My kids, Elise and Brennan, are 8 and 5. They are usually happy go lucky kids who have typical pediatric medical concerns. I am still slightly amazed that my son has not had an orthopedic emergency room visit. Brennan is convinced that if he jumps hard enough, he will defeat gravity. So far, gravity has won every time. Elise has had a broken leg and a broken wrist already in her life, but other than that she is healthy.
My parents are 64. My dad is a retired electrician. He worked on concrete and rebar for over thirty years. Construction beats up on people. His knees are shot. He is starting to slow down but he is in reasonable health all things considered. My mom was a floor nurse for twenty years until she retired this summer. She has a decade of odd conditions. Mass General Hospital attending physicians like to use her as a teaching tool.
Since my dad retired, he has become an avid genealogist and a persistent and occasionally competent golfer. My mom is reveling in being a full-time grandma as her youngest granddaughter is within driving distance.
My kids or my parents: which pair sounds more similar to current Medicare beneficiaries?
Yeah, my parents look a lot like current Medicare beneficiaries.
The Sanders single-payer bill has a four-year rolling transition. Section 106-B-1 says that everyone under the age of 19 is immediately eligible on the first January 1st after the bill is signed into law. Title 10, specifically Section 1001 begins lowering the enrollment age for Medicare.
In the fantasy universe where this bill was signed into law tonight, my kids and my parents would become Medicare eligible at the same time. My wife and I would have several years to wait.
Does this sound plausible to you?
To me, it is not a plausible plan.
Enrolling my parents into Medicare or Medicare Advantage in January instead of sometime next summer is a minor tweak. They’ll get their ID cards several months earlier than they otherwise would have. All of their doctors would be in network and they would be familiar with how Medicare works as that is what they talk about with their friends at the Owl Diner on Jackson Street in Lowell. The Medicare Advantage insurer or the Traditional Medicare ACO would have plenty of experience covering and managing people that are very similar to them.
Medicare and Medicare Advantage has no expertise in enrolling and covering kids. They don’t know how to administer EPSDT screening visits. They don’t know how to manage developmental delays and pediatric behavioral health problems. They don’t know how to deal with puberty. They don’t know how to deal with teenagers and reproductive health. Retirees and near-retirees are a very different universe of people with a distinctive medical profile to manage than kids and teenagers.
New networks would need to be built. New customer service groups would need to be trained. New training would need to be developed for utilization and care management practices. That expertise sometimes could be internal transfers. At UPMC, where I used to work, that knowledge transfer would mean several dozen people would have a new VP as they were transferred from CHIP and Medicaid to move to Medicare Advantage. But CMS and Medicare Advantage carriers that are not multi-line carriers would need to develop that knowledge base and rebuild their claims systems. It will take time; it is not an impossible task but it is not an immediate task.
If one wishes to cover every single kid as soon as possible, there is an easier route. If every kid was presumptively enrolled into either Medicaid or CHIP for the first two or three years while the Medicare system has enough time to adapt and adapt to the changing populations that work. Grabbing programs that are available with the relevant expertise to act as a bridge towards the desired end-state of a single all-encompassing system is an easy and more likely to succeed pathway than throwing millions of kids into Medicare when Medicare could not handle being a pediatric insurer.
raven
Damn, I’m 4 years oder that your pop. I’m going to work for another 10 months but I’m starting to try to figure out if we should keep my wife on my work insurance or put her back on her won. We are both state employees but have different plans. In the plan I am on you get a set amount of money to buy your own insurance and trying to learn how that works for my wife is a challenge. She’s only 60 so medicare doesn’t apply yo her yet. There is a group at the local community council on aging that can help you navigate this stuff so I guess that’s my best bet.
Ohio Mom
Um, unless I missed something, is there a CHIP to enroll in?
How worried should we be that CHIP is currently in limbo? I am having a hard time imagining fifty governors aren’t chewing their Congresscritters heads off, and that eventually it will be funded again. Am I too optimistic?
But I am not surprised that Bernie came up with with a niave plan. Like the Senators trying to ram through their health (non) coverage legislation, he doesn’t need no experts to advise him.
I miss the days I was only vaguely aware of Sanders and he was a cute novelty act.
Steve in the ATL
@Ohio Mom:
I’ll drink to that!
germy
@Ohio Mom:
That all changed when he started attacking Hillary and Democrats. Suddenly the villagers couldn’t get enough of him. They put him all over TV.
Before that, for 30 years he was a vague legend, a trivia question: “Do you know there’s a socialist politician in Vermont?” “Holy shit, really?? I’ve never seen him! Bernie something, right?” And Meet The Press or Face The Nation wouldn’t have considered having him on, any more than they’d consider having Ajamu Baraka discuss the issues of the day.
cervantes
“Medicare and Medicare Advantage has no expertise in enrolling and covering kids. They don’t know how to administer EPSDT screening visits. They don’t know how to manage developmental delays and pediatric behavioral health problems. They don’t know how to deal with puberty. They don’t know how to deal with teenagers and reproductive health.”
So what? Doctors do that, not the insurer. They just have to pay the doctors. I don’t take your point.
Jack the Second
@cervantes:
Doctor bills for 3 tests for your 8 year old. How does the insurance know whether those were tests necessary and what they should be build at, and therefore if your doctor is just doing the normal, necessary stuff or if he’s performing unnecessary tests and overbilling for them?
Kelly
Currently the Oregon Health Plan, our Medicaid, is good coverage. I have several relatives on it. Medicaid for all would work here.
dr. bloor
@Jack the Second:
If they’re like every insurance company I’ve ever dealt with, they will either demonstrate a very impressive learning curve as to what’s kosher, or they will initially preemptively deny everything and then add acceptable procedures per data from appeals processes.
I’m with Cervantes on this. If this is the toughest nut to crack on the road to universal coverage, we’ll be there last week.
PhoenixRising
@cervantes: which doctors are correct to refer a non-sexually-active 15yo with endometriosis to?
I don’t know either but the CHIP team inside my Blue Cross state MCO does. That’s the point.
David Anderson
@dr. bloor: Initially pre-emptively denying everything except for 99281-99285 is a viable mechanism for a naive insurer to learn by doing. It is also a very viable mechanism for pissing everyone else off. And if there are ways of covering people that don’t have the system submerge itself into mutual middle fingers and lawyers screaming at each other for $500 an hour, that alternative method should be investigated.
Ohio Mom
@germy: Yup, my reaction many, many years ago upon learning Vermont had elected a socialist was, “Wow, what is in the water up there? Vermonters must be pretty cool folk.” And then I don’t think I thought about him ever again until he decided he needed to run for the White Hose.
That’s what he was, a living, breathing trivia question’s answer.
Raven Onthill
Ok, so write a letter to Sanders office and propose this. That’s how legislation is shaped in a representative democracy, no?
David Anderson
@Raven Onthill: Already done.
Raven Onthill
@David Anderson: good! Thank you!
Sometimes I wonder if the Medicare for All proposal isn’t a good sort of trolling. If enough policy experts like you stand up and correct it, and those corrections are accepted, it’ll turn into a good law.
Of course, first we have to survive the fascists!
David Anderson
@Raven Onthill: if that is the scenario, I am more than fine with that
jaygee
Isn’t proposing to cover everyone for everything at no out-of-pocket for the insured? That’s called Medicaid, not Medicare.