Yes, at the individual level, you find confused customers in any area of life, whether it be buying cars, buying a house, or selecting from health insurance options. But the law of large numbers tends to indicate if something is a good deal or not. And currently about 1 in 3 are taking Medicare Advantage:
The kaiser link mentions that they expect it to be about 40% in 2027. The Advantage plans, available through these “evil” private insurers, must be a decent deal.
Without commenting about MA (which I know exactly nothing about), this seems like a really bad argument. You could make the same argument about things like payment acceleration or student loan reconsolidation services.
I didn’t use the word “evil.” I have no objection to the existence of MA.
I do not agree that popularity means it is a decent deal. I think if an item is advertised extensively and another item is not, the one that’s advertised extensively is likely to gain market share and the other item is likely to lose it. This is why advertising exists. FFS Medicare is likely to continue to lose market share as people becoming eligible for Medicare have greater familiarity and comfort with managed care, seek OOP maximums that are not available with FFS Medicare without Medigap, seek the limited supplemental benefits (that are going to be extended next year) that are not available in FFS, and get a barrage of targeted advertising for MA plans.
Whether these items add up to a good deal for any given individual is not my decision to make. Whether people actually understand for themselves if it is a good deal is very much in question. Whether people have awareness of or access to the resources they need to make the decision is not in question–they don’t. Medicare Plan Finder is laughably bad. SHIPs are amazing resources but underfunded. Medicare FFS does not advertise (though Medigaps do) and recent changes in Medicare literature has skewed toward MA; last year, CMS didn’t even mention FFS in some of the literature about open enrollment.
FTR, I work in health care policy, specifically Medicare, so I tend to view threads like this as more work–and therefore unappealing–unless someone is asking interesting questions. This will likely be my last post on the topic of MA (which is good as it is off topic for the thread).
Magiver, how long did you have to wait when you came down with cancer? How long did you have to wait when you got hit by a car and paralyzed from the neck down? How long did you have to wait when your kid developed a rare and incurable autoimmune disorder? What’s that, you don’t know, because none of those things have happened to you? Be thankful for that, but what if they do? Catastrophes like that are the very reason why insurance exists, but the vast majority of people, those who haven’t yet had such a catastrophe, don’t know how well their insurance will react to it.
You make some good points. I used the “evil” kind of as a joke, since some others on the thread really don’t like private insurance at all, best I can tell. I didn’t mean to come across as a jerk.
My view on Medicare is that it’s a good program that should be maintained and well-funded. Most doctors accept it, and people who are on it seem to like it. There are a fair number of Medicare enrollees who also get supplemental plans, and a growing and large % who get advantage. This makes me think that basic medicare has some holes where the private players can come in and help. You’re right that advertising influences the %'s, and that people can become confused, as healthcare isn’t exactly an easy topic. But I just have to think that with 1/3 of enrollees now taking Advantage, there must be something there that’s good. Some advantage plans offer extra benefits that basic medicare doesn’t cover, such as dental & vision. This might tip the scales a little. I don’t know.
Since you work in healthcare policy, what’s your view on the ACA? I think the ACA, though it was kludgy, was mostly well-written, and had a good logic behind it. If the states would all accept the Medicaid expansion, and congress would make the subsidy formulas better for lower-middle to middle class, I think we would get to almost full UHC.
wolfpup’s already dealt with this, but it bears repeating: in the UHC system he and I are both familiar with, the Canadian system, bureaucrats aren’t involved in making those decisions on a case-by-case basis, unlike the apparent powers of private insurance agencies in the US.
The government and the doctors negotiate the compensation list for all procedures, and if a procedure is recommended by the doctors as meeting their professional judgment, useful in appropriate cases, it goes on the list. The dickering is about the compensation for that item.
But once it’s on the list, the decision whether to use it is left to the doctor and the patient; the doctor’s professional judgment and the patient’s decision whether to undergo the surgery. The Medicare officials don’t have to be consulted and can’t override the doctor’s recommendation. The doctor does the surgery, puts in the claim, and gets paid.
Is that how it works with private insurance in the US? Or does the insurance company have the power to reject the claim because it disagrees with the doctor’s recommendation?
You seem to assume that it’s like a flat hourly rate for all surgeries, regardless of complexity. 
The compensation list for procedures is very detailed. The more complex the procedure, the higher the fee. And, it’s not like the government can just set the fee by diktat. It has to negotiate with the doctors, knowing that there are 12 other provincial/territorial systems setting the fees for that procedure in their jurisdictions. They have to keep competitive. And then there’s the US, just to the south; and Australia, and New Zealand…
Canadian healthcare systems have to pay fees that keep doctors working in Canada.
Plus, it’s not the Medicare officials who grade the doctors. Again, that’s left to the professional judgment of the doctors themselves. The College of Physicians and Surgeons in each province is responsible for regulating doctors. If a doctor wants to perform certain types of surgeries, the doctor has to get certified for that surgery. The more complex the surgery, the harder it is to get certified, after going through training. So yes, I’m pretty confident in the skills of brain surgeons in Canada.
And that level of confidence has nothing to do with out single-payer system, but with the regulatory requirements of the College, to ensure doctors are competent.
BTW, here’s the latest estimate of uninsured %'s in the USA. It comes from the CDC:
We have 9.1% uninsured over the entire population as of the end of 2017, which is about the same as the prior year. That includes 5% for ages under 18, 12.8% for ages 18-64, and then ages 65+ it’s essentially zero. I predict that will increase in 2018, as the Trump attacks on the ACA & Medicaid continue.
So now poster gtyj has changed his name to survinga. Yeah, that’s sure to add clarity to all the complicated back-and-forths in this thread. :rolleyes:
At least I can pronounce “survinga”.
Sorry, although I think you’ll get over it. I hated the first name, and figured it was better to change now, rather than wait until I had hundreds or even thousands of posts. Note that I did put it in my signature, so people would know I wasn’t doing something sneaky (like changing my name, and pretending to be someone else).
I almost lost my leg. Does that count? It was only repeated on-demand appointments with doctors, specialists, surgeons and diagnostic equipment that saved it.
For years, yes YEARS I had to listen to someone with Canadian parents tell me about the delays that destroyed their health. Imagine waiting so long for bypass surgery that your parent deteriorated to the point they were too weak for the surgery. this is a simple, easily available surgery in the US.
But we can talk about delays in cancer treatments in the UK. “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”
Everybody I know who had cancer treatment got immediate attention. So I’m not hugely interested in anymore arguments about diagnostic equipment sitting idle. It’s a big deal to have to wait for stuff like this.
Oh, and one of those cancer patients I mentioned was on medicaid.
FTR, I wasn’t accusing you of doing anything “sneaky”, but it does make the already-complicated dialog here much harder to follow, since all the responses to your original name still contain that name, that’s all. The discussion is already hard enough to follow with all the obfuscations and digressions.
Yeah, I know you weren’t accusing me of being sneaky. I was just throwing that comment in there, because some people do that on message boards.
If I lived in the USA and wanted treatment for cancer my wait time would be infinite, because I don’t have tens of thousands of dollars handy. Normally I’d go more in-depth into what you’re talking about but right now I have neither the time nor the patience to do more than point out that the story behind wait times isn’t nearly as simple or clear-cut as you’d point out, even after you factor in the fact that for someone who cannot pay for it, the wait time for treatment is effectively infinite.
That’s for sure. When you even approach 65 your mailbox is filled with the things. And they are one stop shopping, often offering dental and vision plans also.
I investigated them, and rejected them because none included my current set of doctors. One does now, but I’m very happy with the Medigap plan I have.
I don’t work in healthcare, but almost felt that I did when I was figuring out Medicare. It is complicated, and I hate to think what people who don’t have PhDs make of it. And I needed Medicare for Dummies.
I actually cane into the process thinking I would choose an MA plan. However the plans for my area had very skimpy provider networks, and there was a big issue about coverage when traveling.
But I can see why people do it - you pick one provider not one for Medigap and other for Part D and others if you want dental and vision insurance. I never got to a real price comparison because of the coverage issue.
You worry about doctors taking Medicare, but a hell of a lot more do than take any given MA plan. I guess if my doctor were in the network it might have come out differently.
Yeah, having all of medical, rx, dental, vision, under one roof kinda makes sense, and that would seem to explain why so many do the MA plans. The networks probably make some MA options unattractive though. I could understand why you didn’t pick an MA plan.
I don’t have tens of thousands of dollars handy either yet I had open heart surgery. What I didn’t have were delays in appointments, diagnostics or surgery. I was able to choose the specialist and surgeon.
The cancer survivor on Medicare I mentioned didn’t have tens of thousands of dollars either. Still alive because there were no delays in treatment.
On helping poor people I agree with Liberals 100%.
Imposing higher taxes on millionaires would save countless lives of poor people.
Fortunate for you. There are many who do not have as good of insurance. Even many who do have insurance and are “happy” with it, would discover that they would not be able to get any surgery by and doctor paid for by their coverage.
BTW, when you say that you were able to choose your medical team, do you mean that you looked at all the specialists in the country, ranked them by your discriminating criteria, and made a decision based on that, or that they gave you a list of a few surgical practices in their network that you got to choose from?
Sounds like a great argument for a government administered healthcare system to me.
Though, slightly confused. In your previous post, you said Medicaid. Now you say Medicare. Both are govt run programs, so both make sense to reference, but there are differences, which is it that you are talking about?