Talk:Medicare (United States)

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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 Alabamaboy (talk • contribs) 19:35, 6 May 2005 (UTC)

medicare fraud cost

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 (UTC)

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)

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 (UTC)

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 (UTC)

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)

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 • contribs) 20:37, 19 March 2006 (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)

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)

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 (UTC)

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)

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)