Post by cookiemdough on Aug 16, 2012 9:44:25 GMT -5
Has anyone found an easy to follow source for how the voucher program for Medicare would even work?
I still have the same questions I did when I first heard about it during the ACA debates.
1) How was the dollar amount of the voucher determined? 2) How does it compare to the actual cost of insurance especially for older Americans? 3) If there is a shortfall that seniors can't cover do they just go without insurance? 4) Will the amount of the voucher increase with COL?
I'm not sure what the initial voucher price is based on, but it WILL rise with the COL. I believe it's slated to increase automatically 2.5% each year. The only problem is that health care costs generally rise about 2.9% each year. So there will be a gap even before you address the issue of whether the original voucher was sufficient to cover costs. Seniors will have to cover the difference out of pocket. Honestly, I'm not entirely opposed to a voucher system, but I am opposed to this one. It doesn't account for any difference in the socio economic status of people. And because the vouchers aren't to purchase health care, they're to purchase health INSURANCE, they ad this really weird layer to things. Instead of being able to just negotiate with your doctors for the cost of things, or having one system (Medicare) that doctors either accept or don't, it's going to be a situation where you either can afford insurance or you can't. So the out of pocket difference issue takes on an even bigger significance because obviously, if you can't afford insurance (and BCBS does not sell "partial policies") then you have to pay for ALL of your care out of pocket, right?
And how would this even be viable for insurance companies. You think our insurance premiums are high now, you wait until BCBS is also paying out for all of the end of life care grandma needs. I just don't see how Ryan's system is any more viable than Medicare. Again, it doesn't reduce the actual cost of the delivery, it turfs it all to private insurance companies (which is my primary complaint even with the ACA), and it doesn't account for the fact that the elderly draw on insurance in greater proportion to their premiums than a 25 year old.
I'm not sure what the solution is. I mean, it's a complex one for sure and it probably does include some element of "If you're 87 and want a quadruple bypass, you're going to have to pay for that out of pocket" (aka death panels). I would also rather we just had a voucher system that paid physicians directly rather than going through private insurance. So, the gov't will set up basically and HSA-like thing for the elderly. It will contribute some set amount with the 2.5% increase each year, and you have to throw in the rest (means tested and graduated depending on maybe your tax bracket?). With that money, you just go to your doctor and pay them cash. The reduction in administrative bullshit should allow the physician to accept less from the patient, so the cost would be cheaper.
But, I guess this is no surprise given that I would rather the ACA took insurance companies out of the system, too. I really think insurance is a part of the problem, so it can never be part of the solution.
Post by sweettooth on Aug 16, 2012 12:06:38 GMT -5
Everything I read says the vouchers would be indexed to the COL, but the problem is that the cost of health care goes up more than the COL does. It sounds to me like it would be falling into a deeper hole each year.