Hi shefftonee,
I have found an answer for you. It's based on total annual healthcare
spending in the US. My figures are based on 2004, the most recent year
that figures are available for all these categories.
According to the Kaiser Institute, here's the breakdown of insurance
coverage in the US: (9)
Employer 54%
Individual 5%
Medicaid 13%
Medicare 12%
Other Public 1%
Uninsured 16%
~~~~~~~~~~~~~~~~~~~~
Medicare--
Medicare is the federal program providing health care insurance to
elderly Americans.
According to the Trustees of the government's Medicare fund,
"Medicare's annual costs were 2.7 percent of GDP in 2005."
42.5 million Americans were covered in December 2005 under Medicare. (1)
"For Medicare, the Hospital Insurance (HI) Trust Fund pays for
inpatient hospital and related care. The Supplementary Medical
Insurance (SMI) Trust Fund is composed of Part B, which pays for
physician and outpatient services, and Part D, which provides the new
prescription drug benefit." (1)
Total spending on Medicare in 2004 was $265 billion.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Medicaid payments--
Medicaid is a health care system paid for by individual states, based
on income, with the federal government providing matching funds from
50 to 75 percent. It is the largest federal grant program to the
states (43 percent of all grants to the states) and on average, states
spend 16 percent of their budget on Medicaid. (6) Here is a graph
from the Kaiser Institute detailing the matching rates for each state:
http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Coverage+%26+Uninsured&link_category=Medicaid+%26+SCHIP&link_subcategory=SCHIP&link_topic=Federal+Matching+Rate
Over 50 million people are covered by Medicaid.
Expenditures for 2004 were $288 billion.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Insured Americans--
Most Americans are covered privately by their employers (54 percent,
or 160 million Americans). An additional 13 million purchase coverage
directly from an insurer. (15)
According to the Kaiser Family Foundation, employer-sponsored
health-care costs rose 11.2% in 2004.
The total cost of private healthcare spending in 2004 was about $1.3 trillion.
On an interesting note, $5.2 billion of this was paid by the automaker
GM, which contributed greatly to its financial difficulties. In
addition, it is estimated that $230 billion of this cost went to
administrative costs and paperwork. (18)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Uninsured Americans--
Overall, there are 46 million uninsured Americans. The amount of money
that they spend on health care (or that is spent for them) is included
in the total annual health care costs.
This spending can be broken down into separate categories, however.
According to the Center for Immigration Studies, $2.2 billion was
spent on health care for uninsured illegal immigrants in 2002. $100
billion was spent for those uninsured Americans for emergency
coverage, much of which could have been prevented had they sought out
primary care previously. That breaks down into three components:
hospitals provide the uninsured with $34 billion worth of
uncompensated care per year. Private and public payers pay another $37
billion, and lastly, the uninsured themselves pay $26 billion. (14)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As far as the rest of health care costs, the National Coalition on
Health Care (NCHC) estimates:
"In 2004 (the latest year data are available), total national health
expenditures rose 7.9 percent -- over three times the rate of
inflation... Total spending was $1.9 TRILLION in 2004, or $6,280 per
person... Total health care spending represented 16 percent of the
gross domestic product (GDP)."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This is not an altogether accurate picture, however, as Medicare costs
are constantly rising. The Medicare trustees' report (1) says that
"while Medicare's annual costs were 2.7 percent of GDP in 2005, or
over 60 percent of Social Security's, they are now projected to
surpass Social Security expenditures in a little more than 20 years
and reach 11 percent of GDP in 2080." This is because health care
costs are constantly rising and more and more people are aging, and
elderly people cost more to insure.
Here is a chart as you requested:
Types of Health Care Spending Cost if covered by Medicare
Current Medicare Enrollees $265,000,000,000.00
Current Medicaid Enrollees, including $288,063,273,817.00
SCHIP children
All Privately Insured +
Personal Spending $1,300,000,000,000.00
All Uninsured Persons $100,000,000,000.00
TOTAL $$1,900,000,000,000.00
Sources:
1. http://www.ssa.gov/OACT/TRSUM/trsummary.html
2. http://www.nchc.org/facts/cost.shtml
3. http://www.cia.gov/cia/publications/factbook/geos/us.html
4. http://www.csmonitor.com/2003/1215/p21s01-coop.html
5. http://www.cis.org/articles/2004/fiscalexec.html
6. http://www.kff.org/medicaid/upload/State-Fiscal-Conditions-and-Medicaid-April-2004.pdf
7. http://www.cms.hhs.gov/HealthCareFinancingReview/downloads/Web_Exclusive_Cowan.pdf
8. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=354
9. http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Coverage+%26+Uninsured&subcategory=Health+Insurance+Status&topic=Total+Population
10. http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Coverage+%26+Uninsured&link_category=Medicare&link_subcategory=Medicare+Enrollment&link_topic=Total+Medicare+Beneficiaries
11. http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Costs+%26+Budgets&subcategory=Personal+Health+Care+Expenditures&topic=Total+Personal+Health+Spending%2c+FY2004
12. http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Costs+%26+Budgets&subcategory=Personal+Health+Care+Expenditures&topic=Personal+Health+Spending+as+%25+GSP%2c+2004
13. http://en.wikipedia.org/wiki/Medicare_%28United_States%29
14. http://www.nchc.org/facts/coverage.shtml
15. http://www.kff.org/insurance/index.cfm
16. http://aspe.hhs.gov/health/MedicalExpenditures/index.shtml
17. http://www.ppinys.org/reports/jtf/medicaidtotal.html
18. http://www.kff.org/medicare/upload/7305.pdf
19. http://www.laborresearch.org/story.php?id=380
20. http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/11/11/BUGM8FM8I11.DTL
21. http://www.aarp.org/research/medicare/financing/the_status_of_the_medicare_part_a_and_part_b_trust.html#SECOND
Search terms:
"medicare current costs"
"gdp medicare"
"hospital insurance trust fund"
"supplementary medical insurance"
"health care costs gdp"
"2004 us gdp"
"SCHIP costs 2004"
"medicaid"
"centers for medicare and medicaid services"
"universal health care"
"uninsured health care costs"
"private insurance health gdp"
"private insurance spending 2004"
"medicaid spending 2004"
"medicare spending 2004"
I hope my answer helped you. If you need any additional help or
clarification, let me know and I'll be glad to help.
Cheers,
--keystroke-ga |
Clarification of Answer by
keystroke-ga
on
08 Jul 2006 17:52 PDT
As I used the latest complete data from 2004, the Medicare Part D
program is not included. However, that spending (presumably for
prescription drugs that people would have to buy anyway without the
prescription plan) would be included in the overall healthcare
expenditures that I cited.
--keystroke-ga
|
Request for Answer Clarification by
shefftonee-ga
on
09 Jul 2006 08:24 PDT
Hello Keystroke:
Thanks for trying to answer my question. Unfortunately you have not done that.
My question, posed in the Subject, the first sentence, the table in
the middle of my question and the closing line is "how much would it
cost to cover all U.S. citizens by Medicare?"
You've shown the (2004) cost of health insurance by major coverage
category, i.e., Medicare, Medicaid, Employers, etc. You've answered
the question "How much does it cost to provide health care in the
current system?", but not the question "How much would it cost to
provide health care if everyone is covered by Medicare?"
My question is what would the cost be if all Medicaid enrollees were
covered by Medicare instead of the 50 or so different Medicaid plans?
What would the cost be if persons were covered by Medicare instead of
employer and individual health insurance plans?
What would it cost be if the Uninsured were covered by Medicare
instead of by charity, uncompensated care and personal payments?
If the cost of health care in 2004 was $1.9 trillion, what would the
cost be if everyone covered by Medicare, Medicaid, Private Insurance
and the
Uninsured--all U.S. citizens--were covered by Medicare?
I didn't expect a Google Expert to develop the cost number. That's why
I referred to academic and research institutions.
Shefftonee-ga
|
Clarification of Answer by
keystroke-ga
on
09 Jul 2006 12:29 PDT
Hi shefftonee,
I'm sorry about the miscommunication regarding the question; I will do
some more research.
But first, could you clarify for me exactly what you are looking for?
Are you referring to a so-called "universal health care system" where
everyone in the US would be covered by the government? Medicare is
for elderly Americans and young people with disabilities. The cost of
it, therefore, cannot be directly extrapolated to the rest of the
population because elderly and disabled citizens cost more to treat,
have different kinds of diseases, etc. A healthy adult would not cost
the same to their insurer as a 90-year-old man would, or someone with
kidney failure. It is not, in fact, possible to say that all
Americans could have Medicare coverage because not all Americans are
elderly or disabled. If you are referring to a universal health care
system, different from Medicare, that would cover all Americans, I
believe I have provided data for that.
If you want me to find research indicating how much each person costs
to Medicare, and extrapolate that to the total of America, I could do
that but it would not be an accurate picture as the populations are
from different generations and different health burdens. Or, do you
want me to find research estimating how much a universal health care
system would cost? Are you looking for studies that would say, for
instance, that the health care cost would rise or fall as there would
only be one provider of insurance and look at the cases of other
countries for evidence?
Thanks!
--keystroke-ga
|
Request for Answer Clarification by
shefftonee-ga
on
10 Jul 2006 08:03 PDT
Hi Keystroke:
Okay, here we go.
First, universal health care system can have a number of different
meanings (Canadian, Swiss, German, etc.) each of which has important
implications for benefits, financing, regulation, etc. Consequently,
I've stayed away from using the term.
Second, you're correct that a healthy adult, under Medicare, would not
cost as much as a 90-year old man. But, Medicare pays specific amounts
for medical acre services, e.g., appendectomy, office visit, chest
xray, etc. Applying these payment levels to the medical care services
consumed by all citizens would produce the cost to cover all citizens
under Medicare, which is what I'm looking for.
Third,you say "If you are referring to a universal health care system,
different from Medicare, that would cover all Americans, I believe
that I have provided data for that." I think that I have been very
clear that I am interested ONLY in the cost to provide all citizens
with Medicare and not 'something different from Medicare'.
Fourth, with respect to your last paragraph, I agree that simply
extrapolating Medicare per capita costs to the entire population is
entirely inappropriate (and wrong). But as I said in my "Second"
above, applying Medicare payment levels to national consumption levels
would produce the result that I'm looking for.
Fifth, I'm definitely not interested in costs for universal health
care systems. The Physicians for a National Health plan (PNHP) is the
most noted advocate for national health. I'm not interested in its
proposal or any other unless it cosists of extending medicare to all
citizens.
Sixth,I am not interested in the costs or changes in costs with a
single-payer health care systems, unless the system consists of
extending Medicare to all.
Seventh, I am absolutely not interested in foreign health care systems.
Finally, all that I'm interested in is an analysis of the cost to
extend Medicare to all U.S. citizens. That analysis will almost
certainly include the application of Medicare payment levels to
national consumption levels.
The analysis will have been done by accomplished researchers of the
quality of the Urban Institute, which I've looked at. I've also looked
at the National Bureau of Economic Research.
I'm far from a sophisticated Google user and expect that there are
paths to the correct answer taht I'm just not aware of.
Good Luck!
shefftonee
|
Clarification of Answer by
keystroke-ga
on
14 Jul 2006 19:37 PDT
Hi shefftonee,
Just to keep you updated, I'm currently working on the answer to this question.
Keystroke-ga
|
Clarification of Answer by
keystroke-ga
on
29 Jul 2006 02:36 PDT
shefftonee,
Still working on this but hope to have an answer for you ready soon!
Please forgive me for the delay.
--keystroke-ga
|
Clarification of Answer by
keystroke-ga
on
04 Aug 2006 13:52 PDT
Another update:
I'm working on this question right now and hope to have it finished
for you by tomorrow at the latest. I really apologize that it's taken
so long, but it is a complicated subject to research and I've spent a
lot of time on it.
--keystroke-ga
|
Clarification of Answer by
keystroke-ga
on
04 Aug 2006 14:01 PDT
In addition, I do have another question for you.
When calculating these figures and finding studies, do you want me to
surmise that in a situation with universal Medicare, that Medicare
only pays for what Medicare pays now or that it would pay for what
private insurers pay currently (I'm already assuming that it would
continue at its payment levels as it does now)? Since that's not a
very clear-cut question, here's an example:
If universal Medicare took over, Medicaid theoretically would not
exist anymore, as its enrollees would have Medicare. Medicare does not
pay for a large percentage of nursing home stays, but Medicaid pays
for 50 percent. Would your universal Medicare system just not pay for
those stays, per the current system, and those nursing home patients
would pay on their own or get other insurance, or would it take over
the Medicaid system of paying for poor elderly to be in the nursing
home? The same would apply to prescription drugs-- the Part D plan
aside, Medicare in past years has not paid for prescription drugs and
private insurance and Medicaid have. Basically, would your universal
Medicare system just have in place a system of payment that is EXACTLY
how it is now (or last year, without prescription drugs) without
taking these factors into account (because they would be huge factors
that people would have to concern themselves with in this type of
system).
|
Clarification of Answer by
keystroke-ga
on
05 Aug 2006 11:25 PDT
Hi shefftonee,
The best single source I could find for how Medicare expansion would
change health care costs is this 2003 study published in the New
England Journal of Medicine:
?Costs of Health Care Administration in the United States and Canada?
Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David
U. Himmelstein, M.D.
http://content.nejm.org/cgi/content/abstract/349/8/768
According to their calculations, a single payer Medicare system would
save $249 billion in administrative costs alone, due to high
administrative insurance costs of private insurance companies. I have
gone a few steps further, however, and added to their findings by
doing the best I could to calculate payment rates for an expanded
Medicare system compared to the current system, and delete programs
from the proposed budget that would not be included under Medicare,
such as dental services and nursing home care.
Here is a chart as you requested (updated with my own calculations):
Types of Health Care Spending Cost if covered by Medicare
Current Medicare Enrollees $265,000,000,000.00
Current Medicaid Enrollees, including $127,463,273,817.00
SCHIP children
All Privately Insured +
Personal Spending $425,343,000,000.00
All Uninsured Persons $71,000,000,000.00
TOTAL $898,557,000,000.00
Here is how I have come up with these statistics:
Medicaid?
Subtracted money spent on nursing homes.
Subtracted $82.1 billion for long term care.
Subtracted $15 billion for ?dual eligibles?
Personal and private insurance funding?
Subtracted $249 billion in administrative costs.
Subtracted $53 billion in Medicare coinsurance payments
Subtracted money that was spent on nursing homes.
Subtracted money spent on dental care.
Subtracted money spent on long term care.
----------------------------------------
These figures have left out the Medicare Part D prescription drug
plan, as the program is too new for its effects to be studied yet.
Part D.
(Source: #4 below)
$34.1 billion in federal payments
$5.7 billion in state payments
$5.43 billion in private insurance administrative costs
$9.1 billion in beneficiary premiums
States would save $10 billion ($15 billion minus the above payment to
the federal govt.) in Medicaid costs from dual eligibles going to
Medicare program.
~~~~~~~~~~~~
Numbers--
43 million now under Medicare.
Uninsured.
47.3 million people.
Medicaid.
55 million people. (6)
Privately insured.
174 million (2004), 60 percent
Many things would change under an entire system under Medicare.
As seen in the study cited above, Medicare would be a more efficient
system because a higher percentage of its collected costs would
actually go to patient care rather than to administration (97 percent
as opposed to 60 to 75 percent under the current system). The Medicare
system does this with a sicker treatment population (elderly and
disabled individuals) than does the general private insurance system.
Medicare would not need to turn a profit. The government would also
have huge bargaining power with doctors and hospitals, as it does
today, but multiplied. There would also be an alignment of incentives
of the health care industry-- to provide care, rather than to make
money for insurance companies.
A 2003 study published in the journal "Health Affairs" by Cristina
Boccuti and Marilyn Moon of the Urban Institute outlined how public
spending on health care grew at a slower rate than private spending
did from the years 1970 to 2000. Spending for private insurers grew at
a rate of 11.1 percent, while Medicare grew at a rate of 9.1 percent.
Over time, the gap between the two programs has expanded, and by 2000
Medicare's cost index was 44 percent less than private insurance per
patient.
"Over the long term Medicare has proven to be a prudent health care
purchaser, with the ability to leverage power in the health care
marketplace," said Karen Davis, president of The Commonwealth Fund.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In 2000, the American Nurses? Association called for universal Medicare.
"Covering the entire population will help stabilize Medicare
financially by providing a large influx of younger, healthier
beneficiaries into the program."
http://nursingworld.org/readroom/rwjpaper.htm
"Despite Medicare's current real and perceived financing issues, its
expansion into a universal program will broaden the pool of
beneficiaries to include a large proportion of younger, healthier
people and provide the basis for a more stable financing system."
Cost considerations.
What would cause expenses to go up under universal Medicare?
Medicare Part D.
While many people feel that a prescription drug plan was necessary,
Medicare Part D differs from the rest of Medicare in that it is
administered by private insurance companies and is kept separate from
Medicare Parts A and B. The administrative costs of the insurance
companies add $38 billion to the cost of the Part D program over seven
years, or $5.43 billion a year.
http://www.cepr.net/publications/efficient_medicare_2006_01.pdf
In addition, since private insurance is handling the prescription drug
benefit, the government cannot lobby the pharmaceutical firms for
lower prices. If they controlled the program themselves and did have
this ability, if they levied the prices at the highest possible rate
found in a Congressional Budget Office (CBO) analysis of countries,
that leverage would save them, worst case scenario, $332 billion (over
a period of six years). If they levied at the lowest rate found in the
CBO country analysis, the US could save $563 billion.
"If prescriptions were covered by Medicare, the purchasing power of
millions of beneficiaries could significantly reduce the costs of
drugs," according to AARP Executive Director Horace B. Deets-- but the
current Part D program is not that answer.
In any situation, the average Part D montly premium is $32, so that
could be expanded nationwide to figure it into the data.
Why it would cost less.
Private insurance administration costs.
Private insurers have $200 to 300 billion in administrative costs, to
cover the costs of expenses such as underwriting and marketing.
"All market-based incremental efforts over the past 30 years have
failed to contain health care costs, while the private insurance
industry has gained from its high administrative charges and
profits-about 30 percent of the health care dollar."
http://www.aafp.org/afp/20050901/editorials.html
"Results: In 1999, health administration costs totaled at least $294.3
billion in the United States, or $1,059 per capita, as compared with
$307 per capita in Canada. After exclusions, administration accounted
for 31.0 percent of health care expenditures in the United States and
16.7 percent of health care expenditures in Canada. Canada's national
health insurance program had overhead of 1.3 percent; the overhead
among Canada's private insurers was higher than that in the United
States (13.2 percent vs. 11.7 percent). Providers' administrative
costs were far lower in Canada."
--Woolhandler
"A large sum might be saved in the United States if administrative
costs could be trimmed by implementing a Canadian-style health care
system."
Reduction of overall administration costs for doctors.
Doctors would have only one insurance company to deal with-- Medicare.
In studies, many doctors have said that they would be willing to be
paid less in order to give up time spent on paperwork.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=14769625&dopt=Citation
Medicare pays less for care than a private insurer does.
Rick Pollack, executive vice president of the American Hospital
Association, says that 40 percent of America's hospitals are
reimbursed less than the cost of delivering services to hospitalized
Medicare inpatients.
It is estimated that Medicare pays for 48 percent of its enrollees'
health costs. If it pays for 48 percent of the health cost all
beneficiaries under a new system, costs will be forced to be further
reduced. Workers' compensation insurance costs the same for both
parties, but it has been determined that the public sector does it
better than the private. (21)
Medicare only pays for 50 percent of outpatient mental health care,
whereas Medicaid and private insurnace usually cover this fully.
Medicare does not pay pharmacists for drug therapy, as private
insurance does.
http://www.ashp.org/news/ShowArticle.cfm?id=2886
Medicare spent 19 percent of its overall budget on physician payments
in 2004, which would equal $50 billion.
Medicaid.
Medicaid is not nearly as efficient as Medicare in delivering care.
Medicaid has high administrative costs. Different programs exist in
each state, creating an administrative nightmare that could be solved
by a nationwide program. If Medicaid was assimilated into a universal
Medicare system, the paperwork costs could be cut down and the cost to
deliver care to these individuals cut.
Medicaid pays for one fourth of outpatient mental health care for
young children, but Medicare only pays for 50 percent of this cost.
Long term care under Medicaid.
In 2002, Medicaid spent $82.1 billion on long term care. Medicare
would not pay for these patients, as it will only pay for the care of
the elderly who have been temporarily switched from hospitals and
those with severe renal disorder, figures which are already accounted
for in its budget.
------------------------------------------------
Medicaid, private insurance, and individuals pay for prescription
drugs (this is leaving out Medicare's new Part D program).
Medicaid spends $30 billion a year, or 13.4% of its total costs,
paying for prescription drugs. It pays for 19 percent of all
prescription drug costs. This year, that number will experience a drop
to $15 billion as dually eligible people switch to Medicare Part D--
but states will have to give up $5 billion back to the federal
government to make up the difference. This has been included in
figures. Pharmacies that dispense these drugs are required to even if
the Medicaid recipient cannot afford a small copayment. Fifty percent
of the time, the copayment goes unpaid, which drives up pharmacists'
overhead and spikes the cost for everyone else.
http://www.cbo.gov/showdoc.cfm?index=6564&sequence=0
In addition, out of $188.5 billion spent on prescription drugs in the
United States in 2004, private insurance paid for 48 percent of
prescriptions and private individuals paid for 25 percent. Going by
2004 figures, this would mean that private insurance paid $90.48
billion for drugs and private citizens paid $47.13 billion. Since
these costs are included in my original figures, I subtracted them for
my final figures (which did not include Medicare Part D). (5) (6)
Ninety eight percent of the 60 percent of Americans who are insured by
their employers enjoy a prescription drug benefit. If Part D was not
extended to them, these Americans would not have a prescription drug
benefit. (5)
Under Part D, Medicare sets the rate at 106 percent of the wholesale
manufacturer's rate, then will pay 80 percent and the beneficiary will
be expected to pay 20 percent.
------------------------------------------------
Nursing home care.
Now, federal and state governments pay for 70 percent of nursing home
care, and for 85 percent of residents, the government pays some or all
of their costs Medicare covers 12 percent; Medicaid covers 50 percent.
When the Veterans Administration is factored in, government pays for
70 percent of the total costs. Prior to 1997, Medicare paid the actual
costs accrued by the patient at the nursing home, but since 1997,
Medicare has paid a "prospective payment" based on a formula that was
developed in 1998 and from which most nursing homes say they get less
of a payment. (7)
"Medicare will pay for 20 days of a skilled nursing care facility at
full cost and the difference between $114 per day and the actual cost
for another 80 days. Private Medicare supplement insurance usually
pays the 80 day deductible of $114 per day, if a person carries this
insurance and the right policy form. However, Medicare often stops
paying before reaching the full 100 days. When Medicare stops, so does
the supplement coverage. The average paid Medicare nursing home stay
was 23 days in 1997, only 1/5 of the allowable time. Nationwide,
Medicare paid 12% of nursing home receipts in 1998."
2002 figures:
$103.2 billion paid for nursing homes overall (7)
Medicare 12.5 percent: $12.9 billion
Medicaid 46.3 percent: $47.78 billion
Insurance 7.5 percent: $7.74 billion
Private costs 25.1 percent: $25.9 billion
Other government costs: (VA) 5.6 percent: $5.78 billion
Under current Medicare methods, it is doubtful that it would pay any
of the private or Medicaid costs indicated above. Medicare does NOT
pay for long term care:
"Generally, Medicare doesn?t pay for long-term care. Medicare pays
only for medically necessary skilled nursing facility or home health
care. However, you must meet certain conditions for Medicare to pay
for these types of care. Most long-term care is to assist people with
support services such as activities of daily living like dressing,
bathing, and using the bathroom. Medicare doesn?t pay for this type of
care called "custodial care". Custodial care (non-skilled care) is
care that helps you with activities of daily living."
http://www.medicare.gov/LongTermCare/Static/Home.asp
--------------------------------------
The Uninsured.
As it is, the uninsured had 1.3 million hospital stays in 2003,
costing $29 million, usually picked up by the hospitals in question
and factored into that above $100 million figure. Under a Medicare
system, these uninsureds would be covered for their hospital stays
under Part A, but with a deductible of $952. That would mean that the
entire bill to treat uninsureds in the hospital would be covered, to
the tune of $29 million.
------------------------------
Dental services.
Medicare does not pay for dental services, which composed $75 billion
of total health spending in 2003.
--------------------
Sources:
1. http://bmj.bmjjournals.com/cgi/content/extract/327/7412/414-a?view=extract
2. http://www.amsa.org/uhc/2005healthcareaccess.pdf
3. http://www.newsday.com/news/columnists/ny-bzsaul4792245jun24,0,1589086.column?coll=ny-rightrail-columnist
4. Center for Economic and Policy Research
"The Savings from an Efficient Medicare Prescription Drug Plan"
http://www.cepr.net/publications/efficient_medicare_2006_01.pdf
5. Kaiser Family Foundation
"Prescription Drugs Fact Sheet" December 2005
http://www.kff.org/insurance/upload/3057-04.pdf
6. Kaiser Family Foundation
"Prescription Drugs Fact Sheet" June 2006
http://www.kff.org/rxdrugs/upload/3057-05.pdf
7. Kaiser Commission on Medicaid and the Uninsured
"Medicaid and Long Term Care"
http://www.kff.org/medicaid/upload/Medicaid-and-Long-Term-Care-2.pdf
8. "Mental Health Care for Youth"
http://www.rand.org/pubs/research_briefs/RB4541/index1.html
9. "Uninsured Hospitalizations 2003"
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb7.pdf
10. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1557
11. http://ftp.cbo.gov/showdoc.cfm?index=5416&sequence=0
12. http://www.aarp.org/research/medicare/outofpocket/aresearch-import-657-DD78.html
Journal articles:
? Woolhandler S, Campbell T, Himmelstein DU. Costs of health care
administration in the United States and Canada. N Engl J Med
2003;349:768-75
Comparing Medicare And Private Insurers: Growth Rates In Spending Over
Three Decades
? Cristina Boccuti and Marilyn Moon
Health Affairs, 22, no. 2 (2003): 230-237
http://content.healthaffairs.org/cgi/content/full/22/2/230
Search terms:
medicare payment levels
medicare payment policy
medicare fee-for-service
medicare expansion everyone
private insurance prescription drugs billion
percent medicaid long term care
medicare coinsurance
outpatient mental health services billion
medicare compensation physicians
Google Scholar:
single payer save money
20. http://circ.ahajournals.org/cgi/reprint/109/12/1448
Is a Paradigm Shift in US Healthcare Reimbursement Inevitable? -
WS Weintraub, K Shine - 2004
21. http://www.joem.org/pt/re/joem/abstract.00043764-199702000-00008.htm;jsessionid=GJ3bhJ1RWCRk3gtLj7lnwP1npQ40Fq3hhXV14vCYpBGQwT9gPQ4X!-1082563917!-949856145!8091!-1
"Public and Private Workers' Compensation Insurance."
Journal of Occupational and Environmental Medicine
I have done my best to answer your question fully. If you have any
more questions, let me know and again I?ll be glad to help.
--keystroke-ga
|
Request for Answer Clarification by
shefftonee-ga
on
11 Aug 2006 04:23 PDT
Hi Keystroke:
I just noticed your communications of 8/4 and 8/5.
First, your clarifications.
I've asked "What is the cost if all citizens are covered by Medicare?"
If medicare covers a service then it's included in the cost. If
Medicare doesn't cover the service it's not included. Medicare covers
limited nursing home care and relatively better home health care
services but far less nursing home care than Medicaid. The answer to
my question would be the cost for the Medicare level of nursing home
and home health care services.
I said in my original question that I'd accept an answer with or
without Part 'D' drugs as long as it was clear that drugs were or were
not included.
Now to your answer.
I'm having some difficulty reconciling some of your numbers.Please help me.
I have no problem with the Medicare value.
Medicaid Cost if Covered
Current Cost By Medicare
$288.063 billion $127.463 billion
This is a difference of $160.6 billion.
You identify the following subtractions:
Long term care $82.1 billion
Dual eligibles $15.0
Prescription drugs $30.0
Total $127.1
This leaves an unexplained difference of$33.5 billion ($160.6-127.1).
You also say that you subtracted an unspecified value for 'nursing
homes'. Is this the difference?
Typically, nursing home expenses are a subset of and included in 'long
term care' expenses.
Please explain.
Private insurance and
personal expenditures Cost if Covered
Current Cost by Medicare
$1300.000 billion $425.343 billion
This is a difference of $874.657 billion.
You identify the following subtractions:
Administration expenses* $249 billion
Medicare coinsurance $53
Prescription drugs $138
Nursing homes
---private insurance $8
---private costs $26
Dental care $75
Total $549
(*these savings are from all payors, not just Private Insurance)
This leaves an unexplained difference of $326 billion ($874.657-$549.000)
Did I miss something?
Please explain.
Uninsured: I'll handle this myself.
Observations:
1) You've done a great deal of research and I hope that it helps you
answer a lot of questions in the future.
2)You've identified those expenses in the current system that would
not be affected by a Medicare-for-All program but you haven't shown
what those remaining expenses would be if paid at the Medicare level
of reimbursement. Am I correct?
3) You've included anecdotes about Medicare reimbursement, e.g.,
Pollock, Bucotti and Moon, etc. Be careful about the Bucotti and Moon
cite: it is an index of cost change and not an index of costs and it's
for a noncomparable set of services.)
4) I'm uneasy about your distinction between nursing home costs and
long term care costs. Typically long term care costs include nursing
home and other facility-type costs as well as home health, adult day
care, etc. If you use different values for nursing home and long term
care please direct me to the specific reference that you use.
5) Regarding the difference in your Medicaid costs recall that the
Woolhandler estimate of administration expense savings includes
Medicaid.
IMPORTANT---NOT HAVING HEARD FROM YOU FOR THREE WEEKS AND UP AGAINST
THE 30-DAY LIMIT, I REQUESTED A REFUND. I WILL NOW CANCEL THAT
REQUEST.
i'M LOOKING FORWARD TO HEARING FROM YOU.
SHEFFTONEE
|
Clarification of Answer by
keystroke-ga
on
12 Aug 2006 21:55 PDT
Hi shefftonee,
Thanks for being patient with me.
I'll clarify your questions as soon as I possibly can. Right now I'm
away on a trip and my notes on this question are on my home computer.
I'll have them sent to me and let you know about the discrepancy in
the figures. I'll let you know what I find, and again, I'm sorry that
my clarification took so long originally, but I did spend a lot of
time working on it-- it's a complicated subject! I can't remember
offhand what this $33 billion would be, but I will let you know.
--keystroke-ga
|
