Readers Write: Healthcare for everybody — A good idea, but…

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The concept of “Medicare for all” means different things for different people. Older Americans are attracted by the prospect of extra benefits, a limit on out-of-pocket costs, and a doctor or nurse who can coordinate their care.

Supporters of national health insurance, to many Americans, would provide a program in which a single-public program would pay most of the bills, but care would still be delivered by private doctors and hospitals.

Having been in a Medicare Advantage program, there were certain elements that were not so terrific, such as a restricted panel of doctors and a restricted drug formulary, where in Medicare, as most people are — the 60-plus percent — there is no restriction on where you can go or to which hospital. If the facility accepts Medicare, you will be seen in both private office or the hospital setting.

The Kaiser Family Foundation, a highly respected foundation, published a report on Medicare spending and financing in June 2018. Try to read the following numbers having in mind the current stalemate in our government of over $5 billion dollars.

In 2017, Medicare benefit payments totaled $702 billion, up from $425 billion in 2007. Medicare spending was 15 percent of total federal spending in 2017, and is projected to rise to 18 percent by 2028. The Medicare Hospital Insurance (Part A) trust fund is projected to be depleted in 2026, three years earlier than the 2017 projection.

Robert Pear, a respected writer on economic issues for the New York Times, wrote on Dec. 30 that the Democrats “fed up with private health insurance companies” are endorsing the goal of a single payer system like Medicare for all Americans.

Medicare as a share of the Federal budget in 2017 was about 15 percent, the same as defense, non-defense discretionary with Medicaid, the Affordable Care Act and CHIP, a children’s health insurance program.

The Kaiser report says that “Medicare spending is expected to continue to grow more slowly in the future compared to long-term historical trends. Medicare’s actuaries project that future spending growth will increase at a faster rate than in recent years, in part due to growing enrollment in Medicare related to the aging of the population, increased use of services and intensity of care, and rising healthcare prices.”

Medicare is financed in the following manner. Part A, the hospital and physician’s office, through a 2.9 percent tax on earning by employers and employees with higher-income taxpayers paying a higher percentage.

Part B, which covers drugs administered by physicians in hospitals and offices, is financed through general revenues and beneficiary premiums, with beneficiaries with higher incomes reflecting a higher share of the costs ranging from 35 to 80 percent.

Part D, your drug plan, is financed by general revenues of about 73 percent of the costs, beneficiary payments of 15 percent, and state payments dually eligible for Medicare and Medicaid. Again, higher-income enrollees pay a larger share of the court-old Part D coverage.

The Medicare Advantage Program (Part C) is not separately financed. The plans cover Part A, Part B and usually Part D. Beneficiaries enrolled in Advantage plans pay the Part B premium, and may pay an additional premium if required by their own plan with about half not paying anything more.

Medicare’s actuaries provide an estimate when the asset level is projected to be fully depleted. In 2018, the actuaries project that the Part A trust fund will be depleted in 2026, three years earlier than their 2017 projection. The actuaries estimate that Medicare will be able to cover 91 percent of Part A costs payroll tax revenue in 2026.

In Kaiser’s June 2018 report on the future outlook for Medicare, writers Juliette Cubanski and Tricia Neuman say that the aging of the population, growth in Medicare enrollment due to the baby boomers reaching the age of eligibility, and increases in per capita health care costs are leading to growth in overall Medicare spending.

Where is the money to pay for this going to come from? Most physicians seem to have no strenuous objections to Medicare as it exists and do support care for younger people as well with the goal being to provide proper healthcare for everyone.

The obvious difficulty is working under conditions of timelines and formularies and abuse of a program, which you can be certain is currently being abused by some and challenged by others who feel they cannot provide proper care under the time frames imposed on them by the people who do the paying, being private or public.

Bertram Drachtman

Great Neck

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