Redefining Success

Member Group : From the Kitchen Table

Every business or civic organization knows that the key to achieving their goals begins with a clear definition of what "success" means.

A delivery business, for example, would define success as a set number of packages accurately delivered each day at a rate that made a profit. They would then develop a strategy that they thought would result in meeting their definition. It might include a system to label and track packages, the job descriptions of the necessary personnel, the equipment they would need to purchase and operate, and a price structure for deliveries. They would begin to implement their strategy, making changes as necessary to ensure that they met their defined goal.

The federal government has defined health care success as Medicare. The health care overhaul even calls for expanding Medicare programs to include those aged 55 to 64. So, using Medicare as the model, what are the elements of what the federal government considers a successful health care program?

Medicare participants across the nation received their new premium rates for 2010. Premium rates rose, some by as much as $800+ dollars each year. For folks on fixed incomes, this constitutes a large jump in costs.

Co-pay rates rose. Some co-pays doubled. Others included a larger deductible before any co-payments could occur, and raised the ceiling a participant would have to meet before getting additional assistance.

So those receiving Medicare are paying more money for less insured health care.

At the same time, hospitals and doctors are reporting that Medicare reimbursement rates only cover about 50% of the costs of providing services to Medicare patients. So they lose money on every Medicare patient they care for.

As a result, an increasing number of them are refusing to accept Medicare in their practices. The physician group at the Mayo clinic in Arizona announced on December 31 of 2009 that they would no longer be accepting Medicare patients, citing an annual loss of over $120 million because of the low reimbursement rate from the government. These patients were invited to either begin paying cash for all medical care, or to find other health care providers. That is not as easy as it sounds as more doctors are forced to stop accepting Medicare if they want to stay in practice.

So those receiving Medicare are paying more money for less insured health care while simultaneously being required to pay for uninsured care.

Additionally, due to the laws surrounding the billing of health care services, doctors must charge these patients at the rate at which they BILL health insurance providers, not the rate which those insurance providers actually pay. Those rates can vary by hundreds, and even thousands, of dollars, depending on the health service being provided.

So, those receiving Medicare are paying more money for less insured care while simultaneously being required to pay for uninsured care at the highest rate.
Seniors trapped in this situation are skipping follow-up visits, halving prescription medication levels, refusing to get new hearing or vision aids, and not participating in any preventive care programs to try to fit their health care costs into their often limited budgets.

And this is the approach to health care that the federal government defines as "success".

It makes a reasonable person wonder, doesn’t it?

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