SAVING MEDICARE
Like so much of my philosophy, first you have to stop the bleeding.
In the case of illegal aliens, first you have to build the fence and arm the border.
In the case of our debt, first you have to stop the spending and cut back government.
In the case of healthcare (after repealing the law) is you start with tort reform
In other words, you use common sense to go after what's obvious. You tackle the things that are right in front of you that are causing the problem or the rise in prices. And the same thing holds true with Medicare.
With all things medical, tort reform is just as important here, in retirement, as it is in any national healthcare program. Doctors and hospitals make choices and decisions on treatment in a defensive posture because of the costs of litigation and settlements, and as a result more tests, treatments, procedures and drug therapies are prescribed as a way of protecting themselves, most of which they would acknowledge as being unnecessary,but resulting in a cost of billions of dollars, driving healthcare out of control. Establish a new medical court system specifically to hear malpractice cases, with medically qualified judges, either one or three judges to hear and rule on a case. There would be no juries. Frivolous lawsuits brought would be dealt with harshly with ten thousand dollar fines to the law firm, which can't be billed back to the customer, and the plaintiff who brought the frivolous lawsuit would be billed the defendants attorney fees as well as court costs, in addition to her own.
In legitimate cases any damages awarded for the actual injury and future medical costs remain uncapped, however the punitive damages awarded would be capped at 3 million dollars. Attorney fees would also be capped at 15% for an out of court settlement and 25% for any case going to court.
The result of just this tort reform would lower malpractice insurance which would in turn lower doctor's expenses leading to lower doctor bills. The resultant canceling of unnecessary tests, treatments and procedures will lower the cost for both patient and insurance company, and as the domino cascade continues, it should lower health insurance premiums. Plaintiffs of malpractice cases will no longer fall victim to juries who get lost in all the technical jargon resulting in coin-flip outcomes, plus they can rest assured that if they win the case they will receive full compensation for their future medical needs as well as enough money to last a lifetime, if that is necessary in extreme cases, without having to worry about trial lawyers taking away half of it.
Right now the Medicare system prides itself on its efficiency at getting bills paid. Under the constant pressure of those providing services to get reimbursement fast, Medicare usually cuts a check the same day the bill arrives. And indeed their promptness has much improved. So much so, that fraud has become rampant within the system for this very reason. Criminals send in fake bills rapidly and endlessly and reap their millions in rewards before disappearing from the scene just as fast, only to open up another fake store front somewhere else. Hundreds of billions has been lost to this type of fraud. Here's what I would do (common sense)...I would see to it that any new physician or medical facility, first register with Medicare, so that their name and address is entered into the system, before taking in their first patient. I would then have modifications made in the software, so that the operator gets notified whenever a bill comes in from a doctor or facility that is not in the system, and that automatically prevents any checks from being cut and sent out. If the software identifies a
quick accumulation of bills from the same location, FBI agents are sent out to close it down and make arrests, thereby eliminating the majority of this waste and fraud.
The next thing I do is see to it that the government do what it did with the Veterans
Administration. As David Walker, a former Comptroller General of the United States, and CEO of the Government Accountability Office from 1998-2007, said in his book, Comeback America, we need to start negotiating more aggressively on behalf of the American taxpayer and requiring more competitive bidding for Medicare and Medicaid and other health programs. If the V-A can negotiate for better prescription drug prices for veterans, we should be able to do so for drugs as well as other products and services in federal healthcare programs. The very fact that our own Congress has never thought of this on their own is incredible.
By the way, while we're at it. There's another thing going on with the price of drugs. When the pharmaceutical companies develop a new drug, they patent it as protection and the patent lasts for twenty years. Usually by the time the drug goes through testing and is approved there is only 8-10 years left on the patent, before other drug companies can produce generics at a greatly reduced price. What's happening is that the drug companies might "tweak" their drug with a new chemical or something and then try and get the patent companies to extend the patent, which does occur. Or, failing that they literally enter into an agreement with the generic making drug companies and pay them to delay offering up the generics. So why should you be concerned? Because a $300/month drug prescription, when it goes generic usually drops the price of that drug to something like $30 bucks. So you pay through the nose for these shenanigans, but more importantly your health and drug insurance companies pay through the nose, keeping healthcare premiums shooting ever skyward. Why doesn't Congress deal with this kind of thing, rather than holding hearings on whether the New England Patriots used video cameras to steal plays from their opposition.
And another thing with these pharmaceutical companies. Let's ban advertisements for drugs on radio and TV. Besides this lowering their overhead costs, more importantly it removes the names of all these new drugs from the viewer, who immediately contacts their doctors to get their prescriptions changed over to these newer, patent-protected, more expensive drugs.
Doctors are already being hit up daily with these drug salesmen, keeping them abreast of
any new drug breakthroughs that might be beneficial to you. The removal of these ads also
removes that so-called "impulse" shopping you do when you see them appear on your TV sets. The result of doing this is a lower prescription bill for you, not to mention a more
enjoyable evening of watching television with the family.
The next thing is to renegotiate with Medicare Advantage Plans (of which I am one) to cut back on the monthly stipend they receive for every Medicare person on their roster. The stipend is for taking responsibility of that person's healthcare. The problem with it, as it turns out, is that a majority of those people on Medicare Advantage plans are fairly healthy and have not been requiring health services, so they've been able to pocket the money. Call it the luck of the draw or whatever. But they have been taking a government stipend all of those months and years for just having a name on their list, not to mention a monthly premium from those people to boot. In other words, there IS room to shave back on costs.
And then there is the commonsense way to bringing in more revenue. Walker says Medicare should charge more for those of us who can afford to pay more. Medicare part A is our hospitalization insurance and we pay for that through payroll deductions throughout our working lives, and as a result Medicare subsidizes about 80% of our bills in our retirement. In retirement we then pay a monthly premium for Part B (doctor bills and the rest)... Part C (Advantage Plans that help defray the remaining 20%) and Part D (drug prescription costs) are all voluntary that we have to pay extra for it. Walker says that the vast majority of Americans use this system and why not. As its hard to beat. Walker goes on to say that this may be great for the retiree who scrapes by just above the poverty level but is not qualified for Medicaid assistance, but makes no sense to the middle and upper income recipients. It makes even less sense now that we are at unsustainable deficits. As a result I am suggesting we look into some minor modified adjustments in paying similar in nature to the type suggested in our plan to save Social Security.
The fact is that we all start out in our adult careers, not knowing what the next day will bring, whether our careers will be successful and whether we will end up richer or poorer. Knowing that our government has these programs in place, just in case, is a good feeling that helps us sleep at night, and allows us to forge ahead, take chances and weighing risks as we climb to the top of our fields or professions. But at the end of the day, when the game is over and retirement arrives, the winners have other sources of income coming in from investments, 401K's, IRA's, pensions, you name it and along with it usually comes complete and total private healthcare policies. And for those successful people who still wish to utilize the Medicare program, the cost should be a bit higher than the rest of us. And just as important are the increases in costs to remain a part of this program, which again should be based on a person's income at the time of retirement, just like with my proposals for social security..
Again, these are all just minor modifications but which have a serious impact on the bottom line and that issue of unfunded liabilities. All these suggestions could go a long way toward bringing Medicare back into line, and making things more affordable again.
I would certainly do all these things first and see how it helps, before doing
anything else. And that includes keeping the current 2.9% payroll withholding
for Medicare at its present rate.
