MEDICARE FINANCES

The problems with the future financing of Medicare are well advertised and have been known for decades.  I do not support the proposal to do away with Medicare entirely and replace it with a "voucher" system.  Instead we must reduce the costs of Medicare.  One component of the $716 billion in expenses "removed" by Obama from Medicare, the so-called "Doc Fix," of reducing the payments to physicians was always unlikely and is now gone.  Hospitals, however, had agreed to cutting their costs because of increased patient "flow" from Obamacare.  There has been resistance to other cuts which were called by insulting names like "death panels" and "rationing."*  About the only cut in Medicare services proposed likely to pass is raising the age of eligibility from 65 to 67, but this could be self defeating by leaving a large group of people without health care and pushing them into emergency rooms, the highest medical cost option.  At times there is mention of tort reform to cut the costs of "defensive medicine," but this proposal never seems to gain traction.  I would hope this would get done.

More than a decade ago, a writer's group of which I was a member was nearly entirely composed of seniors.  Once we had a discussion concerning what cuts in Medicare did we think we could live with.  The unanimous choice was "rationing" of major operations, say a limit of one each of heart, liver, lung or kidney transplants and two hip or knee replacements per patient.  So far as I know, no politician has proposed such a limit.  Yes, this is rationing, but Medicare is full of rationing already as I have discussed before.**  More recently, I recently got a shot for shingles.  These are not covered by Medicare and cost me $225, but I know of five people who have had shingles, including my wife, and it is serious business.  One friend lost an eye to it, and another was on heavy doses of pain killers for a year.  I think that ultimately more rationing is inevitable.

I don't know how we get to this point, but "fixing" Medicare is going to require a stop to trying to gain political points through unpleasant names and false accusations*** and both political parties are going to have to jump off the "cliff" together.****

* http://stopcontinentaldrift.blogspot.com/2012/12/death-panels-715-billion-from-medicare.html
** http://stopcontinentaldrift.blogspot.com/2011/05/medicare-rationing.html
***  http://stopcontinentaldrift.blogspot.com/2012/10/dr.html, http://stopcontinentaldrift.blogspot.com/2012/10/the-obamacare-committee.html
**** http://stopcontinentaldrift.blogspot.com/2011/02/after-you-alphonse.html

MEDICARE & RATIONING

Democrats were flushed in the 2010 election over accusations by Republicans over calling end-of-life consultations Death Panels* and that Democrats were going to ration** health care. Because Democrats were willing to do something to control health care expenses, it was time for both parties to get together and do something. Alas, the Republicans demagogued it. But there was a lot of rationing in Medicare long before the controversy in the 2010 election.

For example will Medicare cover cosmetic surgery?

Sorry, but most likely no - Medicaid pays only for diagnosed conditions, none of which those address. The surgery must address a diagnosed condition or illness and your claim that you will be psychologically damaged would need to be corroborated by an independent psychologist. And even then, I would hazard a guess Medcaid would deny the claim without a ton of supporting tests and possibly a second opinion.

How about Chiropractors? Only for subluxation of the spine.

https://questions.medicare.gov/app/answers/detail/a_id/303/~/does-medicare-cover-chiropractic-services%3F

How often can men get a PSA examination or digital examination under Medicare? Once a year.

http://www.medicare.gov/navigation/manage-your-health/preventive-services/prostate-cancer-screening.aspx?AspxAutoDetectCookieSupport=1

How often can women get a mammogram? Once a year for women over 40!

http://www.eldercareteam.com/public/648.cfm

These are some rationing actions by Medicare that I know about.

Please note that there will always be rationing of health care because the wealthy can afford more health care than the rest of us. And the very wealthy can even self insure.

To preserve some basic coverage in Medicare, more rationing will be necessary which I view as being far preferable to doing away with it by converting to a voucher program. About 15 years ago, we discussed what we might give up in Medicare to preserve it. The unanimous opinion was to put a cap on expensive operations such as organ transplants and perhaps solid body parts (spine, hips, knees).

* http://en.wikipedia.org/wiki/Death_panel

** http://www.nytimes.com/2010/12/26/us/politics/26death.html