The Centers for Medicare/Medicaid Services (CMS) will distribute more than 50 million dollars for their SHIP program this year (State Health Insurance Assistance Program).
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3032&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
In an April 7 article that is a press release from the CMS Office of Public Affairs, consumers can read about the justification for this increased dollar amount spent on an EDUCATIONAL program described: “State Health Insurance Assistance Programs fill an important role in providing information and support to people with Medicare in their communities across the nation,” said CMS Acting Administrator Kerry Weems. The program delivers money to the states to administer localized EDUCATION about Medicare/Medicaid.
Local phone numbers for getting information about insurance choices...including a prominent disclaimer for liability for any insurance product is offered at the Medicare website,
Medicare.gov.
Now we also know, that the AMA is up in arms and has achieved a delay in a planned reduction in physician payments under Medicare and that the AMA threatens that fewer patients will be accepted by physicians if such a cut occurs (http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_alert.pdf).
And we know that seniors and their advocates have at least noticed that Medicare coverage under the new drug plans has reduced coverage of drugs from over 7,000 to around 5,500 drugs. http://seniorjournal.com/NEWS/MedicareDrugCards/2007/7-12-05-SenCitNotReviewing.htm
We also know that Medicare is pushing Private Fee For Service plans for seniors which as noted in this blog do not have the same legal requirements for providing a network of providers for consumers http://conoutofconsumer.blogspot.com/search?q=Medicare+PFFS.
Oh, and let's not leave out the insurance companies, they are against any laws requiring that insurance policies offered cover certain ailments and conditions. They attack this problem in objections to ANY legislative mandates currently imposed on employers offering insurance...ERISA plans, http://conoutconsumer.blogspot.com/2008/04/state-employer-mandate-laws-and-erisa.html.
Remember that insurance company groups said that though they were against mandates that didn't mean that such coverage wouldn't be offered, they simply did not want to be required to offer coverages.
With all the talk of leadership during campaigns, the government is usually the tail, not the head in addressing problems. As they teach in most basic law classes, the laws against stealing from widows and orphans were not enacted because people were NOT stealing from widows and orphans. The law and the government step in when the "free" market forces aren't working because of some illegitimate process beyond the simplistic and phoney arguments of supply and demand that we're fed in defense of "trusting" that things will work out. Don't take my word for it, examine the sites above.
If the free market will take care of the health services process, why are insurers, physicians and other health services providers, spending time and money (and lots of it) trying to influence the government? Because without the support of laws that protect their interests, the free market economy threatens their bottom line. That doesn't mean that they're always happy with what they get, of course they always want MORE: Look at the AMA, while they whine about pay cuts and lack of pay increases under Medicare, they are battling to protect their involvement with that particular cash cow. They aren't opting out they are whining for more. And if they don't get what they want, they're threatening to opt out (there will be no new acceptances of Medicare patients). Consumers who opted out are being told you don't have a choice, you're going to pay one way or another, consumers should have the same right as physicians, opt out if it's not what we want.
Insurers are the smartest group among the stakeholders. Their expense of money and manipulation and their "we'll take care of it" approach to the administration of ripping people off has given the government a fabulous out: We mean well, but what can we do? The government push for PFFS insurance coverage indicates that it is being led by the insurers because it relieves the governmental burdens of actually attending to the health services crisis. But for insureds? Ah, there the government has its bully pulpit. As services coverage is reduced or eliminated, as prescription coverage is dropped and limited, the government has decided to raise its expense on "education", free hotlines explaining what your best choice among the misery is, with no liability for any specific product, by the way. Don't doubt this, go to the Medicare website and examine the legal requirements for these new fabulous plans...there's actually a chart showing how little these new plans must answer to the government or meet any standard of offering services.
Consumers are the tail and they should not be. We have dropped the ball big time and while we argue on some silly elementary level of catchphrases such as free market, entitlements, empowerment, and personal responsibility, we "hope" that the government or some official will "save" us. How's that working out?
Consumers, voters, citizens, are one in the same. We should be represented in government, we should not be the tail chasing those whose livelihoods are earned from our dollars, but, we'd rather watch millions of dollars and decades of meetings boil down to maybe we can get a patient bill of rights that tells us we should not have to wait for four months for an appointment or reimbursement. Government inaction on consumer issues reflects the prominence of blocs of interest group governance in our country. We have two choices: Start pressuring our government and become the head instead of the tail or don't. So far we have chosen to NOT pressure the government but the other stakeholders have not failed to notice our inaction, they have filled the void and our government is following those who work with government, insurers, physicians and other health services providers.
50 million dollars for EDUCATION? Consumers need a way of paying for needed health services, not an explanation and long-winded overfunded explanation of the best they can do in a system that is cutting costs by cutting coverage. The number one way of promoting consumer interests is for our government to actively reclaim monies depleted by FRAUD. According to CMS, the cost of such fraud is in the BILLIONS http://www.medicalnewstoday.com/articles/68371.php. Instead of staffing an AUDIT department that has the authority to discover, prosecute, collect fraudulent dollar amounts and pass on those reimbursements to programs and insureds ripped off, CMS just keeps pretending that managing consumers will solve the problem.
Nobody wants to cover the RISK of the cost of treating illness--that is the ONLY justification for any health insurance program. The complications of health insurance and the new expenditures for EDUCATION and prevention are the natural outcome of a business that wants to justify its existence while increasing its profit margin by ridding itself of covering risk. Consumers must conclude that a new product for assistance in paying for medical care and services is necessary because insurance companies do not want to cover risk and therefore they are no longer insurers.
And prices for health services would drop as everyone becomes the exception to coverage (which is the direction we're going in anyway).
As for the government? Their next several laws regarding health insurance whether through Medicare/Medicaid or private insurance should be legal mandates for governmental audits of every insurance company for fraud, waste and complicity in price-fixing. Hotlines explaining why things are tough at the cost of 50 million are only evidence of how little the consumer, the voter, the patient, the citizen-employer (those who finance the health services industry through taxes, premiums, and cash outlays) counts. We're paying the bill and being told that our opinion doesn't count.
