Category Archives: Healthcare Reform

Medicare Reform: Vouchers?

Medicare Reform – Vouchers – Viable or Not?

Is this simply a shift of the crisis from the Federal Budget to our Senior’s Budgets?  I have other concerns too.

The budget proposed by Representative Paul Ryan, chairman of the House Budget Committee, includes a proposal to replace the current Medicare health insurance for the elderly with a voucher given to those newly eligible for Medicare after 2022. Seniors could use that voucher to purchase health insurance on the open market. From the standpoint of budget management this has clear benefits. Congress can decide how much they are willing to spend on these coupons, disburse them to our older Americans, and carry on with trying to balance the budget.  In estimates I have seen this essentially shifts the escalating costs of health care from being a budget dilemma for the federal government to a budget dilemma for many older Americans, who could end up spending a much higher portion of their Social Security check each month on health insurance premiums than they would under the current Medicare plan.  Besides this cost shift, I have other major reservations about this type of plan.

  1. How will the issue of getting health insurance when you turn 65 be managed if you have major ongoing health problems. If you have cancer, advanced coronary disease, or any of numerous expensive medical conditions, will you be able to automatically enroll in any participating plan, or will some plans be able to exclude the sickest older Americans, leaving the “sick pool” of patients to buy more expensive plans, or not find insurance at all.
  2. How will emergency rooms, hospitals, etc. deal with older Americans who decide not to buy health insurance with their coupons. Will there now be a big new segment of Americans who are uninsured, those elderly who feel they cannot afford the difference between the coupon amount and a health insurance plan? If so will hospitals be required to accept these patients knowing they cannot be paid?
  3. What criteria will the government use to decide on the amount of the coupons? Will it bear any relationship to the actual cost of the insurance plans available to seniors, or will it be based on some other predefined schedule? If so I can see our seniors put in a position very similar to the one physicians have been facing with unacceptable premiums leading congress to put in place temporary fixes like the ones we read about every few months.
  4. Will insurance plans for seniors be truly free market options, or will there be mandated coverage of various services. I can see great political pressure from various constituencies to get their services covered. Examples might be chiropractic, physical therapy, prescription drugs, or diabetic supplies. Will seniors be able to purchase a plan tailored to their needs, or will everyone be forced to purchase a one-plan-fits-all type plan. For some with a high net worth a catastrophic health care plan with a high deductible might be the best option. For others this would not work at all. If the cost of a catastrophic health care plan is less than the coupon cost, could the senior put the excess in an health savings account?

I’m sure many of you have other issues, but these questions make me very reluctant to be in favor of scrapping the current Medicare plan and simply offer our seniors a voucher to use to buy their own health insurance.

I’d love comments on this post to start a discussion of this topic.

Health Care Reform is the Topic of Grand Rounds This Week

Walter Jessen at Hightlight Health blog hosts Grand Rounds this week and does a very nice article outlining the next 4 years of the Patient Protection and Affordable Care Act year by year and integrating the featured articles of the week.  You’ll see a number of the best blog posts of recent weeks, including the… Continue Reading

Catastrophic Plans May Save Even When Catastrophy Happens

For years our family has elected to have a high deductible, catastrophic coverage health insurance plan with a Health Savings Account contribution.  As a partner in my medical business I essentially pay the premium for belonging to the company group insurance plan, and the premium for my wife, myself and my college age son for… Continue Reading

Can We Induce Patients and Primary Care Physicians to Execute Advance Directives and Medical Durable Power of Attorney Documents

You Get What You Pay For Primary care physicians have come under criticism because they have not counseled their patients and encouraged them to execute an advance directive and a medical durable power of attorney.   This is felt to be a factor in the leading to the large percentage of the dollars spent by Medicare… Continue Reading

Individual Mandate Precedent

History buffs and constitutional scholars, check out this article on The Health Care Blog.  It notes a mandate for early American citizens to outfit themselves for the militia, and compares this to the mandate in the recent health care act to purchase private health insurance.  The constitutional challenges will likely need to consider this precedent,… Continue Reading

What if All Americans Had at Least Catastrophic Health Care Coverage

I really dislike the term healthcare reform.  I think our system needs to be changed not reformed.  I assume that I am not the only person who suspects that the recent health care reform act is not going to be the final solution for America’s health care problems.  The cost of healthcare is not really… Continue Reading

How Can We Encourage Medical Students to Choose Primary Care?

A Radical Suggestion – Pay Specialists Less Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.    It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose… Continue Reading

Comparing Enactment of Medicare to Health Care Reform of 2010

Continuing with my series of weekend reads,  you’ll enjoy this one from The New Yorker   Atul Gawandi writes a historical article about the reaction of the medical community, the segregationist south, and others to Medicare first being written into law in 1965.  It is interesting to see how he relates this to the health care… Continue Reading

Medicare to Cover Preventative Care

A nice surprise buried somewhere  in the Health Care Reform Bill is that starting next year Medicare patients will be able to get annual preventative care exams that are paid for by their health insurance. It may come as a surprise to those of you with commercial insurance who think of  coverage of an annual… Continue Reading