Fears of Medicare cuts escalate health care debate
By Rob Hotakainen, McClatchy Newspapers
Monday, September 14, 2009
WASHINGTON — Roger Raines is worried that he will lose access to his doctors if President Barack Obama has his way.
The 66-year-old Sacramento man has survived male breast cancer, diabetes and congestive heart failure. And he pays $480 a month to a private insurer to supplement his Medicare, getting extra benefits by enrolling in an increasingly popular program called Medicare Advantage. He doesn't want to be pushed into the regular Medicare program.
"If they cut from Medicare Advantage, I won't be able to keep my own doctors," Raines said Friday.
Fears of Medicare cuts are providing more fuel for the already hot national debate over health care. While Obama is promising to make no cuts in traditional Medicare benefits, it's clear that big changes could still be in the offing.
So far, Obama has been hazy in saying exactly how he would save billions by going after the always nebulous waste and fraud in Medicare. But he has been very clear in saying that he wants to get rid of $177 billion in subsidies for Medicare Advantage.
"Insurance companies basically get $177 billion of taxpayer money to provide services that Medicare already provides," Obama said at a town hall meeting in New Hampshire last month. "And it's no better. It doesn't result in better health care for seniors. It is a giveaway of $177 billion."
Obama said it would make more sense to use the $177 billion to provide coverage to the uninsured than to subsidize insurance companies.
Raines is one of more than 1.5 million Californians enrolled in Medicare Advantage plans. Those plans account for 34 percent of the overall enrollment in Medicare, giving the Golden State one of the highest enrollment rates in the nation.
Overall, more than 10 million -- or 22 percent -- of all Medicare recipients are now enrolled in Medicare Advantage plans. The private programs became popular during the Bush administration and were designed at injecting competition into the Medicare system.
Critics say it would be a mistake to end the subsidies for the private plans.
"These plans offer seniors more flexibility and treatment options than regular Medicare, including better preventive and coordinated care," said House Minority Leader John Boehner of Ohio. "But thanks to these cuts, millions of seniors will be forced into a government-run plan with fewer choices and lower quality care."
Listening to all the talk in Washington, Raines figures he's sure to be on the losing end if Congress adopts the president's $900 billion overhaul plan.
"I just feel that they're going to take stuff away from me to give to somebody else," he said. "That's exactly the way I feel."
For starters, he said, he's skeptical that Congress and the president will ever be able to achieve much in Medicare savings by focusing on abuses in the system.
"They say they're going to pay for this by finding all these billions of dollars in fraud, which they haven't been able to do yet," Raines said. "So I don't really see any success. If they haven't found it in the last 30 or 40 years, they're not going to find it in the next 30 or 40."
Raines said Medicare Advantage has been a lifesaver, allowing him to keep the same doctors that he had before he retired as an operations supervisor for Sacramento County. He says he doubts that he'd be alive if he had been forced to go on traditional Medicare and change doctors.
And he said watching politicians debate the issue has been frustrating.
"It gives you a real sense of frustration," Raines said. "They just figure they have to do it. It's a party thing. You've got the Democrat Party wants to do it and you've got the Republican Party that doesn't want to do it. I don't think either one really knows what's going on or what they should do."
McClatchy Newspapers 2009
Coordinated Care Facts
In 2007, Medicare Advantage saved seniors nearly $90 per month or $1000 per year in out of pocket costs. An estimated savings of approximately $7 billion annually. Additionally, compared to traditional Medicare, Medicare Advantage plans can reduce out-of-pocket costs by up to $4,000 annually for patients with the highest healthcare needs.
- Comprehensive Care: Patients receive integrated treatment plans, and expert case management and disease prevention strategies for the chronically ill.
- Cost-Effective Care: Integrated medical groups are able to support investments in advanced healthcare information technology, tracking patient follow-through on treatment plans and patient outcomes, and helping to uncover health problems before they become catastrophic.
- Accessible Care: Efficiencies within the coordinated care delivery model mean better healthcare for more seniors, including:
• lower out-of-pocket costs
• increased health services such as dental care, vision care and preventive care
• reduced hospitalizations
• increased prescription coverage
• higher overall satisfaction rates
• greater value for the premium dollar than any other healthcare delivery system
What’s At Risk
If Medicare reforms dismantle incentives for coordinated care, seniors will experience significant increases in out of pocket costs - at a time when many seniors have seen their retirement account’s decline by over 40 percent in value — and decreased quality of healthcare.
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