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I disagree about a couple of claims, especially how "efficient" CMS and medicare are. A "compliance manual six inches thick" and CMS having to pay firms to provide updates and aids for compliance on a weekly basis isn't very efficient in my view. The touted low overhead for Medicare needs to be examined closely to see what is NOT included like the FBI and other costs for supporting functions etc. What about the added paperwork for providers and their overhead costs which are added to prices?
Medicare doesn't ever pay the bills presented for health care so most of us have to have supplement plans, MA or pay out of pocket the difference and it still operates at a deficit! Doesn't make me look forward to "single payer" as a panacea.
Yes, we need to make our national health better comparable to other nations and costs somewhere near those everywhere else instead of by far the highest. It's just that I don't think ACA or "single payer" are the best or ONLY way to do it.
Posted by krlklar
First, Medicare was never designed to pay for everything. It has some pretty serious deductibles and co-payments to discourage excessive utilization and keep the tax rate necessary to support it low. Medicare is a great example of a government - private industry combination for health insurance. First there is what Medicare pays which is uniform throughout the country. Then there are the different supplement and advantage plans that consumers can choose from to augment their Medicare benefits. If someone's income is low enough, then there is Medicaid which acts as a Medicare supplement for those who qualify.
As far as CMS compliance, I do admit that they go overboard with way too many regulations. But those are made by bureaucrats who have no idea of what the market is like or how to deal with consumers. But the regulations and rules are necessary to protect the consumers. If there were no regulations, it would be very easy for a slick salesman to hoodwink the Medicare beneficiaries into something that is not in their best interest.
I have seen more slime and scum in the health insurance business than there is in the Okefenoke Swamp. Many of those slime balls make good money, but they are as dishonest as they come. So many are only in the business for the money and don't care about the people they pretend to serve. If I had no conscience, I could make a million dollars in the health insurance business.
I have said many times that health insurance is very complex and few people understand how it works. But most people understand price and cost. So it is very easy to slip through a junk health insurance policy that has a $20 co-payment for a doctor's office visit and a low premium; but has an annual cap on benefits of $50,000 and a lifetime cap on benefits of $250,000. Such a policy would leave someone on the hook for some serious medical bills should a serious illness or injury strike. I could also make a lot of money selling a "100% policy". But that "100%" benefit is only up to their schedule of benefits that is $200 per day for a hospital confinement and maxes out at $5000 for a heart bypass with other surgical procedures being much less on the schedule.
Those types of individual health insurance policies have been commonly purchased mostly because they have lower premiums than plans that offer comprehensive benefits. Those types of health insurance are not permitted to be offered through the exchanges under the ACA.
So before you complain about excessive government regulation; you should be thankful that CMS requires anyone who sells Medicare plans to be certified each year as to the plans they are offering and ethics involved with Medicare sales. Someone who offers Medicare plans that has met the certification requirements knows the regulations as well as the rules so you, the consumer can have some confidence that they know what they are selling and are acting in your best interest, not theirs.