Baloney Sandwiches For All!!!

I’ve been extremely dismayed in recent months that nobody in the media (including conservative media) is focused on the real questions about this proposal. I’ve hear a lot of hyperbole, name calling, fear mongering and questions about the price tag, but nothing that actually discusses the merits/feasibility of Medicare for all.

Fortunately this is my expertise as an agent who markets Medicare products and so I’d like to provide you with some insight about Medicare that could prove helpful in posing the right questions to the Senator's supporters.

1)     Senator Sanders claims that Medicare for all will cost Americans (outside of taxation) nothing. E.G. it will be free for everyone.

The problem with that is that Medicare as currently structured doesn’t work that way. Individuals pay for Medicare Part A (Hospitalization coverage) via payroll deduction during their working years and Seniors pay anywhere between $135.50 and $460.50 (based on their income) for Medicare Part B (doctor coverage.)

Furthermore, Seniors purchase Part D coverage which costs on average $40 monthly and Medigap Coverage which can run up to $300 monthly (depending on age, state of residence and plan selection.) Alternatively some seniors purchase Medicare Advantage which combines coverage for drugs and supplements Parts A and B (There are some “free” Medicare Advantage plans, but that is only because Medicare is subsidizing it.)

2)     Senator Sanders says you will pay nothing for care, but again that is not how Medicare works. Part A has a hospitalization deductible of $1364 and a per day co-payment of $341 up to $682 (depending on the length of your hospital stay) and in fact after a lifetime reserve is exhausted, a patient will have zero coverage in a hospital past 150 days.

Part B has an annual deductible $185.50 and 20% co-insurance requirement after the deductible.

Medicare Advantage Plans and Part D Plans (as well as some Medigap plans) also all have out of pocket exposures in the form of co-pay, deductibles and co-insurance.

3)     Bernie (jokingly I hope) said that Insurance companies will be relegated to covering nose jobs (which by the way, they don’t cover now) but in fact most every Medicare Beneficiary has at least one form of private insurance complimenting their Medicare Coverage.

That being said, Senator Sanders is either the most uneducated politician as it pertains to Medicare or what he is really proposing is Medicaid for all. Medicaid is the only national entitlement that costs nothing to enroll in and has no associated out of pocket costs.

Even if we give Senator Sanders the benefit of the doubt and assume he is referring to Medicaid, here’s the problem. Medicaid has the poorest outcomes of any coverage available in the US. In fact it has poorer outcomes in some instances than being uninsured.

 

See below references to studies that you can look at yourself to see how Medicaid performs.

In 2013, a study published in the New England Journal

of Medicine found that Medicaid “generated no significant

improvement in measured physical health outcomes”

relative to being uninsured

Other studies have found similar results. A University

of Virginia study published in the Annals of Surgery examined

outcomes for 893,658 individuals undergoing

major surgical operations from 2003 to 2007.32

The authors divided their patient population by the

type of insurance they held—private, Medicare, Medicaid,

and uninsured—and adjusted the database to

control for age, gender, income, geographic region, operation,

and comorbid conditions. That way, they

could correct for the obvious differences in the patient

populations (for example, older and poorer patients are

more likely to have ill health).

They then examined three measurements of surgical

outcome quality: the rate of in-hospital mortality; average

length of stay in the hospital (longer stays in the

hospital are a marker of poorer outcomes); and total

costs.

The in-hospital death rate for surgical patients with

private insurance was 1.3 percent. Medicare, uninsured,

and Medicaid patients were 54 percent, 74 percent,

and 97 percent, respectively, more likely to die

than those with private insurance.

The average length of stay in the hospital was 7.38

days for those with private insurance; on an adjusted

basis, those with Medicare stayed 19 percent longer;

the uninsured stayed 5 percent shorter; and those with

Medicaid stayed 42 percent longer.

Total costs per patient were $63,057 for private insurance;

Medicare patients cost 10 percent more; uninsured

patients 4 percent more; and Medicaid patients

26 percent more.

 

A study of Florida patients published in the Journal of

the National Cancer Institute found that Medicaid patients

were 6 percent more likely to have late-stage

prostate cancer at diagnosis (instead of earlier-stage,

more treatable disease) than the uninsured; 31 percent

more likely to have late-stage breast cancer; and 81

percent more likely to have late-stage melanoma.35

A University of Pittsburgh study of patients with

throat cancer, published in Cancer, found that patients

on Medicaid or without insurance were three times as

likely to have advanced-stage throat cancer at the time

of diagnosis, compared with those with private insurance.

Those with Medicaid or without insurance lived

on for a significantly shorter period than those with private

insurance.36

A Johns Hopkins study of patients undergoing lung

transplantation, published in the Journal of Heart and

Lung Transplantation, found that Medicaid patients

were 8.1 percent less likely to be alive ten years after

their transplant operation, compared with those with

private insurance and those without insurance. Medicaid

was a statistically significant predictor of death

three years after transplantation, even after controlling

for other clinical factors. Overall, Medicaid patients

faced a 29 percent greater risk of death.37

 

In 2008, according to the Centers for Medicare and

Medicaid Services, as shown in Figure 15, Medicaid

paid physicians approximately 58 percent of what private

insurers paid them for comparable services.

Surprisingly, doctors fare even better treating the uninsured

than they do caring for those on Medicaid.

A 2007 study by MIT economists Jonathan Gruber

and David Rodriguez found that, for nearly 60 percent

of physicians, the average Medicaid fees were less

than two-thirds of those paid by the uninsured, and

that three-quarters of physicians receive lower fees for

treating Medicaid patients than they do for treating

the uninsured.38

 

The difference in reimbursement rates does not capture

the additional hassles involved in treating Medicaid

patients—such as late payments from the

government and excessive paperwork—relative to the

uninsured, who pay in cash.

Surveys consistently show that patients with private

insurance have far superior access to care than those

on Medicaid. The 2008 Health Tracking Physician

Survey found that internists were 8.5 times as likely

to refuse to accept any Medicaid patients, relative to

those with private insurance.39

A 2011 study published in the New England Journal of

Medicine found that individuals posing as mothers of

children with serious medical conditions were denied

an appointment 66 percent of the time if they said that

their child was on Medicaid (or the related Children’s

Health Insurance Program), compared with 11 percent

for private insurance—a ratio of 6 to 1.40

Among clinics that did accept both Medicaid/CHIP

and privately insured children, the average wait time

for an appointment was 42 days for Medicaid and 20

days for the privately insured. A related study, published

by the same group in Pediatrics, found that 63.5

percent of Medicaid/CHIP beneficiaries were unable

to get an appointment, compared with 4.6 percent of

those with private insurance—a ratio of 14 to 1.41