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OpEdNews Op Eds    H3'ed 2/9/09

The specifics of how a single payer Healthcare system would look like

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Message Matthew UTae

Let's assume that universal healthcare following the template of Medicare & the VA (aka USERRA) is passed.  This is what a lot of people have been calling for.

First, lets look at Medicare.  I don't think a lot of people have actually looked at it.

Medicare Part A = Pays for the hospital and hospice services.  The hospital benefits are capped at 150 days.  Remember, thats 150 days for people 65 and older.  150 days may not be adequete for a lifetime.  It should be for most people though.  For your first 60 days of hospitalization (per lifetime), you will have a $1068 deductible.  For days 61-90, you will pay $267 per day in the hospital.  For days 91-150, you will pay $534 per day in the hospital.  After 150, your on your own.  You pay for part A with your Medicare taxes.

Medicare Part B = pays for non-hospital services such as doctors, therapists., lab tests, and medical equipment.  It comes with a $131 deductible.  After the deductible, Medicare will pay for 80% of the "Medicare approved" costs.  "Medicare approved" is the fee which Medicare will reimburse.  This fee may or may not be what the doctor bills you.  If Medicare says MRI's cost $1000 in your area, they will reimburse the MRI facility $800.  You will pay the bill for the rest.  If the MRI facilitiy actually charges $2500, you will be on the hook for $1700.  Some states cap how much a provider can bill you (aka "Medicare beneficiary").

Medicare Part D = pays for RX.  This is a free market system.  Medicare regulates what MUST be on the formulary.  Most plans have a deductible as well as the "donut hole".  The donut hole is a way of saying that benefits are capped after $2700.  Once Medicare Part D insurance pays $2700 in your name, your on your own, you pay 100% of the costs.  That is, until $4350, then Medicare says, OK, we'll cover 95% of the costs now.  Your RX costs are "catastrophic".  But you've spent $1650 in the "donut hole".  If you don't want the deductible and donut hole, that's going to be a very expensive Medicare Part D plan.  I'd say to the tune of about $400 per month.

My question to proponents of a single payer system, is this enough coverage?  Let's say you've purchased no additional insurance.  You only have Medicare Part A & Medicare Part B.  You pay $96.40 per month PER PERSON in Part B premiums. $96.40 is the 2009 rate, it increased every year.

What would happen if your child got leukemia?  Lets take a look:

Hospital, lets say about a month in the hospital.  That's still in the first 60 days so thats $992.  But your child has used up 30 days out of his total 150 lifetime pool.  Not to mention the co-pay costs that come after 60 days of usage.  

At the hospital, 6 MRI's were done, 30 doctors visits were billed, medical supplies used (such as pain relievers and such), and 12 diagnostic tests were done (biopsys, blood tests, etc).  Remember, Part A covers room & board at the hospita along with a few procedures.  The hospital Bills the following items to your Medicare part B insurance.

Each MRI costs $2000

Each doctor visit costs $125

Medical supplies used = $2000

Each diagnostic test costs $75

There would probably be other fees, but lets simplify it to these 4 charges.

Medicare will pay for 80%.  Lets hypothetically say that the Medicare approved fee for the zip code the hospital you went to are as follows:

MRI = $1500

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