You’re hearing a lot of bashing of government-run health care these days, but notice the bashers don't call out the programs out by name. There’s a reason for that. SCHIP is hugely popular. arguably the best system of care in the country. Medicaid has less of a sterling reputation, but that's largely because no one really understands how it works or who is eligible for what state-by-state. And Medicare? Well, as a new Americans are significantly more satisfied with Medicare than private insurance. It’s time to get back to basics. “Government-run” may be scary to some, but it’s lovable in practice.Single-payer advocates often call their plan “Medicare for All.” The public health insurance option touted by Obama, Baucus and most of the Democratic leaders is usually referred to as “like Medicare.” Clearly there’s magic in the program, but how strong is it? The poll compared the responses of those over 65 with Medicare to a random assortment of those with private insurance. Now this isn’t exactly apples to apples – Medicare beneficiaries in this poll were nearly three times as likely as those with private insurance to list their condition as “fair or poor” (the lowest ranking), almost four times as likely to have multiple chronic conditions, and twice as likely to be 200% of the poverty line or below. To no one’s surprise, Medicare beneficiaries are older, sicker, more in need of care, and poorer – the exact reasons why Lyndon Johnson and JFK wanted to create the program in the first place.But despite their higher needs for consistent and likely expensive care, the magic of Medicare is that it’s more responsive to the customer than private health insurance. 32% of beneficiaries report having a negative incident with Medicare – a number that’s clearly too high and indicative of how much Medicare needs some reforms to improve the program. But that number is 44% for private insurance. Still, we keep hearing Medicare ain’t as good as it used to be. Think of the developments over the past few years that call into question how satisfied someone might be with Medicare – turns out many of them aren’t as bad as we’d think.First, we hear all the time that more and more doctors accept it because of declining reimbursement rates. We’re even warned that single-payer or a public health insurance plan would lost doctors like a leaky boat if the Medicare reimbursement rates were universal. But you know what? Private insurance is worse: “Ten percent of Medicare beneficiaries’ physicians did not accept their insurance, compared with 17 percent of respondents with employer-sponsored plans.” If you want a choice of doctors, you’ve got slightly better odds with Medicare.We hear about frustration with Medicare Part D’s “doughnut hole,” where prescription drug coverage is cut off for many beneficiaries after a certain spending threshold, causing them to pay out of pocket. It definitely has an effect: “Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints.” But that number is over double – 26% - for those with employer-based insurance. Suffice to say, it’s much, much higher for the uninsured.Earlier today, JOHN saying “One of the building blocks of economics is the proposition that people reveal their preferences through their actions and such revelations are far more reliable than polls.” Very well – then explain the consumer preference in Medicare Advantage, where, s, “21% of Medicare beneficiaries enrolled in [Medicare Advantage] plans decide to leave during the year, compared with 9% of those enrolled in other private Medicare plans.”We’re not talking about Canadians, or Brits, or the Taiwanese. We’re talking about Americans – how satisfied they are in polls, and how they show their preferences through their actions. Really, one of the main barriers to reform for years has been that so few of us know people on SCHIP, on Medicaid, at the VA -- not enough to trust the managers of those programs. But all of us know people on Medicare. It has its problems – so does any health care system – but it also has strengths. Lower costs. Better satisfaction. Better health outcomes which, by the way, markets itself aggressively to healthier beneficiaries). That doesn’t seem scary to me.
No comments:
Post a Comment