Talk:Medicare (United States)/Archive 1

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Archive 1 Archive 2

medicare fraud cost

I deleted the assertion that Medicare fraud is estimated by "law enforcement" to "cost taxpayers over $60 billion in 2008." The cited Washington Post article actually refers to all healthcare fraud as costing that amount, and even that assertion isn't supported by listing any verifiable report. --Nathan, 11:43, 16 August 2009 —Preceding unsigned comment added by 207.180.187.25 (talk)


I deleted a line claiming that Medicare fraud cost $179 billion a year, which is unreasonably high for a $250 billion/year program. I don't have an authoritative source for the actual cost of fraud. It should be noted that some estimates lump together Medicare and Medicaid fraud costs.—Preceding unsigned comment added by 70.22.228.98 (talk • contribs) 07:33, 23 May 2005

Update: While I didn't enter the above note, I do agree that $179 billion is too large. The citations I've seen about Medicare fraud have estimates that range from "billions" source to $33 billion source. However, the best estimate I've seen is this: "The United States General Accounting Office estimates that $1 out of every $7 spent on Medicare is lost to fraud and abuse. In 1999 alone, Medicare lost nearly $13.5 billion to fraudulent or unnecessary claims." source Because all of these estimates are far below the $179 billion one, I believe we should simply state that fraud costs the system billions of dollars a year. --Alabamaboy 16:55, 23 May 2005 (UTC)

In a large majority of government-administered systems everywhere in the world there's fraud, why's it necissary to make a point of mentioning it in this case?--Kbbbb 15:05, 30 April 2006 (UTC)

I'm not sure it's even that great a problem. Consider, that Medicare has low overhead because it doesn't spend any money on insurance agents and as much on fraud checking as private unsurers. It could be that the cost of increasing fraud checking would be greater than the marginal gain in recouped revenues. Therefore, we should also have information on Medicare's overhead versus other forms of insurance, and Medicare's fraud loss per enrollee, versus other forms of insurance.
--Debomachine 21:20, 3 August 2006 (UTC)

Fraud is really not that big a problem, and it is easily solved, but the fact that Medicare is so susceptible to fraud is simply another example of complete ineptitude of U.S. government directed programs, as the majority of truly criminal fraud is easily and simply identified by verifying the physician, beneficiary, and relationship. "Fraud costs" is the straw man usually trotted out by desperate Federal bureacrats who want to impress the public or legislators with their ability to control costs. Usually included in these costs are estimates of the "fraud" which is claimed by auditors for documentation which does not meet guidelines for the level of service charge, a truly debatable "fraud," which is simply a bureaucratic construct and not criminal, as services were delivered and providers coded what they believed to be the accurate level of service. The current plans to send an army of private contract auditors to recoup "fraudulent" payments will achieve only one end, the increase in provider overhead and the hastening of the collapse of a body of capable and willing providers to provide services below cost to these beneficiaries. Fraud is a miniscule demographic compared to the aging of the population, the cost of advanced medication, and especially the costs associated with greater hospitalizations, all completely unavoidable with the snowballing demographic of the baby boomers and longer longevity of the current elderly, which was neither planned for or paid for, even considering the "theft" of the Medicare trust fund for other Congressional spending. Sfhunter (talk) 15:00, 17 May 2009 (UTC)


This is pretty hard to figure out.

http://www.miamiherald.com/news/southflorida/story/1116390.html "Experts estimate the huge entitlement program [Medicare] loses at least $60 billion to fraud every year.'

http://www.msnbc.msn.com/id/22184921 "Law enforcement officials said it's just one of the many widespread, organized and lucrative schemes to bilk Medicare out of an estimated $60 billion dollars a year."

http://online.wsj.com/article/SB124888553192790663.html "More than $800 billion is spent annually on Medicare and Medicaid, the joint federal-state program for the poor, and by some estimates more than $60 billion each year is lost to fraud."

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/12/AR2008061203915.html?nav=rss_print "Law enforcement authorities estimate that health-care fraud costs taxpayers more than $60 billion each year."

Everyone agrees on $60 billion but no one agrees on what $60 billion is referencing! Gruntler (talk) 16:38, 16 August 2009 (UTC)


More:

http://www.stopmedicarefraud.gov/doj_testimony_breuer_05202009.pdf this attributes the $60 billion number to the "national health care anti-fraud association" (NHCAA); the number is not specific to Medicare.

NHCAA site: http://www.nhcaa.org/eweb/DynamicPage.aspx?webcode=anti_fraud_resource_centr&wpscode=TheProblemOfHCFraud The NHCAA "estimates conservatively that 3% of all health care spending—or $68 billion—is lost to health care fraud." I think this is the source of the $60 billion for all the other reports, with the discrepancy between $68 and $60 being due to the passage of a few additional years. However, I can't find anything about how they got that number--for all I know they just made it up. So all those news articles go back to this one unsupported claim on this website.

Also, in for future reference, the FBI: http://www.fbi.gov/publications/financial/fcs_report2007/financial_crime_2007.htm#health "Estimates of fraudulent billings to health care programs, both public and private, are estimated between 3 and 10 percent of total health care expenditures."

It all seems too sketchy to put into the article right now.Gruntler (talk) 17:06, 16 August 2009 (UTC)

Agreed it is too vague. I am a beneficiary and have never seen fraud. Accident billing sometimes which happens with computers and data entry folks. Also missed billings, too sometimes which is just the opposite of fraud. Accidental double billing is caught by computers.
My complaint, which is not exactly fraud, is being sent for unneeded "tests," some of which are preposterous, and are mainly for keeping the local hospital's (or private doctors) medical machines busy. And blood tests all over the place. Many under the guise (Maybe realistic) of protecting themselves against later litigation. Student7 (talk) 23:58, 19 August 2009 (UTC)

Part B

I inserted a paragraph about the payment for office-dispensed drugs under Part B. This is a complex, very expensive area of Medicare, and one that has an interesting story of value to readers.--Dr.michael.benjamin 01:24, 15 February 2007 (UTC)

Rules for coverage

The rules governing Medicare reimbursement are sophisticated, in the sense that they have been developed by doctors and administrators to provide care that is medically indicated for certain reasons. These reasons are sometimes grounded in rational science, but sometimes they are arbitrary, based on advantageous reimbursement patterns for the rulemakers. To say that the rules are complex characterizes them as groundlessly complicated. "Sophisticated" is a better word, since it reflects that the reimbursement criteria are based on different types of reasoning, some more rational than others.--Dr.michael.benjamin 22:07, 15 February 2007 (UTC) —The preceding unsigned comment was added by Dr.michael.benjamin (talk • contribs) 18:03, 15 February 2007 (UTC).

Medicare Advantage plans

Is there a reason that Medicare Advantage plans (formerly known as Medicare Managed Care plans) are not listed in this article? While they are naturally related to Parts A, B, D, (especially when qualifying for a Advantage plan), the Advantages plans are a distinct and separate way for beneficiaries can receive their Medicare benefits. It would seem reasonable to add a sub-section in line with the Part A, B, D sub-sections describing this option. Any objections/comments? Thanks -- Argon233 T @ C  U ∠  18:32, 6 April 2006 (UTC)

I'd suggest making it clear that the Medicare Advantage plans are administered (for a profit) by private health insurance companies; that while they were seen at one time as viable competitors for conventional Medicare, achieving their income for their investors by being more efficient than conventional Medicare, they now are reimbursed about 12% more per beneficiary than conventional Medicare, and that while they may offer 'sweeteners' like prescription glasses that ordinary Medicare does not, they may also carry requirements for co-payments or deductibles much greater than conventional Medicare, and may not cover some services (like physical therapy following a hip fracture) that conventional Medicare provides. Wretan 13:11, 24 August 2007 (UTC)Wretan

Medicare Number

Similar to the SSN entry, it would be useful (imho) to explain what the number means and what the parts mean.

It is, of course, an SSN, but with letters appended.

I haven't found a resource to explain what the letters mean.

Ones i've seen: A, B, B6, D, D4, D6, M, T, & W.

--Bshirley 22:06, 10 July 2006 (UTC)

Found at http://www.wpsic.com/medicare/bene/med_basics.shtml
"An alpha character follows most Medicare numbers. The most common characters are A (wage earner), B (spouse of a wage earner) and D and D6 (indication your spouse is deceased)."
--Bshirley 22:39, 10 July 2006 (UTC)

www.xifin.com lists: A=PRIMARY B=AGED WIFE, 1ST CLAIMANT B1=AGED HUSBAND, 1ST CLAIMANT B2=YOUNG WIFE, 1ST CLAIMANT C=CHILD D=WIDOW E=WIDOW MOTHER, 1ST CLAIMANT E4=WIDOWER F=PARENT OR LEGAL GUARDIAN J1=RECEIVING SPECIAL AGE 72 BENEFIT K1=RECEIVING WIFE'S SPECIAL AGE 72 BENEFIT AS HUSBAND M=UNINSURED, NOT QUALIFIED FOR HEALTH INSURANCE BENEFITS T=NO MONTHLY SOCIAL SECURITY, ENROLLED IN PART A, POSSIBLY IN PART B W=DISABLED WIDOW, 1ST CLAIMANT W1=DISABLED WIDOWER, 1ST CLAIMANT Wretan 14:26, 24 August 2007 (UTC)WRETAN

I'd just like to note here that in a year and a half as a 1-800-Medicare claims CSR, I have never seen an E, F, J, or K. I've also seen M and MA as insured. C numbers are never just C, they are always C1, C2, and so forth with the number indicating first, second, etc child. T and TA are only issued to end stage renal disease patients who don't otherwise qualify, and are converted to other appropriate suffixes if coverage is still in effect at age 65. Also, should we have a bit about the Railroad Retirement Board numbers with the letters at the beginning? Annorax 04:02, 9 November 2007 (UTC)

Enrollment in Medicare

First, a big "Thank You" to those who contributed to the main article. It was much easier for me to understand the essential features of Medicare here on Wikipedia than it was on the offical government website (www.medicare.gov).

Second, we might wish to add a short section on enrollment procedures, because for some people this has been very difficult. My doctor's mother, for example, went to her local Social Security office three times without getting served because of the long lines. Dreading the same experience, I phoned SSA's 800 number to see if I could make an appointment. I was stunned to have the SSA rep ask me if I wanted to enroll right then and there over the phone! Enrolling that way took only 25-30 minutes and the rep was very courteous and helpful throughout.

I can write a few sentences on enrollment procedures in formal Wiki style, but would need some help in deciding where it should go within the main article and in creating a new section heading or subheading for it. --Catawba 04:41, 30 August 2006 (UTC)

Enrollment in Medicare is automatic at age 65, you actually have to reject it if you don't wish to recieve benefits under medicare part B.75.132.36.150 04:24, 4 October 2007 (UTC)

Enrollment is automatic only if you're receiving benefits from SSA, RRB, or OPM when you become eligible. If you're not eligible at that time, you apply through SSA. Annorax 02:59, 6 November 2007 (UTC)

Criticism section stats

A sentence in the criticism section says: "The fundamental problem is that the number of workers paying Medicare taxes is shrinking, while the number of beneficiaries and the price of health care services are both growing." I find it hard to believe that the number of workers paying Medicare taxes is shrinking, since almost everyone who works in the US pays Medicare taxes, and the number of people employed in the US certainly is trending upwards. The references cited that follow that sentence do not appear to support that assertion either. Perhaps the person who wrote that sentence meant to say that the ratio of retirees drawing benefits to workers is increasing. I will rework the sentence if no one has any objections.

Andyrew609 02:35, 11 September 2006 (UTC)

Legislative oversight

Please don't delete my legislative oversight section. I think an encyclopedic entry on Medicare ought to have a list of the Congressional committees that oversee it. This article can serve as a resource for readers who want to contact the legislators "in charge" of Medicare.User:dr.michael.benjamin

Do you have a citation for this material? I see several of these committees which have oversight for CMS & HHS, but have only tangential oversight of the actual Medicare program itself. -- 12.106.111.10 23:06, 14 February 2007 (UTC)
Also there are inconsistencies with the way the table is listing both subcommittees, and the committees they belong to in some, but not all cases. It would seen reasonable that if one or more subcommittees are listed, the committee doesn't also need to be listed, as the subcommittee is a constituent part of that committee, and any authority that the subcommittee has was devolved from the parent committee, and so oversight responsibility is naturally inferred. Could you please share your rational for has been included in this table? -- 12.106.111.10 23:47, 14 February 2007 (UTC)
The citation is the CMS website, buried in the layers. I figured people (i.e., doctors with a beef with Medicare) would want a more convenient way of finding the information. I got to it easily last night, but now I can't seem to find the link again.--Dr.michael.benjamin 00:15, 15 February 2007 (UTC)
Citations need to be used when quoting/reusing material. Also articles should not be use for advocacy purposes (see WP:TIGER), so including the material to advertise how to express a "beef" with Medicare is not necessarily an appropriate reason to include the material in the article. I am going to remove the table until it's clear where this specific material came from, as I question some of it's validity. Note that the table is not permanently gone, and can be accessed from the article history, so extended effort will not be required to to add this back in once a citation is provided. -- 12.106.111.10 22:32, 15 February 2007 (UTC)
I'm not sure how a table summarizing the committees of Congress that oversee Medicare expresses advocacy. These are facts that exist independently of a particular agenda--certain Congressional committees oversee Medicare regardless of what you or I or anyone else think about it. There is value in readers of Wikipedia being able to rapidly identify which legislators help oversee Medicare, since as we are finding, the information is available elsewhere, but not easily accessible. I'm not sure that summarily, anonymously deleting the content serves the interest of readers, who may be interested in contacting their representatives to gather more information about the program. In addition, several people worked hard to format that table and link it to other articles on Wikipedia. By deleting the table, you have diminished the quality of this article by reducing its link count to other articles. I am putting the table back in. The citation appears associated with the table. Please do not remove it again.--Dr.michael.benjamin 06:23, 16 February 2007 (UTC)
Please see response here, on a user talk page. -- 12.106.111.10 16:49, 16 February 2007 (UTC)
The legislative oversight table is out of date. In short, any Republican listed here is incorrect; none of them are committee chairmen anymore. Karichisholm 10:25, 6 March 2007 (UTC)

Can someone check this?

Several unexplained edits have been made to the article on or about 14 March 2007; at least one of the edits appeared to be questionable. I have reverted, but I'm not sure whether I reverted to a good version or not. Someone may be able to check this faster than I can. Yours, Famspear 17:55, 14 March 2007 (UTC)

Legislation and Reform - but there's more?

This section starts out by naming the various legislation and reform to medicare. Next... I get the Clinton note - because it was an attempt at medicare reform... though not really necessary since it didn't actually change anything. But then the section explains the workings of the 2003 legislation: "...this legislation included fixing loop holes in the Medicare Secondary Payer Act that was enacted in 1980. By fixing the loopholes, Congress strengthened the Workers' Compensation Medicare Set-Aside Program (WCMSA) that is monitored and administered by CMS."

How come there's an explanation of this but not any of the other reforms? Possible NPOV issues aside... The point is that there are links to the other legislation so that a user can go and find out about them. If you explain - even briefly or in part - what one reform did... then you have to explain all of them for a balanced article. And, obviously, the MMA did much more than fix loopholes. Let's not forget that it also created many more loopholes and that it was a serious case of corporate welfare for pharmaceutical companies as well as major employers in the US.

I think this section needs to be more specific - you could explain that the MMA was the largest overhaul of Medicare and say what it did in its entirety (good luck)... or, we could remove this one-sided brief. What does everyone else think?

Rob Shepard 04:35, 26 April 2007 (UTC)

Minimal Stay for Medicare A?

Why does this article say that a hospital stay must be 72 hours? "Your Medicare Benefits," published by Medicare and accessible from Medicare.gov (http://www.medicare.gov/Publications/Pubs/pdf/10116.pdf) says nothing about length of stay in the official publication.

Notusip 15:59, 16 June 2007 (UTC)notusip

There is no minimum stay requirement for Part A coverage. There used to be a 72 hour requirement for coverage of a subsequent skilled nursing facility stay, but there never was a minimum hospital stay for Part A to cover hospital facility fees.

Annorax 02:57, 6 November 2007 (UTC)

Cato Institute paragraph

The paragraph referencing the Cato Institute draws a false editorial conclusion rather than just reporting facts. The thesis statement is: "Others, such as the Cato Institute, point to the fundamental interference Medicare has on market prices." The last sentence states a conclusion that "These rules effectively build in inflated non-competitive rates for virtually all health-care costs." The argumentation in between states, in summary, that Medicare reimbursement rates set a benchmark rate, and that medical providers cannot negotiate lower rates with private insurance companies without jeopardizing their Medicare billings. The stated conclusion does not follow from that argument because in fact the argument fails to prove that in the upward pressure on medical costs exceeding the rate of inflation we have experienced for some time is due to Medicare reimbursement rates. The biggest complaint average citizens have related to them by the health care industry across the country is that providers refuse to accept Medicare patients because the reimbursement rates are so low compared to the rates providers can negotiate with private insurers. That is, medical care providers cannot recover enough of the rising costs from other sources that they actually incur for treating Medicare patients. As a result, in many states, the dominant experience for Medicare recipients is that of medical care providers refusing to accept them as patients because the Medicare reimbursement rates are too low. That means that in much if not most of the US Medicare actually exert a disinflationary effect on health care costs that is overwhelmed by inflationary pressures from other sources. Please delete the last, false conclusion from this paragraph as unsubstantiated and counter-factual.—Preceding unsigned comment added by 71.215.189.77 (talk • contribs) 14:29, 7 July 2007

I posted and subsequently removed the content in question. As I was conducting research in regard to the "editorializing" I realized I had violated Wikipedia Policy "Synthesis of published material serving to advance a position". The supporting links substantiate the logic but don't serve to reference the conclusion. While my personal knowledge of Medicare Billing brought me to this conclusion, I have not found sufficient references to support the conclusion of the thesis. This was my first Wikipedia posting and I inadvertently crossed the line.
Nonetheless, I plan to more carefully craft a properly referenced criticism. My retraction was in no way an acknowledgment to the objection stated above. The Medicare policies severely limit competition with the establishment of 'standard rates', and exasperate it by paying only a fraction. How can Medicare be deflationary by paying a small portion of an artificially high standard rate yet require the provider to charge the higher rate to the uninsured? When the reimbursement is too low, providers will avoid Medicare patients. When it is too high, it is doubly inflationary because the 'standard rate' is outrageously high.
Insurance is inflationary because people want as much medical care as they can get. Providers are highly focused on how much they can provide under the terms of the insurance. This creates a kind of all you can eat buffet where you only have to pay a small fraction of the direct costs. All of this is bad enough when people have to pay for the premiums directly or indirectly. Medicare Insurance doesn't even have the downward pressure of premium costs.
The only medical costs that drop over time are ones not covered by Insurance and Medicare. Good examples of these are Cosmetic and Laser eye surgeries. In these areas patients are price sensitive and providers can offer discounts, sales, or simply lower their price. Flexible, free market prices, coupled with a higher responsibility of actual costs will be the only deflationary pressure on medical costs. --Cashfoley 23:16, 26 September 2007 (UTC)

In order to make it easier to see what was removed, here is the deleted paragraph:

Others, such as the [[Cato Institute]], point to the fundamental interference Medicare has on market prices.<ref>http://www.catostore.org/index.asp?fa=ProductDetails&method=cats&scid=33&pid=1441272</ref><ref>http://www.cato.org/dailys/01-28-03-2.html</ref> Medicare specifies standard rates for nearly every medical treatment. Because participating health-care providers must adhere to these rates for all patients, these policies effectively create a regulated price structure for all medical care. Medicare only pays a percentage of the standard rate to the health-care providers and allows the provider to negotiate similar discounts with insurance companies. Health-care providers jeopardize their Medicare billing by providing discounted care to non-Medicare patients who are not covered by a negotiated contract.<ref>http://www.hfma.org/library/revenue/PatientFriendlyBilling/hfmJuly_04.htm</ref> These rules effectively build in inflated non-competitive rates for virtually all health-care costs.

I used the nowiki tags on this in order to make it easier to see everything that was removed . -- 159.182.1.4 17:32, 1 October 2007 (UTC)

Illegals

anyone on illegals as it pertains to medicare- medicaid —Preceding unsigned comment added by Faneuielhall (talk • contribs) 17:17, August 27, 2007 (UTC)

Medicare.com

I have added a link to Medicare.com. This site has original content with an attempt to offer short articles on coverage of medical equipment and supplies covered under Medicare Part B in an easy to read format. I have tried to ad the link in the past. However, being new to Wiki, I think it looked like spam and it was deleted. I'm going to try and ad it again with the blessing from the Wiki gods? Updated --Bkimberlin (talk) 02:02, 12 June 2008 (UTC) --Bkimberlin (talk) 02:02, 12 June 2008 (UTC)

Based on your persistence in trying to add this link, Bkimberlin, it would be useful to know if you have any association or ties with that site. -- 208.81.184.4 (talk) 14:22, 12 June 2008 (UTC)
Yes - I have contributed to the content on that site. There is however no reference to me on any of the content. I'm still learning my way around Wiki, and thought this would be a good topic for me to start with. I have worked with Medicare as a contracted provider, billed Medicare, worked with beneficiaries and built systems to manage patient information for the last 8 years. My persistence was motivated by learning how to post a topic I am familiar with. It was my attempt to contribute, but am starting to think the wiki learning curve may require more time than I have available. I have a lot to learn about Wiki and can see how easy it can be to give up when there are so many forces standing ready to delete any effort. On the other side of that thought,,,,, how cool it really is to have a tool that forces high qualify and valid content. Even if people who know the topic can't figure out how to contribute. Thanks for your question to me.
--Bkimberlin (talk) 03:55, 13 June 2008 (UTC)
Please explain why you believe adding Medicare.com (with which you have a direct association with) is not a WP:COI, meets WP:RS, and does not qualify as WP:EL#AVOID. You also may want to review WP:SPAMMER. You should not be adding links to a site which you are associated with. This link also happens to be a tertiary resource where links to more direct, high quality resources already exist on the article. Medicare.gov itself has won awards for how well it covers its subjects, contains no advertising, and is run by the Medicare program itself. Medicare.com doesn't appear to meet Wikipedia's "reliable source" standard. -- 63.224.135.113 (talk) 17:35, 13 June 2008 (UTC)

Constitutional Authority

Would it be appropriate to include in the Criticism section the topic of Medicare's Constitutionality? I'm not sure of the criteria for deciding which criticisms to include on controversial topics, and if the topic really isn't being raised by anyone it might not belong. -Kris Schnee (talk) 22:21, 15 October 2008 (UTC)

A topic which should be legally addressed is whether the provisions of current Medicare law since 1996 violate the "equal protections" clause of the U.S. Constitution. Specifically, current law denies beneficiaries any remuneration if their provider "opts-out" of the Medicare system. This extremely punitive provision, very purposefully inserted in the 1996 act by Rep. Pete Stark and colleagues, makes the U.S. Medicare program distinctive in attempts to monopolize the health care of the elderly and disabled. This appears to prohibit the use of a benefit and funds to which the beneficiary is entitled, simply because a provider refuses to contract with the government. The beneficiary should be entitled to "equal protection", e.g. remuneration/rembursement, regardless of whether the provider chooses to accept government rates or not. This issue is likely to come to the forefront soon as an increasing number of providers refuse to see Medicare, close practices to new Medicare, or "opt-out" altogether (resulting in no benefits for the Medicare enrollee) because of the financial impossibility of providing care to these needy individuals far below costs at the mandate of an unresponsive and bureacratic system perennially mismanaged by U.S. lawmakers.Sfhunter (talk) 15:32, 17 May 2009 (UTC)

Cost of medicare is incorrect for 2007

Someone else will have to fix it as I have no clue how to add footnotes, but the total spending on medicare for 2007 is 436 billion, not 440 billion. The support for this correction is here-taken from the Congressional Budget Office historical data.

76.208.45.235 (talk) 20:50, 2 November 2008 (UTC)

Quote(s) in notes in this article

Another editor has twice removed a referenced quote from footnotes, stating it is not in line with WP:MOS. As of the current version such an assertion is not substantiated, as supporting criteria is not specifically mention in that guideline. However the current version of WP:NOTES does state the following:

The decision on whether to use quotes in footnotes is primarily a decision of style and may vary from article to article. Some citation templates include parameters for quotes, and quoted text can also be added inside a footnote either preceding of following a template-produced citation. Quoting text can be useful for the verifiability of material in an article. Footnoted quotes are acceptable if they are brief, relevant to the article text that is being footnoted, compliant to copyright (including fair use where applicable), of use or interest to the reader, and not used as an evasion of other guidance (most notably: content policy).[8] Where there is disagreement on the use of quotes in footnotes on a particular article, consensus should be sought on the talk page for that article.

As I disagree with that removal of the quoted material, I am hoping to open a dialog on this topic here. The quote is from Richard W. Fisher, President of the Federal Reserve Bank of Dallas, and states the following:

Medicare was a pay-as-you-go program from the very beginning, despite warnings from some congressional leaders—Wilbur Mills was the most credible of them before he succumbed to the pay-as-you-go wiles of Fanne Foxe, the Argentine Firecracker—who foresaw some of the long-term fiscal issues such a financing system could pose. Unfortunately, they were right.
Please sit tight while I walk you through the math of Medicare. As you may know, the program comes in three parts: Medicare Part A, which covers hospital stays; Medicare B, which covers doctor visits; and Medicare D, the drug benefit that went into effect just 29 months ago. The infinite-horizon present discounted value of the unfunded liability for Medicare A is $34.4 trillion. The unfunded liability of Medicare B is an additional $34 trillion. The shortfall for Medicare D adds another $17.2 trillion. The total? If you wanted to cover the unfunded liability of all three programs today, you would be stuck with an $85.6 trillion bill. That is more than six times as large as the bill for Social Security. It is more than six times the annual output of the entire U.S. economy.

I find the quote as pertinent and useful in the notes section, as it puts the summary of this info found in the article in the context of the actual statement made, but it is too long to be contained in the body of the article. I would invite others to give more detail about why they think that this adds no value to the article in the notes section. -- 208.81.184.4 (talk) 15:27, 21 January 2009 (UTC)

Funding - lack of clarity

The article refers to funding from payroll taxes which seems to imply that the funding of Medicare is just like the funding of the military or any other public service funded by current taxation. But elsewhere it talks about "unfunded liability" and funds "running out of money", as if there is some giant pot of prepaid money from which care is paid from.

It kind of sounds like "unfunded liability" it means "liability for services for those alive today until they die that have not been pre-paid from taxes, disregarding the future stream of taxation income. If the service is paid for from current taxation, such statements would seem to be ludicrous. Does "running out of money" simply mean that, if forecasts are correct of expenditure and growth in income, then either the rate of contribution must rise or coverage must be reduced? Or is there some pot of money that will run dry? Its all a bit misleading.

What is the truth here? Can we get the article to have more clarity on the issue of funding?--Hauskalainen (talk) 21:43, 26 February 2009 (UTC)

Can anybody clarify this question. It is rather an important one to understand. I fail to see how a service funded from taxation and service charges can "run out money".--Hauskalainen (talk) 02:06, 1 April 2009 (UTC)

Basically, the U.S. Congress has turned the Medicare (and Social Security) programs into de facto Ponzi (Madoff) schemes as they have been fiscally unsound for more than a decade with the U.S. Congress continuing to "steal" funds paid in from the "trust fund" (actually a file cabinet of I.O.U.s now). The fund is negative in 2009 and for the future. For the last 10 years the Center for Medicare Services has mandated the maximum possible reimbursement to be below the cost which they have calculated for producing the service. This year the maximum collectible for a service is only 80% of the cost, and in practice only 90% of this amount is collected on average, and in the poor elderly (about 1/3 of all beneficiaries in many states) only 80% of the collectible amount is obtained. This means the entire health care system is trying to deliver the care at what any reasonable accounting would say is 65-70% of the cost. In the past this was subsidized by private insurers who usually paid 30-40% above the cost. As the government has controlled these prices, private insurers have jumped in to claim this is the benchmark. As private insurers continue to pull down profits of 10-20% off the top, with increases of 10% per year in revenue, the payments to providers have declined 25%. The U.S. government has offered no relief to the vast majority of providers who are in large part small businesses, resulting in the increasing demoralization of the providers of medical care, and frequent failure of small businesses.

There is only one possible outcome of this scenario. Complete collapse of Medicare. The U.S. Medicare system is the most punitive in the world for those beneficiaries and providers which opt-out of the system, completely denying them any benefits whatsoever. However, it will come, maybe even within the year, since the average health care provider had a loss of over $5000 for 2009 (much much higher for primary care physicians). Reinvention of Medicare as a high deductible health plan after the collapse is the likely future which is realizable, with means testing of all beneficiaries and balance billing for market-based rates for care, allowing a true market based control of prices.Sfhunter (talk) 14:33, 17 May 2009 (UTC)

Unfortunately we are being played by both sides. One side is presented very cogently above. Doctors have responded by raising "basic" rates to preposterous levels which are not reimbursed by Medicare. Whether they get coverage with other programs seems doubtful but they use it to calculate "losses" which may not really be bottom line losses, per se. The second ploy, a bit more devious, is to cut visits short and schedule another "follow-up" for "review of test results" scheduled during the first visit but somehow never anticipated, or, when they are, dreaming up something else to test for. This helps the "bottom line."
So there are two sides, with everyone, government, suppliers, and patients, all growing more and more frustrated with "the system."
WP:RELY references can probably be found for the above. The article may not cover that yet. Student7 (talk) 22:07, 17 May 2009 (UTC)

"About 50% of all Medicare dollars are spent in the last 6 months of a person's life and 27.4 percent are spent in the last year of a person's life" - doesn't make sense. —Preceding unsigned comment added by 205.168.82.114 (talk) 18:53, 19 July 2009 (UTC)

Sfhunter does a disservice with his nonsensical answer to the simple question from Hauskalainen. It is indeed nonsense to say that Medicare (or Social Security) are paid from "a big pot" that has been saved up previously by beneficiaries. The article indeed could make this clearer. Like the article says, current Medicare disbursements are paid for by current FICA taxes. Medicare is therefore a PAYGO system. That is the main answer to the question. What complicates matters is the looming Baby Boom. In the 1970s (if not earlier) it became clear that this demographic bulge would start to make the burden of the system unbearable for then current payers if nothing was done to make the baby boomers pay, in advance, for the extra costs they would cause after 2010. For that reason Congress put a surcharge on the FICA taxes (which we still pay) to create a surplus in revenues. This surplus is funnelled into the several Medicare Trust funds (as the article states). This "fund" is currently "invested" in Treasury bonds, just like the Social Security Trust Fund, and it engenders the same discussion (into which I don't want to enter for brevity's sake, although I don't agree with most of what Sfhunter says on this point). As soon as Medicare disbursements start to structurally exceed FICA revenues (projections differ) these trust funds will have to be used to supplement revenues. It will take some time before they run out, because they are so huge, though projections when this wil occur again differ. But even when the trust funds run out there will still be the normal revenues of the FICA taxes, so one cannot say that Medicare will then become "bankrupt." FICA-tax rates will probably have to go up then, at least temporarily, until the Baby-Boom Bulge has passed. I hope someone will edit the article to make all of this crystal clear.--Ereunetes (talk) 22:06, 23 August 2009 (UTC)

History of Medicare

Someone has copied supposed opposition quotes from Reagan, Dole, etc. from various political websites about the debate in the 1960s. The material is essentially copyrighted unless they can come up with a good reference that would be from the original source and not from the political websites, These, of course, are all done in support of the current proposed universal medical care bill to demonstrate clearly that only Republicans opposed it.

Of course, that wasn't true, Republicans then, like now, were in the minority and weren't listened to. Medicare was shaped by conservative Democrats. See this for a balanced article on the topic.

As bad as Medicare is, and as much as it has forced up medical costs in the country, it would have been a lot worse without these conservative Democrats. Student7 (talk) 11:41, 13 August 2009 (UTC)

FWIW, as far as the final vote went, most of the against votes were from the minority Republicans, although it passed fairly overwhelmingly. http://www.ssa.gov/history/tally65.html
This article could use some history.Gruntler (talk) 00:10, 14 August 2009 (UTC)

For future reference, are various "socialism" quotes, mostly sourced. http://mediamatters.org/reports/200903050012 Gruntler (talk) 03:11, 23 August 2009 (UTC)

All material in all articles, but particularly controversial, or semi-controversial ones, should be sourced. You are welcome to flag those that you believe should be sourced. Sourcing prevents people from putting in material they happen to agree with but is "top of the head." As often as not, they have some key word or phrase wrong, or is obviously pov (from a poorly rated source). Sourcing makes our job a lot easier. It also helps us to avoid possible copyright infringement. Unless quoted from a secondary source, we can't really be sure about the quote. We all get email where politicians have been misquoted, for example. This sort of thing needs to be traced back before using in here. Student7 (talk) 13:12, 24 August 2009 (UTC)

Medicare role: Public perception v reality

Medicare does more with its X number of dollars. It is not simply a "single payer system for 65+," though this is public perception and is currently the impression one would get from reading this article. Medicare also funds 90+% of all the resident training programs for phsycians in the United States. A huge expense that gets funded by medicare, but doesn't benefit any single patient (it benefits the system as a whole in the long-term by supplying the US with physicians training at a low-cost.) There may be other programs which are funded by medicare which are not mentioned in this article. As such, I'll be adding some tags to this article. Bryan Hopping T 16:27, 1 September 2009 (UTC)

Residency training

This may apply to the above comment. I don't know. But reading the paragraph originally, and I haven't changed it much, there is a pov slant that shouldn't be there. It is okay to say that "critics claim that..." but it is inaccurate to say that there is a one-to-one correspondence without some form of proof, between population increase and demand for doctors. The population may becoming older, therefore... (is the way I changed it). If the population were becoming younger, or as the GI generation passes away, one might expect demand to diminish, at least over the short run until the baby boomers become senior citizens.

There is a lot of presumption in the statements I saw. I think they can be readily amended as soon as people agree/recognize that there is an automatic pro-Medicare, pro-increase in funding bias in the article/subsection. This bias should not be there. Okay to supply actual proofs, but statements by media aren't necessarily without bias. They may be valid criticisms but not necessarily unbiased ones. Student7 (talk) 22:34, 2 September 2009 (UTC)

Congresspeople

What is a listing of congressfolks doing here? This seems to suggest a "how to" section. Write your congressman? Nothing wrong with listing committees that review Medicare, but people seems WP:PR. They format bills for Congress, but it is the full congress that passes it and the president who keeps it going. In short, it is "the government of the people" that is doing this, not individuals. Highlighting individuals after the fact of the initial passage of Medicare, seems pretentious IMO. Student7 (talk) 15:35, 2 October 2009 (UTC)

I agree that listing the head of the committees is less than useful, but the majority of the work done by congress to oversee the Medicare program is done in these committees, so it is useful to list the committees. -- 208.81.184.4 (talk) 20:54, 6 October 2009 (UTC)
I like your changes. Student7 (talk) 18:00, 8 October 2009 (UTC)

Nursing home stays not covered?

In Part A, criteria 2, the article states "The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. For instance, a hospital stay for a broken hip and then a [skilled] nursing home stay for physical therapy would not [italics mine] be covered."

This example seems to contradict itself. According to the first sentence, wouldn't a PT stay be covered if the broken hip was the main cause of the hospital stay? Assuming that all the other criteria (medical necessity for inpatient stay, etc.) are met? I agree that, most of the time, physical tharapy would be covered in a rehab center but it could be handled by a SNF as well. (Also, see criteria 3. Does this point interact with criteria 2??? Are these two points really trying to say that Plan A does not cover inpatient physical therapy? If so, it should be phrased better.)

Anyway, I've added a dubious warning to the article. An expert on Plan A coverage should review all the criteria. --RoyGoldsmith (talk) 12:03, 10 October 2009 (UTC)

You are right. This can't be correct and I have deleted it. I'm guessing there was wording to cover some other situation which is now not mentioned. We do need an expert here. Student7 (talk) 14:17, 14 October 2009 (UTC)

"Impossible" to find insurance?

There is disagreement whether it was "impossible" for the elderly to find medical insurance when Medicare was first enacted. Someone has corrected this back to "impossible" since that is what the politician (political appointee) said. The problem with the quote, though, is that it was designed for the media, not for reality. It is a political statement. "Impossible" is an overstatement best reserved for anti-gravity, perpetual motion, that sort of thing. Of course, it wasn't "impossible" regardless of what the politician said. This is not a WP:RELY statement IMO. But, regarding this issue, they may be difficult to come by! An unbiased statement would read "difficult" which was the "correction" offered by another editor. My suggestion is to either get rid of the quote and find someone less biased, or drop the "impossible" which is a silly modifier, designed for public consumption and not reflecting reality. Student7 (talk) 16:18, 27 October 2009 (UTC)

Piper report link

Deleted link to Piper report because the link is not specific to the subject and also relates to this issue: "Adding links to one's own page is strongly discouraged." from Wikipedia:External_links#What_should_not_be_linked_to —Preceding unsigned comment added by SouthernNights (talk • contribs) 19:35, 6 May 2005 (UTC)

Survey?

We have this quote:

"According to an article in the Journal of American Physicians and Surgeons, in a random sampling of questions asked to Medicare customer service representatives, 96% of the answers given were incorrect. "

But what were they asking about? We would need to know what in order to understand what the sentence means. For all we know, it was a spelling test...— Preceding unsigned comment added by 199.72.97.65 (talk) 19:37, 19 March 2006 (UTC)

Medicare largest public funded health program

I removed sentence "Today, it comprises the largest publicly-funded health program in the world." I could find no reference to this. If true, this needs a citation. However, this fact seems suspect since Medicare covers only 40-50 million people in the US, while public funded health programs in the UK, Europe, Japan and other places cover almost their entire populations. In the UK and Japan alone, this is more than 50 million.--Alabamaboy 28 June 2005 13:16 (UTC)

I think it would be accurate if it said together, Medicaid and Medicare are the largest in terms of dollars spent on medical services and goods. Or something to that nature.—Preceding unsigned comment added by Debomachine (talk • contribs) 21:08, 3 August 2006

Patrick25: I think the largest single-payer health care is the europan union which compromises of 27 member countries! Not the United States. The population estimates 494 million people, and If you are (for example) a German resident, you are entitled to medical treatment that becomes necessary, at reduced cost or usually free, when temporarily visiting a European Union (EU) country, for example Greece, Iceland, Spain, etc. However, to obtain free treatment you will need to take a European Health Insurance Card (EHIC) with you. Which is free for all too. I wish i could use it also in the united states when visiting Florida in summer ;-)) Maybe Florida joins the EU. There are so many poor people without proper unemployment and health insurance. The best single-payer health care are free.—Preceding unsigned comment added by 84.114.183.219 (talk • contribs) 21:38, 26 May 2007

FYI: Iceland is not a member of the EU. --anon.70.23.158.110 (talk) 01:31, 2 January 2008 (UTC)

Size of Medicare

Hi. Actually, Medicaid is now larger than Medicare in both total expenditures (federal and state) and enrollment, so item is moot.

On the issue of Medicare's size relative to other health programs internationally, it is larger than any health program in any of the 29 nations that are members of the Organization for Economic Cooperation and Development (OECD). We don't have good spending data on other countries but these large nations drawf any of the other 180+ countries. See data from House Ways and Means Committee Green Book (waysandmeans.house.gov/media/pdf/greenbook2003/).

Medicare spends considerably more per capita than, for example, the National Health Service in the U.K. Many reasons for this. Medicare pays for much wider range of services and higher quantity of services. Many European health systems ration explicity by not covering, for example, transplants for persons over 55 and by limiting the speed and quantity of services. The U.S. rations but indirectly through insurance market.

Bottom line, it may be more useful to describe Medicare as the second largest health program in the U.S.

Hope this helps.

--Medinomics 4 July 2005 03:37 (UTC)

Its been 4 1/2 years since Medinomics wrote that and federal payments for Medicare are now almost twice that of Medicaid. Even when inlcuding the state's costs for Medicaid, effectively doubling the figure, Medicare costs are roughly equal to Medicaid.--TL36 (talk) 12:06, 4 March 2010 (UTC)


On the issue of size / funding challenges -- the discussion of net benefits (Medicare deficits per capita) -- the table comparing "spousal benefit" to the net for single women is completely wrong and needs recalculation. The "net benefit" for the spousal pair are lifetime costs for 2 beneficiaries (net of one lifetime set of tax payments for the wage earner), instead of lifetime costs for one (net, perhaps, of one-half of a 'set' of lifetime tax payments). The comparison is then much closer but clearly different. —Preceding unsigned comment added by 74.83.1.87 (talk) 23:23, 2 June 2010 (UTC)

Eligibility section

Anyone want to take a stab at creating a section to discuss the various ways someone is eligible for medicare? Ksheka 13:45, 9 October 2006 (UTC)

I took a stab at it, but there is apparently more to it than can easily put into words. Ksheka 13:52, 9 October 2006 (UTC)
Unfortunately, both the entry in the article and the page on the medicare.gov site on which it is based are incorrect, which you'll find out if you go deeper into the site. Citizens and legal permanent residents 65 and over are eligible even if they have paid less than 10 years' worth of FICA-taxes. In case one does not reach the 10 year threshold (and provided there are no other disqualifying reasons, like having been a Federal employee and such) one has to pay a monthly premium for part A of Medicare. Actually, there are two premiums, currently $244 for people with 30-39 quarters of FICA payments and $443 for people with even less. [1]--Ereunetes (talk) 20:54, 23 August 2009 (UTC)

I "stabbed" this with links to the Medicare.gov site. Most people are unaware that Medicare can be purchased and is purchased by rich people who never worked a day in their lives and never paid a dime of Medicare taxes. Adding up the numbers for 'A' and 'B' through an advantage plan seems a really good deal. So I am starting to craft a movement to include ALL income regardless of source in the Medicare tax while possibly cutting the tax rate. Unlike Social Security where benefits depend on the amount wages you earned, Medicare benefits are the same for everyone. So why are only people that have to work for a living the only people paying the tax???? I estimate that broadening the tax to include all taxable income would produce a 28% increase in Medicare revenue (over half a trillion in 10 years). Please understand that earnings in a 401K are not taxable so most middle class would see no tax increase at all.--The Trucker (talk) 07:42, 17 February 2010 (UTC)

Criticism section

Cybercobra reverted my addition of quotation marks to the conservative claim that Medicare is "socialism". I disagree, and think that the entire criticism section is, as currently construed, highly problematic and POV. But sticking to the immediate issue at hand, the charge that Medicare is "socialism" is a claim that is, at best, not demonstrated, and indeed is an unsourced POV claim. Ipso facto, to eschew the quotes implicitly legitimizes the claim. Because it is a claim based on a particular political perspective, it should be characterized as such. The onus of proof that Medicare is "socialism" is on the claimant, and the article should in no way give implicit endorsement of this charge. Cheers, Arjuna (talk) 21:33, 30 September 2009 (UTC)

Maybe you should actually visit a Socialist country and compare. Programs like Medicare are the staple of Socialist countries. --69.154.19.201 (talk) 09:43, 21 November 2009 (UTC)
Actually, I personally agree that the claims of socialism are bunk, but NPOV requires that Wikipedia itself not pass judgment on the issue, especially in such a petty way as a section title. Quoting from scare quotes: "Style guides generally recommend the avoidance of scare quotes in impartial works, such as in encyclopedia articles or academic discussion." I agree the section needs work and a rebuttal could be incorporated, but scare quoting is not a step in the right direction. --Cybercobra (talk) 21:40, 30 September 2009 (UTC)
If Medicare is not a socialist program then what is?--69.154.19.201 (talk) 09:43, 21 November 2009 (UTC)
Thanks for your comments, and I'll defer to the style guideline on this. I may take a crack at revising the criticism section. Generally speaking, I don't think that specific perspectives (in this case, the libertarian one) merit special discussion. There is no "pro-Medicare" section, for example, and I don't think that would be appropriate either. But certainly the way it is currently written uses unacceptable strawman arguments (as I noted in the hidden comments there) and is just generally pushing a POV. It's worth noting also that that whole section was added relatively recently - i.e. it is not "stable" material (no irony intended in those quotes btw). One other thing that I noted but have not yet had time to fully verify, much of the criticism of the financial weaknesses of the system (which is completely appropriate and legitimate) seems to currently be based on partisan or ideologically-oriented sources. Such material really should come from non-partisan, unbiased sources such as the CBO. Cheers, Arjuna (talk) 01:56, 1 October 2009 (UTC)
While the definition of socialism may (now) be rather deliberately vague, it certainly covers paying for services for other people through taxation, to achieve wage distribution (they can't afford medical care. We'll give it to them anyway by taxation or forced insurance), perhaps excepting public safety (army, police) and diplomacy (state). A lot of things are socialist, not just universal medical care. To deny it is socialist is fatuous IMO. Student7 (talk) 02:00, 25 November 2009 (UTC)
To deny state medical aid is socialist, for at least a good number if perhaps not all of the many, much disputed definitions of socialism, is certainly fatuous, perhaps even deliberately misrepresentative. However, to labour the point of its socialist nature at a time when it is under intense debate and regarded as controversial, in doing so resembling a great deal of currently circulating and not very impartial rhetoric, whilst wikipedia articles on so many other basically socialist endeavours do not make a big deal of pointing this out (such as your examples of the army and police), would strike me as somewhat questionable also.94.194.223.17 (talk) 21:24, 14 December 2009 (UTC)
I suspect that "socialistic" programs are ones that cannot be undone because too many people feel entitled to benefits. That is, defense and diplomacy efforts can be reduced. They are not socialistic. Medicare, Social Security, food stamps, etc. can be "modified" but not very much - I suspect that makes it socialistic. There is also the aspect of taking from Peter to pay Paul, but I am not sure that is limited to socialistic programs. Student7 (talk) 23:12, 27 December 2009 (UTC)

Reagan and Bush quotes

I am puzzled by the repeated removal of the Bush and Reagan quotes. Yes, they were said before Medicare was passed, but that's because people discuss legislation before it passes. Granted, given the nature of the legislative process, it's likely that proposed reforms didn't look exactly the same as the finalized 1965 version, but that seems like a technicality to me and it should be fixable by simple rewording, as opposed to deletion of material (WP:PRESERVE). My initial attempt at rewording was reverted. My second suggestion would be to change that section's introductory sentence to "Many conservatives strongly opposed government provision of health insurance" or words to that effect. Gruntler (talk) 18:55, 24 October 2009 (UTC)

The onus is on you to show that they were talking about a program of care for specifically targetted at the elderly. The text specifically mentions Medicare but that seems to me to be not what they were talking about. The Reagan quote was about socialized medicine which is a health care system funded by taxes which is a similar but not altogether the same concept. My understanding is that parts of Medicare are funded by contributions more like insurance but others are funded by payroll taxes. I think the texts could be included if they were reworded to make it clear what they were talking about and that it was the discussions about a Medicare type program that caused them to say what they did. The citation link for the Bush quote also is not working.--Hauskalainen (talk) 23:11, 24 October 2009 (UTC)
Reagan transcript. [2] The bill he is telling people to stop is a bill providing health insurance specifically targeted for the elderly, which is what you require. For Bush, the link is working, just behind a paywall, but that does not disqualify it as a source. To satisfy you, I checked Lexis-Nexis, the quote is accurate. The full sentence is "He hotly criticized Democratic ideas for national health care as a sure bet for an expensive, bureaucratic nightmare, just as he opposed Medicare in 1964 as "socialized medicine." " Gruntler (talk) 02:46, 25 October 2009 (UTC)
Reagan was nobody at the time. Retired president of the Actors's Guild. How far back in a person's bio do you go for a "politician's" quote? Bush, most likely was either thinking about running for representative from Houston or was one. Not quite the visibility of Goldwater IMO. Student7 (talk) 15:06, 26 October 2009 (UTC)
If the section was about the legislative fight, then focusing narrowly on the people who were involved in passing the legislation at the time would be appropriate. But if it's about general conservative opposition, I'm not sure why that applies. Lots of people feel that government shouldn't provide services like this as a matter of principle and Reagan is as good a voice for that point of view as any.
Hmm... now that I'm looking closely at it, perhaps this section should be merged with the section above it on the "Entitlement Question" as they are closely related criticisms. It could help with POV problems in both sections. Thoughts?
Anyway, as the urgent issue (verifiability) seems to be resolved or at least the person bringing it up seems to have lost interest, I'll revert to the long-standing version of the article as we discuss this. Gruntler (talk) 17:21, 26 October 2009 (UTC)
This is a bit "cherry picking" since only Republicans are quoted. Even future Republicans like Reagan are denied status as a Democrat in the article, which he was at the time. The US Congress was usually Democratic between 1948 and the time Medicare passed. Clearly there were dozens if not hundreds of Democrats who didn't like it either or it would have passed much sooner than it did. But no quotes. Even the registered Democrat, Reagan, is denied that status in the article. But his opinion did not differ much from a lot of other registered Democrats. And he was nobody at the time. Can we quote Joe the Plumber? Student7 (talk) 13:59, 2 January 2010 (UTC)
Before I excised Reagan's formal status as a Democrat at the time, it was the only explicit mention of either party in the entire criticism section. That was worse cherry-picking than the current version. I agree with you that the whole section could use a lot of improvement. Gruntler (talk) 14:30, 2 January 2010 (UTC)
One of the problems here that ought to be discussed in a higher venue, is that someone deliberately went back and dug up old quotes to post on the web. Since they were made well before the web was invented. Note that this was done selectively. Quotes from dissenting Democrats, except Reagan, whom we aren't allowed to say was a Democrat, were not posted from wherever they dug the quotes up from. So it was quite selective. Yes, some Republican could do the same here. Somehow, that doesn't seem right.
If a researcher were to publish a book with all quotes in it, that would make sense and be npov. But digging up selective quotes, posting them to the web, then quoting them here, seems pov somehow. Student7 (talk) 13:45, 5 January 2010 (UTC)
I don't even know that selecting Republican opposition *is* cherry-picking; at passage, the pro- vote was overwhelmingly Democratic and the bulk of the opposition was Republican [3]. Though I don't know, I'd be surprised if the few opposing Democrats were out making impassioned speeches attacking it, out of party loyalty if nothing else. Certainly describing opposition as primarily *conservative*, both at passage and throughout most subsequent history, seems basically accurate to me. To the extent that there's cherry-picking going on, it may be more in the recentism sense than in the ideological sense, in that the quotes are from people the modern reader is more likely to recognize. Gruntler (talk) 05:02, 6 January 2010 (UTC)
Well, if the House, usually dominated by Democrats, passed a Medicare bill in each session of Congress, I suppose you are right. If they did not pass such a bill when they were in control, then there must have been Democrats who opposed it. Student7 (talk) 15:48, 8 January 2010 (UTC)
I don't follow. Pick any other bill and apply that logic. By that logic, every Congress until 1996 must have thought that a gay marriage in one state should be recognized everywhere, since DOMA didn't pass until 1996. Republicans from 1994-2000 opposed the Bush tax cuts because they didn't pass until 2001. etc. It doesn't make sense. Anyway, *obviously* there were Democrats who opposed it--you can look at the vote count for that, you don't have to infer it.
Look at today's politics. If things had gone a bit differently and health care reform had failed after Ben Nelson decided not to support it, leaving a 59-41 Senate, I would sure hope that a Wikipedia article on the subject from 2050 didn't scramble to make sure that Democratic opposition to reform was represented equally with Republican opposition. Gruntler (talk) 16:53, 8 January 2010 (UTC)

Criticisms

Why can't it also be called targeted 'votebuying'. —Preceding unsigned comment added by Ericg33 (talk • contribs) 09:20, 3 October 2010 (UTC)

Kaiser evaluation of Medicare Advantage plans

Not sure where this was going. Is Kaiser totally neutral on this? I thought they had plans. 6 out of ten weren't evaluated? How useful is that? The plans averaged out to average. Is that a surprise? Don't most averages, uh, average out? The average baseball player hits an average number of RBAs. That sort of thing. Our kids all get Bs, but that's grade creep. They're no smarter than we were! They still average 100 IQ. I don't see how that report is useful. We aren't supposed to draw conclusions for them, but what conclusion might a reader reach? It seems to me that it was slanted to suggest that the plans were "mediocre" whatever that means. I don't think that Kaiser has an inside track with evaluating plans. They aren't S&P, or Guiness, or Consumer Reports, or something. I think it should be reworked or deleted. Student7 (talk) 22:18, 9 December 2009 (UTC)

Yes, "Kaiser" is totally neutral on this. The source is the Kaiser Family Foundation non-profit health policy think-tank, not Kaiser Permanente the health plan. And yes, I'd argue that the information is useful. There's relatively little research available on the subject, and this source does give a sense for the range of quality that's out there. It's useful to know that roughly 20% ("only"/"as many as", depending on how you see things) are in plans with lower ratings, and that an equivalent number are in plans with high ratings. What conclusion would I, personally, draw? Most plans are, as you say, "average" - but the plan you pick does matter. It's worthwhile to look at HEDIS ratings, the information available from CMS, and local reviews of the plans in your area if you want to make sure you're enrolled in one of the better plans.
Yes, when you average us all out, our IQ is 100. But when I'm picking my doctor, I'd like to take the time and effort to find one who's above average. (It matters, in other words, whether the spread in IQ's is between 92 and 108, or between 60 and 140.) EastTN (talk) 20:11, 14 December 2009 (UTC)
Thank you for clarifying that Kaiser isn't Permanente!
At best, the article needs information on how the plans were rated. "Outcomes" is suggested, but not amplified particularly. Ten points for outcomes, five points for cost, two points for paperwork/bureaucracy? What? The ratings seem vague. When Consumer Reports rates something, it is fairly clear on what it is rating, and not just vagues "I am Consumer Reports and Chrysler is tops" and let it go at that. Nobody would buy it anymore. Sounds like WP:PR.
If six out of ten doctors go unrated, what then is your conclusion? That you will pick only rated doctors? As for me, I would wonder why the six weren't rated. It seems to cast a question on the ratings themselves.
I am still less than convinced this slim survey by a relatively unknown, self-designated guru, deserves this much white space. Even more so when their methodology is hidden. Why is it hidden?
Also, let's think about this. Suppose we have an article on "Automobiles." Do we then mention that Consumer Reports (who is fairly well-known) evaluates cars and has found that 8 out of ten cars require way too much maintenance and gets lousy milage? It seems a bit of a stretch to say that every article on a material item requires presentation of evaluation by anyone, even if rating company is reputable and presents useful information to a consumer. We are not a catalog nor a consumer magazine, nor a how-to magazine. Somehow, this seems to have gone beyond presentation of Medicare itself.
Presentation of material in a political manner may be more germane. "Since Medicare plans are mostly bad, this shows that Congress did the wrong thing by ..." (have to be WP:RELY analysis of course. This take the material out of a "how to" users guide and puts it into a proper role as presenters of material germane to Medicare itself - it would not be aimed at helping users per se.Student7 (talk) 04:15, 21 December 2009 (UTC)

History

Not sure why Medicare cannot have a history which references a germane Wikipedia article.

While I appreciate that an editor who is liberal does not want to hear, nor anyone else to read, that medical care has been tremendously underestimated in the past, it is, nevertheless, true. I do not know why it is being erased as though it weren't true. Nearly everyone in the country knows that medical care costs are totally out of control. One of the prime reasons is this program which subsidized care, driving up the price, as subsidies usually do. (and for people who haven't been reading the censored edits, I never drew that conclusion. The quotes were accurately attributed. The reader may draw her/his own conclusions. Some readers could care less about cost, I suppose). Student7 (talk) 19:12, 29 July 2010 (UTC)

I haven't been following, but am surprised that editors are deleting your edits. Economists have been saying consistently since its inception that Medicare was costing far more than was originally estimated. There's nothing controversial about it -- it's a statement of fact. Wikiant (talk) 01:44, 30 July 2010 (UTC)
Student7 should stop their WP:Disruptive editing of the Medicaid [4] [5] [6] [7] and Medicare (United States) [8] [9] [10] [11] articles—repeatedly adding false and misleading material (mis)citing UNRELIABLE sources.
Repeated addition of WP:SOAPBOX misinformation to the Medicaid and Medicare (United States) articles and careless (mis)citation of UNRELIABLE sources by User:Student7, a Veteran Editor IV with 36,000+ edits and no evident sincere interest in the history of Medicaid or Medicare, is disruptive and unacceptable. Apatens (talk) 03:42, 30 July 2010 (UTC)
Inserting the adjective "conservative" in front of each source doesn't constitute an argument. "Conservative" <> "moron". Reporting figures in nominal terms isn't "silly" if one is comparing to projections that were made in nominal terms. Wikiant (talk) 13:10, 30 July 2010 (UTC)
  • I used the adjective "conservative" once, accurately describing one newspaper (The Washington Times)—the one newspaper to run an article quoting a partisan Republican opinion paper.
  • Comparing nominal figures over a very, very long time—a quarter century (in 1990 the consumer price index was 415% of 1965—with hospital cost inflation unpredictably much faster than that of the CPI)—for the purpose of dramatic exaggeration in trashing prior health care reform cost estimates in a partisan Republican opinion paper [20] is silly.
  • Editorials, opinion columns, and a partisan Republican opinion paper [21] (that is only quoted in an article in one newspaper—the conservative Washington Times [22]) are not WP:NPOV WP:Reliable sources for statements of fact.
  • This article could use a "History" section, but the WP:SOAPBOX "History" section added by Student7 citing a WSJ editorial trashing "ObamaCare"—not a WP:Reliable source:

    In 1965, the US Congress estimated that the program would cost $3.1 billion in 1970. The actual cost was $6.8 billion. In 1967, a House committee estimated that the program would cost $12 billion in 1990. The actual cost was $110 billion.[23]

    is not an appropriate summary style synopsis of the Social Security Act of 1965 nor of the overall history of Medicare.
Apatens (talk) 15:43, 30 July 2010 (UTC)

Still not certain why the following was deleted along with everything else.

"==History=="

Main article: Social Security Act of 1965

The article lacks a history. I realize the editor does not care to have the poor estimates highlighted. But what is wrong with having a rather innocuous "History" subsection? Nearly every other article has one. Student7 (talk) 20:30, 2 August 2010 (UTC)

There is already a wikilink to the Social Security Act of 1965 at the beginning of this article's second paragraph.
There is no need for an empty history section with another wikilink to the Social Security Act of 1965 article. Apatens (talk) 05:21, 3 August 2010 (UTC)

Reimbursement rates

Reimbursement rates for doctors are primarily determined by the Relative Value Scale Update Committee of the American Medical Association. There has been a lot of criticism about these rates. Source:

http://online.wsj.com/article/SB10001424052748704657304575540440173772102.html?mod=googlenews_wsj

Excerpt: "A Wall Street Journal analysis of Medicare and RUC data suggests that services were paid too generously in some cases because the fees were based on out-of-date assumptions about how the work is done. The analysis found more than 550 doctor services that, despite being mostly performed outpatient or in doctors' offices in 2008, still automatically include significant payments for hospital visits after the day of the procedure, which would typically be part of an inpatient stay."

Overall, I suggest a couple of daughter articles:

because the article is getting too long without having a lot of good historical details as well as relevant information (see above). -- John Broughton (♫♫) 00:05, 29 October 2010 (UTC)

External links

This article should not include entries in the external links section for organizations that sell Medicare Part C/D, Medigap, or other related insurance polices, or that collect sales leads for other insurance partners/affiliates. There is no way to reasonably include them all, nor is there a fair way to include some but not others, even if this excludes links to well established advocacy organizations such as AARP. I have recently removed all of the links that fit this criteria that I can see, and ask that they not be added back in without providing very good reasons here on this talk page. -- 208.81.184.4 (talk) 21:24, 4 November 2010 (UTC)

Financial viability

The article currently says the following...

Richard W. Fisher, President of the Federal Reserve Bank of Dallas has remarked that in order to "cover the unfunded liability" for the Medicare program today over an infinite time horizon,[clarification needed] "you would be stuck with an $85.6 trillion bill" which is "more than six times the annual output of the entire U.S. economy", and noted that "Medicare was a pay-as-you-go program from the very beginning."[55]

The present value of unfunded obligations under all parts of Medicare during FY 2009 over an infinite horizon is approximately $36 trillion. In other words, this amount would have to be set aside today such that the principal and interest would cover the shortfall assuming the program continues indefinitely.[56]

The first statement is plain stupid. That figure of 85,6 trillion is (presumably) the Net Present Value of the future flow of costs for medical services paid from Medicare from now until the last person who has contributed to the fund has died. A 20 year old today would not be expected to pay NOW for all his future medical insurance until he dies. The number is pretty much meaningless. A commercial medical insurance company doesn't have to fund its operations over an infinite time horizon. And they are pay-as-you-go schemes!

The second statement is no less stupid. It too talks about unfunded liabilities over an infinite horizon. All those people who will be included in that calculation will be young people who WILL PAY IN THEIR MEDICARE TAXES at some time in the future. The problem is not that big because much that future stream of income will presumably meet much of that "unfunded liability". In other words it would make sense to offset against the unfunded liabilities the unfunded assets (the bonds that will be bought with the future stream of Medicare taxes and Medicare fess to arrive at a NET unfunded liability or surplus. Totallin all the liabilities and ignoring future income is a bizarre way of looking at things.

Also, isn't it technically incorrect to claim that Medicare is a pay-as-you-go system? Surely it is a pay-in-advance system. Your taxes are taken from you and held by the Medicare trust fund as bonds and these are used to help fund your health care when you retire. The English NHS system is a pay as you go scheme. It has an annual budget granted by parliament from which all health care is funded. There is no NHS "trust fund" holding taxes collected in the past. It is funded annually from taxes. Taxed and spent all in the same year. A commercial medical insurance company is a "pay as you go scheme" - all the current year's premiums are used to fund the current year's medical expenses. Sure they hold a contingency reserve, but not as Medicare does, years and years of pre-paid premiums. --Hauskalainen (talk) 16:41, 23 January 2011 (UTC)

Medicare has always had an interesting funding scheme -- FICA taxes are currently collected from those that are not yet Medicare beneficiaries, and those funds are used to cover the costs of current Medicare beneficiaries, with any remainder added to the Medicare trust fund (similar to the Social Security Trust Fund). Funds are dispersed from the trust fund when the costs for current beneficiaries is greater than the FICA taxes taken in; this second scenario is the one that has been happening for many years now, and based on population ageing this will be the case for the foreseeable future unless FICA taxes are dramatically increased, or the Medicare funding mechanism is fundamentally altered.
This means that there is an unfunded liability (the expectation by those paying into the system that they will receive benefits in the future, even though the taxes collected from them were immediately used to pay for benefits received by someone else) which has an "infinite time horizon" (there is no cutoff in place where taxpayers will stop being required to pay into the system, nor a limit beyond which Medicare will stop accepting new beneficiaries that meet enrollment requirements). -- 208.81.184.4 (talk) 19:20, 25 January 2011 (UTC)

Political arguments about the National Debt and Medicare

Maybe I have missed something fundamental in my thinking... but maybe I am not the only one .. so here goes with my question. Has nobody in the U.S. ever questioned the crazy logic of complaining about the various Trust Funds and then fretting about the deficits?


When I hear people in the U.S. complain about the government and health care, the argument seems to run like this....

"We can't have more government programs... the government is already up to its neck in debt...we would be laying down a problem for our children, our grandchildren and their grandchildren".... I am sure you have heard these arguments...

...and it seems logical to Americans until you realize this...


..... that about a third of all that government debt is due to the peculiar way Congress enacted Medicare and Social Security legislation. This requires the creation of IOUs in the form of bonds issued to the Medicare (and Social Security) trust funds when it takes those dollars from peoples' wages and salaries. I say "peculiar" because no equivalent of Medicare in other country I know of acts like this. In those other countries, the current generation of tax payers pays out the health care needs of the current generation of health care beneficiaries, just as the insurance industry takes money from the current generation of well policyholders in their pools to pay for the needs of the sick policyholders in those pools with only a small surplus held back in reserve. And in those other countries national retirement schemes, the current working generation pays out the retirement benefits of the retired. No trust fund needed and no artificial borrowing either.

So the way I look at it is this. Far from being a "bad thing", a huge chunk of the government debt in issue are bonds being held by the Medicare fund (and the Social Security Fund) and so are kind of a "good thing" ... they represent the stored up dollars that were taken out of circulation in the past when people were taxed and converted to debt (i.e. bonds held by the trust funds)to be redeemed later on to pay for benefits in ill health (or retirement).

If the US government were to act the same as other governments around the world do by taxing the current healthy people to paying the health care needs of the current sick ones (and similarly for retirment) it could simply wind up the Medicare and Social Security trust funds and nobody would notice it. One third of the US deficit could be wiped out with the stroke of a pen and a whole layer of bureaucracy would disappear along with it. Is there reason to believe that there could not be a social contract between the older and younger generations or between the sick as happens elsewhere? People in Europe are not threatened by the absence of a "social security trust fund" or a "health care trust fund". One third of America's debt is an accounting trick... Someone surely must have made a case for this in the past or pointed out the hipocrasy of complaining about the rising debt without realizing that it represents something rather positive in the case of health care and retirement benefits. Or have I missed something? --Hauskalainen (talk) 16:55, 15 November 2010 (UTC)

I had a feeling that I may have dealt with a related issue some time ago.. and now I just found it... but I got some very confusing answers then..... See this from the archive of this page.... http://en.wikipedia.org/wiki/Talk:Medicare_(United_States)/Archive_1#Funding_-_lack_of_clarity Here we have one person claiming that its just a Ponzi Scheme and another claim that is a pay-as-you-go scheme (which I presume means what I said is how other countries schemes work, and indeed how the private health industry works). Does the creation of a Medicare fund mean that when people retired in the 1960s soon afer Medicare was enacted that they were not eligible to get Medicare because they had never paid into Medicare? If they were paying out to all seniors then Medicare would seem to be a pay-as-you-go scheme with a fund on the side. To me it still seems very confusing and unnecessarily so.If it is a pay-as-you-go scheme it would be simpler and more honest to close the Medicare Trust Fund and cancel the debt. --Hauskalainen (talk) 17:09, 15 November 2010 (UTC)
The idea behind the Trust Fund (which exists only on paper as you have pointed out) was to allow for different cohorts of Medicare recipients, for example, the Baby Boomers will be going through this shortly. There are a huge number of people in that generation and they will live longer than the "Greatest" generation which is quickly dying off. Right now we are seeing the least demand on Medicare than we will see until 2035 or so. It will escalate. Congress intended to show Baby Boomers that the "money would be there for them", but then borrowed it back and spent it! So the money is not there for them and the burden on the working people per capita will be large, particularly since medical costs are soaring. {"Ponzi" scheme, as you have stated) The Universal Healthcare Bill of 2010 (or whatever it is called) "solves" this problem by chopping 27% from all doctors reimbursements, as though that would help! Doctors aren't getting that much now and are dropping (not taking new) Medicare patients as a result.
The problem is a long way from "solved." Congress hasn't yet begun to address the problem.
If other editors are not seeing a discussion relating to the improvement of this article, feel free to delete all of this! Student7 (talk) 23:54, 17 November 2010 (UTC)
You said something which illustrates precisely the point I make. You said "Congress intended to show Baby Boomers that the "money would be there for them", but then borrowed it back and spent it!" You say that they "borrowed the money and then spent it".
Where do you expect the money to be? In a Citibank account somewhere?
What happened was that the baby boomers contributions went out of circulation (dollar bills and bank deposits are "on demand" debt obligation of the US government) and they was replaced by a "longer term" debt obligation (a government bond) which has been held by the trust fund and has been accruing income. The Social Security and Medicare taxes were not income to the US government that could be spent. In fact the opposite is true. The interest on the debt which has had to be paid has come from the budget. The debt that was created was NOT created by government spending (at least not the debt represented by the Medicare and Social Security Trust Funds). But the way you speak about it is as though the government HAS be "spent the money". There is no basis in fact for that claim. You have to bear in mind that I am only talking about the one third of US government debt represented by money in the Medicare and Social Security Trust Funds. If the US government wound up the Trust Funds, the trust funds would hand over their bonds to the government and the government would destroy the debt. It could still carry on taxing working people and funded Medicare and Social Security from those funds, so there would be not much change except a reduction in government bureaucracy and a reduction in government debt. Medicare itself would still go on functioning just as now and in the same way as similar schemes do in other countries. Funded by revenues and without a mythical "Pot of Money" behind it. So that debt could disappear from the books overnight by a single legislative Act and the markets and the Tea Party people could be joyous about the reduction in the government debt. Complaining about a mountain of debt and the government having spent the Medicare pot is doublespeak. The debt (some of it anyway) IS the money for future Medicare expenditures. --Hauskalainen (talk) 22:24, 18 November 2010 (UTC)
And this all relates to the improvement of this article how? We're not here to change city hall. We just report what city hall does. We don't have to love it or even like it. We merely report it. Student7 (talk) 03:46, 20 November 2010 (UTC)
Well it was because I asked "Someone surely must have made a case for this in the past or pointed out the hipocrasy of complaining about the rising debt without realizing that it represents something rather positive in the case of health care and retirement benefits. Or have I missed something?".. to me it sems obvious that the "debt" representing peoples premiums for Medicare coverage in retirement or retirement pensions) is completely different to debt created when the government spends money on current expenditure. No other country does this, and it seems from what I hear that people do not seem to have grasped this.... they talk about the government being in debt AND Medicare going broke.... but if the U.S. only accounted for this in the same way as other governments do one third of the debt would not be there and they could not claim that Medicare was going broke. To me it seems important that the article ought to point this out... but I cannot add it unlesss someonr other me has said.. The fact tat I have not heard it said made me wonder if I had made an error of thinking also... but I don't think I have. So I asked both questions. They are related to a possble addition to the article.— Preceding unsigned comment added by Hauskalainen (talk • contribs) 19:05, 20 November 2010
Can add with WP:RELY references. Because these are controversial remarks, the references would need to be close to scholastic/academic. They can't be OpEd pieces of someone with a political axe to grind. Whether I, or another editor, agreed with it or not would be irrelevant. Student7 (talk) 18:45, 21 November 2010 (UTC)

The arguments that Medicare is going broke come up so often that they probably have WP:WEIGHT. The best commentary I've seen is by [Paul Krugman]. --Nbauman (talk) 23:05, 5 May 2011 (UTC)

Removal of information illustrating financial problem

To illustrate the problem confronting the system, the Associated Press published this example, picked up by many media nationwide.

"As an example of the problem, the average wage couple jointly earned $89,000 annually in 2010. Upon attaining eligibility for Medicare and retirement in 2011, they would have paid in $114,000 in Medicare payroll taxes total. But their expected average medical services, including prescriptions are expected to cost $355,000, about three times what they paid in. When the last of the Baby Boomers retire in about 2030, 80 million people will be expecting coverage; the ratio of tax payers supporting the system is expected to drop from today's 3.5 for each person, to 2.3.(ref)"With Medicare, people take out more than they put in". Florida Today. Melbourne, Florida. 2 January 2011. pp. 1A.(end ref)"

An editor "WP:JUSTDONTLIKEIT and removed it. I think his last rm said, in effect. That is tough, you pay in whatever. Sometimes you don't get it all out. That is the way insurance works.

Actually, that isn't the problem at all. The problem, since it affects everyone, is that there might not be sufficient money for the baby boomers. 80 million of them or so. The government can then, either borrow the money from somebody (China?). Somebody with deep pockets. Or cut back on services. Neither the quote nor the article mentioned any of these "conclusions", but an insightful reader might infer that. Both Democrats and Republicans understand the problem, just not the solution. It is merely an neutral, un-WP:BIASed representation of the problem. It is from a reliable source. Why can't it be recorded here? Student7 (talk) 14:49, 5 February 2011 (UTC)

This is not a case of "I don't like it" but one of "not writing from a neutral perspective". You choose to see a problem. In my country, health care is financed year by year with no carry over of surplusses as happens when the medicare trust fund was created. The trust fund is there surely to even out the flows. One expects the fund to deplete as the baby boomers come in. The issue of getting back more than what you paid in is what investors do all the time. Compound interest and/ or dividends on reinvested dividends do the job silently too yo know. There is no magic and no problem. The problem is your perspective. You have to write from a neutral perspective. You are NOT writing from a neutral perspective. You are saying "this is a problem".. but that is your opinion (or perhaps the opinion of the AP or its journalist). Its not for you to assert that there is a problem. WP does not express its own opinion as you made it do. The NHS in UK and Medicare in Canada and Australia do not have the equivalent of the Medicare trust fund... they are funded annually and nobody is the least bit scared when the budget balance trends to zero at year end or that there is an "unfunded liability". With Medicare in so much surplus (that is the trust fund). Those who in America say "the trust funds are bankrupt because they have an unfunded liability" would be laughed at in the UK, Canada or Australia because there, nobody is the least bit concerned that they have a zero balance at year end and a huge future unfunded bill for health care costs. Its only your perspective as a writer that says their has to be. And that is not a normal view from my perspective.Hauskalainen (talk) 00:35, 8 February 2011 (UTC)
The US has a "trust fund" as a mere illusion only. There is no "trust fund" per se. There has never been in Medicare. All money paid in in taxes during a year are (mostly) paid out to claimants. There is no "investment" of funds anyplace. It goes into the general fund which is oversubscribed. Except for a few years, the US Federal Budget has never balanced in the lifetime of most readers. The extra money needed has always been borrowed from somebody. In the past ten years or so, Americans have insufficient money to lend the government and the government has been forced to sell bonds to the Chinese, the only government with sufficient cash to buy them. Yes, there is a theoretical "trust fund" someplace which has always "lent" its money elsewhere. It's "assets" are fictional, in government bonds. This is pretty much like having a piggy bank that is empty except for an IOU from yourself! It is meaningless.
The problem is, this situation is getting worse, both for Medicare (and other social programs which aren't the problem here). Therefore, the US will have to do "something." And BTW, China has told us as much since they may not have funds or be willing to lend them at some future time. Neither the Democrats nor Republicans dispute this. The only problem they have is what that "something" should be.
The problem is not an illusion. It is a serious current problem on which many people are attempting to find a solution. Refusing to allow it to be presented, is not helpful. The source is unbiased; or, at worst, left-wing biased, usually sugar-coating the truth. It is not presenting a conservative pov, because they never do. Student7 (talk) 18:18, 10 February 2011 (UTC)
A couple of key points: the funds from Medicare trust were not just deposited into the general fund; what happened is that they were actually loaned from the trust fund to the general fund at a pre-determined interest rate. While it is true that there is no trust fund lock box as had been proposed in the past, the monies collected under FICA do actually belong to the trust fund, not the general fund, and must be repaid if congress doesn't legally restructure Medicare's funding mechanisms. -- 208.81.184.4 (talk) 23:30, 21 February 2011 (UTC)
Whatever the mechanism, my issue with the text is that it is NOT WRITTEN FROM A NEUTRAL PERSPECTIVE. It is written from the perspective that there IS A PROBLEM and that is NOT HOW WIKIPEDIA ARTICLES MUST BE WRITTEN. WP does not have an opinion about anything. We present the mainstream opinions of experts in their field with their supporting arguments. The argument that more is being taken out than ever got paid looks to me like a piece of OR that the AP published. People who are retiring soon. had they invested their money instead in mututal funds over the years, would also be able to take out more than they pay in. This is not how actuaries look at funds like this. The actuaries, as well as stating when the funds will run out on current trends will have pointed out the two main alternatives to prevent this. (1) to increase Medicare contributions and (2) to decrease Medicare costs. As health care in the US is currently twice as expensive as health care in other industrialized countries and delivers worse outcomes, I think most experts reckon the second option is eminently realizable. If the costs are reined in, there is no Medicare "problem". Opinions about Medicare's sustainability should come first and foremost from the trustee. The text as it currently stands is NOT WRITTEN FROM A NEUTRAL POINT OF VIEW, and for that reason I am deleting it (again).Hauskalainen (talk) 07:36, 22 February 2011 (UTC)
I don't understand why you believe that "it is a problem" is POV. The Medicare Board of Trustees report warns that Medicare will be bankrupt within the next few years. Your claim that "if costs are reined in there is no problem" is itself POV as there is no plan to rein in costs. According to the verifiable information from the most reliable source (the Medicare board of trustees), under current law Medicare is going to go bankrupt. End of story. Wikiant (talk) 00:01, 23 February 2011 (UTC)
The American way of doing things creates this "problem" but it is an illusion. For instance in Britain, as in most other countries, when old age pensions were introduced, the idea was that everybody would pay money in taxes during their working lives that would pay for pensions in old age. In practice, this is a pact between the generations and not a savings scheme. The current generation of working people pays the pensions of the presently retired. In other countries the national pensions and health care schemes do not create "savings plan" to create a fund from which future pensions (or medical expenses= are paid, which is how the Americans view their Social Security and Medicare systems. This makes the whole thing much more complex than it needs to be because then there has to be actuaries. The same problems have to be managed... for instance better health care and life styles mean that people are living longer in most countries and the solution may have to be that people work longer or pay more in during their working lives. When retirement pensions were introduced most people of retirement age were really at the end of their lives. Nowadays they have twenty of more years ahead of them. But only America can say their system "is going bankrupt because of their POV that the systems of national pensions and health care are akin to savings systems and insurance systems. It is a POV way of looking at the issue. No British politician would ever claim that the old age pension system or the NHS is "bankrupt" because there is no fund from which to pay future claims. The very idea is ridiculous. But it is true that there is no fund. In other words, as I have said above, the American government could tomorrow decide to terminate the Medicare and Social Security Trust Funds. The only net effect would be that government debt would be reduced in an instant by quite a sizeable sum. Going forward, all Medicare and Social Security payments could be met from taxes just as most other governments do. Then it is a political issue to determine what the Medicare and Social Security benefits ought to be and what the Medicare and Social Security taxes should be and who should pay them. Saying that Medicare and social security are "going bankrupt" is what certain politicians in America say all the time. But the truth is that there IS a fund behind these schemes and it has created a whole lot of government debt. But you can get rid of the debt and the funds in an instant if you had the political will. Then nobody could claim that Medicare or Social Security are "going down the pan" or words to that effect which make it seem that government is incompetent. This is just an illusion created because the designers of the system built the illusion into the system. You still have to manage the same basic problems .... at what medical benefits are payable, at what age a people entitled to get them, what is the copay in retirement, what are the taxes paid before becoming eligible. You just get rid of the misleading claim that the system is faulty if the fund depletes to zero. Other countries have a zero fund and they are perfectly healthy. Hauskalainen (talk) 13:41, 24 February 2011 (UTC)
I understand the details as to how the system works. This isn't a play on words. The term, "bankrupt" is used in its correct sense -- Medicare's liabilities will exceed its assets. There are only two ways that this bankruptcy can be avoided: (1) the US government increases wage taxes coming into Medicare, or (2) the US government reduces benefits flowing out of Medicare. There is no plan to do either of these things. Therefore, given the current facts, the statement that Medicare will go bankrupt is correct. To argue that bankruptcy can be avoided through unspecified and future political solutions is to introduce POV. Wikiant (talk) 00:43, 25 February 2011 (UTC)
I agree with Wikiant. Hauskalainen suggests that if the programs were cancelled, government debt would drop. I presume he meant the government's current annual deficit. The long-term debt for previous years Medicare liabilities, borrowed from various people and institutions, including China, would remain the same.
At least one country, Chile, does indeed have a trust fund for social security, as do various individual states in the U.S. for government pension funds. The books are kept separate. There is actual money in them, not IOUs. Student7 (talk) 23:22, 26 February 2011 (UTC)
My understanding of law is that bankruptcy is something that happens when an organization cannot meet its liabilities as and when they fall due. Medicare is not bankrupt. It is not illiquid. And it is actually in asset rich relative to its current liabilities. The issue is, as Wikiant says, what the position will be in 2025 or whenever it is when, under current rates of funding, the fund has been exhausted. Of course if there are no changes, then at that point Medicare will be bankrupt. But that is a huge IF. And there are big assumptions in there. That costs will not be able to be contained (though everyone knows that the American health care system wastes money presently on expensive tests, repetitive tests, rewarding doctors for doing interventions instead of keeping patients healthy and out of hospital in the first place. ) And there is an implicit. As I keep saying, other systems fund health care quite successfully out of taxes and even though they get an annual spend allocation, they may have a huge future liability and have no reserves beyond their annual budget they can never be termed "bankrupt". That is because the triangle (funding, service, quality) can always be managed to meet the budget. There is no reason to think that these three aspects cannot be applied to Medicare and to this extend it is highly POV to say that Medicare will be bankrupt in 2025 or whenever. Furthermore, it places a requirement on Medicare that is not placed on medical insurers. Because of law in many states, even before the PPACA, insurers cannot cancel policies. So in theory they too have long term liabilities. But insurers accounting policies only require that they cover their ongoing liabilities. So in that sense they too have future liabilities completely uncovered by their assets and rely on churn and flexibilty to modify premiums to stay solvent year on year. Nobody says that the health insurance industry is going bankrupt but they have if anything a bigger problem than Medicare has. Hauskalainen (talk) 18:28, 27 February 2011 (UTC)
I remember something similar on the Social Security System. Okay, the system takes in $100 billion in 2015 (say), and pays out $110 billion. On one hand, it is not totally bereft of money. It may be able to con billing agencies by "slow-paying," for example, for this relatively small amounts. Medicaid, in various states, has done that to nursing homes for years. On the other, since this is a spiraling situation, it is not "good", either. The money either has to come from the General Fund, or benefits have to be reduced.
It can be "prettied up" with a different name, but it is as close to bankruptcy, a term everyone understands, as I would like the government to get. I suppose it can be called something else, but it would not be understandable. An entity that didn't own the government and control the laws, would file for Chapter 11 and have their bills restructured and perhaps force bondholders to accept less. Can't do that to China, and would prefer not to do that to its own citizens either, for fear that they would never buy another bond again!
So, is the question "nomenclature?" There is a problem. It is "not good" fiscally. Are you saying we must rename it? Or you don't agree that there is a problem at all? Student7 (talk) 21:37, 28 February 2011 (UTC)
No new nomenclature is necessary. "Slow-paying" creditors is what happens in bankruptcy. In every sense of the word, what is projected for Medicare is pure and simply bankruptcy. Wikiant (talk) 23:34, 28 February 2011 (UTC)
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