Medicare

Vietnam veteran John Otte did his best to forget the war. He got married, raised two sons and made a career working at credit unions. But as Otte neared retirement, memories of combat flooded back. Starting in 2005, he filed a series of claims with Veterans Affairs for disability compensation, contending that many of his health problems stemmed from the war. The VA agreed, and now the 65-year-old with two Purple Hearts receives $1,900 a month for post-traumatic stress disorder and diabetes - and for having shrapnel scars on his arms.

When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles. Be it a cardiac stent, a hip replacement or a pacemaker, Cedars-Sinai's list prices for these routine treatments ranked among the top 5% in the country. For example, the average charge at Cedars-Sinai for gallbladder surgery with complications was $153,302 in 2011 compared with the U.S. median charge of $42,380, government data show.

I'm an 84-year-old man on Social Security with original Medicare and Mutual of Omaha gap insurance. My insurance premium was raised from $262 to $363 a month, a 39% jump. After all my monthly expenses, I have just $240 left. What can I do in the event of another increase in my premiums? If you've had your current Medicare supplement plan for years, it's not surprising that you've seen your costs steadily rise, says Steve Zaleznick, senior Medicare advisor at PlanPrescriber, a Maynard, Mass.-based online provider of Medicare education and plan comparison tools.

Re "Remove Medicare's straitjacket," Opinion, March 29 Art Kellerman misunderstands why Congress delayed inclusion of oral-only drugs in the Medicare payment bundle for dialysis services. It wasn't to give Amgen and other drug makers a major windfall; it was done because of major changes in how Medicare pays for dialysis care. This action by Congress ensures that vulnerable dialysis patients, who are among our nation's most chronically ill, continue to receive the medicine they need.

At the headquarters of Boston Medical Group in Costa Mesa, six salesmen were working the toll-free appointment line on a recent afternoon, fielding calls from men around the country enticed by newspaper and radio ads promising a "proven" solution to erectile dysfunction in "one office visit. " The results are visible "right there in the office," one sales representative told a caller. "It's amazing. " Following a script, he answered a few questions and offered to schedule a $195 consultation at one of the company's 21 U.S. clinics.

Medicare's new prescription benefit will cover sexual performance drugs, like Viagra, in addition to medications for such ailments as high blood pressure and heart disease, program officials confirmed Monday. The move into what some consider "lifestyle" -- rather than life-saving -- pharmaceuticals is being criticized by conservatives, who see it as an unnecessary frill for a program that already is projected to cost at least $400 billion over its first decade.

Secure Horizons, the nation's largest Medicare HMO, said Thursday it will freeze membership next year in 41 counties nationwide, most of them in California. The announcement that new members will not be accepted in 24 California counties, among them Riverside, San Bernardino, Santa Barbara, Kern, Alameda and Contra Costa, came as Secure Horizons' parent company reported disappointing results for the third quarter, though they beat estimates. Santa Ana-based PacifiCare Health Systems Inc.

One recent afternoon in Los Alamitos, I watched Marcy Zwelling-Aamot, M.D., pick her way through a government website designed to help elderly patients select the right Medicare drug plan, based on their prescription needs and hometown. The website, created for the launch of Medicare's new prescription drug benefit, identified 48 individual plans available for Southern California residents.

When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles. Be it a cardiac stent, a hip replacement or a pacemaker, Cedars-Sinai's list prices for these routine treatments ranked among the top 5% in the country. For example, the average charge at Cedars-Sinai for gallbladder surgery with complications was $153,302 in 2011 compared with the U.S. median charge of $42,380, government data show.

Medicare is like Humpty Dumpty. If the Republicans push it, we will never be able to put it together again! BOB MORGAN Van Nuys

The budget that President Obama released Wednesday doesn't include the sort of headline-grabbing initiatives that House Budget Committee Chairman Paul D. Ryan (R-Wis.) included in his proposal for fiscal 2014, such as a dramatic overhaul of the tax code and a transformation of Medicaid into block grants. But it offers a few ideas on Medicare that, while not as cage-rattling as Ryan's plan, would still bring important changes to the program. Make that, important but unpopular changes.

What's most impressive about our highly dysfunctional heathcare system is that we're always finding clever new ways to make it worse. The latest such move comes on the Medicare front, where lawmakers had been trying to rein in costs by modestly lowering the amount that large insurers would be paid for managing Medicare Advantage plans, which are a private-sector version of the government program. The Obama administration had proposed a 2.3% reduction in payment for the plans, arguing that insurers were making plenty of profit as it was. But after the insurance industry unleashed its lobbyists and started throwing its considerable political muscle around, it ended up not with a pay cut from the Centers for Medicare and Medicaid Services, but a 3.3% increase . I have no idea what the correct reimbursement rate should be. But I do know that, as the baby boomers age, Medicare represents a cash cow for insurers with Medicare Advantage plans.

Now that the budget "sequester" is in effect, Congress is shifting its attention to entitlement reform. There's simply no way to achieve long-term reductions in federal spending without touching the big health programs, particularly Medicare. Although raising the age of Medicare eligibility from 65 to 67 appears off the table, at least for now, the budget plan that Rep. Paul D. Ryan (R-Wis.) is proposing would shift a greater share of the program's growing costs to beneficiaries in the years to come.

Re "No debt agreement, no break," Opinion, March 25 Debt hysteria, or "austerity," is the bad idea of late that just will not die. America does not have a debt crisis; it has an employment crisis, which, if appropriately addressed, would reduce the debt. Social Security does not contribute to the federal budget deficit; it is projected to pay out 100% of benefits due until at least 2033, and could remain at 100% forever by raising the contribution cap. Spiraling healthcare costs can be solved by doing three things: end fee-for-service, establish Medicare for all and allow Medicare to negotiate drug prices.

CODY, Wyo.--Alan Simpson has spent the better part of two years flying around the country ticking people off, though that's putting it more politely than the former Wyoming senator does. Simpson is the Republican half of the Simpson-Bowles duo (Erskine being the Democrat) that produced a 2010 deficit reduction plan that gored just about every sacred cow in Washington before succumbing to a scarcely lamented death. He continues to campaign around the country for the controversial recipe of tax hikes, spending cuts and entitlement reforms.

Robert M. Ball is one of the most revered figures in Social Security history, a man whose devotion to safeguarding the program from ideological attacks and political cant over six decades made him the program's  "undisputed spiritual leader. " Alice M. Rivlin is a distinguished budget expert at the  Brookings Institution  whose willingness to promote "entitlement reform" (read: cut benefits) as a deficit nostrum has given her a reputation as a danger to Social Security and  Medicare . So when Rivlin was named the ninth recipient of the annual Robert M. Ball Award for Outstanding Achievements in Social Insurance this week, Social Security advocates erupted in fury.

Re "Ryan plan may hurt disabled the most," Column, Aug. 21 Without Medicare, those of us who have pre-existing conditions will have difficulty getting health insurance. After we lost coverage because of a layoff, Blue Shield, which was at the time one of the three companies in California's program for high-risk patients, would not insure my husband because he has acid reflux and takes medication for it. I was turned down because I was a six-year cancer survivor. Apparently, Blue Shield forgot it was part of the high-risk program.

In a major shift triggered by the national healthcare law, nearly half a million low-income California seniors and disabled patients will begin moving into a new managed care program this fall. The patients, who receive both Medi-Cal and Medicare, are among the most costly in the state. Officials believe that the program, Cal MediConnect, will reduce spending and improve care by shifting the patients out of a fragmented system and into one that is more coordinated. The state and the federal government signed an agreement Wednesday officially establishing a test program for the patients, known as dual eligibles.

Reforming the healthcare system is largely about fixing the incentives it provides for doctors, hospitals and patients to overspend. For example, the "fee for service" payment model that Medicare relies on encourages physicians to do as many things for a patient as they can bill for -- the more services provided, the higher the compensation. That's a model that profits from sickness, not health. House Budget Committee Chairman Paul Ryan (R-Wis.) made a similar point in his latest budget proposal about Medicaid, the health insurance program for the poor that's jointly funded by federal and state governments.