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We
haven't really explored one of the lingering issues
emerging from the more civil discussions on the several
bills before
Congress
to reform the American system of health insurance: Will
it be good for the 45 million Americans on
Medicare
?
We've
discussed the possibility that the
Congress
will eliminate the special subsidies for
Medicare Advantage
insurers, which could raise the cost of these policies.
This could strengthen traditional
Medicare
and hold Part B premiums down.
However,
the cynics who have sought the death of
Medicare
now have the chutzpah to protest these cuts as a threat
to
Medicare
. But Dr.
Howard Dean
points out that those
$176 billion
in subsidies will be saved for the beneficiaries of
Medicare
and the reforms. More important, this may be the
beginning of the end of efforts to privatize
Medicare
that these cynics pushed.
Aside
from that issue,
Medicare
advocates have worried lest this most popular health
insurance program gets mangled in the maelstrom over
health insurance reform. Many of those people screaming
against a "public option" seem to forget that
Medicare
has been working fine as a public option for 44 years
(along with Veteran Affairs and
Medicaid
).
But
because of fears about
Medicare's
future,
AARP
— in special mailings to members and on its Web site (aarp.org/getthefacts
or call 800-497-1967) — says "none of the care
reform bills that have been introduced would cut
Medicare
benefits or increase your out-pf-pocket costs for
traditional
Medicare
services."
AARP
supports gradually eliminating subsidies to private
insurance companies, including
UnitedHealth
. And despite
AARP's
profits from selling
United's
insurance,
AARP's
literature supports a public option that would compete
with
United
and other insurers.
The Center for Medicare Advocacy
(medicareadvocacy.org) is more explicit. Its newsletter
says, "Eliminating these subsidies will end
cost-shifting from private plans to the larger
Medicare
program and will put the traditional program back on a
'level playing field' with the private plans. It should
also help reduce the increases in Part B premiums
..."
The
center, which provides legal help for
Medicare
enrollees, also says most of the reform bills would
postpone scheduled 21 percent cuts in physician payment
and change the payment formula to emphasize primary
care. While
Medicare
covers most cancer screening services, the bills provide
that beginning
Jan. 1, 2011
, no deductibles or co-payments will be required. And as
of this January, all vaccines will be covered under Part
B.
Most of
the bills would also provide more help for low-income
beneficiaries using Part A (hospitalization), Part B
(outpatient visits) and prescription benefits by raising
the amount of assets they may retain to be eligible for
low-income subsidies. Most bills would gradually
eliminate the "doughnut hole," the Part D
coverage gap during which many pay the full price for
drugs.
During
the current struggles in the
Congress
, the more liberal House, with a bill proposed by three
committees, and the more conservative
Senate
, with two committee bills, will sort out the
differences under the eyes of the
White House
, which may weigh in as the legislation comes to the
floor of both houses this fall. It's possible there will
be other
Medicare
improvements, such as ending budget restrictions that
stunt
Medicare's
growth, and permitting
Medicare
to bargain for the best Part D drug prices.
The main
question on health reform, so far, is whether the final
bill will include a strong
Medicare
-like public option among the private choices. If it
does, most experts believe that it will help strengthen
Medicare
as a model that could eventually cover all Americans.
That's the reason the drug and insurance industries
oppose a
Medicare
-like public plan.
Along
with thousands of doctors, nurses and other health care
professionals, the AFL-CIO has been a powerful supporter
of
Medicare
for All, which carries with it the cumbersome name
"single-payer," that is often misunderstood.
It merely means that in the case of
Medicare
, the government pays the bills.
The
labor-affiliated
Alliance for Retired Americans
, whose predecessor, the
National Council of Senior Citizens
played a leading role in winning
Medicare
, was organized as a more aggressive voice for retirees
(retiredamericans.org). The alliance is among the
advocates worried that
Medicare
has been maligned in the current battle.
Finally,
here's the official administration site on
Medicare
and the reforms: healthreform.gov/reports /medicare/index.html.
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