What happens to Kaiser under the Medicare for All plan?

[Barry]

Kaiser currently participates with Medicare as a Medicare Advantage provider. My understanding is that Bernie's Medicare for All eliminates Medicare Advantage programs, but I'm having a hard time finding anything definitive on that. Got links?

If that is true, I and a whole bunch of people are going to be against that because we actually like our "insurer" because they coordinate our care. I have Kaiser coverage and I am very happy with their care. While I'm sure that sentiment is not universal among their clients, given that kaiser is often a choice people make, I presume it is common.

Medicare Advantage is getting more popular. It's going to be a big deal if it goes away and a whole bunch of people are not going to support a candidate that will take away their current system that they like.

[Janice Gendreau]

Barry,

Bernie and Elizabeth's plans cover all medical costs. There is no longer a 20% co-pay. Right now Medicare is processed by private health care companies like Blue Cross/Blue Shield, Aetna, etc. In other words the government sub-contracts to these companies to process the claims. We do not have a government claims processing center. I assume this arrangement would continue. How do I know this? I worked for Blue Shield as a technical analysis for many years. What I assume will change is that the "New Medicare for All" will pay more than it currently does (80% of an outdated fee schedule). Otherwise physicians would not accept it as payment in full.

Both Bernie and Elizabeth need to explain this.

[Barry]

Bernie and Elizabeth's plans cover all medical costs. ...

Thanks for your comments, Janice, but they are not definitive. And this is a big issue!

I agree with you: "Both Bernie and Elizabeth need to explain this."

[SonomaPatientsCoop]

Bernies plan- which warren also backs- will kill medicare advantage plans... the question I guess is how quickly.

His plan will instantly add hearing and vision to Medicare (maybe I've missed it but dental seems left out), which is a big portion of the medicare advantage plans. His plan also reduces the age for medicare by a decade each year, and I believe it's the 3rd year? does away with private insurance entirely.

So yes- Medicare advantage would die if "medicare for all" became a reality. How quickly would be up to the number crunchers ad the market. The big caveat of course - whether the companies believe "medicare for all" would survive with the next election...

And... to the post above about it removing "co-pays" ... while this sounds like a good thing if you look at the socialized medicine systems around the world... it is not. The evidence is that a zero co-pay has people running to the doctor for every scratch. Every time they feel "off" or that "something" is coming on. Which greatly increases costs on the system and over burdens it- causing increased wait times for people that actually need help. The evidence suggests that even a nominal $20 co-pay greatly reduces the abuse of the medical system...greatly benefitting all.

Having family and friends in the medical world... I'll mention a few other issues that aren't really being discussed:
Private insurance (and, as is very common in CA - "fee for service") , - essentially subsidize Medicare. Many medical practices - including hospitals, can not survive on the fees the government pays.

Many good health insurance programs cover a multitude of alternative treatments - from massage to naturopathy to Chinese medicine to off-label drug treatments and alternative therapies. Good luck getting the Feds to cover *any* of that.

We are currently in the midst of a generation of doctors bearing the burden of $150-250K + in student loan debt. Many of whom are struggling even with higher private insurance payments and fee for service. This is a disaster waiting to happen.

There is no such thing as a free lunch. Medicare currently is ~ 10% more cost effective then private insurance. Most experts think that number will shrink once everyone is covered. And by most of the analysis I have seen those savings come from 3 things - they control how much is repaid (ie: lest $ to doctors, hospitals, pharmacies etc). The government employees are paid less than the private sector. And they deny higher cost treatments at a greater rate.

[Barry]

Bernies plan- which warren also backs- will kill medicare advantage plans...

If that is so, which is as far as I can tell is true, then I presume Kaiser and other HMOs (Aetna Health, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Sharp, UnitedHealthcare, Western Health Advantage) goes away!?!

This disturbs me. I like the integrated care they provide, particularly their digitized medical records that instantly available for any service provider to access.

My primary objection to "Medicare for All" is that it is going to cost us votes, and quite possibly the election , because of the fear that will be ginned up by the republicans. People will object, even if they may be better off under MFA.

Now I also object because I want to keep Kaiser! There will be many other people who want to keep their HMO. I'm sure some people who will be happy to get rid of them, but there will be lots of people who don't want anything to change with regards to their health care.

The answer is simple. Give people a choice!! A public option was the liberal wish with Obamacare, but it was a bridge too far. Now a public option (ie "Medicare for All Who Want It") is well within reach. Let's not blow this opportunity!

[foxrosie]

i too want to keep Kaiser. i do NOT want to be out looking for a Medicare doctor. Or any doctor. I just want to keep what i have. and all the digitized records, etc. how can we get this across to Elizabeth and Bernie? If losing Kaiser spooks me, then I'll bet it spooks alot of other people too. We don't want to lose whatever we are comfortable with ---- or too lazy to change (both are true with me for Kaiser). This could create a serious problem.

[Barry]

i too want to keep Kaiser. ...

I have not definitively determined that the Kaiser system goes away. I'm working on it trying to nail that down. Shouldn't be so hard. It's just one little bit of a VERY LARGE CHANGE to the health care system, the MFA want to make compulsory. I'm sure there are many other issues that need to be discussed that have not surfaced yet.

"Medicare for All" has garnered lots of positive reactions because many people think they can still keep their private insurance if they want, and no one has has said anything about how to pay for it.

[wisewomn]

You make a couple of good points, SPC. However, I have known a number of people who are Kaiser members who run to the doctor at the drop of a hangnail, and others who have received substandard care so that Kaiser can save money (The very thing people complain about when referring to MFA). I know of 3 people who have died from Kaiser's slapdash approach to care. I also know people who can't find available "good" docs at Kaiser because they are all booked up.The bottom line is that Kaiser works well for some people and not well for others. Its chief virtues are that it's cheaper than other plans and it's one-stop shopping.

I don't see any good reason why Kaiser can't continue to operate under MFA. Its funding would come from the feds rather than from the individual members' co-payments. That's what it pretty much does now with Medicare recipients and supplemental Medicare coverage for low income patients.
And, no, I'm not a Kaiser member, as you might have guessed already. :-)

[QUOTE=SonomaPatientsCoop;229834]Bernies plan- which warren also backs- will kill medicare advantage plans... the question I guess is how quickly.
.../QUOTE]

[BethLinley]

Unfortunately the other plans will become like Kaiser...

You make a couple of good points, SPC. However, I have known a number of people who are Kaiser members who run to the doctor at the drop of a hangnail, and others who have received substandard care so that Kaiser can save money

[Rustie]

I think you misunderstand the relationship between health insurance companies and Medicare, though I am not asserting myself as an expert. Medicare does not sub-contract with the private insurance sector to process claims. Private insurance is not required with Medicare, though obviously there is a mechanism to integrate private insurance with Medicare for those who choose to obtain the additional coverage. There are many Medicare Part B recipients without additional private insurance and these medical claims are handled within the government system. The salient point here is that we already have a functioning government claims processing center.

What Medicare currently does not provide is coverage for prescriptions. This means that if your only insurance is Medicare you will either pay out of pocket in full for prescriptions or you can purchase a Medicare Part D drug policy. This Medicare Part D policy is only available through the private sector. Many insurance companies provide drug only policies however they are not cheap. Kaiser's Senior Advantage plan typically costs less than drug only plans and it includes drug coverage.

Currently Medicare's monthly premium is around $140/mo per person. I'm sure there is someone out there who has the exact figure. The amount, I believe, is the same for everyone unless you didn't sign up for Medicare within the 6 month allotted time frame from your 65^th birthday.

Additionally everyone who has earned income has paid into Medicare Part A, which is hospitalization coverage. This coverage has been paid for via employee withholding’s at the rate of 1.45% of your gross earnings for every penny you have earned since your first job. This number is matched by your employer. If you are self-employed , and file tax returns, you pay the full 2.9% on 92.35% of your net taxable income. That having been said, Medicare Part A is limited by comparison to private insurance hospitalization coverage. Either way after having paid thousands of dollars to insurance companies the misfortune of serious illness, injury or accident leaves many bankrupt.

Nonetheless in our current system of combined government/private insurance schemes we just keep paying and purchasing. Meanwhile about 40% of monies paid into the system never gets to our health care providers. Instead were funneling billions of dollars every year lining the pockets of private hospitals, insurance and pharmaceutical industry's CEOs and stockholder's.

Barry,

Bernie and Elizabeth's plans cover all medical costs. There is no longer a 20% co-pay. Right now Medicare is processed by private health care companies like Blue Cross/Blue Shield, Aetna, etc. In other words the government sub-contracts to these companies to process the claims. We do not have a government claims processing center. I assume this arrangement would continue. How do I know this? I worked for Blue Shield as a technical analysis for many years. What I assume will change is that the "New Medicare for All" will pay more than it currently does (80% of an outdated fee schedule). Otherwise physicians would not accept it as payment in full.

Both Bernie and Elizabeth need to explain this.

[Rustie]

How can we get this across to you? ALL doctors, facilities, labs, pharmacies, technicians, etc will be completely covered under MFA. Additionally dental, vision and hearing will be added and completely covered. Preventative care, mental health, rehab programs and all reproductive services will be included. There will be no providers, facilities, etc that will refuse you because of MFA. All doctors will be “Medicare Doctors”.

Digitized records are not a Kaiser phenomenon. There are a variety of integrated digitized record systems currently in place throughout the medical community. I would venture to guess that the entire country has and utilizes these systems. Implementing a national integrated digitized record system will likely be relatively seamless.

The only choice taken away with MFA, if you insist on viewing through that lens, is the choice that medical providers currently have to refuse patients based on their insurance carrier and economic means.

MFA will be the only game in town and as such ALL doctors will accept MFA and everyone will have equal access to quality care. This is the primary difference between a Single-Payer system and a Public Option plan.

If you leave the for profit insurance industry in place you maintain a profit driven health industry and create a class divide health care system. Currently we have 32 million people without insurance and another 41 million who are under insured. That is what I consider a serious problem.

If you agree that health care is a human right not a privilege I would think it would be easy to see that a profit driven system is not acceptable.

If on the other hand your personal convenience and comforts are your priorities than neither Bernie or Elizabeth are for you. You might want to consider one of the centrist insider Democrats who will keep the corporate ruling class in power and the working class oppressed. Might I suggest Biden, Buttigieg or Klochubar.

i too want to keep Kaiser. i do NOT want to be out looking for a Medicare doctor. Or any doctor. I just want to keep what i have. and all the digitized records, etc. how can we get this across to Elizabeth and Bernie? If losing Kaiser spooks me, then I'll bet it spooks alot of other people too. We don't want to lose whatever we are comfortable with ---- or too lazy to change (both are true with me for Kaiser). This could create a serious problem.

[SonomaPatientsCoop]

Nonetheless in our current system of combined government/private insurance schemes we just keep paying and purchasing. Meanwhile about 40% of monies paid into the system never gets to our health care providers. Instead were funneling billions of dollars every year lining the pockets of private hospitals, insurance and pharmaceutical industry's CEOs and stockholder's.

You made some very good points... and sorry I deleted them for brevity in this reply...

Healthcare- like any business- has high overhead. My understanding is the medicare currently has about a 10% cost saving over private insurance. Part of this is negotiated prices...which seem to be made up in the real world by the private sector. Part of this also seems to be those in gov't making less then those in the pvt sector- though I am still unclear if this considers the long term benefits govt employees get.


I honestly don't know what the answer is here. Is but as much as I'm loathe to agree with anything Reagan said.... but his "nine most terrifying words"... "I'm from the government and I'm here to help" ring true...

[podfish]

I honestly don't know what the answer is here. Is but as much as I'm loathe to agree with anything Reagan said.... but his "nine most terrifying words"... "I'm from the government and I'm here to help" ring true...

I'd go along if it was "mildly concerning", not terrifying. It's way more terrifying when a health-care provider says "sign here". Is the next doctor who walks up to you in-plan? Wanna hit them up for that and negotiate to have an in-plan replacement as you're being rolled into surgery? 'cuz that's when you meet your anesthesiologist, for example.

And much as I hate it when government gets in my way, it's often over things that I know half the wacco audience would find appropriate for the government to prevent me from doing.

[RicoBoccia]

As usual, Rustie gets to the heart of the matter. This breakdown, however, is precative — it describes one idea of how things might work in the future. As with the ACA, any proposal coming from a Democratic (Bernie) White House would likely be sliced & diced & watered down by the corporate weasels in Congress (which includes many Dems) to something much less effective.

A small side note re digitized records: As an old IT guy, I've seen the difficulty in integrating previously unconnected systems. In other situations (e.g. at the Pentagon and in intelligence agencies), the gov't has spent insane amounts of money, mostly on contractors, and waited years for projects to complete only to have those projects collapse. It's like renovating an old house — you get well into it before you realize it would have been faster & cheaper to tear the whole thing down & rebuild from the ground up.

Regardless, the IT work needed to implement MFA — whether expanding a single, existing system; integrating several current systems; or building a new one from scratch — would be a huge, multi-year project fraught with umpteen ways it could fail. (Remember the Obamacare website rollout failure? That was a relatively simple, stand-alone system and it still choked badly.)

To me, the real question is about the left-behind. Every time someone expresses fear about losing his/her current coverage and therefore opposes anything like MFA, I ask what we should do about the one-third of the country that has either no health insurance or has crummy policies: How do we stop the daily horror show of people going bankrupt because they get ill? (Many people have no clue how crummy their policies are until they actually need them. Then they're stunned to learn how lousy those policies are.) I've never heard anything but the sound of crickets in response.

Is everyone entitled to decent health care or only those with money? If you answer the former, then think twice before saying MFA won't work because you'll have to explain how else we might get there.

How can we get this across to you? ALL doctors, facilities, labs, pharmacies, technicians, etc will be completely covered under MFA.... All doctors will be “Medicare Doctors”.

Digitized records are not a Kaiser phenomenon. There are a variety of integrated digitized record systems currently in place throughout the medical community. I would venture to guess that the entire country has and utilizes these systems. Implementing a national integrated digitized record system will likely be relatively seamless....

[Rustie]

If that is so, which is as far as I can tell is true, then I presume Kaiser and other HMOs (Aetna Health, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Sharp, UnitedHealthcare, Western Health Advantage) goes away!?!

This disturbs me. I like the integrated care they provide, particularly their digitized medical records that instantly available for any service provider to access.

My primary objection to "Medicare for All" is that it is going to cost us votes, and quite possibly the election , because of the fear that will be ginned up by the republicans. People will object, even if they may be better off under MFA.

Now I also object because I want to keep Kaiser! There will be many other people who want to keep their HMO. I'm sure some people who will be happy to get rid of them, but there will be lots of people who don't want anything to change with regards to their health care.

The answer is simple. Give people a choice!! A public option was the liberal wish with Obamacare, but it was a bridge too far. Now a public option (ie "Medicare for All Who Want It") is well within reach. Let's not blow this opportunity!

You're fortunate enough to have health insurance that has provided you with acceptable health care and you don't want anything to upset your apple cart. Fair enough. Now let's try addressing those concerns.

As a health care facility Kaiser could certainly still exist under MFA. Technically they already do just that. As you well know Kaiser's Senior Advantage insurance plan coordinates with our current Medicare program. No reason this relationship could not smoothly transition within the 4 year Medicare expansion plan that is included in Bernie's MFA bill.

HMO health care facilities and hospitals could function just as they currently do with a few patient value changes. One, they would no longer collect premiums, co-pays and deductibles from their patients. And two, they would no longer impose restrictions on their patients health care procedures and providers.

Kaiser and the health insurance industry are obviously fighting this tooth and nail. They certainly would prefer to not lose their ability to rob the American people blind. But, will Kaiser actually shut down every facility Nationwide?

I doubt it. And if they did, what's really at risk? Let's pretend that all Kaiser medical facilities collapse and their entire medical staff ceases to practice medicine. Result: temporary inconvenience for about 8.9 million Kaiser customers while they find new doctors. Versus: maintaining the status quo with 32 million people having zero access to health care.

You be the judge. I personally don't consider the highly unlikely collapse of Kaiser as an MFA deal-breaker. I also don't consider a public option as any answer let alone "the simple answer". Buttigeig's plan still leave 6 million people uninsured and maintains a class divide health care system. Is it simply OK with you to continue to perpetuate a have and have not society leaving millions of people at risk just to maintain your comfortable status quo?

With or without Kaiser your integrated health care is not at risk. Digitized record transfers are common throughout the medical community. This information, currently, is easily shared between health centers, hospitals, labs and private physicians. Perhaps it will take some time to establish a well integrated national system but personal experience makes it clear to me that within Sonoma County such systems currently exist and function very well outside of the HMO world.

There are, in my opinion, obvious benefits with Kaiser under MFA. Most important, your doctors will be acting on behalf of your best health care needs rather than corporate profits. Additionally you would not be restricted to providers employed by Kaiser. Without the threat of out of pocket expenses looming over your head, which for many is very real concern, you would have complete freedom of choice to see medical professionals, receive treatment and have prescriptions filled at any facility anywhere in the U.S.

It appears to me that Kaiser, their HMO counterparts and the health insurance industry in general are the real culprits taking our choices away.

The reality is that with Medicare for All the entire nation becomes an integrated quality health care system serving everyone with no restrictions, no deductibles, no co-pays and no premiums.

Let's be clear, there is no phase out of medical care or medical care providers of any kind. It is the private for profit insurance industry that will be phased out over 4 years under Bernie's MFA. These people do not provide our health care. In fact, their role is to impede our health care. Their role, first and foremost, is to ensure billions of dollars of corporate profits, CEO salaries and stockholder dividends.

In my opinion, it's time to get rid of our profit driven health industry and replace it with a non-profit system dedicated to health care.

[Barry]

You're fortunate enough to have health insurance that has provided you with acceptable health care and you don't want anything to upset your apple cart. Fair enough. Now let's try addressing those concerns.

As a health care facility Kaiser could certainly still exist under MFA. Technically they already do just that. As you well know Kaiser's Senior Advantage insurance plan coordinates with our current Medicare program. No reason this relationship could not smoothly transition within the 4 year Medicare expansion plan that is included in Bernie's MFA bill.

HMO health care facilities and hospitals could function just as they currently do with a few patient value changes.

Kaiser's Senior Advantage program is a Medicare Advantage program. Medicare Advantage, which is private insurance, paid by medicare, goes away with Medicare For All. As far as I can tell there is no role for HMO's under MFA. I can find nothing that addresses this issue directly! The fact that this is not discussed and explained is unconscionable! How can you support a system that doesn't address what will happen to a large swatch of the medical system!

You are just making stuff up, if well intentioned. You don't know. I don't know. I called Kaiser today and they had nothing to say about it either!

...Buttigeig's plan still leave 6 million people uninsured and maintains a class divide health care system.

The first part is not true. Pete's plan covers everybody. In addition to letting everybody by in, Pete's Plan includes these two elements:

• Automatically enroll individuals in affordable coverage if they are eligible for it.​ Over half of people with no insurance are eligible for either free insurance or an affordable insurance option.Anyone eligible for free coverage in Medicaid or the public option will be automatically enrolled, and those eligible for subsidized coverage will have a simple enrollment option. Individuals could opt out of public coverage if they choose to enroll in another insurance plan.
• Retroactively enroll those who fall through the cracks in the public option. ​A backstop fund will reimburse health care providers for unpaid care to patients who are uninsured. Individuals with no coverage will be retroactively enrolled in the public option.

...With or without Kaiser your integrated health care is not at risk. Digitized record transfers are common throughout the medical community.

Yes, they are now common but doctors are not happy with them: "Yet, US primary-care physicians are discontent. In a 2018 survey by Stanford Medicine in California, 59% said they felt that the systems needed a complete overhaul." Plus there are many different kinds of them that are often not interoperable.

See: "The Need for Interoperable and Portable Electronic Medical Records".

So bottom line, there is no information out there about what happens to Kaiser or other HMOs under MFA. They might exist, they might not. I challenge you to find a well informed link that explains this.

If Kaiser goes away, and I can go to any doctor I want, they may or may not be able to share my health records.

I like my kaiser coverage and I like their medical records system. I don't want to switch to anything else until I decide to, not when Bernie Sanders tells me to!

[Finell]

My wife and I have Kaiser's Senior Advantage program. We are very happy with the medical care we receive. The extra medical care that the plan covers (that is, care beyond what standard Medicare pays for) is easily worth the monthly $91 per person.

I believe that Kaiser would continue to market private health insurance to supplement Medicare benefits, as Kaiser now does. If Medicare For All disallows private Medicare Advantage programs, Kaiser's coverage would probably cost more than $91 monthly because Kaiser would no longer receive money from Medicare to cover basic Medicare benefits for Kaiser Advantage "members."

Furthermore, Kaiser's hospitals, medical offices, equipment, etc., won't simply disappear. The Permanente Medical Group, the physicians and other medical care practitioners that now care for Kaiser's patients, will continue to exist and to provide care under Medicare For All. Kaiser is more economically efficient than private medical offices, so Kaiser should thrive under Medicare For All.

I saw George McGovern lecture in Sebastopol in 2007. After the Clintons failed to pass universal health care legislation, McGovern said he thought that phasing in Medicare for everyone was probably the best option for enacting universal health care.

Finell

Kaiser's Senior Advantage program is a Medicare Advantage program. Medicare Advantage, which is private insurance, paid by medicare, goes away with Medicare For All. ...

[Finell]

Yes, I like Kaiser's integrated care, and their modern digital medical records enables integrated care. When another doctor covers for my usual doctor, or when I call an advice nurse, they actually do look at my record (e.g., treatment, lab test results, prescriptions) and take my history into account. I also like being able to look at my records whenever I want to, and see graphs of past results for each lab tests. Telephone "visits" with doctors (with no co-pay) are also effective and convenient. Ordering prescription refills couldn't be easier.

Finell

If that is so, which is as far as I can tell is true, then I presume Kaiser and other HMOs (Aetna Health, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Sharp, UnitedHealthcare, Western Health Advantage) goes away!?!

This disturbs me. I like the integrated care they provide, particularly their digitized medical records that instantly available for any service provider to access. ...

[Finell]

I agree that eliminating all co-pays is a bad idea because it encourages wasteful utilization. Look at what happens every Wednesday, when the free Bohemian hits the street. I do think that the truly indigent should be able to get health care even if they cannot afford a co-pay.

Whatever a candidate promises, legislation requires a majority in both the House of Representatives and the Senate. None of the proposed plans will sail through the legislature as-is.

Finell

B...And... to the post above about it removing "co-pays" ... while this sounds like a good thing if you look at the socialized medicine systems around the world... it is not. The evidence is that a zero co-pay has people running to the doctor for every scratch. Every time they feel "off" or that "something" is coming on. Which greatly increases costs on the system and over burdens it- causing increased wait times for people that actually need help. The evidence suggests that even a nominal $20 co-pay greatly reduces the abuse of the medical system...greatly benefitting all....

[foxrosie]

Finell wrote that he and his wife have Medicare Advantage with Kaiser. and that they pay $91 each in monthly premiums to Kaiser, in addition to basic Medicare premiums. My husband and I have the same program (Medicare Advantage) with Kaiser, but we pay only $24/month each to Kaiser. Is that a sliding scale premium, or a different plan? I know that I make co-pays for every doctor's visit of $40, and have an out-of-pocket max that is close to $5,000. I am asking only because I was under the impression that Medicare Advantage is a one-size fits all program that was the same deal for everyone, but perhaps I'm wrong. I would just call their business office to ask that question, but have been known to be on the phone for hours trying to get someone there to answer a simple question!