By Maggie Mahar
Writing on Health Care Policy and Market Place
Review over the week-end, Bob Laszewski called what happened in the Senate last
week : “ the most amazing turn of events I have seen in 20 years of following health care policy in
It all began Tuesday, when the House voted 355 to 59 to block a pay cut for physicians. As regular
readers know, Medicare is scheduled to slash physicians’ fees tomorrow (July 1)
by an average of 10.6 percent across the board. Another 5 percent cut is
scheduled for January 1, 2009. Some physicians have
threatened that if legislators take an axe to their fees, they will stop taking
Medicare patients
In the face of a 15 per cent cut many primary care
physicians might well decide to retire early. As I’ve explained in
the past, primary care physicians, family doctors, gerontologists, and
palliative care physicians who practice “thinking medicine” (listening to and
talking to the patient) are not well-paid.
Yet, these are the
very doctors who seniors need to to co-ordinate their care.
Who
to Cut: Physicians or Insurers?
Concerned, the House voted 355 to 59 to cancel the pay cut, and
raise the money Medicare needs another
way–by bringing an end to the private fee-for-service version of Medicare Advantage by 2011.
According to the Washington Post, the legislation
could result in $14 billion less for
insurers over five years, though an estimate by a conservative House Republican caucus put the tally at $47.5
billion over 11 years.
Readers may well remember that, when Congress originally voted to let private insurers offer
Medicare through a program called “Medicare Advantage,” it agreed to pay
insurers a huge premium -–13 percent more than traditional Medicare lays out to provide care for similar
seniors.
As
the program unfolded, some insurers began setting up private fee-for-service
(PFFS) versions of Medicare Advantage that do not rely on provider networks and are even more
expensive, “costing Medicare 17 percent more” than it would spend if it provided the care directly.
In December, I wrote
about these fee-for-service Medicare Advantage programs, explaining that they are
not providing the quality of care
that the Medicare Payment Advisory Commission (MedPac) had envisioned. When the panel reviewed data on quality, MedPAC
Commissioner Jack C. Ebeler called it "disappointing."
“I’m struggling to
get to ‘disappointed” said MedPac chairman Glen Hackbarth.. “I’m more depressed."
The problem is that
while the fee-for-service Medicare advantage plans are becoming more popular
than plans that use networks, doctors providing the services are not
co-ordinating care. “I feel like we’re going backward,’” said Hackbarth.
“Since PFFS
was only supposed to be a transitional product to real network plans when it
was first created in 2003, it’s hardly seems unreasonable,” to suggest that
insurers phase it out by 2011, Laszewski
observes.
But insurers didn’t
see it that way. Nor did President Bush,
who made it clear that he would veto
any legislation that cut Medicare advantage.
In
response, the Senate Finance Committee worked out a bi-partisan compromise that would freeze 2009 physicians payments and forget
about making any changes to Medicare
Advantage. “Everyone was ready to be happy with that–Democrats and Republicans–and go home
for the week-long holiday recess,” says Laszewski , whoone of the most astute observers of health
care politics in Washington.
The End
of a Bi-Partisan Compromise
Until
last Tuesday, when the Senate saw the House
vote 355 to 59 to save the physicians, and throw the insurers
under the bus. Surprised by the landslide,
“Senate Majority Leader Reid and
the Senate Democrats decided to shelve the bipartisan compromise and bring the bill just passed the House the Senate” Laszewski reports.
“Late Thursday night they did just that and missed getting the necessary 60
votes by just one Senator. It is
notable that Senator Kennedy was not present and could have been the 60th vote”
This led to what Laszewski describes as “a very undignified
scene on the Senate floor . . . Republicans felt betrayed,” he explains “ thinking they had an amicable deal
to get past the cuts and go home.”
The Washington Post provides some of the
gory details: “The roll call vote was held open for an additional 25 minutes so
Sens. Barack Obama (D-Ill.) and Hillary Rodham Clinton (D-N.Y.) could make it
to the chamber from their fundraiser at the Mayflower Hotel.
“Sen. Jim Bunning (R-Ky.) grew irritated about
waiting for Clinton, the last to arrive, and called for ‘regular order’ to shut
down the vote. That led to a shouting match with Sen. Robert C. Byrd (D-W.Va.), who yelled ‘Who
are you?’ and mockingly called his colleague a ‘great baseball man.’
“Bunning, a Hall of Fame pitcher in the 1950s and 1960s,
shouted back that he has the same rights on the floor as Byrd, the
longest-serving senator in history and the chamber’s leading parliamentary
expert. The exchange ended with Byrd
loudly laughing . . ‘That display
last night on the floor is something I’ve never seen,’ said Sen. Arlen Specter (R-Pa.).”
This is the sort of behavior—on both sides of the aisle–
that makes one wonder how legislators will ever manage to pass health care
reform..
Let me be clear: I am not picking sides here because what
happened last week had less to do with health care policy (my main interest)
than with partisan politics (which could ruin any chance of achieving true
reform.)
As Laszewski explains , the Senate Democrats set the
compromise aside because “they saw a huge election-year opportunity–stick the
Republicans out on a limb and
start sawing it off.”
Prior to the House vote, many observers thought that
legislators would have to balance the interests of physicians against the
interests of Medicare Advantage, which has already enrolled so many seniors.
Thus, a compromise seemed inevitable.
Indeed, Laszlewski points
out, in the past, people often asked him him: “’Would Congress really cut private Medicare with almost 10 million seniors
in it?” Today, he offers his reply: “355-59–any other questions?”
Moreover, he points out, “AARP is also
backing the docs,” giving legislators “political cover with seniors to vote against the private Medicare plans.”
This leaves
Republicans with a politically unpalatable choice: either vote against their party’s sitting president—or
vote against the doctors and the AARP. For
legislators who will be up for re-election in November, this is a lose/lose proposition
“At one point during Thursday’s debate,” the Washington Post
reports, Senate Majority Leader “Reid literally hopped around the chamber,
predicting Democrats would hold ‘at least’ 59 Senate seats next year because
Republicans toed Bush’s line.
"’I don’t know how many people are up here for
reelection, but I am watching a few of them pretty closely,’" Reid said,
staring at the GOP side of the chamber. "’I say to all those people who
are up for reelection: If you think you can go home and say, ‘I voted no because
this weak president, the weakest political standing since they have done
polling, I voted because I was afraid to override his veto’ — come on.’
On that note, Congress left town for its one-week July 4
recess.
The Democrats’ plan, according to Laszewski, is “to let the Senate Republicans stew in a provider lobbying onslaught of
unprecedented proportions during the week-long recess.” His advice to doctors: “I would go find your Republican Senator at the nearest
Fourth of July picnic and get at it. “
Tune in
July 7
Friday, the Bush administration did the only thing it could
do. Mike Leavitt, Secretary of the Department
of Health and Human services, announced a
reprieve for the thousands of doctors expecting to be hit tomorrow with a
10.6 percent cut in Medicare payments. The freeze is scheduled to last 10 days
This means that when Congress returns on July 7, it will
have three days to decide the matter.
Laszewski is the expert on the politics of health care
reform, so let me give him the last word: “We will have extraordinary
political theater the week of July 7.
Let me suggest that it will be well worth reading Laszewski’s blog that
week.
once again we seem to be chasing the political rabbit here and no one is asking why doc fees are about to be cut by 10% and whether there’s any justification for it. that isn’t to defend the medicare advantage guys who defy defense, but their involvement in this is totally political and has nothing to do with what docs should get.
Exactly. That’s what bothers me. Legilslators are not debating policy.
They’re not talking about whether Medicare Advantage fee-for-service is providing good care. (According to MedPac is isn’t)
They are not asking whether some physicians may now be Underpaid while others may be Overpaid for certain services.
The Dems & Reps are simply go at each other.
There have been some suggestions that rather than trying to make “the difficult decisions” Congress such hand healthcarereform over to an independent panel.
I think that’s an interesting idea & will write about it.
Exactly. That’s what bothers me. Legilslators are not debating policy.
They’re not talking about whether Medicare Advantage fee-for-service is providing good care. (According to MedPac is isn’t)
They are not asking whether some physicians may now be Underpaid while others may be Overpaid for certain services.
The Dems & Reps are simply go at each other.
There have been some suggestions that rather than trying to make “the difficult decisions” Congress such hand healthcarereform over to an independent panel.
I think that’s an interesting idea & will write about it.
And you want healthcare to be taken over by the government when it is run by politicians????????
Dr. Sh–
I have never suggested that politicians take over
health care.
If you read my posts,
you will see that, time and time again, I talk about health care being overseen by a board of physicians, medical reserachers, ethicists and health care economists who have no financial interest in the outcomes of decisions they make and who are insulated from Congress and lobbysists.
See the posts I have written about Dr.
Emanuel’s plan.
What we cannot continue to afford is a system where individual doctors set their own fees, practice medicine however they like (less than half now follow “best practice guidelines, the Institute of Medicine reports) take kickbacks from drug-makers and device-makers etc.
Obviously not all phsyicians are doing these things. But some do–in many cases, without realizing that they are not practicing evidence-based medicine, or that the American Cancer Society and NCS no longer recommend what they are doing.
Dr. Sh–
I have never suggested that politicians take over
health care.
If you read my posts,
you will see that, time and time again, I talk about health care being overseen by a board of physicians, medical reserachers, ethicists and health care economists who have no financial interest in the outcomes of decisions they make and who are insulated from Congress and lobbysists.
See the posts I have written about Dr.
Emanuel’s plan.
What we cannot continue to afford is a system where individual doctors set their own fees, practice medicine however they like (less than half now follow “best practice guidelines, the Institute of Medicine reports) take kickbacks from drug-makers and device-makers etc.
Obviously not all phsyicians are doing these things. But some do–in many cases, without realizing that they are not practicing evidence-based medicine, or that the American Cancer Society and NCS no longer recommend what they are doing.
Dr. Sh–
I have never suggested that politicians take over
health care.
If you read my posts,
you will see that, time and time again, I talk about health care being overseen by a board of physicians, medical reserachers, ethicists and health care economists who have no financial interest in the outcomes of decisions they make and who are insulated from Congress and lobbysists.
See the posts I have written about Dr.
Emanuel’s plan.
What we cannot continue to afford is a system where individual doctors set their own fees, practice medicine however they like (less than half now follow “best practice guidelines, the Institute of Medicine reports) take kickbacks from drug-makers and device-makers etc.
Obviously not all phsyicians are doing these things. But some do–in many cases, without realizing that they are not practicing evidence-based medicine, or that the American Cancer Society and NCS no longer recommend what they are doing.
Why am I not surprised? Private Medicare can give campaign contributions, public Medicare can’t. So here we have it. Politicians whose elections are funded by private insurers deciding where to cut costs and where to increase them.
It is also notable that McCain was absent, and if Kennedy was called in you can be assured that McCain would have been there.
Health care is just one of our nation’s problems, and to reform it and every other problem we must (a) get rid of the current Republicans and (b) pass public funding of campaigns. With the latter we’d have seen healthcare reform years ago, plus reduced spending and reduced taxes. Our corrupt system is no better than Mexico’s.
Dr. Sh–
Are you happier with the current system that is being run by MBAs and the for-profit corporations and gatekeepers?
This desire for “bipartisanship” in order to get “reform” done is a good description of what is wrong. Mahar starts off okay by pointing out how bad the insurance companies have been, getting extra money from medicare and providing no extra benefit. Remember, the original promise was that they would offer savings, then they needed an additional 12% bailout. Then an additional 17% bailout. The problem is that the insurance companies in their profit skimming cannot it turns out actually offer any savings. They just need to suck more out of the system. And Republicans and free market extremists need to prove that governement medicare cannot work.
So instead of phony compromise and biparisanship, how about going with the better bill. Even if Democrats are more for it, and Republicans are more against it?
Gee… come to think of it, maybe we could go with the even better plan, expanded and improved Medicare for All HR-676. Even if the insurance companies don’t like it, even if it is not bipartisan, even if it is not phony compromise. After all, non-partisan CBO and GAO scored single payer as best approach in 1990s, and Levin etc score various single payer plans as the best today.
I’m not a doctor. I will accomplish the medicare-eligible age of 65 in the next few days. I thought I was in trouble not having healthcare insurance. The more I learn about medicare, as it stands at this point in time, the less secure I feel about the future! Insurance industry involvement is creating problems for medicare providers and recipients. In my view, medicare is fast becomming MEDI-MESS!
by the way, the House vote of 355 to 59 is a bipartisan vote. So why was that a bad thing? And why is Republican scuttling of having a an actual vote by the ridiculous overuse of the “it takes 60 votes in order to actually have vote” nonsense okay, compared to just having the vote on the House version of the bipartisan vote. Why is the only good compromise one that favors the insurance companies?
You should check out:
http://www.guaranteedhealthcare.org/blog/nyceve/2008/06/30/and-then-they-came-medicare
“That’s what bothers me. Legilslators are not debating policy.”
How can anyone is surprised by this? Government-run health care is politicized health care. Donald Johnson has a good post on that subject over at The Health Care Blog.
http://www.thehealthcareblog.com/the_health_care_blog/2008/06/doctor-fee-stal.html
Dr. Steve B,, Jack, Hammah Allah,
Thank you for your comments.
Dr. Steve– No where did I suggest that the House vote was a bad thing.
I’ve written a number of posts indicating that the bonus that Medicare is paying insurers who deliver “Medicare Advantage” is excessive. It’s a pay-off for past campagin contributions.
I’ve also written a number of posts about how we don’t want to take an axe to physicians’ fees. Many physicians (primary care, palliative care, pediatricians) are paid too little by Medicare while others (specialists who provide the most agressive service) are paid too much for certain services, encouraging over-treatment.
Adjustments need to be made with a scalpel, not an axe.
The problem was not in the House but in the Senate where progressives compromised with conservatives too quickly–and then, when they saw the House vote, went back on their word.
This suggests that Senators were not deeply committed to the principle of making sure that Medicare is getting good value for its dollars.
Instead, they were more interested in a)breaking for vacation and then, when they saw the opportunity b)sticking it to the Republicans.
This is not how we are going to get smart health care reform.
Some (including Tom Dascle) have suggested that perhaps Congress should hand health care reform over to an unbiased knowledgeble board (MedPac with teeth) rather than trying to handle the “difficult” questions itself.
I hope to write about that idea in the future.
Jack– You’re entirely right: campaign contribution reform would go a long way toward making serious health care reform possible. But I wouldn’t hold my breath.
You’re right–if Kennedy had been there, McCain would have shown up–though keep in mind, McCain was one of few Republicans who voted Against the Medicare bill that gave the private insurers the huge bonus for providing Medicare Advantage . .
Halimah Allah–Don’t give up hope. I think we’ll see Medicare reform next year.
Legislators don’t have much choice–it’s running out of money.
And the Medicare Payment Advisory Commission (MedPac)has many good ideas for raising the quality of care whil reducing costs.
What was the anticipated financial loss to the insurers with the bill that didn’t pass?
dr. LR–
Thanks for your question.
According to the Washington Post, the bill that passed the House and lost, by one vote, in the Senate would have resulted in “$14 billion less for insurers over five years” though the Post reports, “an estimate by a conservative House Republican caucus put the tally at $47.5 billion over 11 years.”
The compromise that Senate Democrats originally agreed to would have made no cuts in Mmedicare Advantage, costing insurers nothing.
This is why I think the Democratic Senators were foolish to compromise.
Medicare cannot afford to pay insurers so lavishly; the evidence suggests tha they’re not getting good value for the money; and the House vote shows that Independents and Republicans also realize that it’s an unwarranted windfall.
So I am curious as to how the numbers reported by the Washington Post for anticipated potential loss by the insurers compares to the anticipated savings from cutting physician reimbursements by 10%?
And if in the days to come there is no reprieve for the cuts am I to understand that that is an additional win for the private insurance companies providing Medicare Advantage plans. That is, would their profits further increase because they would reimburse physicians 10% less?
You made what seemed to be snarky dismisssive comments about the Senate Democrats standing up and getting a spine after the House move. You suggested that it was “just politics” gotchas and that both sides were engaged in it equally. That was my objection. No! The Senate Republicans were engaged in unilateral obstrcution of the better policy. Period.
Dr. Steve–
Sorry, didn’t mean to be snarky. But yes, I do think the Senate Democrats should have gone for the Medicare Advantage cuts the way the House did.
The House vote suggests that politically, there was a window of opportunity there. (I’m not enough of a politico to know for sure, but I would asume that if House members could sense this, Senate Democrats could have too . . . Despite the propaganda that the Bush administration had been putting out about how seniors love Medicare Advantage, many are very unhappy. The AARP knows this. Couldn’t Senate Democrats figure it out that it woudl be “okay” to vote against the insuers?
Or were they succumbing to pressure from insurance lobbyists? I don’t know. I just don’t understand why they were so much more cautious than the House . . .
Maybe it’s the difference between Reid and Pelosi . ..
In any case, I think that Progessives have to be critical of the Democrats when they don’t do the right thing. Otherwise, too many of them they’ll just sit in the center and play it safe.
And I have been disappointed with Senate Democrats on many issues in recent years–particuarly buying the WMD lie and letting Bush go into Iraq.
I’m hopeful a new Congress will be more pro-active.
Dr. LR
I don’t have the numbers on how much the 10 percent cut would save, but over time, the planned cuts (ultimately totalling about 25 percent) would I think be enough to bail Medicare out–for now.
But it’s an extremely dumb,crude plan which ignores the fact that Medicare now underpays doctors who practice “cognitive medicine” –which is why we don’t have enough primary care doctors. These are the people we need to co-ordinate senior care.
If they actually passed the legislation, would this mean that MA plans would get a second bonus –they could pay doctors 10 percent less?
That’s a very good question.
I don’t think that insurers are obliged to follow Medicare’s fee schedule. (Though by and large they probably do. )
But if they were half-way smart, they wouldn’t cut doctors fees (at least not right now) and would use that to persuade doctors to take medicare advantage, but not traditional Medicare patients. . . Their patients would follow the doctors.
The political goal here is to privatize Medicare. If, say 80% of Medicare patients wind up in MA then insurers will be calling the shots on healthcare for seniors in America: how much doctors are paid; what’s covered; what the co-pays are, etc.
Since we don’t regulate private insurers, they will do whatever is best for their bottom line.
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Across the board cuts are a typical poorly thought out response to a complex problem.
Let us suppose that as a family, our food bill is too high. We could respond by cutting out the expensive cuts of meat, the fancy French wines and the imported cheeses. This would be an intelligent response.
Or we could approach the problem like our government. We could cut everything 10%; 10% less on rice, 10% less on potatoes, 10% less on vegetables, and 10% less on Champagne.
This is the dumb way. This is the way we choose because we don’t have the courage/intelligence to approach the problem correctly.
I am a medical specialist (and therefore overpaid according to Maggie). I support intelligent health care reform and a single payor system. But I don’t expect to see intelligent health care reform in my lifetime. I expect to see dumb healthcare reform – 10% across the board cuts.
Fortunately, my youngest child only has 3 more years of college (talk about cost inflation) and then I can retire/go part time.
Hopefully, the young, sensitive, politically correct physicians will be around to cover the shifts/see the patients that us “dinosaurs” don’t cover any more. (Are you holding your breath?)
Douglas–
The House vote suggests that physicans’ salaries will not be cut across the board.
Before last week, everyone I know assumed that the across the board cut was a poltical non-starter–just because it is so dumb.
If you’re really interested in policy, see MedPac’s March 2008 and June 2008 reports. (google MedPac and the dates.)
It’s very clear in the reports that MedPac sees these across the board cuts as foolish.
Finally, I’ve never said that all specialists are over-paid. I have said that some specialists are over-paid for certain services. Many doctors agree on this point–as does MedPac.
This is why an unbiased panel (perhaps a panel of doctors who work on salarly, not fee-for-servcie) needs to go over the fee schedule with a scalpel, not an axe.
Finally, if this isn’t too personal or intrusive, I’m curious how much you make a year (ballpark)?
In other words, at what point is it not worth working? How little is too little? Won’t you miss seeing patients?
As someone who makes less than six figures (even though I have a Ph.D.a great resume, and have written two books), I can’t imagine saying “It’s just not worth working. I’m not making enough.” If I stopped working I’d be too bored.
Let me add: I live in Manhattan, raised two children here, live in a beautiful, sunny apt. that I bought 22 years ago, grow roses, iris and blueberries on my terraces and consider my “quality of life” to be pretty high.
So I’m not complaining about my salary–I like the place where I work, and am proud of what we do.
Maggie,
I am glad that you enjoy your job. (And by the way, I enjoy what you do too. I think you have a very good web site) I used to enjoy mine, but find it less satisfying after almost 30 years. I am not really unhappy, just not as happy as I was. Also, I am not complaining about my salary, I think I am well paid for what I do.
Don’t know what it would take to make me bail. The good thing (from my perspective) is that I will be able to bail. In any case, my personal situation is not all that important or relevant. What is important and relevant is how close many doctors are to bailing. A 10% across the board Medicare cut will push a lot of docs out. This will be a major problem for our country.
I also can’t disagree with you that some specialists are overpaid. Of course what pay is “fair” and what is “overpaid” is not easily determined. Primary care docs are definitely not overpaid in my opinion.
Personally, I believe we should adopt a single payor health care system similar to what they have in the UK and Europe. We simply can’t afford to continue on as we are. I just don’t see that either the Democrats or the Republicans have the courage and wisdom to do what it will take. Both are too beholden to lobbies and interest groups that pay too much money and will scream too loudly for real reform to occur. In other words, I expect things to get much worse before they get better – if they ever do. I hope I am wrong about this both for my sake as a prospective Medicare patient and for my children’s sake.
Douglas–
Thanks for your kind words.
I’ve had three careers over the course of my adult life, so I can imagine how being in one situation for 30 years could become wearing . .
And certainly our health care system is a mess, which is very distressing to most good doctors.
I do think that things will have to get worse before we have the medical reform we need. You are right about the lobbyists: they are a huge problem.
You might be interested in this interview with former Senate Minority leader Tom Daschle. He talks about handing Medicare reform over to an independent panel here: http://www.prospect.org/csnc/blogs/ezraklein_archive?month=05&year=2008&base_name=tom_daschle_on_health_care
“As someone who makes less than six figures (even though I have a Ph.D.a great resume, and have written two books), I can’t imagine saying “It’s just not worth working. I’m not making enough.” If I stopped working I’d be too bored.
Let me add: I live in Manhattan, raised two children here, live in a beautiful, sunny apt. that I bought 22 years ago, grow roses, iris and blueberries on my terraces and consider my “quality of life” to be pretty high.”
Maggie,
It’s great to be able to do something you enjoy and to live a good quality of life without making a large income. Whether you were fortunate enough to benefit as a renter from a low insider price when your building converted to co-op status or you just bought an apartment before Manhattan residential real estate skyrocketed in value, the fact is that someone relocating to NYC today to practice medicine, even without school loans, will have to make a far higher income than yours in order to live the same lifestyle because he or she will have to pay current (very high) market prices to buy or rent an apartment. Housing in the better suburbs is also very expensive while property taxes in NJ, Westchester and on Long Island are among the highest in the country. Add in progressive taxation, and a new arrival would probably have to make well over $200K to live a lifestyle comparable to yours, again, even without medical school debt. For families with school age children in Manhattan that think they need to send them to private school, that’s a significant additional cost burden.
As someone who has your housing costs locked in at a comparatively low level and with your children grown and on their own, it’s a lot easier to be less concerned about making a lot of money. New arrivals with children need to be a lot more money driven than you are just to live a lifestyle that passes for middle class to upper middle class in Manhattan even though that same income would put them in the near wealthy category in many other locales.
My wife and I bought our modest house in 1973 and had it paid off by 1978. My son is grown and on his own now, so I don’t need to make a lot of money either. Indeed, when I came to my current job 14 years ago (to reduce my stress level), I took a 40% pay cut, and I consider it one of the best decisions I ever made.
Barry–
Actually I bought close to the top of the 1980s market–in 1986. Took a huge risk but I knew that I would be willing to live here for the rest of my life, and given the location and views, over the long-term, I thought the apt. would appreciate.
(During the first six or seven years that I owned the apt. real estate crashed and it depreciated.)
I also took a variable rate mortgage tied to short-term rates that adjusted very year becuase people I greatly respected in the financial world thought that, going forward, short rates would drop. I agreed This worked out. I never converted the mortage; I’m very old-fashioned, I want to pay off my 30 year mortage when I retire.
Finally, I put an enormous amount of sweat equity into the apt., acting as y own general contractor. This meant we lived on a construction site for more than a year–very little furniture, mattresses on the floor . Since the kids were little, they thought this was fun–like camping out. I thought it was the only practical thing to do.
I realize that I sound like I’m bragging, but what I’m really saying isthat if you like what you do, you can choose to earn a lower income and still live very well. (I’m not suggesting that people earning median income can do this: today, joint median household income is somewhere in the low 50s. If you have kids, you have almost no discretionary income. But people earning, say $76,000 (a rough figure) really can be creative with the money.
This is still true today. My twenty-something daughter (who teaches public school in NYC) and her husband earn just about six figures and, in six years, have managed to save enough for a donwpayment on a $600,000 small but very nice condo in Park Slope (the gold coast of Brooklyn.) They’re going to wait until prices bottom.
Over time, they plan to trade up, and will probably end up in a great home.
Barry– Just saw the end of your post (just scrolled down far enough.)
I’m very glad for you that you made that decision.
I should add that when I came to N.Y. I wanted to send my kids to public school here, and that was extremely important in deciding where to live.
That also worked out–they went to excellent colleges, got a very good education, adn are now doing work that they both find very satisfying. (My daughter teaches 1st graders; my son teaches English lit to college students. They both teach people how to read.)
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Maggie, are you familiar with how this problem plays out in home health care? Insurance company reps call on elderly persons to sign them up for the Medicare Part D medications benefit. With little fanfare, they slip in an additional form to sign which enrolls them in the company’s Medicare Advantage plan. Should they happen to be in the midst of a Medicare home care episode (60 days), the home care provider is not automatically informed. Between insurance companies dragging their feet to inform CMS and CMS taking two months to update their systems, sometimes it is several months before the enrollment news reaches the home care provider. But Medicare refuses all payments for services that occurred on or after the day of enrollment. Insurance companies are not required to pay providers with whom they do not have pre-established agreements in place so the home care provider is subject to the goodwill of the insurance company. Any wonder how it turns out most of the time?
Timothy–
Thanks for pointing out what is happening to scam seniors into these programs.
(You wrote: “Maggie, are you familiar with how this problem plays out in home health care? Insurance company reps call on elderly persons to sign them up for the Medicare Part D medications benefit. With little fanfare, they slip in an additional form to sign which enrolls them in the company’s Medicare Advantage plan.”)
This is all absolutely true. Congress needs to take a much, much closer look at Medicare Advantage.
Republicans as well as Democrats know that Medicare Advantage is cheating seniors while wasting taxpayers’ dollars.
(McCain voted against the bill that created Medicare Advantage)
In 2009, I pretty sure that Congres will act in a major way to cut the windfall bonus to MA insurers.
MedBlog Power 8
7/2/2008 – 7/9/2008Next revision: 7/9/2008
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