Fiscal Cliff Folks Debate Social Security & Medicare “Fixes”

Thanks to John Brady for the link to The Huffington Post article. There are truly some great ideas regarding the Medicare/Social Security dilemma we face on this thread. I'm curious if anyone has forwarded any of this information to our apparently brain dead politicians.

Single payer health care is not "government-run" health care - rather, its goernment FUNDED health care. I am Canadian and had great health care when we lived there. The federal government funds each province for health care and the Provincial governments pay the doctors. ALL health decisions are made by the doctors - NOT by government - and Docs (as a group) negotiate their salaries through their Medical Associations. Its not a government system. This is a misnomer and one that is used to leave the impression that individual citizens are somehow at the whim of a government. Nothing could be farther from the truth. We have first class health care in Canada - I have never waited to see my doctor more than a few hours or the next morning. I know there are people in Canada who have had issues finding a doctor and getting access... Those are normally folks who live in small towns or in the rural areas - where there are few doctors and hospitals. The same thing applies in the U.S. Doctors want to live and work in a setting that affords them access to research, a community of medical practitioners and then there are the other amenities that the rest of us enjoy - theatre, music, sports, school and communities that are family-friendly. Canadians pay high taxes which pays for universal health care. The cost is one they are prepared to pay to have: the choice of doctors, no such thing as being denied by anyone for any reason, no matter the illness nor how long one is ill. We didn't always have this system (started in the 60s) and some of us old enough to remember when we didn't,and can recall the burden it placed on families. I had a sick mother and my father was financially ruined trying to keep her alive and well. He never really recovered financially. The system in Canada has evolved over decades to where everyone has it no matter your income. It is the great equalizer. IF, however, you wish to pay for some of it, you can purchase some services. OR, certainly, come to the U.S. where the costs are many times more for ALL services - doctors, hospitals, MRIs, drugs. That's because the costs are negotiated and accountability is built into the system. There's also the myth that because its "free" its misused. Not so. Most Canadians - me included - wait until we HAVE to see the doc. We look after colds and flu outselves, and try to wait until its really necessary to go see a doctors. We are aware of our personal responsibility to not abuse the privilege. Not everyone thinks this way, its true. But the majority do. Its not a perfect system but those who have it, wouldn't give it up for the world.

Julie & Linda:
You are really lucky to be healthy.
Some of us need the standard medicare & an extra supplemental plan. Forget some medical "IRA" plan, that would never work for people like me. Last year if I had not had a good supplemental health plan, I would have had to pay over a 1/2 million because of 3 major cancer surgeries, 1 pre-cancer surgery, and an entire year of treatments. Since I live on less than $20,000 a year, that just might have been a problem.
I am not eligible for medicaid, but make too much ( HAH!) money. I pay over $200 a month for my supplemental insurance & am happy to have such a good plan.

Marge,

I am sorry to hear about the health problems you have faced, but indeed an HSA with a high deductible insurance would cover you well...at least the one I have created in my head for my perfect world. :wink: Unexpected health issues happen out of our control and we should not face financial devastation because we or our spouse have had an uncontrollable health crisis. Insurance should be for that which you can not afford to pay, and for each of us that is different. So if the HSA requires you to pay the first $5,000, AND allows you to bank that $5,000 in your medical savings account annually, eventually convertible to retirement funds, you will be more careful in managing the small stuff. The HSA funding would be means tested so that if you could not afford to fund it yourself, it would be Federally funded, though most likely not accrued year to year beyond the initial sum. Anything over that $5,000 deductible would be paid for by your insurance co. Clearly, that would also involve some hard decisions as to what is medically advisable given our age and condition. I watched with protestation as my parents were put through medical procedures that would have been best left undone.

Dollar amounts can vary, income levels to qualify for means testing too, but the bottom line is that if we are given incentive not to go to the emergency room for the sniffles, as some people without insurance are currently forced to do, then maybe we can get costs under control and get the health care system solvent. I realize I am mixing Medicare and the need for universal care together, but if we are universally covered, then we don't need separate plans.

Retiree health care used to be much more common until Medicare became mandatory. The gov't basically gave companies an excuse to eliminate retiree health care and replace it with Medicare, and now that the fiscal burden is too high they are looking to leave us high and dry. Beware the unintended consequences of legislation. In my opinion, the Federal Government has no moral right to wind down Medicare given that it was their interference in the first place that caused many to lose their ability to retire even earlier than Medicare allows now. Medicare was not without it's benefits, as before your health care in retirement was only as good as the solvency of your company and their desire to maintain the program, but many would have been well covered without it, a rarity today.

Yes, we are healthy, but pre-existing conditions would render us uninsurable if we did not have group health care via a corporate retiree plan, even though thanks to modern medicine we are very healthy! We have seen too many supposedly healthy co-workers without pre-existing conditions, in their 40's and 50's, die behind their desks, particularly in this era of 60+ hour work weeks and continuing to work at home once the work day is "over." I will not risk DH any longer than absolutely necessary, and have been saving hard for the past 20 years with that exact intent.

Ahhh...time to get off my soapbox!

John is wrong. No one is ever REQUIRED to take Medicare, not even if you take SS. If SS signs you up at age 65, they have broken the law, by taking your money each month without your signature - assuming you did not go in and sign up. One can put off taking Medicare until one wishes, but may have to pay a penalty for not signing up at age 65. But no one is ever REQUIRED to take Medicare and SS cannot automatically sign you up. If one has no health insurance, one would probably be a fool to not take Medicare; something in the way of health insurance is better than nothing. But no American citizen is REQUIRED to participate in Medicare insurance, A or B. In fact, as more and more of my doctors begin to refuse to take any Medicare patients at all, and as they begin to refuse to accept Medicare assignment, I am seriously considering dropping my Medicare insurance totally, and just keeping the health insurance plan I was (fortunately) able to carry into retirement. Medicare insurance is becoming more expensive and fewer doctors will accept patients who have it.

John, Julie and Carol

Social Security will assume you want Medicare Parts A and B if you are receiving SS and then become eligilbe for Medicare. They will send you a Medicare card enrolling you in A and B. I as stated previously, there is no cost for Part A (hospital) and there is no reason not to take it. If you do not want Part B, send the Medicare card back and they will issue you a new card for just Part A. Once again, Medicare is not mandatory for most people. However, some health plans such as Tricare for Life for military veterans do require you to sign up for Part B to continue Tricare coverage.

Editor's note: We just checked this at Medicare.gov and LS is correct. If you are signed up for Social Security, Medicare will automatically (and legally) enroll you in Medicare Parts A and B at age 65. Because Part B involves premiums, you have the option to turn that part down. Part A is free (to you) and most insurers will require you to have it. However, in the odd event you never apply for Social Security, we are not aware of any law that would require you to sign up for Medicare (but again, most private insurers will require it).

Sorry, LS. When I stated "Retiree health care used to be much more common until Medicare became mandatory.", I should have said when Medicare came into being it gave companies the excuse to get out of retiree health care. Either way, the result was the same, with retiree health care being an almost extinct work benefit.

Why funds sent to other countries? These funds should be cut back to help the deficit?

No one ever speaks about this, it's our money.

Carol is correct that many doctors will not accept new Medicare patients. Here in the District of Columbia, if you have not an already established relationship with a Primary Care doctor, then forget signing up with one if you only have Medicare. I am a nurse and many of may neighbors contact me for help to find a GYN, or even a Dermatologist that will take Medicare--this is necoming more and more dfficult as well as with Primary Care.

I think Part A Medicare would be taken by most people, but perhaps one should consider a medical doctor who uses alternative treatments instead of a classically trained MD who prescribes drugs at the drop of a hat. Many of the alternive doctors do not participate with any insuance, but they do keep one healthy and out of the hospital as much as possible. Also they charge less.

Hi,
Like John Brady says, BRAVO to all the ideas. I think, stepping back a bit, is that we need to revamp both Social Security AND Medicare to reflect the current situation. A blanket "fix" won't solve the problems.
I have worked for 26 years and have met requirements for Social Security on my own. I was also a housewife for 17 years and qualify for 1/2 of my ex-spouse's SS benefit which I can take and defer my own, allowing it to grow 8% per year. I am certainly not complaining, but that illustrates that the current rules need to be redone to not allow this kind of "double dipping". At the same time review other ways of funding.

Medicare, of course, would be solved with Universal Healthe Care, but we would have to fight the Insurance lobby to get it! We actually pay MORE now with private insurance than we would with public insurance.

Hi Lulu:

Other countries like Canada have had private insurance and then outlawed it for the public good. We in the USA coyuld do the same. I think that Medicare for all is the way to go as the codes for billing it are developd and we would not have to reinvent the wheel. The all doctors who want a license in the USA must be required to participate in addition 10% of their practices could be devoted to private patients if the choose--England allows this. With the young people paying into the systems it could be tweaked so that everyone would benefit. I cam convinced that those who live in countries that have Universal Healthcare feel some security as they have both health care and their pensions taken care of even though they pay more in taxes--they do not have to worry abour the most vulnerable times in their lives bad health and old age.

to Lulu: Why shouldn't we fight the insurance lobby? Why should we allow that lobby or any other lobby to control how we live? It is a national disgrace that congress does what these folks tell it to.

Someone mentioned above that Medicare pays 80% of a charge, that is untrue. They pay 80% of the approved cost. I have no idea how they arrive at "approved." I recently had rotator cuff surgery. Medicare paid $108.16 out of a billed $384.00 for pre-op visit, $935.34 out of $12,415.00 billed for surgery, $24.06 of $243.00 billed for xray of shoulder - that is 10%!!! I could list many more. I have never seen Medicare pay 80%. This program is a disaster and it is no wonder Doctors are increasingly refusing to take us as patients!!! Several years ago I asked a saleswoman at a Senior living place in Denver if I would have trouble finding a Dr there, she said it would not be easy. It is bound to worsen as doctors become scarce - especially primary care doctors.

Hmmmmm, wonder why the Canadians and others come to America for operations? After all they get it free(?) where they live. Oh I remember - they might have to wait 9 months and in the mean time could die!

Robert, do you actually have any experience with Canadians and their health plan? First of all, the plan is not free. They pay for it. Secondly, if their having to wait for 9 months for surgery would mean that they would die, they won't have to wait for 9 months. My Canadian boss who now lives in the US went to Mayo about a kidney problem. They decided he needed to have a kidney removed and they could schedule him at 8:00 a.m. the next morning. He declined, told the doctors he would prefer to think about it. He said it was like they had a slot they needed to fill. Ultimately, he decided against having one of his kidneys removed. He's still alive and well today. He said that would never happen in Canada. He missed his Canadian health coverage.

Maybe American doctors would be more willing to take Medicare (National Health Service) patients if their medical school education were free, as it is in England. And in England, most doctors, after they do government medical work for several years to pay for their medical education, begin a private practice and work parttime for the NHS as contracted doctors.

Let's here from Shiela, a former Canadian on how she see's their medical system. From a previous comment: I am Canadian and had great health care when we lived there. The federal government funds each province for health care and the Provincial governments pay the doctors. ALL health decisions are made by the doctors – NOT by government – and Docs (as a group) negotiate their salaries through their Medical Associations. Its not a government system. This is a misnomer and one that is used to leave the impression that individual citizens are somehow at the whim of a government. Nothing could be farther from the truth. We have first class health care in Canada – I have never waited to see my doctor more than a few hours or the next morning. I know there are people in Canada who have had issues finding a doctor and getting access… Those are normally folks who live in small towns or in the rural areas – where there are few doctors and hospitals. The same thing applies in the U.S. Doctors want to live and work in a setting that affords them access to research, a community of medical practitioners and then there are the other amenities that the rest of us enjoy – theatre, music, sports, school and communities that are family-friendly. Canadians pay high taxes which pays for universal health care. The cost is one they are prepared to pay to have: the choice of doctors, no such thing as being denied by anyone for any reason, no matter the illness nor how long one is ill. We didn’t always have this system (started in the 60s) and some of us old enough to remember when we didn’t,and can recall the burden it placed on families. I had a sick mother and my father was financially ruined trying to keep her alive and well. He never really recovered financially. The system in Canada has evolved over decades to where everyone has it no matter your income. It is the great equalizer. IF, however, you wish to pay for some of it, you can purchase some services. OR, certainly, come to the U.S. where the costs are many times more for ALL services – doctors, hospitals, MRIs, drugs. That’s because the costs are negotiated and accountability is built into the system. There’s also the myth that because its “free” its misused. Not so. Most Canadians – me included – wait until we HAVE to see the doc. We look after colds and flu outselves, and try to wait until its really necessary to go see a doctors. We are aware of our personal responsibility to not abuse the privilege. Not everyone thinks this way, its true. But the majority do. Its not a perfect system but those who have it, wouldn’t give it up for the world.

Carol, it is true that College and even Medical School are free in other countries. My husband was an MD/Ph.d and got some of his traiing in England. The Enlish docs get a salary, pension and othe benefits and they DO NOT have to employ an office staff or billing service. They live very well, just not over the top as American Doctors do. In the future here in the USA a doctor will be more humanittian as they too will be salaried, and those who choose the profession will not do it for huge incomes. There are programs to defer the tuition of Medical School if doctors agree to work in underserved areas here in the USA. Thre problem is not many do--only foreign trained doctors tend to do so.

CANADIAN Health Care: As I stated, we Canadians love our health care. I also stated, no system is perfect, but universal health care in countries, like Canada, that offer it is a huge improvement over what is offered in the U.S. I am healthy, thank goodness. But my husband and I worry about what would happen if or when we aren't, while we are living here. yes, we have Medicare but so what? If we can't find a doctor to look after us because Medicare doesn't pay them enough (according to the Doc) or the coverage isn't adequate then really we have substandard coverage. In Canada - contrary to what Robert thinks - we do have to wait for things like hip and knee surgery (although less waiting times than previously). However, heart, cancer and other urgent matters are dealt with immediately. IF, for whatever reason, the hospital can't accommodate a patient that requires this kind of urgent care then the patient may be sent to the U.S. for the surgery - AT THE EXPENSE of the province in which the patient lives. This is all covered by the high taxes we pay for the privilege of having coverage for all - regardless of one's income. Young, old, seniors, rich or poor - all have access to the same docs and same hospitals. Is it perfect? Not if you have to wait for hip surgery and can't get it right away.... But oh my, its head and shoulders ahead of what is on offer here. The costs are driven here by demand - Americans are willing to let the insurance companies and doctors, medical suppliers, hospitals set their own rates and they just rise, and rise. There surely must be a tipping point soon as the system is very badly broken and we the patients are the losers. I am praying for an American single payer/universal healthcare system. Its the only way for all of us who need medical help to survive. My husband and I believe we are blessed in our mid-late 60s to have good health...but are equally aware that this could change on a dime. So, in the meantime, we are doing everything we can to eat the right foods, live as healthy a lifestyle as we can so we can avoid the healthcare system at all costs... Happy New Year and my wish for you all is a healthy 2013..

Sheila:

Great post--Amen to that! I have cousins in Canada and they do not worry about a greedy healthcare system putting them out of business or taking their homes. I too am praying that Americans will get on their phones and let their representatives know how they feel about getting Universal Healthcare.

PS Sorry for the typos in my last post--my keyboard sticks at times.
Regards,
Jennifer

Linda, you are correct. I should have worded it differently. As with all Socialst programs you of course pay for the services with higher taxes etc and a certain lack of freedom and choices.

All choices have consequences. I personally object to being taken care of by a government whether it's Canadian, American or any other.

My point is (again) Some Americans want Government to take care of them from the cradle to the grave while they sit on their fat asses, stuff themselves and become obeese (70% of America is now overweight and 20-25% of the 70% are obeese. Their children ae obeese and their pets too. Approximately 40 million now on government assistance - food stamps etc.

It's one hellva mess and Freebies and continued printing money is not going to solve the problem - in the meantime everyone wants FREEBIES.

What ever happen to Self Reliance - oh no, just let my good ole Uncle Sam take care of me. Work - why should I work when I get all this free stuff.

American has lost it's soul

Robert

Robert, as several people have pointed out to you, the medical insurance in Canada is not free. And the "government" is not taking care of you. The people of Canada have decided to tax themselves so that they may have a rational system of health care. Who do you think is currently taking care of you in the US? I guarantee you it's your health insurance company. They could give a damn about your health. They're all about taking in more money than they have to pay out.

We do not have a rational system here in the US and we are paying twice as much as the Canadians for worse outcomes. It's not about health care in the US, it's about health insurance. Two vastly different issues. I know people who pay $900/month for health insurance. That's insane!

Folks. It's getting a little heated on this topic - obviously it's one we all feel very strongly about. So far so good, but if we stray too much into political venting then we'll have to do some editing. :sad: The Topretirements site guidelines could be paraphrased by saying that there is too much ranting and raving on the cable shows and in the halls of congress, we would prefer this to be a gentler, kinder refuge.:cool:

I suggest you google Canadian health care system. Many Pros and Cons.
Of course one of your choices is Move to Canada since you are so enamored with their system and the European systems.

ciao - Happy New Year

ADMIN. My intention was never to have the discussion become political. However, I do think its important to make sure the facts about it NOT being a "government" program are provided. I also want folks to understand that the cost for having access to Universal healthcare is quite high taxes. I have no problem paying high taxes in order to have that kind of access. Others have an opposite view and don't want to pay those taxes - no matter what. As a Canadian living in the U.S. for a number of years, I am constantly hearing myths about what the Canadian healthcare system IS and ISN'T - much of which is inaccurate or downright propoganda and untrue. Apologies if my contribution provoked a political firestorm. I agree that there is enough bickering in Congress and that this blog should be a place to provide info. BUT you have to know that if the subject is about Social Security, Medicare, Fiscal Cliff, Deficit, debt ceiling or any other hot button issues - there is going to be a plethora of views expressed - some of which may not be presented in a very pleasant fashion, unfortunately. Thanks for giving us all a forum to express our thoughts, share our knowledge and learn from each other.

I do have to agree with Robert (in a kinder, gentler way) that the country has moved from an environment of personal responsibility and Yankee ingenuity to “I should get everything and you should pay” society. I believe in paying taxes, just wish the government has some common “cents” in spending my money.

I do wish the conversation was on health rather than health care. No politician would get elected but I think good health behavior should be rewarded and health care should be more expensive for those who smoke, become fat (excluding those who have a REAL medical reason for such) or have other bad health behaviors.

Some health system basics for those who care: There are four basic types of health care systems in industrialized countries. Canada is a national health “insurance” system. The US is a complicated, pluralistic system. There is a national health system (example United Kingdom) and a socialized health insurance (example Germany) as well.

The funding for national health insurance and national health system are general taxes. The socialized system is usually general taxes and employee-employer MANDATED payroll contribution. Funding for the pluralistic system is (are you ready) pluralistic. Not really all that different except that the USA tends to make things so complicated. And of course, the USA has the lowest general mean marginal tax rate of the four countries illustrated. We (me included) do not wish to pay.

Each system has some advantages and disadvantages, but we tend to look at them from our personal perspective. I could go on about this, but your eyes are glazing over.

Thanks Shiela for your comment on the Canadian Health system. I have heard the stories both pro and con and it was refreshing to hear it from someone that has used it. I had previously commented to Robert about your post but it was edited removing the first sentence and thus making it sound as if it was to you. Unfortuately the Admin. selectively edited my comment which was factual and allowed others that are idiological in substance to stay unedited
. Thanks again for your time and insight. Lefty

As someone who has to pay nearly $1000 per month for coverage for my wife and myself, I cant wait for another year to get on medicare. My wife has 3 years to wait. Now I am under a system that is out for pure profit, not my best interests.
My daughter had to declare bankruptcy when she owed over $25,000 that her insurance company would not cover. This country can do way better than this insanity.

Bill. The system is worse than you think. My wife and I, both retired, pay about $110.00 a month each to Medicare. I buy supplement health insurance from my last employer who gives me a small discount, and that coverage for both of us is just under $400.00 a month (not bad. It includes a prescription drug plan.) What I tell people near retirement is that they have to start paying attention to what Congress is up to. And that somebody may be a conservative now, but unless we fight to stop all wars, shutdown most of our foreign military bases, and cut the Pentagon's budget, the government will put the budget burden on retirees' social security, medicare, and medicaid. This is not a liberal/Conservative. I'm a realist who has paid double into Social Security and Medicare since Reagan, and so have you. And now the U.S. government is trying to default on paying back the $1.4 trillion dollars in Social Security funds it owes U.S. citizens.

ELAINE: Thanks for the definitions. I've never heard it explained that way before. Helpful to know the differences. Although you may think health "behaviors" will lower health costs, I'm not sure that's the major driver of health costs. Its a fact that as we age, we aren't as healthy as we have been in our youth. Yes, we can eat well, exercise and not smoke nor engage in risky lifestyles. However, many of us are unhealthy as a result of things outside of our control - heredity, environment, diseases that we may contract from other,, precarious food safety system, compromised water sysems, are just a few examples. The drivers of health care are the cost of health insurance (and the administration costs associated with it); doctor's salaries; the administration costs docs incur when trying to get insurance companies to pay and the admin. costs of trying to get government to cover costs; the cost of hospitalization - room costs and charges for everything from tissue to bandaids to dressings (this is double/triple "dipping" as they get it at cost, charge the patient retail at exhorbitant rates and then show it as an expense when filing with IRS); cost of medical devices - the cost for an MRI ranges from $800 - over $4,000, based on where you go and what you can negotiate; the cost of prescription drugs - the costs are 5-6 times what they are in industrialized countries with universal health care. These are the items that must be brought under control. No one is "managing the store" on these items. Its capitalism at work - which is fine - unless you are having to foot the bit. You aren't paying taxes for Universal health care but you are paying for all of these things as a health consumer - and then some. Your tax dollars to pay for this and manage these costs would be very much less than you pay for health care now. Trust me. I've seen both systems up close and personal. Since we moved here to Texas, I've had physicians put me on medication I didn't need; send me for tests that weren't required (at exhorbitant costs) until I figured out what was going on. (I was new to the U.S. and didn't have a clue that this was standard procedure). I've now determined I'm my own best health care advocate and do everything I can to stay well and question these kinds of medical decisions on my behalf. I live in dreaded fear of every getting really sick. I'm blessed to have an excellent pension income and we are very well. BUT if we didn't have either then I'm afraid life could be stressful and our quality of life might be less. We are most grateful for our personal situation and agree with BILL, ED and LEFTY that we must do everything we can to preserve what we've all paid for - Social Security and Medicare. Even with all their "warts" they are the best we have right now and we must ensure that those EARNED BENEFITS stay right where they are. Do I think there need to be some adjustments to have them there for the next generation. Yes, I do. But not if lower income seniors have to bear the burden. I have no problem paying taxes when I have a higher income than most. I can afford it.