(9-16-09) Young Adults Likely to Pay Big Share of Reform's Cost (Shailagh Murray, Washington Post)

[agatha]

source (http://www.washingtonpost.com/wp-dyn/content/article/2009/09/15/AR2009091503716.html?hpid=topnews)


As health-care legislation advances through Congress, the young adults who were so vital to President Obama's election are emerging as a significant beneficiary of his top domestic priority, but they are also likely to play a major role in funding any reform.

In a campaign-style rally Thursday at the University of Maryland at College Park, Obama will aim to tap his richest vein of support -- voters younger than 30 -- to help sell his reform plan to a more skeptical general public. "We're at an important turning point in our push for real reform," read the e-mailed invitation, "and it's critical that we seize this moment."

A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

Another bill will be introduced Wednesday by the chairman of the Senate Finance Committee. Sen. Max Baucus (D-Mont.) will offer in it a proposal to keep premiums manageable: a bare-bones catastrophic policy that would protect young people from financial calamity while providing basic preventive care.


Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums -- effectively subsidizing coverage for their parents.

An array of Democratic senators continued to complain Tuesday about the affordability of reform, insisting that the final package should include much larger tax credits to help people cover the cost of insurance premiums.

"I want to make clear that in its current form I cannot put my support behind the Finance bill -- it will not have my vote," said Sen. John D. Rockefeller IV (D-W.Va.).

In part, young adults are uninsured because they are less likely to work for employers who offer coverage; they may not qualify for public programs such as Medicaid; and even the skimpiest private insurance plans may be too expensive alongside hefty student loan payments and credit card debt.

But some young people -- nicknamed the "young invincibles" -- are also likelier than other Americans to assume that they won't need health insurance or to decide that they'd rather spend their money on other things.

To discourage that attitude, the Finance Committee bill would fine individuals who do not purchase coverage. An early draft of the proposal set the penalty at $750 or $950 per year for single people, depending on income. But according to various insurance experts, even the least expensive plan under the bill could cost more than $100 per month, making it cheaper for people to pay the fine than to buy insurance.

All the bills seek to blunt the additional cost to young adults, mainly through subsidies, but it is not clear what effect that would have. "The primary question is what the premium is and what people get for that," said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and a former senior Bush administration official.



more at link...

[CGP]

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

Good. Guess what? Young people without insurance can get sick, have an accident, and/or require major medical treatment. Who's going to pay for the bill when they can't? Everyone needs insurance so that everyone else isn't left paying the hospital bill for them!

[sojourner]

Good. Guess what? Young people without insurance can get sick, have an accident, and/or require major medical treatment. Who's going to pay for the bill when they can't? Everyone needs insurance so that everyone else isn't left paying the hospital bill for them!

Why can't they?

When I was in graduate school there were complications when our second child was born and we ran up a large medical bill that wasn't covered by insurance. It took a while to pay it off and I had to drop out of school for a while to do it but we did.

Not having insurance does not absolve you paying your medical bills.

[TheTaoOfBill]

And it's the young adults who are fighting for reform. So you say we're going to pay the bill and we say "Fine by us"

Young people overwhelmingly support liberal causes.

[Valin]

(915/09) Health-Care Reform and the Constitution (WSJ) (http://www.commongroundpolitics.net/discussion/showthread.php?t=48959)


Begs the question, Is there anything the Federal Government can't do?

Real Clear Politics: The Bigger the Government, the Smaller the Citizen (http://www.realclearpolitics.com/articles/2009/09/01/the_bigger_the_government_the_smaller_the_citizen_ 98114.html)

All I'm asking is for people to think...and I mean really think hard. Are you really sure you want this?

[Kbentleyis]

(915/09) Health-Care Reform and the Constitution (WSJ) (http://www.commongroundpolitics.net/discussion/showthread.php?t=48959)


Begs the question, Is there anything the Federal Government can't do?

Real Clear Politics: The Bigger the Government, the Smaller the Citizen (http://www.realclearpolitics.com/articles/2009/09/01/the_bigger_the_government_the_smaller_the_citizen_ 98114.html)

All I'm asking is for people to think...and I mean really think hard. Are you really sure you want this?

I completely agree Valin. But, since the youth are so fond of paying for liberal causes... ha ha ha, wait till they find out the figures in the latest bill is projected at 13% of their annual income!

Good! They get what the voted for!!

[Valin]

I completely agree Valin. But, since the youth are so fond of paying for liberal causes... ha ha ha, wait till they find out the figures in the latest bill is projected at 13% of their annual income!

Good! They get what the voted for!!

Short story if I may.

Where I work the company has a $500 bonus if you you recomend someone who is hired. This young woman I worked with got a friend of hers hired, Needless to say she was all excited about her bonus and what she was going to do with the $500, until she got the check (Something like) $270. "Where's the rest!" Taxes my dear...taxes.
A teachable moment

[jlynne]

Why can't they?

When I was in graduate school there were complications when our second child was born and we ran up a large medical bill that wasn't covered by insurance. It took a while to pay it off and I had to drop out of school for a while to do it but we did.

Not having insurance does not absolve you paying your medical bills.

Amen! I will add to that having insurance doesn't mean that you don't incur medical bills. I can easily total $500K of "noncovered" medical services that my husband received during the last decade even though he had private insurance, Medicare, Medicare supplements, and towards the end Medicaid.

Having insurance, especially Medicare-type coverage, isn't very helpful unless you can afford to pay all the copays and all the deductibles that go along with it. I know I've worked two and three jobs at times just to make sure that he could get the routine care that he needed and we had *good* insurance.

[foxyladi]

it,s seriously a mess

[TheTaoOfBill]

I completely agree Valin. But, since the youth are so fond of paying for liberal causes... ha ha ha, wait till they find out the figures in the latest bill is projected at 13% of their annual income!

Good! They get what the voted for!!

And what percentage of my annual income would healthcare cost if we did nothing? How much income are we already losing by paying for people who are not insured?

[Valin]

it,s seriously a mess

Begs the question: What business is it of the Federal Government?

"A government big enough to give you everything you want is a government big enough to take from you everything you have,"
G Ford

[jlynne]

And what percentage of my annual income would healthcare cost if we did nothing? How much income are we already losing by paying for people who are not insured?

I suspect less than you're paying for Medicare fraud and waste since Obama feels his administration can cut billions of dollars from the program without cutting any services for the elderly.

[TheTaoOfBill]

I suspect less than you're paying for Medicare fraud and waste since Obama feels his administration can cut billions of dollars from the program without cutting any services for the elderly.

Medicare on the administration level is MUCH more efficient than any private sector insurance company. And there is always waste that can be cut without sacrificing quality. You just have to find it. Humans are inefficient by nature.

[Lealy]

Medicare on the administration level is MUCH more efficient than any private sector insurance company. And there is always waste that can be cut without sacrificing quality. You just have to find it. Humans are inefficient by nature.

So why not cut it. Why do we have so much waste, fraud and abuse? Because the system is too big, the little people on the fringes committing the fraud and abuse will continue to do so because such a large organization is basically incapable of policing it. I agree and I don't know that anyone in there right mind does not understand that this does go on. You say humans are inefficient by nature, I find this interesting that you also don't understand that huge organizations especially run by govt and its unintended consequences are more so by design inefficient.

I have seen alot of waste, fraud and abuse working in healthcare and I do not see anything in any of these bills addressing it. You don't need legislation to fix what you have you just need to do it.

I have only gone maybe one year of my life without insurance and I did not go to the doctor because I was healthy. If I would have gotten into a car accident I have car insurance (I keep hearing people use this as an example). There are lots of people who are private pay by choice. If you go your entire life without getting into a car accident you have paid in thousands of dollars for nothing, this is what we are talking about doing to young people. Pay into a system for years and years that you will not use except for the few.

Instead of dealing with the mess of medicare and medicaid we are not going to demand that the youth of this country again pay for the the clean up and in the end the same thing will happen. It is a ponzi scheme. It is designed to crash one day. This is why SS is on the path to failure. We never learn.

[TheTaoOfBill]

So why not cut it. Why do we have so much waste, fraud and abuse? Because the system is too big, the little people on the fringes committing the fraud and abuse will continue to do so because such a large organization is basically incapable of policing it. I agree and I don't know that anyone in there right mind does not understand that this does go on. You say humans are inefficient by nature, I find this interesting that you also don't understand that huge organizations especially run by govt and its unintended consequences are more so by design inefficient.

I have seen alot of waste, fraud and abuse working in healthcare and I do not see anything in any of these bills addressing it. You don't need legislation to fix what you have you just need to do it.

I have only gone maybe one year of my life without insurance and I did not go to the doctor because I was healthy. If I would have gotten into a car accident I have car insurance (I keep hearing people use this as an example). There are lots of people who are private pay by choice. If you go your entire life without getting into a car accident you have paid in thousands of dollars for nothing, this is what we are talking about doing to young people. Pay into a system for years and years that you will not use except for the few.

Instead of dealing with the mess of medicare and medicaid we are not going to demand that the youth of this country again pay for the the clean up and in the end the same thing will happen. It is a ponzi scheme. It is designed to crash one day. This is why SS is on the path to failure. We never learn.

That's called throwing the baby out with the bathwater. We can have stable safety nets for both retirement and healthcare. And you're right. More needs to be done to cut the waste in the system. But the biggest thing that can be done to cut waste significantly right now is to start a public option. Actually scratch that. The biggest thing to cut waste right now would be single payer. But that's not going to happen.

But once you have the administrative efficiency that comes with a government program you can work on cutting waste in other non administrative areas. We need to set up the system first though because the biggest waste right now is that we don't have a government healthcare system that covers everyone.

After the system is created we can look into things like tort reform and reducing the cost of drug research.

[jlynne]

Medicare on the administration level is MUCH more efficient than any private sector insurance company. And there is always waste that can be cut without sacrificing quality. You just have to find it. Humans are inefficient by nature.

The administration of Medicare is NOT more efficient than the administration of private insurance on a per person basis.

Advocates of a public plan assert that Medicare has administrative costs of 3 percent (or 6 to 8 percent if support from other government agencies is included), compared to 14 to 22 percent for private employer-sponsored health insurance (depending on which study is cited), or even more for individually purchased insurance. They attribute the difference to superior efficiency of government, private insurance companies' expenditures on marketing efforts to deny claims, unrestrained pursuit of profit, and high executive salaries.

However, on a per-person basis Medicare's administrative costs are actually higher than those of private insurance--this despite the fact that private insurance companies do incur several categories of costs that do not apply to Medicare

...

Medicare patients are by definition elderly, disabled, or patients with end-stage renal disease, and as such have higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Administrative costs are incurred primarily on a fixed or per-beneficiary basis; this approach spreads Medicare's costs over a larger base of patient care cost.

....

In 2005, Medicare's administrative costs were $509 per primary beneficiary, compared to private-sector administrative costs of $453. In the years from 2000 to 2005, Medicare's administrative costs per beneficiary were consistently higher than that for private insurance, ranging from 5 to 48 percent higher, depending on the year. This is despite the fact that private-sector "administrative" costs include state health insurance premium taxes of up to 4 percent (averaging around 2 percent, depending on the state)--an expense from which Medicare is exempt--as well as the cost of non-claim health care expenses, such as disease management and on-call nurse consultation services.


http://www.heritage.org/research/healthcare/wm2505.cfm

[Lealy]

That's called throwing the baby out with the bathwater. We can have stable safety nets for both retirement and healthcare. And you're right. More needs to be done to cut the waste in the system. But the biggest thing that can be done to cut waste significantly right now is to start a public option. Actually scratch that. The biggest thing to cut waste right now would be single payer. But that's not going to happen.

But once you have the administrative efficiency that comes with a government program you can work on cutting waste in other non administrative areas. We need to set up the system first though because the biggest waste right now is that we don't have a government healthcare system that covers everyone.

After the system is created we can look into things like tort reform and reducing the cost of drug research.



Please show me examples of where in the national govt we have ever cut waste? Normally they may try but end up making the programs bigger and more inefficient. In the hospital they have add more chiefs and then need more chiefs to watch the chiefs, one of the problems in the hospital that I worked at to many chiefs. Anyone can find examples of it but it never gets done because once a program is in place you can never cut back. You think you can go back it does not happen you must go with reality not what you want or wish to happen. Reality.

[jlynne]

Why would we want administrative cost that are so low that the system is fraught with not only inefficiencies and waste but large amounts of outright fraud? Looks like it is an ongoing problem with both Medicare and Medicaid.

The Federal agency that oversees Medicare points to the program's tiny overhead as proof it is well administered. But recent reports suggest that Medicare's administrative costs are shockingly low, below 2 percent of costs, because Medicare is shockingly unsupervised. The amount of fraud and waste is huge, and supervision of the quality of medical care provided recipients is largely nonexistent.

In recent weeks, Federal auditors have estimated that $23 billion in Medicare payments last year -- about one dollar in every seven -- was due to fraud or mistakes. In Medicare's home-health program, which spends about $20 billion a year treating about four million elderly people, fraud and waste account for perhaps 40 percent of expenditures. At 125 teaching hospitals, a yearlong investigation is uncovering Medicare overpayments of hundreds of millions of dollars. Two Philadelphia hospitals have coughed up $40 million in reimbursements and fines, and officials of the nation's largest for-profit hospital chain have been indicted.

Some of these gargantuan overpayments reflect outright fraud. Others reflect billing errors and other inadvertent mistakes. The truth is that the Health Care Financing Administration, the Federal oversight agency for Medicare, has neither the financial means nor the ability to tightly supervise the numbingly complex system.

http://www.nytimes.com/1997/08/01/opinion/fraud-and-waste-in-medicare.html


Millions of tax dollars are likely being wasted in Utah's Medicaid program on procedures -- including a breast augmentation and nose jobs -- that aren't covered by the government insurance program, according to a scathing legislative audit released Tuesday.

Millions more are lost because the Medicaid department isn't adequately going after providers who submit fraudulent bills. And while there are three sets of internal auditors charged with overseeing the department and its $1.7 billion budget, none are independent enough to do their jobs appropriately, the report says.

"I don't know that I've read a more damning report," said House Speaker Dave Clark, R-Santa Clara, during a Tuesday legislative meeting. He called leaders of Medicaid and the health department "somewhat lazy and sloppy."

"Every single page of this audit talks about lack of leadership, lack of management, lack of organization, lack of follow up," he said. "Lack of, lack of, lack of. ... I'm concerned."

http://www.sltrib.com/news/ci_13152189

A federal program with a history of making billions of dollars in erroneous payments for wheelchairs, oxygen machines and other medical equipment continues to grossly underestimate its own mistakes, according to federal investigators.

The Medicare program spends about $10 billion annually in payments to suppliers of medical equipment for the elderly and disabled. For years, federal inspectors have documented payment errors that expose the program to fraud and abuse. Last year the inspector general who oversees Medicare estimated the waste could be as high as $2.8 billion annually.

A sampling of payments for fiscal year 2008 conducted by an outside contractor found that roughly 70 percent should not have been approved, according to a new report by the inspector general for the Department of Health and Human Services. But Medicare estimated the error rate at less than 10 percent, citing its own contractor, AdvanceMed of Richmond, Virginia. The review was not comprehensive and consisted of a sample of just 250 payments.

http://money.aol.com/article/payment-errors-continue-to-plague/488304