This story comes from our partner

What provides health care coverage to 47 million Americans, consumes 12 percent of the federal budget, and accounts for $1 of every $5 spent on health care in the U.S. each year?

If you answered Medicare, you win a piece of the nation’s deficit problem – a big piece.

“If you look past the next eight to 10 years, Medicare is the deficit problem,” says Douglas Holtz-Eakin, former head of the Congressional Budget Office. “And there’s simply no way we can address our fiscal problems without coming to terms with Medicare’s future.”

It’s a future that includes 78 million baby boomers, the first of whom are just now getting their Medicare cards. Health policy analyst Jeff Goldsmith, who has studied the boomer generation, says that has been largely overlooked in the debate over the new health law.

“In the first 10 years of health reform being implemented, you’ll see 30-some-odd million baby boomers become eligible for and enroll in Medicare,” he says.

That’s an increase in Medicare’s population of about 30 percent.

Unless you change who is eligible for the program – something no one seems to be suggesting – there are really only two ways to make Medicare cost less: Pay health care providers like doctors and hospitals less, or make Medicare patients pay more. Until now, neither has been very popular politically.

“Conventional politics are providers say, ‘No, no, no, I can’t live with less.’ Citizens say, ‘No, no, no, I can’t pay more.’ But the ultimate irony here is conventional politics have to change,” says Holtz-Eakin, now president of the American Action Forum, a Republican think tank. “Because the numbers don’t add up.

“Either we proactively take this on as a nation, or international lenders are going to say, ‘Forget it, drop dead,’ and we’ll have an enormous economic crisis.”

Goldsmith says one small ray of hope is that the generation coming onto Medicare isn’t quite as attached to it as the current one.

“I don’t think the typical baby boomer has thought for more than five minutes about the effect of Medicare on their lives, because they’re not old,” Goldsmith says. “And Medicare is perceived as something for old people.”

Still, it may be hard to load much more cost onto patients. Over the past decade, Medicare recipients have already been asked to spend more of their own money out of pocket on health care. According to the nonpartisan Kaiser Family Foundation, median out-of-pocket spending on health care rose from 11.9 percent in 1997 to 16.2 percent in 2006.

Or, as President Clinton’s Medicare chief Bruce Vladeck puts it more succinctly, “What people don’t understand about Medicare is how crappy the benefit package is.”

Asking Medicare beneficiaries with higher incomes to pay more – another popular idea among would-be deficit reducers – probably won’t fill the gap, either. Vladeck says that’s because there probably won’t be that many high-income boomer beneficiaries.

“They’ve lost their retiree health benefits,” he says. “They’ve lost their pensions. They had most of their wealth in their houses,” which aren’t worth nearly as much as they used to be.

Then there’s what Vladeck calls the regional politics of Medicare. Because the program is so large, and health care is so expensive, Medicare winds up being a major source of federal funding in virtually every congressional district. That leads to politicians often wanting to boost funding rather than cut it.

Vladeck says that scene played out repeatedly during this year’s health care overhaul debate, with members from “these allegedly conservative parts of the country saying, ‘This bill is too expensive and we can’t afford it,’ but holding out for special treatment in Medicare payments to providers in their districts.”

There’s one other big problem stemming from the new health care law, Goldsmith says. It made a lot of funding reductions to Medicare providers – about a half-trillion dollars over the next 10 years – but uses that money to help pay for expanded coverage for the rest of the population.

“That’s a significant amount of money. And if that money is to be spent on extending the benefits, it certainly isn’t going to be available for deficit reduction,” Goldsmith says. “So if you wanted to reduce the deficit, you’d have to go back and challenge the physicians, the hospital community, the health plans to accept additional reductions – very difficult to do.”

Most analysts say getting a handle on health care costs in general would go a long way toward solving the Medicare problem. But no one is sure how to do that, either.

This <a target="_blank" href="/medicare/npr-medicare-deficit-dilemma/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This聽story comes from NPR’s health聽blog .

Among the new provisions of the health law that take effect later this month is a ban on something most people don’t even know they have – a on benefits covered by their health insurance.

Starting late next week, new health plans or plans that are renewed, won’t be able to the dollar amount of benefits they cover. No more yearly caps either, though those limits will be phased out over three years, disappearing entirely in 2014.

The change apply even to health plans that don’t have to abide by some new rules because they were “” under the health law.

Karen Pollitz, head of an office at the Department of Health and Human Services to help consumers navigate overhaul, says it’s a big change:

This is sort of the ultimate example of what insurance is for. We’re buying protection against the financial ruin that comes with a very expensive medical condition or injury as well as assurances that we’ll be able to connect to the care we need to get better. So when you hit the lifetime limit, you often lose access to the treatment, not to mention your house.

Until now, many people with expensive chronic conditions simply considered it their lot in life to have to change jobs every couple of years in order to maintain coverage.

Take Edward Burke, of Palm Harbor, Florida. Burke, who has hemophilia, and has “capped out,” as those with chronic conditions call it, twice in the past seven years. “I would have capped out four or five times,” he says, but for the fact that the industry he works in, home health care, had been going through a series of mergers and acquisitions. So every time his company was bought and changed names, he was lucky enough to start with new health insurance – and a new lifetime limit.

Burke estimates he spends about $900,000 per year on , which replaces a clotting factor he lacks. That makes chewing through a lifetime limit of even several million dollars a matter of when, not if.

But it’s not just people who know they will have high medical bills who are at risk. “It could happen to any of us,” says Pollitz, who said she had a friend who had twins born prematurely. “And before their first birthday, the father had hit the lifetime limit on his family’s coverage because of all the health problems they had.”

Even so, relatively few people are affected by the change. So HHS estimates that the added premium cost of making health plans eliminate lifetime limits is modest – adding about a half a percentage point to group health plans and three-quarters of a percentage point to individual policies.

But for people like Edward Burke, not to have to worry about “capping out,” anymore, as he says, “is huge. It’s just huge.”

This is one of KHN’s “Short Takes” – brief items in the news. For the latest from KHN, check out our

News Section

.

This <a target="_blank" href="/health-industry/npr-shorttake-health-overhaul/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

What provides health care coverage to 47 million Americans, consumes 12 percent of the federal budget, and accounts for $1 of every $5 spent on health care in the U.S. each year?

If you answered Medicare, you win a piece of the nation’s deficit problem – a big piece.

“If you look past the next eight to 10 years, Medicare is the deficit problem,” says Douglas Holtz-Eakin, former head of the Congressional Budget Office. “And there’s simply no way we can address our fiscal problems without coming to terms with Medicare’s future.”

It’s a future that includes 78 million baby boomers, the first of whom are just now getting their Medicare cards. Health policy analyst Jeff Goldsmith, who has studied the boomer generation, says that has been largely overlooked in the debate over the new health law.

“In the first 10 years of health reform being implemented, you’ll see 30-some-odd million baby boomers become eligible for and enroll in Medicare,” he says.

That’s an increase in Medicare’s population of about 30 percent.

Unless you change who is eligible for the program – something no one seems to be suggesting – there are really only two ways to make Medicare cost less: Pay health care providers like doctors and hospitals less, or make Medicare patients pay more. Until now, neither has been very popular politically.

“Conventional politics are providers say, ‘No, no, no, I can’t live with less.’ Citizens say, ‘No, no, no, I can’t pay more.’ But the ultimate irony here is conventional politics have to change,” says Holtz-Eakin, now president of the American Action Forum, a Republican think tank. “Because the numbers don’t add up.

“Either we proactively take this on as a nation, or international lenders are going to say, ‘Forget it, drop dead,’ and we’ll have an enormous economic crisis.”

Goldsmith says one small ray of hope is that the generation coming onto Medicare isn’t quite as attached to it as the current one.

“I don’t think the typical baby boomer has thought for more than five minutes about the effect of Medicare on their lives, because they’re not old,” Goldsmith says. “And Medicare is perceived as something for old people.”

Still, it may be hard to load much more cost onto patients. Over the past decade, Medicare recipients have already been asked to spend more of their own money out of pocket on health care. According to the nonpartisan Kaiser Family Foundation, median out-of-pocket spending on health care rose from 11.9 percent in 1997 to 16.2 percent in 2006.

Or, as President Clinton’s Medicare chief Bruce Vladeck puts it more succinctly, “What people don’t understand about Medicare is how crappy the benefit package is.”

Asking Medicare beneficiaries with higher incomes to pay more – another popular idea among would-be deficit reducers – probably won’t fill the gap, either. Vladeck says that’s because there probably won’t be that many high-income boomer beneficiaries.

“They’ve lost their retiree health benefits,” he says. “They’ve lost their pensions. They had most of their wealth in their houses,” which aren’t worth nearly as much as they used to be.

Then there’s what Vladeck calls the regional politics of Medicare. Because the program is so large, and health care is so expensive, Medicare winds up being a major source of federal funding in virtually every congressional district. That leads to politicians often wanting to boost funding rather than cut it.

Vladeck says that scene played out repeatedly during this year’s health care overhaul debate, with members from “these allegedly conservative parts of the country saying, ‘This bill is too expensive and we can’t afford it,’ but holding out for special treatment in Medicare payments to providers in their districts.”

There’s one other big problem stemming from the new health care law, Goldsmith says. It made a lot of funding reductions to Medicare providers – about a half-trillion dollars over the next 10 years – but uses that money to help pay for expanded coverage for the rest of the population.

“That’s a significant amount of money. And if that money is to be spent on extending the benefits, it certainly isn’t going to be available for deficit reduction,” Goldsmith says. “So if you wanted to reduce the deficit, you’d have to go back and challenge the physicians, the hospital community, the health plans to accept additional reductions – very difficult to do.”

Most analysts say getting a handle on health care costs in general would go a long way toward solving the Medicare problem. But no one is sure how to do that, either.

This <a target="_blank" href="/medicare/npr-medicare-deficit-dilemma/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This聽story comes from NPR’s health聽blog .

Among the new provisions of the health law that take effect later this month is a ban on something most people don’t even know they have – a on benefits covered by their health insurance.

Starting late next week, new health plans or plans that are renewed, won’t be able to the dollar amount of benefits they cover. No more yearly caps either, though those limits will be phased out over three years, disappearing entirely in 2014.

The change apply even to health plans that don’t have to abide by some new rules because they were “” under the health law.

Karen Pollitz, head of an office at the Department of Health and Human Services to help consumers navigate overhaul, says it’s a big change:

This is sort of the ultimate example of what insurance is for. We’re buying protection against the financial ruin that comes with a very expensive medical condition or injury as well as assurances that we’ll be able to connect to the care we need to get better. So when you hit the lifetime limit, you often lose access to the treatment, not to mention your house.

Until now, many people with expensive chronic conditions simply considered it their lot in life to have to change jobs every couple of years in order to maintain coverage.

Take Edward Burke, of Palm Harbor, Florida. Burke, who has hemophilia, and has “capped out,” as those with chronic conditions call it, twice in the past seven years. “I would have capped out four or five times,” he says, but for the fact that the industry he works in, home health care, had been going through a series of mergers and acquisitions. So every time his company was bought and changed names, he was lucky enough to start with new health insurance – and a new lifetime limit.

Burke estimates he spends about $900,000 per year on , which replaces a clotting factor he lacks. That makes chewing through a lifetime limit of even several million dollars a matter of when, not if.

But it’s not just people who know they will have high medical bills who are at risk. “It could happen to any of us,” says Pollitz, who said she had a friend who had twins born prematurely. “And before their first birthday, the father had hit the lifetime limit on his family’s coverage because of all the health problems they had.”

Even so, relatively few people are affected by the change. So HHS estimates that the added premium cost of making health plans eliminate lifetime limits is modest – adding about a half a percentage point to group health plans and three-quarters of a percentage point to individual policies.

But for people like Edward Burke, not to have to worry about “capping out,” anymore, as he says, “is huge. It’s just huge.”

This is one of KHN’s “Short Takes” – brief items in the news. For the latest from KHN, check out our

News Section

.

This <a target="_blank" href="/health-industry/npr-shorttake-health-overhaul/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">