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The Kaiser Family Foundation has released a massive report on options for stabilizing Medicare, based on a year's review of the literature and interviews and input from dozens of health care experts. They came up with 150 cost cutting possibilities in the 206 page report in five sections: "Medicare eligibility, beneficiary costs, and program financing; Medicare payments to providers and plans; delivery system reform and options that focus on Medicare beneficiaries with high needs; the basic structure of the Medicare program; and Medicare program administration and governance."

The program's costs do have to be reduced and stabilized to make it sustainable. While Medicare costs are growing at slower rate than private insurance costs, they're still rising.

Projected costs of Medicare as part of GDP through 2040
But the options for getting there, as this report shows, are many and varied. The 150 recommendations aren't all-inclusive, for instance, lowering the age of eligibility to open the program up to a younger, healthier premium-paying population wasn't considered. But there's a ton of good stuff here nonetheless, to be mined over the coming weeks as Medicare reform plans are floated.

Here, though, is the key takeaway that should inform the basis of the Medicare solution discussion.

Medicare out-of-pocket spending as percentage of income since 1980
Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services.
Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn't a solution for saving this program, for keeping it's promise to America's seniors and disabled. That basic premise should be the starting point for reforms.

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Comment Preferences

  •  Summed up in one sentance (27+ / 0-)
    Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn't a solution for saving this program, for keeping it's promise to America's seniors and disabled.
    Why do we always look to the most vulnerable to help defray costs? These folks are already stretched to the breaking point, while the wealthy keep getting richer.
  •  Solution: MedicareForAll. Why shouldn't young (21+ / 0-)

    people pay into Medicare the premiums they are currently sending to for-profit insurance companies who just base their payment rates off of Medicare anyway? Of course, an insurance pool that only covers the oldest and sickest in the country will have trouble. Duh!

  •  The problem with Medicare reform (15+ / 0-)

    the problem is extremely simple. The folks in Washington and or state capitals don't understand that medicine is a lot different today than it was 50 years ago. we have advanced. Whether it's right or wrong things are different. CT scanners are used to diagnose appendicitis with greater accuracy than ever before. I am taking out the appendix through three small incisions using a scope that is hooked up to an expensive monitor. Just this technology alone allows patients to go home after 24 hours and return to work within 7 to 10 days. This is a huge advance but it is expensive. Nobody wants to pay. Everybody wants fancy equipment and minimal surgery but nobody wants to pay for It. If we truly want modern medicine, were gonna have to pay for it. Somehow, someway.

    Be involved!

    by ecthompson on Sat Feb 02, 2013 at 08:28:20 PM PST

    •  They Understand Perfectly. Never Confuse What They (9+ / 0-)

      say with what they think.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Sat Feb 02, 2013 at 08:38:28 PM PST

      [ Parent ]

    •  i had an appendix out (7+ / 0-)

      the traditional way. With a largess incision a few months ago. Still was less than 24 hours in hospital and went back to normal activities in 10 days. It cost 10k with insurance paying 80 percent, and it was in an expensive area DC suburbs.

      fact does not require fiction for balance (proudly a DFH)

      by mollyd on Sat Feb 02, 2013 at 09:57:00 PM PST

      [ Parent ]

      •  Medical cost vary wildly from one part of the (1+ / 0-)
        Recommended by:
        Pescadero Bill

        country to the other. 2 years ago I had my gall badder taken out the new fangled way, out patient, back to work next day, piece of cake and the cost was $27,000. My insurance paid all but my $700 deductible. But honestly, this hospital only offers the latest because it is easier for them and makes them more money. My X had bi-pass surgery last year done laproscopically fast recovery and just under $120,000  roughly 6 months earlier and 200 miles away at my hospital son had same surgery old fashioned way and it was more than $250,000. These costs are crazy and make very little sense.

        The work goes on, the cause endures, the hope still lives and the dreams shall never die. ~ Edward M. (Ted) Kennedy

        by cherie clark on Sun Feb 03, 2013 at 08:45:47 AM PST

        [ Parent ]

  •  It makes my head explode (13+ / 0-)

    when I hear some "very serious person" talk about this country not being able to sustain the rising costs of Medicare, as though if we don't provide health insurance through Medicare the cost will just vanish.  No!  The cost will only increase if we pass the responsibility on to the private insurance sector.

    LaPierre. What is that.......FRENCH ???

    by jazzmaniac on Sat Feb 02, 2013 at 08:34:34 PM PST

    •  "Unsustainable" should be banned (2+ / 0-)
      Recommended by:
      musiccitymollie, jazzmaniac

      The same folks don't think public education or public universities are sustainable.  You wonder if they think the interstate highway system is sustainable.   Is the MIC sustainable?  Is it sustainable to be sending our Secretary of State off to over 100 countries and thinking that's a great thing but figuring that you have to pay for it by cutting the COLA on an old woman getting $14K in Social Security?

  •  Why not allow wage earners pay more when they are (6+ / 0-)

    working and can afford it rather than cut benefits for seniors when they can least afford it?

    Fighting Liberal at
    “You must be the change you wish to see in the world.” --Gandhi:

    by smokey545 on Sat Feb 02, 2013 at 08:34:51 PM PST

    •  The problem is timing (5+ / 0-)

      Most people's income arrives in relatively regular amounts each time period. So we all essentially plan to spend a set amount of that income, usually above 80% on a similarly regular schedule each time period.

      Health costs rarely match that pattern. Instead they arrive suddenly and often in very large amounts.

      The best way to allow the costs to be covered from relatively regular income streams is by insurance or tax payments. The alternative is to create a debt which has to be paid off over time.

      The uncertainty of future incomes makes the debt solution rather unreliable. The statistical law of large numbers which permits insurance companies to predict overall future costs reliably is the only solution.

      But since people do not buy insurance for unpredictable events like illness a voluntary insurance is unworkable. Payments have to be as near universal as possible and cannot be voluntary if anything like universal coverage is to be implemented.

      And yeah, that means that working out the inefficiencies of the ACA over time will force the system into some form of single payer as long as the system is transparent enough so that the media can expose its failures.

      The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

      by Rick B on Sun Feb 03, 2013 at 12:43:34 AM PST

      [ Parent ]

  •  Where is Kaiser in this melodrama? (2+ / 0-)
    Recommended by:
    sebastianguy99, worldlotus

    I don't know where they stand in this. There are a lot of players that are easy for me to read but not Kaiser. Just don't know enough about them.
    If anybody has objective information I, for one, would appreciate it.

    •  kaiser family foundation is different from (9+ / 0-)

      Kaiser Permanente, the association of docs and hospitals.   From it's website:

      Kaiser Permanente is a health plan with a Medicare contract.
      The Henry J. Kaiser Family Foundation is a health policy analysis and research organization.
      A leader in health policy analysis, health journalism and communication, the Kaiser Family Foundation is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people.  Kaiser is a non-profit, private operating foundation focusing on the major health care issues facing the U.S., as well as the U.S. role in global health policy.  ...

      We serve as a non-partisan source of facts, information, and analysis for policymakers, the media, the health care community, and the public. ...

      The Kaiser Family Foundation is not associated with Kaiser Permanente or Kaiser Industries."

      "There's nothing serious about a plan that claims to reduce the deficit by spending a trillion dollars on tax cuts for millionaires and billionaires." - President Obama

      by fhcec on Sat Feb 02, 2013 at 11:58:59 PM PST

      [ Parent ]

    •  I've listened to Kaiser reporters for years on (2+ / 0-)
      Recommended by:
      sunny skies, Capt Crunch

      C-Span's Washington Journal call-in program, and on NPR.

      You want the truth?  They speak for the One Percent.  There line is that of the PtB, the so-called Washington Consesus, the Corporatists.

      IOW, they would NEVER support Medicare-for-All, etc.  All the while, they go out of their way to say that they are impartial.

      Actually, guess that part is true.  They are in support of the corporatist agenda, regardless of which party controls the White House.

      Having said that, they are one of my main resources for policy briefs, reports, etc.  

      Just take their reporters "on TV" with a huge grain of salt, LOL.



      "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

      "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Sun Feb 03, 2013 at 01:49:29 AM PST

      [ Parent ]

    •  they provide pretty accurate data (2+ / 0-)
      Recommended by:
      tb mare, Capt Crunch

      and have done so for a long time. They are not (see musiccitymollie's comment) an advocacy group.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 03, 2013 at 05:30:18 AM PST

      [ Parent ]

    •  Thanks for your input. nt (1+ / 0-)
      Recommended by:
  •  More austerity, eh. (4+ / 0-)

    Let’s tax the banksters (many of whom should be in jail, instead of ‘rescued’) instead. They’re the ones who wrecked the economy, resulting in less-revenue-than-what-should-be going into Medicare (due to excessive unemployment, brought on by, uh….. deregulated banksters). That’s where the money is.

  •  Lying with statistics (4+ / 0-)

    Medicare part D was introduced in 2006.  According to the data presented in the graph, a person might be expected to pay $140 in medicare premiums in 2000, and $200 in 2010.  That means that there is $60 increase.  However, that increase would have to include $30-$40 for medicare part D premium.  Therefore the real increase was only no more than $30.  That is a 14% increase, the same from 1990 to 2000.

    As I understand it the benefits for part D recipients are great.  One gets $3000 worth of drugs for about $1000 in premiums and co-payments.  Certainly this value has be added.

    This is not to say there are not problems with social security.  For example teachers, who have put in their 40 quarters just like any other American, only get half the social security.  This is the earned benefits that conservatives say should not be cut, but still feel the need to cut.  Yes teachers also have a pension, but give up significant income to contribute to the pension.  For many retired teachers, social security does not cover the medicare payments, and the pension medical plan only covers expenses after meicare.

    Again, these are benefits that teachers has paid for through 30 years of service.

    One hope of Affordable Health Care is that we establish a lifelong trend of healthy maintenance and payment so that we can not only remain healthy, but pay for potentially needed health care all our lives, instead having to make those payments when we are least able.  When we pay a health insurance company, those premiums will do nothing to help us when we are older.  Now they will.

    Which is why conservatives hate it.  Rather than the premiums going to fund airplanes, mansions, and illegal drugs and sex, they are used to actually maintain the health of Americans, even those who choose not to work and collect unemployment.

  •  Why didn't they include opening up the program? (4+ / 0-)
    Recommended by:
    fhcec, worldlotus, JamieG from Md, tb mare

    How about a deal where the early people sign-up, the less they'll pay when they are seniors? I think there is a way to incentivize early buy-in that might be the quickest path to single-payer.

    If we want to get single-payer, or Medicare-for-All, then people are going to have to want to increase the demand on their own. Given the response to the ACA, I'm not sure imposing such a Progressive solution is going to work. If we are lucky, after Obamacare is fully implemented and the world doesn't end, we might be able to accumulate the political nerve and capital to be more aggressive.

    Whatever we do, we cannot be caught again unprepared for the inevitable pushback.

    "There is nothing more dreadful than the habit of doubt. Doubt separates people. It is a poison that disintegrates friendships and breaks up pleasant relations. It is a thorn that irritates and hurts; it is a sword that kills.".. Buddha

    by sebastianguy99 on Sat Feb 02, 2013 at 11:13:22 PM PST

    •  KFF reports increasing support for ACA (2+ / 0-)
      Recommended by:
      worldlotus, tb mare

      A majority of both Rs and Ds now want states to make implementing exchanges under ACA a top priority, so that's some improvement. Strangely (to me), less than a majority of independents feels the same way. See the chart at the link.


      Majority Of Republicans And Democrats Say Creating Exchanges Should Be A Top Priority For States.  Fifty-five percent of the public, including majorities of Republicans and Democrats, say that establishing health insurance exchanges is a "top priority" for their governor and legislature.

      "There's nothing serious about a plan that claims to reduce the deficit by spending a trillion dollars on tax cuts for millionaires and billionaires." - President Obama

      by fhcec on Sun Feb 03, 2013 at 12:11:04 AM PST

      [ Parent ]

  •  Cost reduction, not cost shifting, and a slight (2+ / 0-)
    Recommended by:
    JamieG from Md, tb mare

    increase in revenue from the wealthy, such as lowering the threshold where capital gains is taxed for medicare and adding dividends, will cover it all.

    Further, affiant sayeth not.

    by Gary Norton on Sun Feb 03, 2013 at 03:49:38 AM PST

  •  THANK YOU THANK YOU! (4+ / 0-)

    I've been researching this Medicare issue.  It sucks.  The elderly have to become impoverished, have no property, in order to also get Medicaid if they have expensive chronic diseases

    I receive Medicare shortly.  Just the Part B premium will equal 1/7th of SSI or 1/14th of my annual income IF NOTHING IN THE ECONOMY CHANGES.

    I gathered my family, all struggling with the high costs of everything and teenage kids w/school and athletic fees.  I won't be fighting to stay alive.  I have had a magic life.  I take good care of myself and have great health.  They don't like my choice, but they understand.  

    Heck, some of them aren't getting things like MRIs or much needed counseling because they can't afford the co-pays!  Even though their ins premiums jumped by ANOTHER $200.00 a month recently.

    I'm also no dummy.  With the Medicare premiums, $1,400 deductible, 90 day limit on hospital care per event, and the 20% co-pays, And the fact that we live in a highly toxic air quality area, I can see how quickly my retirement nest egg will be gone with a cancer or heart disease.   If that happens, I won't be able to pay the ever increasing real estate taxes, and the county will take my home.

    It's a heartless, cruel set up, IMO.  NO interest on savings, no courage for the stock market, and grand kids always needing some help.

    I'm convinced the State and FED want my home, which I paid off, and every dime of my nest egg.

    Well screw them.  I'd rather die and leave the nest egg to the next generation.  Half the people I grew up with are already dead or seriously diseased so I am one of the lucky one.

    FUCKING GREED is destroying us.  Feels like passive aggressive euthanasia to me.

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Sun Feb 03, 2013 at 06:46:58 AM PST

  •  Euthanasia imo (0+ / 0-)

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Sun Feb 03, 2013 at 07:16:52 AM PST

  •  Kaiser does good work (0+ / 0-)

    I am a bit o/t here.  Sorry.  Their health insurance customers have some of the highest customer satisfaction levels of any health insurance company in America.  They spent billions modeling their system after the Mayo Clinic system.  It's pretty interesting stuff, really.  

    Has anybody read "How American Healthcare Killed my Father" by David Goldhill?  It's worth reading, although it's long:

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