What we learned from the conferences

[sayhey24]

A "universal insurer"? I don't think so. Each insurer bids for covering Medicare. They will ALL just raise their bids. These companies are not in business to lose money. They are not Uncle Sam. What is also important to remember is Medicare as a system only works because it is able to leverage the existing infrastructure which is paid for by commercial insurance. Medicare for seniors is a great system as it currently exists because it can leverage this existing infrastructure. However, if it was in a "universal system" Medicare would collapse.

[agedhippie]

Sept 15, 2024 7:24:53 GMT -5 sayhey24 said:

A "universal insurer"? I don't think so. Each insurer bids for covering Medicare. They will ALL just raise their bids. These companies are not in business to lose money. They are not Uncle Sam. What is also important to remember is Medicare as a system only works because it is able to leverage the existing infrastructure which is paid for by commercial insurance. Medicare for seniors is a great system as it currently exists because it can leverage this existing infrastructure. However, if it was in a "universal system" Medicare would collapse.

Medicare has existed since the 1960s and doesn't rely on commercial insurers. This is the difference between Medicare Advantage and original Medicare. With Medicare Advantage Part A and B coverage is managed by a commercial insurer in exchange for a fee from Medicare, with original Medicare coverage is managed by Medicare itself with no commercial insurers involved. Personally I am enrolled in original Medicare because I am unconvinced Medicare Advantage is good value. The AARP have an article explaining the differences: www.aarp.org/health/medicare-qa-tool/what-is-original-medicare.html

It would not be hard to extend the existing Medicare Part A and B infrastructure to cover Part D (some of Part B already overlaps Part D, for example if you have a pump then you can get insulin for free under Part B). The big block was that the MMA which set up Part D explicitly banned Medicare from negotiating drug prices, only commercial insurers were allowed to do that, but that was removed in the IRA. At this point Medicare could have end to end coverage if desired.

[sayhey24]

You are missing the point. In the 1960's most hospitals where run by church's. Today it seems most hospitals are for profit corporations. Regardless, the concept of medicare is assuming the hospital and doctor infrastructure exists and it uses that foundation and sits on top of it. Medicare is a great program and I personally could have a pretty great commercial plan through my employer but I decided to have a Medicare Advantage plan which is even better and a lot cheaper for me with the same doctors.

Medicare is the one thing the government got right but it only works because the foundation is provided and funded by commercial plans. Universal Medicare for everyone would collapse this pyramid scheme.

With that said - how and who is paying for what with the drugs and specifically afrezza is not straight forward. I would really like a slide from Mike which lays out what MNKD is getting paid and how much they are getting.

[agedhippie]

I thought you were discussing insurers rather than hospitals. The reason Medicare was established back in 1965 was because seniors could not afford commercial insurance premiums which were three times that of younger people. Medicare was the response and the government provided the cover that insurers were not prepared to. If insurers price themselves out of the market then the government has the capability to step in as proven by Medicare.

Insurers provide a package in the form of Medicare Advantage plans, but you can entirely ignore them if you want and simply use the underlying Medicare program itself. There are advantages in doing that and I heartily recommend you read the AARP article in my last post as it covers the pluses and minuses of original Medicare vs. Medicare Advantage, as an example you are not limited to the insurer's doctor network and can go to any doctor that accepts Medicare (which is most of them).

I would also like to see a breakdown slide, but I doubt we ever will because it is commercially sensitive.

On the topic of hospitals, for hospitals that accept Medicare 49% are not for profit, 36% are for profit, and 15% are government owned. That makes the for-profit sector just over a third rather than most.

[sportsrancho]

That's what I do, no advantage programs for me.

[Thundersnow]

Sept 16, 2024 10:34:07 GMT -5 sayhey24 said:

You are missing the point. In the 1960's most hospitals where run by church's. Today it seems most hospitals are for profit corporations. Regardless, the concept of medicare is assuming the hospital and doctor infrastructure exists and it uses that foundation and sits on top of it. Medicare is a great program and I personally could have a pretty great commercial plan through my employer but I decided to have a Medicare Advantage plan which is even better and a lot cheaper for me with the same doctors.

Medicare is the one thing the government got right but it only works because the foundation is provided and funded by commercial plans. Universal Medicare for everyone would collapse this pyramid scheme.

With that said - how and who is paying for what with the drugs and specifically afrezza is not straight forward. I would really like a slide from Mike which lays out what MNKD is getting paid and how much they are getting.

I was told by several doctors to go with Traditional Medicare w/ a supplemental plan versus MC Advantage.