Record Low Birth Rate, A Crisis For Older Americans

Last August, amid all the coverage of the presidential election, a significant news item was overlooked.  That was the fact that, last year, America's birth rate reached a record low of 59.8 births per 1000 women.  By comparison, at the peak of the baby-boom years, the average was 122.9.

In a country that is getting older with a projected percentage of the over-65 population rising from 15% today to 24% by 2060, this is a problem.  The problem lies in the fact that social programs rely heavily on younger Americans paying into programs like Medicare and Social Security to keep them buoyed into the future.  If there are fewer young people and more older people, the young are going to have to carry a bigger burden to support the seniors of the future. Plus, who will take care of an aging population?  Is senior-care the big job sector of the future?

Facing the same outlook, Japan is desperately trying to "develop" robots to take care of its sick and older population.  But, what about the cost of caring for an aging population in the U.S.?  Has anyone heard of a single politician that seems concerned about this?  Democrats seem to think that Medicare and Social Security are solvent programs as far as the eye can see!

References:

US fertility rate falls to lowest on record: http://www.cnn.com/2016/08/11/health/us-lowest-fertility-rate/

Fact Sheet: Aging in the United States: http://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-fact-sheet.aspx

Development of care robots growing in aging Japan: http://www.japantimes.co.jp/news/2016/01/27/national/social-issues/development-care-robots-growing-aging-japan/#.WM7adWclTb1

Will You Lose Your Medicare Doctor? Probably!

Quietly, last year, President Obama signed a bill into law that could greatly affect Medicare patients.  Called the Medicare Access and Chips Reauthorization Act (MACRA), it will substantially change how doctors and clinicians are paid for treating Medicare patients.

This innocuous sounding law will move payments from a fee-for-service system, to one based on the "quality" of services performed.  Doctors exceeding their peers in the "quality" of care given, will receive bonuses.  Doctors who fail to meet the average score of their peers will receive, initially, a 4% penalty on the billings being submitted.  This is already below the average of 11% that Medicare underpays doctors.  In other words, our government will start picking winners and losers among our base of doctors; and hopefully yours won't be on the losing side.  Using a 100 score potential, anyone scoring 49 will be the penalized, although this does not mean that half the docs will be dinged on their billing.  For example, if 75% score 50 or better, only 25% will be penalized.  Doctors who bill less than $10,000 and have fewer than 100 Medicare patients are exempt from the program.

The biggest problem with the system is that a computer will take all the scoring data being submitted by doctors in 2017, and apply an applicable bonus or penalty starting in 2019.  And, in typical government fashion, the doctors won't get their quality score until they submit their billing.  Of course, there's no recourse for contending their status.

When I learned of MACRA's nearly 2500 pages of final rulings submitted by Health and Human Services, it was a day before I had a doctor's appointment.  From what I read about the law, a number of doctors may stop taking Medicare patients; especially those slightly above the $10,000/100 patient threshold.  God help you if your doctor has, say, 105 patients.  You just may be one of the 6 unlucky patients that he/she may stop seeing to avoid the law altogether.

So, when I saw my doctor the next day, I asked him if he will continue to take Medicare patients when MACRA kicks in and, to my relief, his response was "yes".  However, that was short lived when he continued on to say that any Medicare patients may be changed to a cash only basis because that is one of the options that he and his partners are looking at in order to avoid the onerous penalties and paperwork that they would be subjected too with MACRA.

 I could go into all the problems with MACRA that could ultimately result as doctors, either stop treating Medicare patients, or just retire early; but, that is best explained in the link referenced below.  As of 2014, a Merritt Hawkings survey found that only 76% of the doctors surveyed took Medicare patients. Will this law make it less than 50% or, even, 40%?  Needless to say, MACRA, like ObamaCare, is another government intervention that won't work and will probably need to be repealed before too much damage is done.

References:

 Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know: https://www.brookings.edu/blog/health360/2016/05/04/physician-payment-in-medicare-is-changing-three-highlights-in-the-macra-proposed-rule-that-providers-need-to-know/

MACRA Proposed Rule Creates More Problems Than It Solves: http://healthaffairs.org/blog/2016/10/12/macra-proposed-rule-creates-more-problems-than-it-solves/

How Physicians Can Prepare for the Financial Impact of MACRA: https://www.healthcatalyst.com/physicians-must-prep-for-the-financial-impact-of-macra

50% of physicians have never heard of MACRA, Deloitte finds: http://www.beckershospitalreview.com/finance/50-of-physicians-have-never-heard-of-macra-deloitte-finds.html

Beleaguered by electronic record mandates, some doctors burning out: http://www.chicagotribune.com/business/ct-doctors-hate-records-mandate-1213-biz-20151211-story.html

Medicare vs. private insurance: Which costs less: http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

American Hospital Association: Payment Facts: http://www.aha.org/research/policy/finfactsheets.shtml

How MACRA will decimate the private practice physician: http://www.kevinmd.com/blog/2016/07/macra-will-decimate-private-practice-physician.html

The Mess That is MACRA: http://www.pnhp.org/news/2016/april/the-mess-that-is-macra

Risk of ‘Mass Exodus’ of Doctors from Medicare: http://www.lifezette.com/polizette/risk-of-mass-exodus-of-doctors-from-medicare/

With MACRA looming, doctors can't afford waiting to plumb its intricacies: http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239981

Physician Frustration and Fear of MACRA: http://catalyst.nejm.org/physician-frustration-fear-macra/

Merritt Hawkins Medicare Medicaid Acceptance and Wait Times: http://www.merritthawkins.com/uploadedfiles/merritthawkings/surveys/mha2014waitsurvpdf.pdf

The MACRA rule: Not what Congress ordered: http://www.kevinmd.com/blog/2016/06/macra-rule-not-congress-ordered.html

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A Grim Future For America's Retirees

Recently, the Trustees Report for Social Security and Medicare was released and the news was not good.  Social Security will run out of money in 2034.  Medicare will be insolvent two years earlier than previously stated, with a new date of 2028.  But, this is rosier than the Congressional Budget Office's drop dead date of 2026 that was released early this year.

On top of that bad news, a new report from Pew Charitable Trusts found that, in 2014, State public pension plans were under-funded by $1 trillion.  Three states -- Illinois, Kentucky and New Jersey -- have less than 45% of the funds needed to sustain their State pension plans.  And, only three states -- Wisconsin, Oregon and South Dakota -- have adequate funding to sustain their plans.

The simple fact is that America is aging.  With the lowest birth rates in our history and with people living longer, the sustainability of retirement benefits keeps getting more questionable because there are more people using the benefits than there are contributing to them.  Add to that the fact that wages aren't growing at a fast enough rate to fund Social Security and Medicare through FICA and other payroll deductions.

Despite all of this, the nation's lawmakers continue to sit on their hands while letting the clock run out.  The time to act is right now.  One of the reasons Detroit went bankrupt is because it couldn't afford to pay its pensioners.  The same is true for GM when it was forced into bankruptcy.  Are we now going to see entire states go belly up for the same reason?

God help us if they wait to act when the inevitable happens in 2026 or 2028 and 2034, because at that point, the problem will be too big to fix.  Of course, Hillary Clinton wants to hasten the collapse of Medicare by allowing enrollment 10 years earlier at age 55.  Perhaps we should fix it before we talk about expanding it!

References:

Trustees Report: Status of the Social Security and Medicare Programs: https://www.ssa.gov/oact/trsum/

Trustees' report says Medicare will be insolvent by 2028: http://www.modernhealthcare.com/article/20160622/NEWS/160629973

States face pension fund gap approaching $1 trillion: http://www.cnbc.com/2016/08/25/state-pension-fund-gap-to-top-1-trillion.html

Average Hourly Earnings:  https://fred.stlouisfed.org/graph/?g=2r4C

Birth rate - Wikipedia, the free encyclopedia: https://en.wikipedia.org/wiki/Birth_rate

Hillary's war on Medicare is big trouble for seniors | New York Post: http://nypost.com/2016/07/19/hillarys-war-on-medicare-is-big-trouble-for-seniors/ 

Bernie Sanders' Dishonest "Medicare for All" Ploy

One of the most important big-ticket items on Bernie Sanders' socialist agenda is to ditch all other forms of health care insurance and put every American on Medicare.  Even though this would represent a $2 Trillion increase for health care spending over the current $4 trillion in current federal spending, not to worry.  The rich and Wall Street will pay for it.  Probably tanking our economy and making us as screwed up as Greece; economically.  But, let's put that aside.

A lot of people like Bernie's plan because most people think Medicare works; providing 55 million elder Americans with the kind of health care they need at the time the need it most.

However, for millions of Medicare beneficiaries, the system is broken.  In a 2008 study by the Independent Payment Advisory Commission for Medicare that reports to Congress, 29% of Medicare enrollees were unable to find a primary care doctor that would accept the insurance because, simply, Medicare substantially underpays doctors and hospitals for their services.  In fact, the American Hospital Association (AHA) found that, on average, hospitals received only 86 cents on the dollar for the care they provided in 2012; substantially less than those cities and states that have higher costs of living.  The only reason that a doctor or  hospital accepts Medicare patients is that they can offset that deficit by charging the privately insured at a high rate, and if unable to do so, they stop treating Medicare patients.

The reality is that if private insurance didn't exist, few if any doctors or hospitals would be able to survive on what Medicare pays.  Our whole system of health care would collapse.  That would be the legacy of Bernie's "Medicare for all" plan.

One last thing. When trying to justify his plan, Sanders continually repeats the lie, that as a country, we pay the most for our health care and get little in return.  While it is true that we do pay more, we also have the highest disposable income of almost every other country.  For example, the average American had an annual personal purchasing power of $54,582 in 2012.  When comparing that to the United Kingdom, where they have universal free health care, the number is $30,064.  So, it is only logical that our standard of living would result in higher health care costs.  Also, the costs are lower in other countries because they cap damages for medical malpractice.  Not so here, where malpractice litigation can result in payouts in the multi-millions, forcing doctors and hospitals to practice defensive medicine by increasing the number of referrals to expensive specialists and pushing them to order a greater number of tests to insure that he/she doesn't miss something.

More importantly, contrary to the Democrat's claim that we don't have the best healthcare system in the world, just look a this table from a Forbes article:

This is why so many people who have universal health care in their own countries, elect to fly here (if they can afford it) to get treated for serious diseases.  Again, this shows Bernie's dishonesty by making it sound as if we don't have the best health system in the world. Enough already with the socialist crap!

References:

Bernie 2016: On the Issues: Medicare for All: Leaving No One Behind: https://berniesanders.com/issues/medicare-for-all/

New York Times: Finding a Doctor Who Accepts Medicare Isn't Easy:  http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html

AHA: Medicare, Medicaid Underpaid Hospitals by $56B: http://www.beckershospitalreview.com/finance/aha-medicare-medicaid-underpaid-hospitals-by-56b.html

U.S. Cancer Care Is Number One: http://www.ncpa.org/pub/ba596

U.S. Cancer Care Is Number One

U.S. Cancer Care Is Number One

U.S. Cancer Care Is Number One

The Myth of Americans' Poor Life Expectancy: http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/#2be5abb13b35

How Other Countries Judge Malpractice The health-care systems Democrats want to emulate don't allow contingency fees or large jury awards: http://www.wsj.com/articles/SB124631652544770707

Lists of countries by average wage and disposable incomes: https://en.wikipedia.org/wiki/List_of_countries_by_average_wage

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An October 1st Nightmare For Our Doctors and Ourselves

Unless you are a doctor, you are probably unaware of an upcoming change in the way medicine will  be practiced in the U.S.. It will complicate lives and could greatly affect whether or not your insurance company, Medicare, or Medicaid will pay for medical services you receive.

As of October 1st, doctors are now required by law to use a new coding system for diagnosis and treatment called ICD-10 (International Classification of Disease version 10).

For years, they have been using version 9 of the ICD.  Under that system, there were 14,000 different codes that a doctor could pick from to specify a diagnosis and the associated treatment.  More often than not, most insurance claims that were denied were usually because of coding errors.

Now comes ICD-10 and the doctor must now be more specific about his/her diagnosis and treatment to the tune of 87,000 different coding options for a claim submission.  Besides the obvious potential for a severe increase in coding errors and claim denials, the application of ICD-10 coding creates an administrative nightmare for both doctors and the insurers who must interpret what each claim is all about; including the processing of Medicaid claims by both state and federal agencies and by the federal government and supplemental insurers for Medicare claims.  Don't be surprised if Health and Human Services doesn't call for a substantial increase in personnel at the Centers for Medicaid & Medicare Services to handle this additional workload.  In addition, your private insurance rates are sure to go up because of the increased burden.

Now, to the politics of this new ICD-10 implementation.

Obama's Centers for Medicaid & Medicare Services (CMS) have already announced that no claims will be denied on the basis of  coding errors for a period of one year through September 30, 2016; just five weeks before the 2016 Presidential election.  Since it typically takes a few weeks to process a claim, no voter will be aware of the massive amount of claims that were denied until after the election.  How, convenient!

In my opinion, this is a big deal and the media is totally ignoring it.  But, I'll bet they won't be ignoring it next year when claim denials pour in at a higher rate than ever before.  And, while this will be because of doctor coding errors, a lot of billing departments will probably just bill you because of the denial and the poor patient won't even know why.  Thus, the insurers and CMS will be inundated with calls and complaints, complicating the administrative nightmare that ICD-10 created.  Ask yourself this: Will your healthcare be improved by more precise coding?   Probably not!

References:

The New Disease Classification (ICD-10): Doctors and Patients Will Pay: http://www.heritage.org/research/reports/2015/05/the-new-disease-classification-icd-10-doctors-and-patients-will-pay

ICD-10: CMS won't deny claims for first year: http://www.healthcareitnews.com/news/icd-10-cms-wont-deny-claims-first-year

American Medical Association: The Differences Between ICD-9 and ICD-10: https://www.unitypoint.org/waterloo/filesimages/For%20Providers/ICD9-ICD10-Differences.pdf

The Looming Crisis for America's Hospitals

Having formerly lived in the Chicago area for years, I was shocked to hear that the city's oldest and most famous hospital, Michael Reese, had shuttered its doors in 2009.  Some think that the upkeep on this 120 year old facility was just too costly to maintain.  But, there was another set of reasons that were best explained by documentarian, Arlen Parsa, in the piece titled "Waiting for Michael Reese":

Located on the South Side of Chicago, many of Michael Reese's sick patients were not able to afford the care they received. A substantial number of the hospital's patients relied on government programs like Medicare (for the elderly) and Medicaid (for the poor) to cover their care expenses, but the reimbursement rates that the federal government provides for these has been insufficient for years. This is a problem that hospitals around the country have struggled with, particularly those in urban areas (the uninsured population on Chicago's South Side for instance is twice the national average and is growing).

So, clearly, Michael Reese -- which operated in an aging and increasingly poor minority inner city area of Chicago -- found itself being starved of funding because of a high charity patient load and too many whose only insurance was either the underpaying Medicaid (for the poor and disabled) or Medicare (for the retired, older American).  This will be a challenge for many hospitals in the country that are operating anywhere but among the younger and more affluent areas.

First of all, Americans are living longer and, as a consequence, are in need of increased hospital care in their later years.  As a result, the Medicare rolls are expected to increase substantially:

Medicaid, too, underpays.  Because of the slow recovery from the recession and the lack of good paying jobs and because of the expansion of Medicaid under ObamaCare, there are now nearly 70 million Medicaid enrollees; or, approximately 22% (more than 1 in 5) of our population.  And, it is expected that Medicaid will add another 10 million to its rolls by 2020.  Also, that number would be even greater if 22 states hadn't refused to expand Medicaid under ObamaCare.

A recent survey conducted by the American Hospital Association found that, on average, 58% of the patients treated in 2013 were insured by either Medicaid or Medicare.  On average, hospitals were only reimbursed 88 cents on the dollar for Medicare and 90 cents for Medicaid.  When it comes to Medicaid, there's an additional problem: State budgets. In all 50 states, Medicaid is the highest expenditure just behind education. So, when it comes to budgeting and politics, Medicaid tends to get cut before education.  In 2012 alone, 13 states cut the Medicaid budget in order to balance their budgets.  This is a trend that will only get worse and the current 90 cents on the dollar will only get lower.

For the hospitals, there is another problem and that's the uninsured which may, most likely, wind up as charity cases if they can't reimburse a hospital for their care.  Despite 2 years of ObamaCare enrollment, the number of uninsured is still high at 41 million (12.9% of a population of 320 million).  While that number is expected to drop to 31 million by 2016; the Congressional Budget Office expects that it will remain at that level for years forward.

ObamaCare insurance policies (sold in the exchanges) are also hurting the hospitals profit models.  Most people don't understand that the ObamaCare insurance plans are either Health Maintenance Organizations (HMO's) or Preferred Provider Options (PPO's).  What this simply means is that doctors and hospitals, in order to be plan eligible, must agree to treat their insured patients at prices less than their normal rates.  This is why so many -- who have been forced off their private insurance and into ObamaCare -- can't find their former doctors or hospitals.  And, the problem of hospitals losing full-fare private and employer-provided insurance is only going to get worse.  This year, as many as 12 million may signup for ObamaCare's insurance plans, but, in 2010, the Obama Administration predicted that 93 million insured would lose their private and employer-based insurance and will be forced to buy underpaying policies in the exchanges.

Another way that ObamaCare is hurting hospital profit margins is the 3.2% Medical Device Tax.  While the tax may affect veterinarians and doctors, the greatest impact will be on hospitals which, daily, must buy disposable medical equipment like surgical gloves, irrigation needles and syringes, plastic procedure sets, etc.   But, medical device tax also includes the replacement or upgrade of defibrillators, EKG's, and MRI's.   While the tax, itself, seems like a small amount at 3.2%, when taken against a $110 billion/year industry, its an additional $3.2 billion/year that most hospitals will have to pay to stay in business.  If a hospital is already struggling financially, this tax may could possibly be what finally forces it to close down.

The bottom line is that many hospitals in this country -- especially those in the inner cities and in rural America -- are going to shut their doors unless they are paid above their costs for medical services they render.  As usual it will be the poor and elderly who will be hurt the most.  Additionally, all of us will suffer because fewer hospitals will only increase wait times and seriously reduced bed availability for those hospitals that are able to remain open.  Also understand, that those hospitals that do close because of underpaying patients, will be pushing those problem patients to stable hospitals that, as a result, might then find themselves, too, in financial trouble.  So, in essence, this could cause the problem to spiral out of control.

References:

Waiting for Michael Reese: http://waitingformichael.com/about-reese.html

Hospitals, doctors moving out of poor city neighborhoods to more affluent areas: http://www.jsonline.com/news/health/hospitals-doctors-moving-out-of-poor-city-neighborhoods-to-more-affluent-areas-b99284882z1-262899701.html

Medicaid Enrollment: http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/

Medicare Medicaid Underpayments: http://www.aha.org/content/15/medicaremedicaidunderpmt.pdf

13 States Cut Medicaid To Balance Budgets: http://kaiserhealthnews.org/news/medicaid-cuts/

22 States Are Refusing to Expand Medicaid: http://www.whitehouse.gov/share/medicaid-map

If you loathed HMOs, you're not going to like Obamacare: https://www.aei.org/publication/if-you-loathed-hmos-youre-not-going-to-like-obamacare/

Health Plan Types: HMO or PPO? - Obamacare Facts: http://obamacarefacts.com/health-plan-types-hmo-ppo/

Gallup: Uninsured Rate at 12.9%: http://www.gallup.com/poll/180425/uninsured-rate-sinks.aspx

CBO Graph: Projected Uninsured Rate Through 2025: http://www.newrepublic.com/sites/default/files/u18524/coverage_-_what_cbo_really_said.png

Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare: http://www.forbes.com/sites/theapothecary/2013/10/31/obama-officials-in-2010-93-million-americans-will-be-unable-to-keep-their-health-plans-under-obamacare/

ObamaCare Shuttering Hospitals and Free Clinics: http://www.thenewamerican.com/usnews/health-care/item/19726-obamacare-shuttering-hospitals-and-free-clinics

Rural hospitals in critical condition - USA Today: http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/

Medical Device Industry: http://selectusa.commerce.gov/industry-snapshots/medical-device-industry-united-states

The Financial Consequences of Amnesty For 4.5 Million Illegals

Just recently, the White House admitted that President Obama's executive action giving illegal immigrants permanent residency, would also give them Social Security and Medicare benefits. In defense of this, they are claiming that this will actually benefit programs like Social Security because these people will now be paying payroll taxes in support of those programs. This in turn, will help balance out our aging population

Well, on the surface that all sounds great.  However, a majority of those who would benefit from Obama's executive order can't speak English; have few, if any, high level skills and little education. Many are functionally illiterate in their own language, and as a result, are incapable of learning English. Over their entire lifetimes they will only be able to work in low level jobs. Taking all this into consideration, you have to understand that the President will be  creating a large and permanent underclass.  In this country, those kinds of people will always take more from the government than they put in.

Take, for example, paying taxes. Only 53% of all Americans pay any federal income tax.  However, most of those who make up the remaining 47% -- especially those who have low incomes --  actually get money back from the government for having children and by qualifying for Earned Income Tax credit.  So, if most of these people are low income workers, what benefit are they going to be to our tax system when they don't pay income taxes?

Then, there's Medicare and Social Security.  The White House claims that these programs will only be strengthened by having them pay into the Federal Insurance Compensation Act (FICA) fund (the payroll tax that collects the funds needed to support Medicare and Social Security).  Of course that would be true only if they weren't so far skewed to the low income side of the equation.

You see, the FICA tax is a fixed percentage tax on your gross wages.  The amount paid diminishes with low income individuals; meaning that he middle class and the upper middle class will foot the bill for most of the future payouts.  Thus, when a low income worker goes on Medicare, he/she receives the same benefit as everyone else; while having paid relatively little into the system. The same is also true with Social Security.  Therefore instead of strengthening these two benefit programs, these newly minted beneficiaries are only going to help speed them toward insolvency.  If you don't think this isn't already a problem, just look at this chart on Social Security:

Of course, this projected insolvency was calculated before Obama's action on immigration. There might be a short term increase in funding from these younger workers paying into the system, and thus, delaying insolvency.  But, when they do start retiring, the impact on will be significant and rapid because too few dollars were added to the fund to pay for their benefits.

In my opinion, the long-term survivability of the benefits to our nation's seniors is being put at risk so this President can garner future Hispanic votes for Democrats.  Similarly, this nation's debt will only increase as we payout an increasing number of tax dollars in Earned Income Tax Credit refunds.  This is why there should have been a fully explored and debated reform of immigration through Congressional means.  Instead, we have another go-it-alone action that will have far reaching consequences; long after Obama is out of office. Then some other President or Congress will be saddled with the cleanup.


References:

Under Executive Action, Immigrants Are Entitled To Social Security Benefits: http://www.npr.org/blogs/thetwo-way/2014/12/03/368216062/under-executive-action-immigrants-are-entitled-to-social-security-benefits

Illegal immigrants could receive Social Security, Medicare: http://www.washingtonpost.com/politics/illegal-immigrants-could-receive-social-security-medicare-under-obama-action/2014/11/25/571caefe-74d4-11e4-bd1b-03009bd3e984_story.html

Commonsense Immigration Reform Will Strengthen Social Security: http://www.whitehouse.gov/blog/2013/07/01/commonsense-immigration-reform-will-strengthen-social-security

TPC Tax Topics | Who Doesn't Pay Federal Taxes?: http://www.taxpolicycenter.org/taxtopics/federal-taxes-households.cfm

Policy Basics: The Earned Income Tax Credit: http://www.cbpp.org/cms/?fa=view&id=2505

What is FICA? - CNN Money: http://money.cnn.com/magazines/moneymag/money101/lesson18/index4.htm

 Social Security to Become Insolvent Far Earlier Than Expected: http://www.mrctv.org/blog/chart-social-security-s-end-date-fast-approaching-far-earlier-expected

Chart: Medicare insolvency projection: https://kaiserfamilyfoundation.files.wordpress.com/2014/07/7305-08-exhibit-6.png

Only a Third of Americans Work Full Time

In the latest employment report, it was stated that only 119 million people are working full time.  That is only about one third of the nearly 320 million people making up the country's population.

While this is up from a low of 116 million in January, it is still a very sad statement on the jobs situation.  It means that too few of our people are paying all the taxes necessary to support the multitude of government programs such as Medicare and Social Security, which depend on income taxes collected from those full-time workers.  This is why these two programs are destined to run out of money faster than previously thought.

References:


The Good And The Not- So-Good News About US Jobs In One Chart: http://www.zerohedge.com/news/2014-06-06/good-and-not-so-good-news-about-us-jobs-one-chart

May Employment (Situation) Report: http://www.bls.gov/news.release/empsit.toc.htm

Monthly number of full-time employees in the United States from May 2013 to May 2014 (in millions, unadjusted): http://www.statista.com/statistics/192361/unadjusted-monthly-number-of-full-time-employees-in-the-us/

Cost Containment: What Medicare Seniors Should Worry About

For years, the bureaucrats in Washington have been trying to control rising Medicare (and Medicaid) costs by underpaying doctors, diagnosticians, and hospitals for their services using some false assumption that those healthcare professionals will find a cheaper means to provide services.  But the healthcare system can't cheapen their services because, to do so, would open itself up to more and more costly malpractice suits.  So, more often than not, this Medicare cost containment tactic is like squeezing a balloon.  All that happens is that non-Medicare patients are billed at higher rates to compensate for the losses incurred in taking care of Medicare patients.  But, at some point, those medical professionals will find that the other private insurers won't pay more either.  When that happens, they are likely to drop their Medicare patients to avoid going broke.  For example, in 2010, the prestigious Mayo Clinic announced it was no longer taking Medicare patients at one of their hospitals because they had lost a total of $840 million in the previous year.  Right now there are no comprehensive statistics as to how many doctors and hospitals are refusing to provide healthcare to Medicare seniors; but it is happening and gaining speed.

However, what is really ridiculous is that the Democrats and Obama have decided to double-down on this cost containment tactic that is causing so many health care professionals to refuse Medicare patients.  When they crafted ObamaCare they created something called the Independent Payment Advisory Board or IPAB.  IPAB is basically a 15-member board of bureaucrats that will determine what Medicare will pay out for certain medical procedures and devices. By law, they must find ways to cut costs if those costs exceed actuarial estimates for any given year.  In effect, IPAB has the authority to independently tell the health care industry which procedures will be covered by Medicare and for how much.  Congress cannot block or overrule them unless they pass legislation that would meet or exceed the IPAB's recommendations for any given year.

The problem with all these cost containment gimmicks, like IPAB, is that they don't address "why" costs are going up as fast as they are.  You can't mandate a bunch of free annual check ups and free diagnostics and expect Medicare costs to be lowered.  Sure, early diagnosis might avoid some future expenses but, many experts have concluded that widespread recommended diagnostic routines are not cost effective and are not necessarily preventative.  With mammograms, for example, the U.S. Preventive Services Task Force (USPSTF) set new recommendations in 2009 that effectively removed the testing regimen of having bi-annual mammograms for women over 40.  Their new recommendation is for bi-annual mammograms for women over 50.

In my opinion, the USPSTF is better able to make cost-lowering recommendations rather than IPAB.  IPAB will only result in more seniors being dropped by doctors, hospitals, and diagnosticians.  The result will be to force Medicare patients into "cattle-car" clinics with extremely long wait time and less qualified doctors.  In fact, seniors will probably wind up seeing physician assistants rather doctors. This is what every senior should fear as a result of ObamaCare.

One last thing.  Healthcare costs are being driven by doctors practicing defensive medicine as a safeguard against being sued for malpractice.  Unless there is tort reform, costs will continue to rise at rates faster than inflation.  But, ObamaCare never included tort reform because the Democrats are in bed with the trial lawyers for campaign donations.

For Further Reading:

Mayo Clinic Bridles at Medicare Payments: http://www.cbsnews.com/8301-505123_162-43841043/mayo-clinic-bridles-at-medicare-payments/

Wikipedia On IPAB:  http://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board

U.S. Preventive Services Task Force Website: http://www.ahrq.gov/clinic/uspstfix.htm

To The Democrats: Seniors Fear ObamaCare More Than Ryan Plan

When Ryan's name was announced, some Democrats rejoiced over the fact that they could eat Romney and Ryan alive over Ryan's "extremist" views on reforming Medicare.  But, once again, this attitude by Democrats failed to understand that seniors aren't some robotic bunch of idiots that will only vote Democrat when it comes to Medicare. Like a lot of people  in this country,  seniors are concerned about the impact of ObamaCare on Medicare.  Nearly half of all seniors understand that ObamaCare robs Medicare of billions.  They understand that they will lose the Medicare Advantage programs; thanks to ObamaCare.  And, they understand how ObamaCare may infringe on the ability to get broad-based and adequate health care in the future because, ObamaCare will ultimately decide that some seniors will be considered  "too old" to receive certain drugs and certain procedures.

Rasmussen took a couple of polls and here are the results that prove the Democrats wrong:


Poll: Florida voters more afraid of Obama's Medicare plan than Ryan's: http://www.foxnews.com/politics/2012/08/16/poll-florida-voters-more-afraid-obama-medicare-plan-than-ryan/

National Poll: 47% Fear Health Care Law More Than Ryan’s Medicare Reform Plan: http://www.rasmussenreports.com/public_content/politics/current_events/social_security_medicare/47_fear_health_care_law_more_than_ryan_s_medicare_reform_plan

Why Romney/Ryan Medicare Voucher Systems Are A Good Thing

Forget about the Democrat's ad that shows a Ryan-looking person throwing Grandma off a cliff.  Instead, there should be an ad showing the Democrats throwing Medicare off a cliff.  Because, that's what's really happening.  First, and foremost, ObamaCare steals $716 billion from the Medicare trust to pay for non-senior ObamaCare expenses.  Secondly, to control costs, ObamaCare establishes something called an IPAB (Independent Payment Advisory Board) who will try to control costs by rationing how much care seniors will be able to get and when.  The bottom line is that Medicare will start going broke in 2024.

Now, enter Paul Ryan and Mitt Romney.  Each of them understand that Medicare is going broke because the cash outlays are exceeding the program's sources of revenues; with this situation only getting worse as the country ages due to the retirement of the baby boomers.   Like Social Security, there just aren't enough younger people paying into the system in order to cover the high cost of providing healthcare to citizens in their later years.  Essentially, Medicare is a program that is completely trapped into providing healthcare to the most costly group of patients: This nation's elder population. So, the trick to saving Medicare is to create a system in which there is a lot cash input from younger participants to help offset the high cost of providing care for our nation's elders.

Understanding this, both Ryan and Romney have independently decided that a "voucher system" would push the cost of caring for seniors out of the federal domain and shove it into the private sector by inviting private insurance companies into the Medicare program.  In essence, future seniors would be given the option of either traditional Medicare or a voucher; something that the "throwing Granny off the cliff" ad doesn't say.

If they elect to stay with traditional Medicare, then, they will have all the benefits and, make no mistake, the weakness of the current system.  However, if they opt to go with the voucher system, they will be able to go into the free marketplace and insurers will compete for their business.  The participants can then pick and chose the type of coverage they want and how much they are willing to pay for it.  If the voucher participants can find good health care at a cost lower than the amount of the voucher, they can pocket the savings.  If they want more of an upscale health plan, they pay the difference.  But, the big thing about the voucher system is that the high cost of payouts for the healthcare of the voucher system participants will rest with the private sector and no longer with the federal government vis a vis the Medicare trust. 

In essence, free-market competition will save Medicare because costs (and, I think fraud) will be controlled by the private sector and because those private sector insurers will have a healthcare insured base of both young and old.  Something that Medicare is unable to achieve. 

For a concise understanding of current Medicare spending and financing, please refer to this Kaiser Family Foundation Report: http://www.kff.org/medicare/upload/7305_03.pdf 

Ryan Will "End Medicare As We Know It" ?

In psychology, it is well known that you can condition one's mind through word associations and the constant repetition of those associations.   When it comes to Paul Ryan and his Medicare reform planning, the Democrats have consistently repeated the phrase "end Medicare as we know it".  If you don't think so, just go to YouTube and search on those very words.  You will find, video after video, from Obama on down, Democrat after Democrat, like the lemmings they are, using those exact same words when talking about the GOP or Paul Ryan's attempts to reform or save Medicare..

Of course, logically, any change to Medicare would "end Medicare as we know it".  So, basically,  the Democrats have decided on this particular phraseology to block any changes.  Yet, Medicare is in trouble and, if not 'ended as we know it,' it will go bankrupt at least by 2024; just 12 years from now. Note this report from CNBC last year:



I find it utterly disgusting that the Democrats are willing to let Medicare go belly up when it could be saved through some moderate changes as being proposed by Paul Ryan and the GOP.  What is the Democrat's strategy?  Just let it go insolvent and then raise taxes -- on the rich, of course -- to save Medicare.  But ask yourself this: At what point do you run out of the rich's money to save all these floundering social programs like Medicare, Social Security, Medicaid, and Food Stamps? Probably not too long from now with the way that Obama and the Democrats have spent money in the last 3-1/2 years.

On Medicare, The Dems Are Living In A Glass House

There's that old saying: "People who live in glass houses shouldn't throw stones."  Apparently, when it comes to Medicare, the Democrats have forgotten this sage advice.  As soon as Ryan was named as Romney's V.P. pick, they went after him on the basis that he would change Medicare.  This was stupid on their part, because, as we all know now, Obama and the Democrats have, themselves, "changed Medicare as we know it" by draining $716 billion from it to pay for ObamaCare.

The cat's out of the bag and, believe me, there's no putting that cat back.  From now to November, the Republicans should just hammer Obama on his handling of Medicare.  Medicare is already in trouble because of funding and is expected to be insolvent in just 12 years, and taking $716 billion away from it will just shorten that time. 

For Reference: Trustees: Medicare Will Go Broke in 2016, If You Exclude Obamacare's Double-Counting: http://www.forbes.com/sites/aroy/2012/04/23/trustees-medicare-will-go-broke-in-2016-if-you-exclude-obamacares-double-counting/

"Free" Health Care and Contraception Under ObamaCare and Medicare

In this, an election year, Obama and his campaign commercials are hyping the fact that, thanks to him, Americans will receive free contraception, free medical check ups, and free diagnostic screenings. But, this "free" B.S. is just that; and, it should only play well to the dumbest in our society. Nothing in health care is free. Doctors and nurses aren't working pro bono so that millions of Americans won't have to pay for checkups. Laboratories and their technicians aren't taking cuts in pay so they can hand out free diagnostics work. Lawyers aren't backing off their malpractice lawsuits so that doctors are cut a break in the cost of their malpractice insurance so they can more easily provide free services.

The reality is that "free" means that private health insurance providers will have to raise their premiums. Free also means that the federal and state governments will have to raise taxes to pay for the free services under Medicaid. It also means that Medicare will go broke faster unless tax revenues are increased. And, for those who think they get "free" service under Medicaid, think twice. Increasingly, the better doctors in America are dumping Medicaid (and Medicare) because those physicians lose money on every one of those patients they see. This means that Medicaid patients are literally being herded toward high volume clinics that are typically short on quality. The wait times for the poor and elderly to see a doctor are increasing dramatically. So, you see, money isn't everything went it comes to the "cost" of health care.

Even the air we breathe isn't free. Millions of dollars in tax money are being spent to support state and federal environmental protection agencies. U.S. manufacturers are spending billions to comply with the Clean Air Act and those costs are passed on to you and I in almost everything we buy. That car you own is probably 20 to 25% more expensive because of EPA standards. Even the gas cap on your car is 4 times more expensive than it should be.

So, stupid people will vote for Obama because they really think that things are free. However, the more intelligent of our society know that all "this" free health care will only raise costs for everyone. And just like TSA terrorism screening at airports, 99.99999999% of those being screened "for free" don't really need to be.

Socialism Spawns Socialism

We know from past experience, that the welfare system in America has actually locked generations into a losing system for the rest of their lives. Originally intended as a so-called "safety net" to help people get back on their feet during hard times, it, instead, became a way of life with children of welfare recipients becoming future captives of the same system they grew up in.

Socialism is often referred to as "creeping socialism" because it, like some kind of cancer, spreads until, someday, the state government literally runs everything. Socialism is like a narcotic that pulls more and more citizens into its grasp; and, eventually the nanny-state fully evolves.

I often hear people say that the United States is not Europe when it comes to socialism. But, it wasn't very long ago when Europe wasn't what it is today, with all its socialist burdens.

I'm of the belief that socialism spawns socialism by weakening a capitalistic society. With every social program created, workers and money makers have to ante up more and more of their own money in order to subsidize an increasingly larger group of state-dependent citizens. As the state keeps taking more from the successful segment of society, those money makers find themselves being driven out of business and, thus, forced to join the increasingly larger group of state-dependents. Eventually -- too many have jumped into the wagon, with no one left to pull it.

Usually, unemployment insurance is the first step in the creation of a socialist state. It follows the logic that you can't have the unemployed starving and dying in the streets while they're looking for a new job. Then, the socialist will push for a government-run retirement program like our "Social" Security system. Next there's the institution of a welfare system for those who are determined, by the state, to be unemployable. Often, this includes food stamps, housing, and some kind of state-provided salary. Then, there has to be a government-run health care system so that, again, you don't have people dying for lack of care. Oh, and let's not forget that, eventually, higher education should be the right of every citizen as well.

With each of these programs, more and more citizens are being cared for by the government and more and more government funds and people (working for the government) are needed to support the programs. As this occurs, the burden of taxes rises and shaky businesses are forced to go under with the owners and the employees of those fallen businesses being forced to join the increasingly larger group of government-shepherded citizens. Then, ultimately, you have a society like Greece where the state can no longer support itself. Make no mistake, Obama and the Democrats have put us ever closer to the day when that fate will be our own.

Obama's Plan All Along

Because of the Internet, not much of what our politicians have said or done in the past escapes scrutiny; except, of course, by the main stream media.

Thanks to some heads up research by the Naked Emperor News, it appears that Obama had plans to expand Medicare and Medicaid all along as the migration strategy to a Government controlled, single-payer health care system in America. Now, Harry Reid is just complying with that ideological vision after meeting with Obama -- his lord and master:

Once again, it is a case of Obama saying one thing to the public for approval and then doing exactly what he intended all along. This guy can never be trusted!

On Health Care Reform: The Truth Is Dribbling Out

In another one of those raucous Town Halls with right-wing mobs, a Democratic Representative from Colorado, Betsy Markey, let it slip that: "There's going to be some people who are going to have to give up some things, honestly, for all of this to work..." (Click to See Full Story: "Markey: Medicare will take hit").

So, what is it that we'll have to give up? Money? Care? Our lives? I'm quite sure the true answer is: "All of the above!"

The Truth About Medicare & the Public Health Care Option

Right now, the Democrats are pushing a "public option" for health care insurance in America.

Seniors, have already had a "public option" for years. It's called Medicare.

The impression that most people have is that Medicare is "free" government-paid health care coverage. Nothing could be farther from the truth.

First, not all care is covered by Medicare. In fact, routine office visits are not covered. Secondly, any unskilled nursing care will not be paid for. Third, for the things it does pay for, the most that the government will pay is 80%; leaving the senior to cough up 20% of the cost (Click to See Full Story). If that senior is living off of Social Security (alone) and they rack up a couple hundred thousand dollars in hospital/surgery billing, they could wind up owing the hospital $40,000 against their meager social security income of less than $18,000 a year.

This is the very reason why many senior advocacy groups like AARP sell supplemental Medicare insurance to pay for the things that Medicare won't cover (Click to See Full Story). But, this is private insurance and it has a cost that many Social Security dependent seniors can't afford. Consequently, it is not uncommon for seniors to lose everything -- their homes and their cars, etc. -- because they can't pay their medical bills under Medicare. Many just become wards of the state that they live in; living their lives out in understaffed, low-quality nursing homes.

The other thing that people don't seem to understand is that Medicare doesn't provide anything that could be literally defined as "extraordinary" care. This precludes seniors from accessing latest surgical and drug regimens because they aren't approved by Medicare. Or, even if the procedure is approved, Medicare's payment for that procedure is so low that Doctors and Surgeons won't even offer it to their patients. The type and amount of care that any senior can expect to get is defined by Medicare's Diagnosis-related Group (DRG) classification system (Click to See Full Story). Medicare DRGs clearly define what methods of care can be given and how much a health care provider will get for that care. Everything from age to sex is defined by the DRGs.

The belief that Medicare is somehow "free" and not "rationed" is simply political bull. Medicare is rationed care and isn't "free". In fact, if you haven't paid at least 40 quarters of FICA payments before becoming Medicare-eligible at age 65, you will have to pay at least $233 per month in insurance premiums. If less than 30 quarters of FICA payments, expect to pay $423/month (Click to See Full Story). And, that's before you buy any supplemental insurance to cover those things Medicare won't pay.

Even with all it's conditions on the amount of care that will be provided, Medicare is in deep financial trouble. It represents $450 billion in Federal spending and that is 16% of all spending by our government. It is now estimated that the unfunded amount of Medicare payouts are about $38 billion dollars per year. Seven percent of Medicare payouts -- about $31 billion in this year alone -- are said to be due to waste and fraudulent billing and in double billing for services.

I find it interesting that, yesterday, Henry Waxman declared that he was able to get his proposal for health care out of his committee. He did so with no Republicans and 2 Blue Dog Democrats voting no. The proposal, itself, needs $1 trillion in additional funding over ten years. To offset part of that additional cost, Medicare benefits will be reduced if the bill passes. Consequently, it appears that what many people think is already free, but hardly isn't, will just get a lot more expensive for Medicare recipients in the future. I suspect that this Waxman bill has even more rationing provisions for Medicare recipients if passed.

And, let's not forget that this Health Care bill will extend coverage to millions of uninsured Americans. I'm sure that everytime you go to the doctor you get in to to see your doctor, almost immediately. Right? My guess is, actually, not! Just think about your "wait times" once your doctor has to serve 20% more patients than he has right now. Believe me, you will be waiting longer and getting less care once the Democrats get through with this "health-care-less" health care bill.