January 26, 2015
In the near future, the new Medicare rules may prove increasingly more onerous than the private ones. It could yield another hit to Medicare’s fee for service scheme. Doctors may well choose to see Medicare patients only under the auspices of an Advantage plan – preferring to deal with the rules imposed by one or a few insurers, rather than the increasingly more byzantine rules imposed by Washington.
The political irony is that there’s a class of progressive policy wonks who decry the growth of Medicare Advantage, fearful that the rise of these plans represents the slow privatization of how the Medicare benefit gets delivered. They favor, instead, a single payer scheme administered by Washington. Yet we already have a single payer scheme – it’s Medicare’s traditional fee for service program.
The same political class that targets the Advantage plans has presided over successive waves of new regulations on providers, and repeated failures to improve how Medicare pays doctors. That failure to maintain a workable alternative is one of the single biggest factors in the burgeoning success of Medicare Advantage.
via Who benefits as Medicare burns? » AEI.
January 26, 2015
How Washington handles Medicare changes could be relevant to the major medical community, because many of the features of the Patient Protection and Affordable Care Act (PPACA) exchange system are based partly on the government’s experience with the Medicare Advantage and Medigap markets.
The outcome could also be relevant to the long-term care (LTC) planning, because of Medicare’s role in paying for home care, and because of possible interactions of Medicare program changes with proposals to have traditional Medicare or Medigap policies pay for nursing home care.
To learn more about what SGR hearing witnesses were saying today about Medigap, read on.
via Why Medigap sellers’ ears are burning | LifeHealthPro.
January 24, 2015
SSDI paid $140.1 billion to disabled workers and their dependents in 2013 (according to the latest trust-fund data). By the end of that year spending outpaced receipts by $32 billion, and the balance of the program’s trust fund was a little more than $90 billion. Trust-fund reserves are expected to run out in late 2016.
Congress can reallocate payroll tax revenues from the Old-Age & Survivors Insurance trust fund to shore up the SSDI trust fund. But the Congressional Budget Office estimates that rebalancing tax revenue between the trust funds would cause the reserves of both to run out in 2030.
via Lanhee J. Chen: A Capsizing Disability-Insurance Program – WSJ.
January 15, 2015
The problem in a nutshell is that Social Security’s disability trust fund is running out of money. The latest trustees’ report projects a reserve depletion date in late 2016. By law Social Security can only pay benefits if there is a positive balance in the appropriate trust fund (there are two: one for old-age and survivors’ benefits (OASI), the other for disability benefits). Absent such reserves, incoming taxes provide the only funds that can be spent. Under current projections, by late 2016 there will only be enough tax income to fund 81 percent of scheduled disability benefits. In other words, without legislation benefits will be cut 19 percent.
via Warning: Disability Insurance Is Hitting the Wall | Economics21.
November 15, 2014
The worst-kept secret on Capitol Hill is that Congress will always, just in the nick of time, pass a doc fix to prevent these payment reductions. This charade results in a multitude of problems.
The Congressional Budget Office is forced to operate under the assumption that Congress will comply with SGR, even though the last 11 years have shown that to be pure fantasy. CBO treats passage of a doc fix as a spending increase. But it’s not, in reality, because Congress always passes a temporary reprieve. Everyone in Washington knows this.
Underscoring this fact, for the first time ever, even Medicare’s own actuaries admitted this year that scheduled SGR payment cuts never would occur. They began factoring that truth into their accounting, noting “it is a virtual certainty that lawmakers will override this reduction as they have every year beginning with 2003.”
via Time for truth in Medicare accounting | Other Views | NewsObserver.com.
October 27, 2014
The solution to the SGR mess, then, may be simpler than convoluted formulas and political horse-trading. The Medicare Advantage program can serve as a “baseline” for physician reimbursements. For instance, traditional Medicare can take the second-cheapest MA plan in each county across the country, and base physician payments on that plan’s reimbursement schedule, plus any penalties/bonuses required under the program. This would eliminate the bureaucracy of the federal government trying to determine how much physicians should be paid, and for what. Plans in the private sector are clearly already figuring this out, and there’s no sense in reinventing the wheel.But this doesn’t have to happen all at once. Indeed, it would make sense to test such an approach before implementing it across the board. Medicare could pick, at random, a set of counties where reimbursements would be based on private plans for a set period of time. Quality and cost data could then be analyzed to determine whether this method is worth it.
via Want To Fix The “Doc Fix”? Experiment!.
September 30, 2014
In a 2013 study the Organization for Economic Cooperation and Development compared the incomes of a country’s retirees with the average income in that country. The results are surprising. Despite a supposedly stingy Social Security program and ineffective retirement-savings vehicles, the average U.S. retiree has an income equal to 92% of the average American income, handily outpacing the Scandinavian countries 81%, Germany 85%, Belgium 77% and many others.
In dollar terms, America’s retirement incomes are 53% above the OECD average, second highest in the world. If there’s a crisis in the U.S., the rest of the developed world must be a virtual retirement hellhole. No one truly believes that.
via Andrew G. Biggs and Sylvester J. Schieber: The Imaginary Retirement-Income Crisis – WSJ.