed to provide a little inflation, their so-called target interest rate? Presumably, this is, they say, a desirable “stimulus”… but also it would be somewhat a contradiction if government steps in to help pay for stuff?

    Also, isn’t it a public sector invasion to get involved in the private sector’s insurance world. After all, those poor, poor people have to put food on the table, too. They have to profit! They can’t compete against all that New Deal mentality. What are they to do!? How will they get on? oh dear..

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  6. Average exchange rate in 2019: 1.2772 USD for 1 GBP. England’s population was 56 million in 2018.

    In 2018/19 (their fiscal year starts in April) around £115 billion ($147 billion) was spent on the NHS England budget. That’s around $2623 per person once converted.

    The total of all health spending in England was around £129 billion ($165 billion) in the 2018/19 fiscal year of which 89% was through the public NHS system.

    American healthcare spending is what like $3.5 trillion for 330 million people? Really getting bang for the buck spending four times as much while having far worse outcomes.

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    1. The U.S. federal government, having infinite bucks, does not need “bang for the buck.” It merely needs “bang,” regardless of the bucks. Clearly, it has not been buying enough “bang,” which in part is due to the healthcare insurance industry, and in part is due to the Big Lie, that federal spending is paid for by taxpayers, and deficits are owed by taxpayers.

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      1. Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …”

        President Nixon: [Unclear.]

        Ehrlichman: “… the less care they give them, the more money they make.”

        President Nixon: “Fine.” [Unclear.] https://en.wikisource.org/wiki/Transcript_of_taped_conversation_between_President_Richard_Nixon_and_John_D._Ehrlichman_(1971)_that_led_to_the_HMO_act_of_1973:

        Just love how now most news stories about the healthcare debacle are dependent on data from the Kaiser Family Foundation. Another family of phonies. Pretty sure ‘deny deny until they die’ was the policy for all their former workers whose lung cancer decades later came from the asbestos that rained down like snow at times in the Kaiser Permanente shipyards.

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        1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170066/ Good chart in there.

          True HMOs at the time had been devised by health care reformers who hoped to control costs, improve patient care, and facilitate coverage for the uninsured. For Ehrichman, however, the HMO idea represented an opportunity to develop a private sector-based, profit-driven alternative to a national health care proposal offered by Senator Edward “Ted” Kennedy (D-MA).

          https://web.archive.org/web/20040506072205/https://kaiserpapers.org/clerk.html Kaiser Clerks Paid More for Helping Less. Bonuses were given for limiting members’ calls and doctors’ appointments. HMO defends program

          Moore included tape of President Nixon and chief aide John Erlichman discussing what would become the HMO Act of 1973. Based on conversations with executives at Kaiser Permanente, the largest health plan in California, Erlichman assured Nixon that the incentives at Kaiser run toward less medical care. The less care provided to members paying a flat premium, the more money Kaiser makes. Nixon expressed his approval.

          To no one’s surprise, Kaiser Permanente issued a rebuttal, although it is surprising how clumsy a case Kaiser makes. Attempting to discredit Erlichman, Kaiser cites two documents from the National Archives that supposedly refute Moore’s evidence. One document turns out to be irrelevant, but the other one, a Feb. 6, 1971 letter from chairman Edgar Kaiser to Erlichman, is a gem.

          Mr. Kaiser explained that Kaiser physicians, organized as the Permanente Group, receive both a salary and a share in any surplus left over from the contractual payments by the Kaiser Health Plan to the Permanente Group. The incentive is to minimize the number of physicians in ratio to Kaiser members. Chairman Kaiser’s letter goes on to complain about several features of the draft HMO Act. In particular, he insisted, “Organized health care programs, including associated physicians, must have a significant incentive to elect the HMO framework. The rate-based, rather than cost-based, method of payment . . . could provide such an incentive.”

          In other words, said Kaiser, you must allow our plan to retain a difference between premium income and the cost of delivering care.

          The drive to minimize care caused Kaiser much embarrassment in 2002 when the Los Angeles Times reported that Kaiser “awarded financial bonuses to call center clerks who spent the least amount of time on the phone with each patient and limited the number of doctors’ appointments” (“Kaiser Clerks Paid More for Helping Less,” Los Angeles Times, 17 May 2002)

          Despite providing evidence that confirms SiCKO‘s reporting (although buried in a Web link), Kaiser praises itself for being “a non-profit health plan.” In fact, Kaiser aims to generate the same surplus that everyone recognizes as profit in ordinary corporations. A “non-profit” is different only because it is tax-exempt and does not pay dividends to shareholders.

          Certainly, Kaiser executives are not of a non-profit mind. Kaiser chief executive officer George Halvorson takes around $2 million a year, and dozens of Kaiser top officials get $500,000, $700,000 and $900,000 a year.

          In its so-called rebuttal to Michael Moore, Kaiser ends up taking pride in having “served as a model for the HMO Act of 1973” — the very legislation that legalized the big HMOs skewered by SiCKO.

          Enter SEIU

          United Healthcare Workers-West (UHW-W), a large subunion within the Service International Employees Union (SEIU), represents many Kaiser workers. One might expect UHW-W to recognize in SiCKO a wonderful opportunity to expose and denounce Kaiser Permanente’s systematic incentives to minimize the care provided to members. The barely hidden profit drive makes work at Kaiser intense, frustrating, and stressful for many Kaiser employees.

          Instead, UHW-W attacked Michael Moore for “smearing the reputation of one of our nation’s most progressive, reform-minded, pro-worker health-care organizations: America’s premier not-for-profit, pre-paid, integrated health-care delivery system, Kaiser Permanente.”

          UHW-W does acknowledge that Kaiser packed a dazed, disoriented Carol Ann Reyes, 63, into a taxi and had her dropped in the skid row area of Los Angeles. After all, viewers of SiCKO cannot forget the observation camera that recorded Reyes walking aimlessly in the street, still in a hospital gown and diaper, trying to figure out where she was and what she should do next.

          However, UHW-W simply ignores Nixon’s delight in discovering Kaiser’s essential profit motive, except to drag up a statement by Edgar Kaiser . . . from 1938.

          UHW-W insists there is “a fundamental distinction between a not-for-profit, pre-paid, integrated health-care delivery system and a stereotypical, for-profit insurance company.” As far as the members who represent a “medical loss” to both kinds of health plans can see, the main difference is that one displays “Inc.” at the end of its name while the other does not.

          Finally, UHW-W expresses pleasure at its 10-year labor-management partnership with Kaiser Permanente. Remember the bonuses for phone center employees who kept members from making doctor appointments? UHW-W officials served as straw bosses, working with Kaiser bosses urging clerks to get with the program. Now the Kaiser-SEIU partnership extends to distorting history.

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  7. You ever have luck winning anyone over with sectoral balance explanations? Balance sheets have to balance… hence the name! Surely all people want to have some savings, but then so many of them turn around and enthusiastically agree with some know nothing congressman that we as a nation should swiftly do all we can to pay off that big scary “debt”.

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    1. You are right on target. I have been doing the same thing for 25 years, and can’t even convince some of my friends. Was it Einstein who said that doing the same thing over and over, and expecting different results, is madness? So, after all this time, I am mad, in ever sense of the word.

      The problem is, I don’t know a different way to tell the truth other than to tell the truth. The problem is that liars and the ignorant have much larger megaphones.

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      1. Thankfully the architect who made these simplified diagrams kept it simple and stupid explaining things as they are now (no mention of any hypothetical distractions like buffer stock workfare):

        https://neweconomicperspectives.org/2014/01/diagrams-dollars-modern-money-illustrated-part-1.html

        https://neweconomicperspectives.org/2014/01/diagrams-dollars-modern-money-illustrated-part-2.html

        Could use it as a template fixing any errors or adding overlooked points in a cursory re-write. Something with simple diagrams like this should be published in half page ads over two or three days in the largest newspaper in West Virginia. Fire a salvo against morons like Manchin.

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        1. Mark, those are good illustrations and explanations, with one exception: Inflation.

          Sadly, Randy Wray and the rest of MMT still cling to the “too many dollars chasing too few goods and services” meme. The correct words should be “too few goods and services.” Period.

          Inflation never is caused by too much federal spending. Inflation is caused by shortages of goods and services. Inflation, in fact, can be CURED by federal spending IF the spending is directed toward curing the shortages.

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          1. * The correct words should be “too few goods and services.” Period

            What is their excuse for continuing to overlook the role shortages [of stuff people want] play in causing and driving inflation?

            Too much money floating around in more advanced cases is more a symptom than anything. Successfully treat the actual disease and the symptoms will themselves fade away.

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          2. Broken governments (Zimbabwe, Argentina et al) print currency in RESPONSE to shortage-caused inflation.

            You are correct: Cure the shortage and you cure the inflation. Cutting back on the money supply only causes recessions and depressions.
            The historical statistics are staring economists in the face, but they are too tied to old beliefs to look at the data.

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  8. How does RMM feel about those vocal CAVE dwellers who stoke paranoia about genetically modified anything? CAVE = Citizens Against Virtually Everything. NIMBY on steroids.

    This could of helped a lot of people by now if it hadn’t of been shut down and stymied. From a nearly twenty year old article:

    Replacement Therapy has such enormous potential because tooth decay is so prevalent. According to Hillman, tooth decay is the most common chronic infectious disease in the world; essentially everybody has it. Yet at the present time there is nothing available to help prevent tooth decay. Despite the typical hygienic precautions followed by most people for the past 25 years — using fluoridated water, brushing thoroughly and undergoing regular cleanings — tooth decay continues to thrive. In unindustrialized countries where fluoride and cleanings are not readily available, Replacement Therapy could have a tremendous impact.

    “Replacement Therapy has a major advantage over these approaches because there is no patient compliance required,” Hillman says. “Replacement Therapy can be done in the dentist’s chair. The dentist just swabs the replacement strain (of bacteria) on the patient’s teeth for five minutes, and that’s all you need to do. When the patient leaves the chair, nothing else will have changed except that the chance of tooth decay and incidence of cavities will be dramatically decreased.”

    The science behind Replacement Therapy is based on the fact that most human tooth decay is caused by a naturally occurring bacterium called Streptococcus mutans. These bacteria sit on the surface of teeth and convert sugar that we ingest to lactic acid that, when excreted by the bacteria, dissolves the mineral that makes up tooth enamel and dentin. Hillman succeeded in genetically engineering a strain of Streptococcus mutans that produces a small amount of antibiotic capable of eliminating all other strains of Streptococcus mutans. Moreover, through recombinant DNA technology, this modified strain can no longer produce lactic acid. Topical application of the patented strain of Streptococcus mutans to a person’s teeth actually displaces any decay-causing strain of Streptococcus mutans. This approach has been described as fighting fire with fire.

    https://news.ycombinator.com/item?id=17095954

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