This article discusses how premature mortality before age 65 years has varied over time and by race. Since Medicare is financed by payroll taxes but benefits begin at age 65, premature death cheats people who die prematurely.
Both whites and blacks had increases in premature mortality between 2012 and 2022. This includes the Covid pandemic. There was a lot of variation between states.
Between 2012 and 2022, mortality among adults aged 18 to 65 years in the US increased by over 27%. During this period, racial disparities in premature mortality widened substantially, with Black individuals experiencing persistently higher and worsening rates compared with White individuals across most states. Age- and sex-standardized mortality rates increased by 38.2% for Black adults and 27.7% for White adults. Thatâs really shocking!
The authors suggest that Medicare eligibility should be younger for Blacks so their coverage would be fairer, but of course thatâs not going to happen. Even without extending coverage Medicare will run out of money within 10 years.
I wonder what the numbers would have been like without the Covid pandemic.
A more straight-forward solution is to abandon private health insurance, and implement a Medicare-for-all solution. There would be issues with reimbursement rates (doctors wonât like it), but then nobody is cheated out of anything. Cradle to grave coverage.
Obviously, it wouldnât be free. Though the funds directed at private insurance would be redirected to Medicare, so not as expensive as one might think. Also, young people tend to consume a lot less medical care than older people.
Probably not. Iâve been hearing âMedicare is headed for a cliffâ almost my entire adult life. Also, SS. Still no cliff in sight.
And itâs pretty easy to fix. First, direct all the monies from healthcare insurance companies into Medicare instead (which I alluded to in my previous post). Know that Boomers are dying off, and the unusually high demand at this time will abate as they expire. Iâm at the tail-end of âBoomersâ, and I can expect another 20 or so years. Maybe 30. But demand reduction will occur well before that as the older (and more numerous) Boomers expire.
Wendy said it is very contentious, but not that it is a particularly hard problem. If I was emperor, it would be fixed by next week (I would want to take time to get it right).
Or, it would be like fixing our broken immigration system by increasing the budget by 300%.
Clearly, throwing more money at a problem occasionally seems to work.
Now, if we could get the Admin to care about the health of citizens as much as they do about illegal immigration, we might be able to find a solution (and one that obviously will cost more to solve - like immigration).
Depends how you do it. Medicare has the lowest overhead of any other health insurance out there. By a lot. It helps when you donât have to pay CEOs and shareholders and armies of adjusters to deny claims.
Of course covering more people will cost more. Thatâs just numbers. Including ~40M more people who presently donât have anything (since the ACA subsidies appear to be dead) will not be free. Saving money by excluding them is saving money, but itâs also âcheatingâ if you are going to compare budget scenarios. We could save a fortune if we killed Medicare and SS, compared to continuing to fund them. Itâs true. Itâs also a really bad idea.
Cover everyone, raise taxes as necessary to do it. Preferably not a VAT, as that would be a hardship on poorer people.
All you really need is a Medicare Public Option. Youâre always going to have people who are bad at arithmetic who will buy private health insurance. Freedom is letting them make bad decisions.
Sure - because if you were emperor, you would be able to âraise taxes as necessary to do it. Preferably not a VAT, as that would be a hardship on poorer peopleâ without limitation.
However, since we donât have an emperor, you canât have this kind of system unless you get political buy-in to âraise taxes as necessary to do it.â Which has always been the obstacle, which is why it is a hard problem to solve.
Nonsense. If you understand arithmetic, you wouldnât need to raise taxes.
To give you an easy to understand example, take Medigap insurance.
CMS does all the accounting and benefit administration for Medigap. All the for-profit insurer does is pay what Medicare tells them to pay, and conduct a sales & marketing operation to sell the policies. The for profit insurer adds a 20% skim rate to the actuarial risk for this completely useless activity.
Medicare could offer you a Medigap policy for 20% less and it would just be a box to check when you signed up for Medicare. No need to screw with an insurance salesman. That the public doesnât have this simple option is a measure of the complete corruption of our current system.
If you expand Medicare to everyone, someone has to pay for all the people who arenât currently paying for insurance to now get complete coverage. And someone has to pay for all the folks who are currently getting health coverage at Medicaid rates to now start getting coverage at Medicare rates. And someone has to pay for all of the Medicare coverage to be improved to the standard of typical workplace plan - typical Medicare has an actuarial value of somewhere in the mid to low 80%âs, while employer plans are just under 90%. To say nothing of the fact that medical providers and hospitals will go insane if you slash their reimbursement rates down to Medicare levels - private insurance pays anywhere from 143% to nearly double Medicare rates. So the tab goes even higher if youâre not willing to slash the budgets of nearly every medical provider in the country that takes private insurance:
Taken together, itâs very expensive to shift from private insurance to a Medicare for All type plan - which is why none of the states that have made serious efforts to implement that kind of switch were successful.
What are you talking about? Traditional Medicare is going to be the best health plan most employees ever see. Most health plans today come with the âprior authorizationâ nonsense that people hate.
But like I wrote upthread, you donât have to convert everyone to Medicare for all. Just give us a Public Option run by CMS and let the for profit insurers compete against that. The insurers will always be able to scam a large portion of the public and a big private sector would still be intact.
Medicare Advantage is the perfect example of that.
The way insurance works, as you add more healthy people into the mix, the cost comes down. Also, if we move to single payer, lots of paperwork could come down.
Only for the health insurance industry. Some 70% of the public do not find this contentious at all.
SS runs out of money. Medicare has been costing the budget all along.
They want to end Medicare. Then again, no social programs, no taxes, no debt, and no FDIC. Listen to your garage mechanic. Donât judge his IQ. He believes.
Traditional Medicare only has an actuarial value (percent coverage) of around 82%. Private employer plans have an average AV of about 89%. So you canât just move people from the latter programs onto Medicare - you have to increase Medicare coverage levels to match those of current employer-based programs. Which adds expense.
Traditional Medicare has program admin expenses of 1.2%-1.3%, while private employer plans average 10% or more, plus what they can price gouge you on prescription drugs through the insurerâs captive Pharmacy Benefit Manager. That more than makes up for the difference in âactuarial valueâ.
With private insurance, youâre buying âskim, scam and fraudâ, plus more time on the phone arguing with the insurer to get the health care you paid for.
Not albaby1, of course, but to my laymanâs eyes, isnât actuarial value just a simple way to show how much of the average medical costs a health insurance plan will pay? If a plan has an actuarial value of 80%, for example, it means the insurance company will cover about 80% of the typical medical bills, and you would pay the remaining 20% out of your own pocket through things like copays and deductibles (It doesnât mean you will pay exactly that amount every time, of course, but on average for a group of people, thatâs the split between the insurer and patient costs.).
So, when someone says Medicare has an actuarial value of 82%, it means Medicare pays about 82% of covered healthcare costs on average, leaving 18% for the patient to pay. Employer plans that have a higher actuarial value (like 89%) cover a bigger portion of costs, so moving people from those plans to Medicare would mean they might have to pay more out-of-pocket unless Medicareâs coverage improves. If this 82% is actually the costs of Medical Advantage programs v. traditional Medicare that is say 89%, it obviously means another group of calculations.
The actuarial concept helps compare how generous different health plans are in covering medical expenses. At least thatâs my understanding.
