Talk:Medicare (United States)

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Piper report link=

Deleted link to Piper report because the link is not specific to the subject and also relates to this issue: "Adding links to one's own page is strongly discouraged." from Wikipedia:External_links#What_should_not_be_linked_to

medicare fraud cost

I deleted a line claiming that Medicare fraud cost $179 billion a year, which is unreasonably high for a $250 billion/year program. I don't have an authoritative source for the actual cost of fraud. It should be noted that some estimates lump together Medicare and Medicaid fraud costs.

Update: While I didn't enter the above note, I do agree that $179 billion is too large. The citations I've seen about Medicare fraud have estimates that range from "billions" source to $33 billion source. However, the best estimate I've seen is this: "The United States General Accounting Office estimates that $1 out of every $7 spent on Medicare is lost to fraud and abuse. In 1999 alone, Medicare lost nearly $13.5 billion to fraudulent or unnecessary claims." source Because all of these estimates are far below the $179 billion one, I believe we should simply state that fraud costs the system billions of dollars a year. --Alabamaboy 16:55, 23 May 2005 (UTC)

In a large majority of government-administered systems everywhere in the world there's fraud, why's it necissary to make a point of mentioning it in this case?--Kbbbb 15:05, 30 April 2006 (UTC)

I'm not sure it's even that great a problem. Consider, that Medicare has low overhead because it doesn't spend any money on insurance agents and as much on fraud checking as private unsurers. It could be that the cost of increasing fraud checking would be greater than the marginal gain in recouped revenues. Therefore, we should also have information on Medicare's overhead versus other forms of insurance, and Medicare's fraud loss per enrollee, versus other forms of insurance.

--Debomachine 21:20, 3 August 2006 (UTC)

Medicare largest public funded health program

I removed sentence "Today, it comprises the largest publicly-funded health program in the world." I could find no reference to this. If true, this needs a citation. However, this fact seems suspect since Medicare covers only 40-50 million people in the US, while public funded health programs in the UK, Europe, Japan and other places cover almost their entire populations. In the UK and Japan alone, this is more than 50 million.--Alabamaboy 28 June 2005 13:16 (UTC)

I think it would be accurate if it said together, Medicaid and Medicare are the largest in terms of dollars spent on medical services and goods. Or something to that nature.

Patrick25: I think the largest single-payer health care is the europan union which compromises of 27 member countries! Not the United States. The population estimates 494 million people, and If you are (for example) a German resident, you are entitled to medical treatment that becomes necessary, at reduced cost or usually free, when temporarily visiting a European Union (EU) country, for example Greece, Iceland, Spain, etc. However, to obtain free treatment you will need to take a European Health Insurance Card (EHIC) with you. Which is free for all too. I wish i could use it also in the united states when visiting Florida in summer ;-)) Maybe Florida joins the EU. There are so many poor people without proper unemployment and health insurance. The best single-payer health care are free.

Part B

I inserted a paragraph about the payment for office-dispensed drugs under Part B. This is a complex, very expensive area of Medicare, and one that has an interesting story of value to readers.--Dr.michael.benjamin 01:24, 15 February 2007 (UTC)

Size of Medicare

Hi. Actually, Medicaid is now larger than Medicare in both total expenditures (federal and state) and enrollment, so item is moot.

On the issue of Medicare's size relative to other health programs internationally, it is larger than any health program in any of the 29 nations that are members of the Organization for Economic Cooperation and Development (OECD). We don't have good spending data on other countries but these large nations drawf any of the other 180+ countries. See data from House Ways and Means Committee Green Book (waysandmeans.house.gov/media/pdf/greenbook2003/).

Medicare spends considerably more per capita than, for example, the National Health Service in the U.K. Many reasons for this. Medicare pays for much wider range of services and higher quantity of services. Many European health systems ration explicity by not covering, for example, transplants for persons over 55 and by limiting the speed and quantity of services. The U.S. rations but indirectly through insurance market.

Bottom line, it may be more useful to describe Medicare as the second largest health program in the U.S.

Hope this helps.

--Medinomics 4 July 2005 03:37 (UTC)

Survey?

We have this quote:

"According to an article in the Journal of American Physicians and Surgeons, in a random sampling of questions asked to Medicare customer service representatives, 96% of the answers given were incorrect. "

But what were they asking about? We would need to know what in order to understand what the sentence means. For all we know, it was a spelling test...

Rules for coverage

The rules governing Medicare reimbursement are sophisticated, in the sense that they have been developed by doctors and administrators to provide care that is medically indicated for certain reasons. These reasons are sometimes grounded in rational science, but sometimes they are arbitrary, based on advantageous reimbursement patterns for the rulemakers. To say that the rules are complex characterizes them as groundlessly complicated. "Sophisticated" is a better word, since it reflects that the reimbursement criteria are based on different types of reasoning, some more rational than others.--Dr.michael.benjamin 22:07, 15 February 2007 (UTC) —The preceding unsigned comment was added by Dr.michael.benjamin (talk • contribs) 18:03, 15 February 2007 (UTC).

Medicare Advantage plans

Is there a reason that Medicare Advantage plans (formerly known as Medicare Managed Care plans) are not listed in this article? While they are naturally related to Parts A, B, D, (especially when qualifying for a Advantage plan), the Advantages plans are a distinct and separate way for beneficiaries can receive their Medicare benefits. It would seem reasonable to add a sub-section in line with the Part A, B, D sub-sections describing this option. Any objections/comments? Thanks -- Argon233 ^T _@ ^C _¶ ^U _∠  18:32, 6 April 2006 (UTC)

Medicare Number

Similar to the SSN entry, it would be useful (imho) to explain what the number means and what the parts mean.

It is, of course, an SSN, but with letters appended.

I haven't found a resource to explain what the letters mean.

Ones i've seen: A, B, B6, D, D4, D6, M, T, & W.

--Bshirley 22:06, 10 July 2006 (UTC)

Found at http://www.wpsic.com/medicare/bene/med_basics.shtml

"An alpha character follows most Medicare numbers. The most common characters are A (wage earner), B (spouse of a wage earner) and D and D5 (indication your spouse is deceased)."

--Bshirley 22:39, 10 July 2006 (UTC)

Enrollment in Medicare

First, a big "Thank You" to those who contributed to the main article. It was much easier for me to understand the essential features of Medicare here on Wikipedia than it was on the offical government website (www.medicare.gov).

Second, we might wish to add a short section on enrollment procedures, because for some people this has been very difficult. My doctor's mother, for example, went to her local Social Security office three times without getting served because of the long lines. Dreading the same experience, I phoned SSA's 800 number to see if I could make an appointment. I was stunned to have the SSA rep ask me if I wanted to enroll right then and there over the phone! Enrolling that way took only 25-30 minutes and the rep was very courteous and helpful throughout.

I can write a few sentences on enrollment procedures in formal Wiki style, but would need some help in deciding where it should go within the main article and in creating a new section heading or subheading for it. --Catawba 04:41, 30 August 2006 (UTC)

Criticism section stats

A sentence in the criticism section says: "The fundamental problem is that the number of workers paying Medicare taxes is shrinking, while the number of beneficiaries and the price of health care services are both growing." I find it hard to believe that the number of workers paying Medicare taxes is shrinking, since almost everyone who works in the US pays Medicare taxes, and the number of people employed in the US certainly is trending upwards. The references cited that follow that sentence do not appear to support that assertion either. Perhaps the person who wrote that sentence meant to say that the ratio of retirees drawing benefits to workers is increasing. I will rework the sentence if no one has any objections.

Andyrew609 02:35, 11 September 2006 (UTC)

Eligibility section

Anyone want to take a stab at creating a section to discuss the various ways someone is eligible for medicare? Ksheka 13:45, 9 October 2006 (UTC)

I took a stab at it, but there is apparently more to it than can easily put into words. Ksheka 13:52, 9 October 2006 (UTC)

Legislative oversight

Please don't delete my legislative oversight section. I think an encyclopedic entry on Medicare ought to have a list of the Congressional committees that oversee it. This article can serve as a resource for readers who want to contact the legislators "in charge" of Medicare.User:dr.michael.benjamin

Do you have a citation for this material? I see several of these committees which have oversight for CMS & HHS, but have only tangential oversight of the actual Medicare program itself. -- 12.106.111.10 23:06, 14 February 2007 (UTC)

Also there are inconsistencies with the way the table is listing both subcommittees, and the committees they belong to in some, but not all cases. It would seen reasonable that if one or more subcommittees are listed, the committee doesn't also need to be listed, as the subcommittee is a constituent part of that committee, and any authority that the subcommittee has was devolved from the parent committee, and so oversight responsibility is naturally inferred. Could you please share your rational for has been included in this table? -- 12.106.111.10 23:47, 14 February 2007 (UTC)

The citation is the CMS website, buried in the layers. I figured people (i.e., doctors with a beef with Medicare) would want a more convenient way of finding the information. I got to it easily last night, but now I can't seem to find the link again.--Dr.michael.benjamin 00:15, 15 February 2007 (UTC)

Citations need to be used when quoting/reusing material. Also articles should not be use for advocacy purposes (see WP:TIGER), so including the material to advertise how to express a "beef" with Medicare is not necessarily an appropriate reason to include the material in the article. I am going to remove the table until it's clear where this specific material came from, as I question some of it's validity. Note that the table is not permanently gone, and can be accessed from the article history, so extended effort will not be required to to add this back in once a citation is provided. -- 12.106.111.10 22:32, 15 February 2007 (UTC)

I'm not sure how a table summarizing the committees of Congress that oversee Medicare expresses advocacy. These are facts that exist independently of a particular agenda--certain Congressional committees oversee Medicare regardless of what you or I or anyone else think about it. There is value in readers of Wikipedia being able to rapidly identify which legislators help oversee Medicare, since as we are finding, the information is available elsewhere, but not easily accessible. I'm not sure that summarily, anonymously deleting the content serves the interest of readers, who may be interested in contacting their representatives to gather more information about the program. In addition, several people worked hard to format that table and link it to other articles on Wikipedia. By deleting the table, you have diminished the quality of this article by reducing its link count to other articles. I am putting the table back in. The citation appears associated with the table. Please do not remove it again.--Dr.michael.benjamin 06:23, 16 February 2007 (UTC)

Please see response here, on a user talk page. -- 12.106.111.10 16:49, 16 February 2007 (UTC)

The legislative oversight table is out of date. In short, any Republican listed here is incorrect; none of them are committee chairmen anymore. Karichisholm 10:25, 6 March 2007 (UTC)

Can someone check this?

Several unexplained edits have been made to the article on or about 14 March 2007; at least one of the edits appeared to be questionable. I have reverted, but I'm not sure whether I reverted to a good version or not. Someone may be able to check this faster than I can. Yours, Famspear 17:55, 14 March 2007 (UTC)

Legislation and Reform - but there's more?

This section starts out by naming the various legislation and reform to medicare. Next... I get the Clinton note - because it was an attempt at medicare reform... though not really necessary since it didn't actually change anything. But then the section explains the workings of the 2003 legislation: "...this legislation included fixing loop holes in the Medicare Secondary Payer Act that was enacted in 1980. By fixing the loopholes, Congress strengthened the Workers' Compensation Medicare Set-Aside Program (WCMSA) that is monitored and administered by CMS."

How come there's an explanation of this but not any of the other reforms? Possible NPOV issues aside... The point is that there are links to the other legislation so that a user can go and find out about them. If you explain - even briefly or in part - what one reform did... then you have to explain all of them for a balanced article. And, obviously, the MMA did much more than fix loopholes. Let's not forget that it also created many more loopholes and that it was a serious case of corporate welfare for pharmaceutical companies as well as major employers in the US.

I think this section needs to be more specific - you could explain that the MMA was the largest overhaul of Medicare and say what it did in its entirety (good luck)... or, we could remove this one-sided brief. What does everyone else think?

Rob Shepard 04:35, 26 April 2007 (UTC)