Looking at the cost of Medical Insurance, who is the winner, the Insurance Providers'!!
Who is the loosers?? Is the Peoples'!!
Who are the one that suffer?? The People!!
Be it Doctor's, Patients', Health Care staffs'....all are people.
The one that who gain the most is those Insurance Providers' & the Presient's & CEO's of these corporations & Drugs corporations.
As Lao Tze said:
Too many rules that help to create the complications of life.
It is time to go back to the basic & emptiness to solve these issues.
Otherwise it would be never end!!
For now, it is for sure that the trend of toward self-diagnostic era as we moving into Knowledge Based Economy!!!!!
Medicare: The next riddle for the ages
By William M. Welch, USA TODAY
WASHINGTON — As President Bush and Congress try to fix Social Security, the other huge federal program for seniors faces insolvency even sooner. But when it comes to Medicare, the politicians have no prescription. (Graphic: Medicare by the numbers)
The national health program for Americans 65 and older faces all the demographic difficulties that have made Social Security the president's No. 1 domestic priority: aging baby boomers, fewer workers paying taxes in the future, and a system that will soon be unable to deliver on its promises. Social Security's fiscal problems escalate in about 2018, when it is projected to begin paying out more in benefits than it receives in taxes; Medicare reached that milestone last year.
Medicare's problems are compounded by soaring health care costs, which are running at more than twice the general rate of inflation. And they're made less predictable by future medical technologies whose emergence, impact and cost are impossible to foresee.
The steps Congress could take now to restrain Medicare's growth are politically perilous. Deny end-of-life care? Restrict eligibility? Reduce treatments? Raise costs? No one in Congress is willing to take them on, and there are few options the public might accept.
"Social Security is merely the warm-up for a very big struggle over how to reform Medicare," says Maya MacGuineas, president of the Committee for a Responsible Federal Budget. She laments that while the Social Security debate is in full throttle among policymakers, Medicare "is a discussion we haven't even started."
Overhaul unlikely this year
The daunting job of fixing the seniors' health care program was underscored last month by Federal Reserve Chairman Alan Greenspan, who told a Senate panel that Medicare is "several multiples more difficult than is Social Security."
Bush said last month that Medicare's problems can wait. "Obviously," he said, "I've chosen to deal with Social Security first."
That's also the preferred order of business in Congress. Lawmakers voted in 2003 to add prescription-drug coverage to Medicare, a program now estimated to cost more than $700 billion over 10 years. But Congress has not proposed any way to slow Medicare's growth.
"Social Security is solvable," says Sen. Lindsey Graham, R-S.C., who's trying to bring together Republicans and Democrats for a plan that includes new private investment accounts. "I just don't know how to do Medicare."
More than 41 million Americans depend on Medicare to pay for doctors' visits and hospital bills. Beginning next year, it will cover part of their prescription-drug bills as well. The program's $325 billion cost is dwarfed by the $517 billion spent on Social Security. But Medicare is projected to grow by 9% a year through 2015, while Social Security's annual growth rate is estimated at 5.6%. By comparison, general inflation is projected at 3.2%.
Political considerations make it unlikely that Bush or Congress will try to overhaul Medicare this year.
By tackling Social Security instead, Bush is addressing a longtime ideological goal he has held since at least 1978. It also has been gaining momentum among conservative Republicans; they envision a nation of investors who will share other Republican goals, such as reducing or eliminating taxes on capital. They also see it as a way to appeal to voters in their 20s who may not be thinking about retirement but who stand to gain the greatest return from investment accounts.
Bush just won a hard-fought victory on Medicare in 2003, when the prescription-drug benefit was added. He wants it to take effect next year before making further changes and has no interest in reopening a battle he already won. Bush argues that treating more diseases with drugs will reduce future medical costs. But the Congressional Budget Office projects no net savings to Medicare as a result of the drug benefit.
Solutions carry risks
Treasury Secretary John Snow agrees that Medicare is a bigger problem than Social Security, "with the added complexity of rising health care costs." He says the administration is tackling the problem with proposals to encourage people to save money to pay their own health care bills, and to limit medical lawsuits. The problem, he says, is escalating costs throughout the entire health care system.
"Medicare is an important issue and does present the country with significant long-term fiscal issues. It's a very large potential liability we face there," Snow says. "We're not overlooking the problem by any means. We're addressing it."
As President Clinton discovered in 1993-94, restructuring the USA's health care system is difficult. Imposing sharp cost-saving limits on health care to seniors is likely to provoke a backlash from Medicare patients who find themselves denied life-extending treatments that are available to others who can afford them.
"Society is not likely to tolerate large discrepancies in health care for different groups," says William Gale, an economist at the Brookings Institution, a think tank. "We're not going to stick seniors with year 2000 health care quality while the rest of us are enjoying 2050 health care quality."
There are a number of lesser steps that have been suggested to restrain Medicare's cost. But each has a downside that makes it politically unlikely:
•Cut payments to doctors, hospitals and other providers. Congress has regularly cut payments to providers other than drug companies and has faced pressure to repeal those reductions. If federal payments are cut too much, doctors could refuse to treat Medicare patients, just as some decline Medicaid patients.
Congress imposed a formula in 1999 that sets physicians' rates based on spending targets, but it usually sets aside the targets. Medicare was supposed to spend $77 billion on physicians in 2004 but spent $85 billion. To avoid physician rate cuts of 4.5% in 2004 and 3.3% in 2005, Congress voted to give physicians an increase of at least 1.5% in both years.
•Increase seniors' premiums, deductibles or co-payments. For many seniors, Medicare premiums and health care costs not covered by Medicare consume a big share of their Social Security checks. Actuarial studies by Medicare show that on average, premiums and cost-sharing amount to 34% of the average Social Security benefit.
Medicare patients now pay $78.20 a month, deducted from Social Security checks, for Medicare supplemental insurance (Part B) that covers doctors' visits. That covers 25% of the program's cost; the government pays the rest.
Medicare's hospital coverage (Part A) has a deductible of $912. The Medicare prescription-drug benefit, which starts next year, is expected to include premiums of about $37 per month and a $250 deductible.
•Reduce the number of treatments that Medicare will cover. Eliminating coverage of expensive, high-tech treatments could produce a backlash when recipients are denied care.
Medicare now covers all medical treatments that are "reasonable and necessary," regardless of cost. The new prescription-drug benefit will even cover Viagra and other impotence drugs. Previous efforts to let Medicare consider cost in determining what is "reasonable and necessary" were unsuccessful
•Restrict eligibility. Congress could raise the eligibility age from 65 to 67, to match Social Security. That would save Medicare $28 billion a year and reduce the number of beneficiaries by 11%, according to the Urban Institute. But it would hit low-income workers hardest, leaving many 65- and 66-year-olds without health insurance, the study found. The political pressure is in the opposite direction — to make Medicare available sooner to people who want to retire early from jobs that provide health coverage.
•Adopt free-market solutions. The president and Republicans in Congress want to use competition — between insurance plans, doctors, hospitals and within the pharmaceutical industry — to bring down medical costs. They also favor expanding tax-deductible health savings accounts that will let consumers finance more of their medical expenses from their own savings. The 2003 Medicare law provided incentives to steer seniors into managed-care plans backed by Medicare, such as HMOs. But those incentives were expensive, and the government pays more to cover a senior in an HMO than for one in traditional Medicare.
•Improve efficiency. Computerized records and other technology, slow to come to medicine's front lines, hold the promise of savings. But they are not likely to bring significant change immediately.
The biggest challenge
The real answer for Medicare, many on both sides argue, lies in improving the nation's entire health care system. Determining which treatments work best and are most cost-effective, and eliminating coverage of treatments deemed ineffective, could produce savings and improve medical outcomes. Treatments that can extend and improve life at age 70 might not be as good a bet when a patient is 90. Yet limits on care could trigger a strong reaction from those who find themselves or their loved ones unable to get treatment.
"The problems affecting Medicare and Medicaid will be much more difficult to solve than Social Security," says David Walker, comptroller general of the United States and head of the Government Accountability Office. "We need to reconsider how we define, deliver and finance health care in this country, both in the public and the private sectors. We need to weigh unlimited individual wants against specific societal needs."
Contributing: Dennis Cauchon
USATODAY.com - Medicare: The next riddle for the ages
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