#Medicare Dependent Hospitals

[hislop3]

Legislation Grab Bag

Within the normal news cycle, legislation often gets ignored, especially in this hyper volatile election cycle we have begun. I’m expecting very little in terms of reform or new legislation on important healthcare issues to come forward, and, so far, I’m right. With near gridlock due to small opposing majorities in both houses of Congress, compromise will be kicking the same can down the road, a…

[kineticpenguin]

It's becoming very clear that the health insurance industry is tolerated due to the profound ignorance of the average American regarding it.

I've seen people insist that health insurance companies need to deny claims, otherwise hospitals would charge infinite money and the patients wouldn't care because it's the insurance company that pays.

To be clear, this is absolute nonsense. First of all, before the insurance company pays a cent, the patient has to meet their deductible. Basically, until you've run up a certain amount in medical bills in a year, you're paying for everything yourself (with some exceptions, depending on your plan). Once you've hit that amount, and it can be anywhere from $0-$10,000 or more, that's when the insurance company starts paying out. But they don't pay for the whole thing, they pay coinsurance with you. Different procedures may be covered at different coinsurance percentages. Medicare Advantage commercial plans (another can of worms I'm not touching for now), for example, typically pay 80% for medical equipment. The patient is still on the hook for 20%.

The only time your insurance company starts paying for everything is when you meet your out-of-pocket maximum. This is basically hitting the point where you've been billed so much that coinsurance stops and the insurance company pays for everything. That said, they can still deny claims at this point, and like the deductible, the OOP resets to zero every year.

Clearly, patients would still have reason to care.

Next, insurance companies don't pay the list price, they pay the contracted rate. It's why they insist their customers use "in-network" providers: these are providers that the company has already negotiated prices with. If you have no insurance, a doctor might give you a bill for $5355.50. If they're in network with your insurance, they give you a bill with the contracted price of, say, $2025.87.

Denied claims do not protect patients and insurance companies from greedy doctors and unnecessary procedures. They exist entirely to maximize profits.

[justinspoliticalcorner]

Oliver Milman and Anna Betts at The Guardian:

A federal judge has temporarily blocked a Trump administration freeze of all grants and loans disbursed by the federal government, a decision that upended programs relied upon by millions of Americans.

US district judge Loren AliKhan ordered an administrative stay on the funding pause on Tuesday afternoon, moments before it was set to take effect. The stay, issued in response to a lawsuit brought by a group of non-profits and small businesses, pauses the administration’s action until Monday. In a two-page internal memo on Monday, Matthew Vaeth, Trump’s acting head of the office of management and budget (OMB), instructed all federal agencies to “temporarily pause all activities related to obligations or disbursement of all federal financial assistance”. Vaeth said that the pause did not include social security or Medicare , and that the assistance put on hold “does not include assistance provided directly to individuals”. If allowed to take effect, the order could have far-reaching consequences that touch nearly every corner of American society, including universities, the non-profit sector, cancer research, food assistance, suicide hotlines, hospitals, community health centers, non-profits that help disabled veterans and many more.

Democratic attorneys general said on Tuesday they also planned to sue to prevent the memo from taking effect. Letitia James, the New York attorney general, said her office would take “imminent legal action against this administration’s unconstitutional pause on federal funding. We won’t sit idly by while this administration harms our families.” The administrative stay came in response to a lawsuit filed by four groups representing non-profits, public health professionals and small businesses in which they said the directive was illegal and would have a “devastating impact on hundreds of thousands of grant recipients who depend on the inflow of grant money”. The groups said the directive would disrupt education, healthcare, housing and disaster relief and would devastate “hundreds of thousands of grant recipients who depend on the inflow of grant money”. At a news conference on Tuesday morning, Chuck Schumer, the Democratic Senate leader from New York, described the order as “a dagger at the heart of the average American families, in red states and blue states, in cities and suburbs and rural areas”.

Joined at the news conference by the Democratic senators Amy Klobuchar, Patty Murray, Jeff Merkley and Andy Kim, Schumer noted that among the programs potentially affected was Meals on Wheels, which provides hot meals to at-risk seniors and is partly funded by the federal government. The proposed halt in spending comes days after the US also immediately cut off all foreign aid, and was designed to ensure that financial assistance is in line with Trump’s policies, Vaeth wrote.

[...] Karoline Leavitt, Trump’s press secretary, said that the White House was aware of the “website portal outage” and that they had confirmed that no payments had been affected and that payments “are still being processed and sent”. “We expect the portal will be back online shortly,” she added. In a press conference on Tuesday, Leavitt pushed back against suggestions the memo caused chaos and uncertainty and said it would not affect direct assistance to individuals, including social security, Medicare, welfare and food stamps. She did not clarify, however, whether aid that goes through organizations to individuals, like Meals on Wheels, would be affected. “[The] only uncertainty in this room is amongst the media,” said Leavitt, blaming the press for anxieties spurred by the measure.

In a dose of good news, just before the disastrous freeze would have taken effect at 5PM ET/4PM CT yesterday, Judge Loren AliKhan put a temporary halt to Tyrant 47’s egregiously dictatorial order to freeze all federal grants and loans.

[crossdreamers]

Donald Trump's horrific plan for transgender people

Warning: The content of this article may be traumatizing for trans people living in the US.

Now that Trump as won the US presidential election as well as the Senate, LGBTQ people around the country need to prepare for a long and painful battle.

During the campaign Trump made it perfectly clear what he wants to as far as transgender protections and health services are concerned.

The following summary is based on a presentation made by the Trump Vance campaign. We have rewritten the most offensive language.

The new Trump administration will:

Revoke current policies that support gender-affirming treatments for minors, including puberty blockers and surgeries.

Issue an executive order to end federal agency support for programs that promote the concept of sex and gender transition at any age.

Prohibit the use of federal funds to promote or cover the cost of gender-affirming procedures.

Introduce legislation to ban gender affirming procedures on children nationwide.

Penalize healthcare providers involved in these procedures by removing them from Medicaid and Medicare compliance.

Support legal avenues for individuals to sue medical professionals who have performed gender-affirming procedures on minors.

Mandate investigations into pharmaceutical companies and hospital networks for potentially concealing negative side effects and marketing unapproved drugs.

Direct the Department of Education to ensure school personnel do not encourage discussions about gender identity without repercussions, and punish those that do.

Promote education that emphasizes traditional gender roles and the nuclear family.

Request a law to formally recognize only male and female genders assigned at birth.

Ban transgender women from taking part in women's sport.

Uphold parental rights concerning their children's gender identity decisions.

Will they do all of this?

There is no reason to believe that Trump will not follow up on this. To what extent the new administration will be able to implement these policies, will depend on several factors, including:

The outcome of legal processes in courts.

Public outrage.

Whether the Republicans take the House of Representatives.

To change federal legislation in this area, the Republicans need to control both houses of Congress.

A war on transgender people

This list proves that the Republican Party has now declared war on transgender people. This is a policy aimed at erasing trans people from society.

It is true that some of the proposals are aimed at children only, but we will not be surprised if that approach is extended to adults as well later on. In any case the message that gender incongruence in children is "not real" carries the message that this applies to adult identities too.

Note that the Republicans want to scare and numb people and institutions from supporting trans people. Out of fear of legal action individuals, companies and institutions may avoid giving trans people any support, even if it is legal on paper.

The public policy of the Trump administration will also encourage transphobes to attack trans people both in public and in private spaces.

Trans people and their allies inside and outside the US will have to plan for the worst. We have to do everything we can to unmask the cruelty of Trump and his Fascists. We need to make sure that the Republicans are not able to normalize this kind of cruelty.

See our article "Trump and the transphobes won in the US. But there are still ways trans people can win" for more on what we can do.

Free hotlines for gender & sexual identity, LGBTQ+ in the United States.

Photo: Boogich

[mariacallous]

Almost one in five Americans over age 65 are unable to manage basic activities of daily life—bathing, dressing, eating, toileting—without assistance. Among those over age 85, the proportion is closer to half. Friends and family members can and do help out, but even so, about half of people reaching the age of 65-years of age will use paid long-term services and supports (LTSS) at some point. Most Americans do not have enough income or savings to cover these costs. The private long-term care insurance industry has never worked well despite many creative efforts to fix it and to encourage enrollment. The Federal Medicare program covers only short spells of home care after a hospitalization and does not provide coverage for long-term support. That leaves Medicaid. Medicaid offers a critical long-term care safety net for people who get their healthcare primarily through Medicaid—but it isn’t a good solution for most Medicare beneficiaries as it doesn’t align with the system that manages their care and pays their providers. Moreover, eligibility for Medicaid is restricted to those with very low incomes and few assets, so few older adults qualify. It is well past time to add a universal home care program to Medicare itself.

Prior efforts to move in this direction have been stymied. Some proponents have called for a universal, open-ended benefit. Critics have argued that any universal home care benefit would be a budget buster. These tensions are ubiquitous in social program design. An additional tension in designing a program that serves people towards the end of their lives is that public funds should be focused on expanding access to necessary care rather than protecting the ability of people to leave large bequests to their children. Designing a fiscally responsible, universal benefit that does all that is a challenging task—but we believe it is not an impossible one. In this post, we describe some design options for a Medicare home care benefit that could be dialed up or down depending on the priority assigned to program generosity or fiscal feasibility. 

Several features make designing a universal home care benefit challenging.

The need for home care is based on measures of functioning, not lab tests. A program must have simple and reliable ways to measure who needs care and how much care they need.

Most people report a preference for care in their own homes over that in nursing homes or other institutional settings. This is because, unlike medical care, which is often unpleasant and painful, home care typically provides support, comfort, and a degree of safety for beneficiaries. One consequence of these preferences is that a home care benefit would be susceptible to overspending. The program will need to have measures in place to avoid overuse.

Income alone is a poor indicator of how much Medicare beneficiaries can afford to pay for home care. For example, beneficiaries who are renters may depend on their incomes to afford housing; other beneficiaries may have very large, non-liquid assets but limited incomes, leaving them ineligible for Medicaid programs while unable to pay for care. Program design will have to address the importance of assets in this population.

Much LTSS is provided through informal care. Beneficiaries often prefer care provided by family members, but paying for informal care raises the potential for overspending, fraud, and exploitation of older adults.

State Medicaid programs currently cover the cost of home care for 4.2 million people, according to KFF, though eligibility and costs vary considerably across the country. Medicaid would continue to provide home and community-based services for people who are not Medicare beneficiaries. Some of this spending could be redeployed by states to improve the quality of nursing home care and for home and community-based services for people who are not eligible for Medicaid. The federal share of Medicaid savings could be used to defray the costs of a new Medicare home care program.

None of these challenges can be ignored—but none of them are damning either. As with any program, policymakers will need to make tradeoffs across these challenges to design a program that provides the maximum benefits consistent with their budget appetite. The good news is that the current landscape of home care financial protections is so limited that even a modest program that made conservative choices across these parameters, with costs we estimate at around $40 billion annually, would make many people who currently lack services much better off. Turning the dials more generously would, of course, cost more—and it would extend more benefits to more frail and vulnerable Medicare beneficiaries. 

What might such a very-conservatively designed universal program look like? Eligibility for the program would be restricted to people who independent clinical reviewers determined were unable to perform two activities of daily living (e.g., bathing, toileting, or eating). That’s the standard that many State Medicaid programs already use, and it could be assessed annually during the initial implementation period to further develop and monitor the uniformity of functional assessments over time. Second, the program would include cost-sharing that varied according to people’s means. Medicare beneficiaries with high income and assets would receive modest assistance from the program to defray a portion of the costs of home care; those with fewer assets and less income would pay much less. Third, beneficiary contributions to the costs of their care would depend on both their current income and their accumulated assets, but through cost-sharing rather than a strict cutoff. For example, at the cost listed above, we could allow all qualifying Medicare beneficiaries to fully retain income up to 150% of the poverty line ($22,600 in 2024) and assets up to $30,000; beyond that limit, individuals would still qualify but would pay cost-sharing out of their resources to defray taxpayer costs. Fourth, only care provided by formal caregivers associated with home care agencies would be covered. Hours of support would be based on need, but provider agencies would be subject to a population-based hours of service budget. The combination of resource-based copayments with population-level budgeting will ensure that the costs of this program will not explode. Finally, Federal Medicaid savings from shifting home care benefits from Medicaid to Medicare would be used to defray the costs of the program.

The program we’ve outlined tightly focuses benefits on the most vulnerable people who currently have little eligibility for care, and few means to pay for services. But many others could also benefit from a new home care program. People who have impaired functioning that does not meet the two activities of daily living standard may also need assistance. Lower cost-sharing for middle-class people would leave them more resources to make the most of their lives. The tradeoff is simple: at a higher cost to the federal budget, more people would get more protection. We can’t define where the lines should be drawn—that’s Congress’s job—but our analysis suggests that there are programmatically tractable, fiscally feasible ways to add a home care benefit to the Medicare program.

[fenrislorsrai]

Healthcare denied

This happened a few years ago, to my father, who had managed Medicare. (Aetna, I'm naming names)

We got hit with a hurricane. All power is out for miles around. Note: no evacuation warning. Was not expected to do that kind of damage. We had no power for 10 days.

This man in OXYGEN DEPENDENT. He uses an electrically powered oxygen concentrator and has some back up bottled oxygen. But oxygen place would never give us more than a 24 hour supply. Because insurance.

He's also got COPD and needs nebulizer treatments several times a day. That also requires power.

Hurricane had finally cleared out enough we can get out of the house. All the hotels in safe travel distance: either NO POWER or fully booked. We managed to find ONE with power. "we have one out of service room with no working shower, if that fine"

We'll take it.

Throw elderly man in the car, his oxygen, his oxygen concentrator, the nebulizer, everything, in car and get him checked in at hotel. It is STILL not enough. His oxygen is crashing, he can't breathe.

The ambulance arrives to take him to the hospital. The fire department and ambulance corp are all running off generator power because there is nothing with power.

The only things WITH power are the things on this one circuit: a nursing facility, this hotel (where every lineman is staying, its filling with utility trucks as we stand there), and the Lebanese restaurant. This is suburb connected to NYC city by train. It is PITCH BLACK.

I and my mother go home, to the pitch black house while Dad goes to the hospital. (fortunately it was summer, so okay weather) Someone else with similar health problems immediately snagged the room with broken shower. I pray they had better outcome.

The power is STILL OUT days later. it is declared a federal disaster area.

Hospital: we're discharging him!

Us: the hell you are. there is no power here. there is no water. He will be back a few hours later. also every time he's had a crisis like this, he's gone to a step down rehab for a few days to make sure he doesn't immediately crash again.

Hospital: insurance says no . Come pick him up. they won't pay for more hospital care or rehab facility

We had enough money banked we could GET him to the rehab facility for a week that meant we finally had power again. We just had to pay for a full week. Up front. We talked to our congresswoman (Jahanna Hayes) who went to bat vs the healthcare company because it was managed Medicare. They eventually reimbursed us for that nursing care, which he really needed!

If we hadn't had that savings available...

TLDR: Aetna denied care to a medically fragile oxygen-dependent patient and tried to have him sent back to a federal disaster zone where his house had no power or water. Or bottled oxygen.

[vague-humanoid]

“Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”

Many universities’ most robust income streams come from their technically nonprofit hospitals. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services; at the University of Chicago, patient services brought in 49% of operating revenue in fiscal 2022.

To be sure, many hospitals’ major source of income is still likely to be pricey patient care. Because they are nonprofit and therefore, by definition, can’t show that thing called “profit,” excess earnings are called “operating surpluses.” Meanwhile, some nonprofit hospitals, particularly in rural areas and inner cities, struggle to stay afloat because they depend heavily on lower payments from Medicaid and Medicare and have no alternative income streams.

But investments are making “a bigger and bigger difference” in the bottom line of many big systems, said Ge Bai, a professor of health care accounting at the Johns Hopkins University Bloomberg School of Public Health. Investment income helped Cleveland Clinic overcome the deficit incurred during the pandemic.

[helluva-dump]

So Sinsmas may be about the 7 deadly sins…

I won’t lie I’m nervous but I’m very interested in seeing Belphegor… she may not live to my expections though… But is it bad to admit I kind of want her to be bad too??? Or morally Grey???

Like instead of being evil like Mammon, but not super nice like Ozzie and Bee… but an actual morally grey character from the deadly sins????

Like I always picture that she’s not evil but also not good, and I imagine her biggest fatal flaw is self sabotaging and sucking the energy from others…. Like I can see her being passionate about Medicare… but she’s kind of a lost cause herself because working in the hospital with too many patients drove her mental health to pieces???

I kind of wish we saw more of a psychological horror with Belphegor. I’m not too keen on how the sloth ring is all pinky and cutesy… but what if that’s like an illusion?

Like I know it seems all pink and almost like a fever dream for patients to feel comfort and relaxed… but here me out if this is just an illusion.

My headcanon is whenever the patient take pills or are under some hypnosis (since Bel is suppose to be like that in a circus )… they get these hallucinations and wake up in some nightmare

With everything looking distorted and abandoned depending on how these patients feel with their mental health, nightmares, and intrusive thoughts

I know this may sound way too dark and too horror like for a show like Helluva boss but I feel like it’s such a missed opportunity. Plus they can tackle issues like mental health and how they overcome their struggles with addiction, depression, ect

I also can picture Belphegor being almost like a Lisa Garland form Silent Hill design wise but her actual demonic form being almost like Incubus.

Sorry you can tell I have silent hill on my mind and it be so cool to see a sin resembling to psychological horror.

Plus it be nice to see characters go through these intrusive thoughts, having Bel challenge their inner fears and how to overcome them.

I’m actually planning to draw out for fun and do a fun design for Bel before the episode airs.

[entitledrichpeople]

is this factually true for all of america? https://prnt.sc/LmJPFf0JCCaF

Generally, yes. Though SSI and SSDI are different, with SSI being the program that applies to those who were disabled young or had very low incomes during their working years and SSDI is higher with far fewer income and asset limitations but is still inadequate.

SSI's maximum payment is below poverty level ($914 a month maximum) and yes, it is counted against other anti-poverty measures like food stamps. Basically every time I get an extra dollar from SSI, I lose one from food stamps. On SSI you're not allowed more than $2000 in assets total (with some exceptions, like primary residence) and no income from any sort more than $1913 of income from any source. If you can work, you're not eligible.

SSDI levels are based on income during working years, if you paid in more than so many quarters (it's possible to have income so low it doesn't count) and payments tend to be significantly higher than SSI. The asset cap doesn't apply, nor does a general income prohibition, except income through work. Living on SSDI alone is difficult, even on the higher end, but some of this group have pensions or spouses with higher incomes. If you're on SSI and you marry they automatically cut your benefits even if you partner has no income or is also on SSI-it's a bad idea to marry if you get SSI, but people on SSDI's spouse's income isn't counted against them.

As to health insurance, both SSI and SSDI qualify you for (certain parts of) medicare, which, yes, has obscene drug prices generally. People on SSI also almost universally qualify for medicaid, though how the combination of the two gets administered is absurdly inconsistent between states & can fluctuate a lot. Medicaid tends to be better than private insurance when it comes to paying for drugs and testing, but discrimination by healthcare providers is rampant and, again, this isn't consistent state to state. I live in one of the better medicare states, but the way they farm out administration means you lose some aspects of medicaid when you qualify for both. Medicare pays for medical equipment in a way that medicaid never did for me, but medicaid alone never complained about name brand vs generic or tried to nickel and dime me to death by making me pay $1 to get some of my prescriptions.

You can't afford typical rent on SSI, let alone rent on the extremely small amount of housing that is accessible to people who use wheelchairs. Public housing also has only a few accessible spots and elevators in most public housing are constantly non-functional. Depending on where you live, those waitlists-even for extremely inaccessible or frankly unsafe and run down apartments-can be years long. Some places use a lottery system.

Oh, and if you get hospitalized for a month they take your SSI for that month so you can't pay whatever nominal level public housing insists on, so you can end up being evicted for being hospitalized.

If you don't have family that can take you in, it's extremely easy to end up homeless on SSI. And if you do have people that can take you in, the power dynamics of that situation enables a high rate of abuse.

As absurd as it sounds "it's illegal to not be poor on SSI" is the literal truth.

[goatsandgangsters]

since most hospitals and doctors take medicare and medicaid and depend on them, Trump's promise to ban doctors who take it from taking part in gender affirming care for kids effectively shuts that down totally, because no doctor can function without the money from medicare, while less clear he does want to make medicare/medicaid from covering gender treatment, and could extend that to banning doctors who take medicare (again all of them) from also doing gender care in general on any one

also "Project 2025 equates the act of being transgender, or “transgender ideology,” to pornography, and declares that it should be outlawed."

so yeah its not clear he's totally called for outlawing HRT for adults as such, however he's said a number of things that imply an HRT ban, and is closely linked to Project 2025 which clearly wants to not just ban HRT but jail anyone who says "trans" in public.

gotcha gotcha gotcha, thank you! I try to make it a habit to read the full article from any excerpt I see/watch the subtitled in this case bc I cannot stand his voice video myself, just for my own understanding of the whole context. BUT we were heat wave at the time and my brain was SOUP and only processing it from the "individual user interacting with the healthcare system" perspective and not considering the whole interconnected labyrinth of hospital payment systems and all of those implications, or the aspect of "if you accept this insurance, you cannot provide this care to anyone, regardless of it they have different private insurance"

so, thank you for taking the time, I appreciate it! and also, everything is a nightmare and I hate it here and The Monumental Existential Dread Of Being A Trans Person In The US sure is a fucking lot

[transporttoanotherplace]

I just finished Husband Material by Alexis Hall and the ending has me in deep thought about marriage. A lot of the discussion centered around the emotional health of marriage but I was actually surprised that there was no mention of the economic health. And now I want to know if it's because I am from the USA (the book is set in London).

Is marriage not as powerful as an institution in other nations as it is in the USA? I know in some it is even more powerful and in my view in a negative way as marriage is used as power over women (Yeah, I know that's how it started out in most nations too. Not here to argue that). I am talking marriage here where two consenting adults go into it deciding they want to be with each other til death do them part.

Here are some benefits in the states for married couples:

Insurance-I could be added to my spouse's health insurance for an extra cost if I didn't have it or no cost (depends on how great your company is). This one I am sure is very US-centric as many other nations have universal healthcare. Anyway, you can imagine why this would be such a big bonus in our eyes.

Tax benefits- If my spouse were to die all estate, property, and assets given to me are tax-free. Joint filing is really helpful when there's a large income disparity (for example when I was in school and my spouse was working full time).

Benefits in general-Disability, social security income (income we receive after age 62 that we've paid over time while working), Veteran's benefits, Medicare (health insurance for the elderly). Basically, any money given to my spouse for a benefit they qualify for I could tap into.

Family leave- Don't get me wrong, I don't know of many companies that would deny you taking leave or calling out sick for a friend or boyfriend/girlfriend/partner. But that's sick hours. I get bereavement leave if it's my spouse (not much but hey it's a benefit).

Medical rights- I can visit my spouse in the hospital. I get say over their medical care if they're incapacitated. I can decide how they are buried.

Consumer stuff- there's a lot of discounted stuff for families

School- This isn't one many people think of but it's why my wedding was a small civil court marriage vs a grand wedding. I could not qualify for financial aid because my parents refused to provide tax documents for aid. Even if they had I think it would have been too high of income but my parents never wanted to help me with school financially (it's a very privileged person who has a family that will pay). To remove my dependent status we decided to get married and that is how I was finally able to obtain my dream of going to college in my twenties without taking out 50K+ in private loans.

Court- conversations between my spouse and I are confidential and I will not be charged with a crime for refusing to share it (exceptions apply)

These are just a few I know about. I am sure there is more but I think you get the gist. Marriage is extremely powerful in the USA and it's a big reason why the LGBTQ+ community fought so hard. I remember reading stories about gay couples adopting one another before it was legal as a workaround to get the inheritance and medical benefits married couples do

There are a lot of workarounds to some of these, especially with wills. However, I can't count how many times someone has been screwed over for not being married to someone and the person dies. So I am really curious to hear from people all over if it's similar or really different?

[lunod]

Why did they discontinue your drug plan? Are you still on Medicare?

Turning this into a Medicare Explanation Thing since a lot of people don't know, feel free to save this if you/someone you know is waiting on SSI/SSDI case or thinking about it. Medicare comes in 5 separate parts because why not make disabled people jump through a bunch of complex unnecessary stuff.

Part A is hospital, covering specifically hospital bills not regular outpatient appointments. Part B is medical insurance which is your primary Dr and everything outpatient. When you get on disability they will give you Part A and/or Part B. If you have both they call it Original Medicare. Original Medicare also only covers 80% of the cost of everything, you have to pay 20% out of pocket and they don't have a limit meaning there's not a point where you stop paying the 20%. Oh and Original Medicare doesn't cover vision, dental, or hearing.

Part D is prescription drug coverage. They usually do not immediately put you on this because it costs extra, but also if you fail to sign up for it and then sign up several months after getting Medicare you will be penalized with an extra cost for the rest of the time that you have Medicare (yay!). Part D is not directly through the govt, it's private insurances like United Healthcare that are contracted with the govt. If you only have Original Medicare, none of your meds are covered and you have to pay full price.

Part C is also called Medicare Advantage, it is optional where you get Part A, B, and D all bundled together but you do this through private insurers like UHC and BCBS. Some of them do not charge a premium but some of them do, which is important because you would be paying for Original Medicare and then also potentially paying another premium for Part C. There is also the downside that Medicare is accepted by a LOT of places, but if you do Medicare Advantage you have to go through drs that that insurer covers. That may/may not be an issue depending on where you live. Upside is it may cost less (because they often have limits on how much you pay before they cover 100%) or cover more things than Medicare.

Last one is Medigap which is a separate plan (that you also pay for and get penalized if you don't sign up in time) that helps pay for your deductible. The Original Medicare deductible is $200-something for 2023 meaning you have to pay that amount before Medicare even bothers covering 80%.

So for my specific circumstance, I still have Original Medicare and there's no issue with my govt disability payments either. I was auto-enrolled for Part D because I qualified for Extra Help (basically I am Extra Poor), but for some reason UHC gave me drug insurance for a state I don't live in. I called to correct it and they told me it was fine and they would just switch me to the correct state, except the contractor actually just cancelled the plan entirely without telling me that's what they were doing and also without signing me up for a new plan. Which I found out when I went to pick up from the pharmacy. If I did not qualify for Extra Help, which has Special Enrollment Periods, I would have had to go 4 months without drug insurance until Open Enrollment in October...I just lucked out so instead of waiting til Oct I only have to wait til next month.

[thenewwei]

Here are some thoughts on Germany/Italy/Austria and my European trip generally:

In general, I had a great time. Everyone I met was friendly, and I did make new friendships. Hopefully they’ll last.

Here are some questions and answers, from good to not so good:

Do you like Europeans?

Of course, I love everybody! Whether they love me back or not, depends.

Do Americans travel in Europe?

Yeah, they do. I met quite a few Americans on my travels in Europe, and most accents I heard were American.

Is the system better here?

I would say in general, it is. Food and general costs are pretty much the same as in the US, gas is a little higher (I actually thought it was significantly lower until I realized it was in liters!), rent is usually lower than NYC but like everywhere it depends where you are.

But your food costs are in-built, there’s no extra sales tax or tips. Universal health care, longer vacations and not paying for an active military helps a lot. I doubt there are too many law suits in Europe either. It was ethnically diverse everywhere I went, even in smaller cities I could get Thai, Vietnamese food, whatever. Nowhere is the quality as good as NYC, but they have it.

Train strikes are common, there was another one in Germany on this trip and it cost me an extra night of rent and I had to change my plans. Public transportation is easy to navigate, though it’s generally more expensive than NYC. Can’t say anything about tolls, parking etc.

And despite staying in plenty of “poor” neighborhoods, I never really felt unsafe, except for once in Turin, and I just avoided that area.

The one major positive we have is texting. Texting is expensive in Europe, and almost everyone here uses WhatsApp (ironically, an American company). Almost everyone texts in America if you have a smartphone, it’s usually included.

Do Europeans know anything about Americans, and what are misperceptions?

Their knowledge is nearly totally based on anti-American propaganda and movies/Netlix shows (almost all of which are set amongst wealthy Californians). They know basics, usually negative, but rarely specifics.

The first question I was asked by multiple Europeans (and an Australian) when I mentioned I was from NYC was the “homeless” problem based on the belief that homeless shelters are either expensive or non-existent. Homeless shelters are free in NYC, last I checked, though you do need to create a plan with a case worker to ultimately get out of one. We also have Section 8 housing, rent control, Mitchell-Lama apartments, a rent moratorium during the pandemic and a million other programs to assist with admittedly crazy housing costs.

Yes, we have had a significant homeless problem since the pandemic, but that was mainly due to closed mental hospitals during the De Blasio admin—it wasn’t a significant issue in the 20-25 years before the pandemic, though we did always have some homeless people, including entire families and children—I mean it’s a city of 8-10 million people, some people will always fall through the cracks.

Granted, the average NYer doesn’t know anything about these issues either, but it’s significant that almost every person, mostly educated young people, mentioned this issue to me as soon as I said I was from NYC. Also, I saw plenty of homeless people in European cities, especially Salzburg, even as it was claimed that wasn’t an issue here.

The real issue in NYC now is crime, gang shootings, crazy people pushing people in front of train tracks and punching people in the face, and house fires, but no one mentioned those to me. Also not significant issues before the pandemic, though they’ve always been there to an extent.

The other constantly mentioned issue is the lack of universal health care. True, the system is horrible on multiple levels and ideally should be made universal and reformed, but I have comprehensive coverage through my employer, and most people do. Poor people have Medicaid, seniors have Medicare, the disabled have Social Security disability. A terrible, greed-based system for sure that could put you in the hole if you have to individually buy coverage, but it’s also not like no one has coverage.

The border/migrant crisis—complex for sure, but their general perception of an American is a tall muscular white guy with an AK-47 shooting migrants at the border, and that’s not exactly true. But then, most Americans don’t know anything about the complexities of our immigration system, whether legal or otherwise.

Gun/school shootings. Of course true and horrible, though there was a shooting in Belgrade, Serbia, while I was there, and there have been shootings in Germany and Norway, I think. There are also riots all the time in France. Also almost all shootings in NYC occur using illegal guns. But yeah, there’s no other country on Earth where mass shootings happen regularly, yet we’re politically powerless to stop it (assault weapons, etc.).

Americans pay low taxes. Scandinavians always mention their 32% tax rate that pays for everything. I pay nearly 50% in NYC and I don’t even make that much. Or get that much. But most of my salary is paid through taxes, so I’m not complaining. But tax rates depend on where you are in the USA. Sales taxes are added everywhere and property taxes are a killer too.

Our tax dollars also help defend Europe’s security, and nearly all of Germany’s security. Things are easier when you don’t have to pay for bombs.

Almost no one knows that the USA is one of the most ethnically, culturally and linguistically diverse nations on Earth, a nation of immigrants, and the most charitable people too, by far. In NYC, more than 800 languages are spoken, and we have tons of social programs. Apparently, Americans are Bible-toting idiots who can only speak English, and badly. Plus we hate immigrants.

Everyone hates America, but no has any particularly logical or fact-based reason for it.

Do Europeans love India and Indians?

Yes, they do. The trend of wanting me to identify with India over America continued on this trip.

Are Europeans socialists? Are Europeans nationalists?

I noted on my last trip in 2015 that nearly all Europeans I met worked in marketing of some type (among Germans there were also engineers and academics/potential academics). This time, I mostly met people in various teaching-based professions, or at least people who are in and out of it.

What they do constantly market are their countries. Their number one goal is to sell their country to you so you will hopefully move there. I mean I don’t know many Americans who are constantly pitching America. Maybe because we’re constantly told by our media how horrible our country is, but more likely it’s because we’re a country that values individualism over patriotism.

European women are almost universally like this, men are definitely more critical. One German waiter in Augsburg told me he thought Germany was “hopeless” because Germans aren’t welcoming. He contrasted this with Ireland, where he apparently visited, and where they will welcome you into their homes and give you tea. He was happy because I was the first person to speak English to him in weeks. I certainly do not think Germany is hopeless, but it’s another example of how European men tend to be more negative and realistic about their countries, and less wedded to them, culturally and otherwise.

Germans will ghost you

Yes, it’s not just an American phenomenon. I was ghosted by a couple of women who I’ve corresponded with for years and thought were my friends/acquaintances who would at least meet me or show me around their respective cities while I was in town. Nothing romantic or anything. I think ghosting is disrespectful and dishonorable, but I’m pretty old school, and it is what it is, moving on. But I wasted a couple of days this way when I could have done other things or gone to other places. Whatever.

Will you be back?

Probably not so soon, though I do love both Berlin and Milan. I would definitely go back to both locations, and I do want to explore more of northern Italy specifically, esp. Bologna and cities around it, and the beach towns around Genoa. I realize I definitely prefer the urban though. I had an allergic reaction in Italy and a cold in Germany. Next year, probably back to the Greek Islands and Turkey/Istanbul.

[justinspoliticalcorner]

Ian Millhiser at Vox:

Oklahoma v. Department of Health and Human Services is the sort of case that keeps health policy wonks up late at night. On the surface, it involves a relatively low-stakes fight over abortion. The Biden administration requires recipients of federal Title X grants — a federal program that funds family-planning services — to present patients with “neutral, factual information” about all of their family-planning options, including abortion. Grant recipients can comply with this requirement by giving patients a national call-in number that can inform those patients about abortion providers. Oklahoma had long received Title X grants to fund health programs in the state. After receiving a $4.5 million grant in 2023, however, the state decided it would no longer comply with the requirement to give patients the call-in number. Accordingly, the administration terminated Oklahoma’s grant. Now, however, Oklahoma wants the Supreme Court to allow it to receive Title X funds without complying with the call-in number rule. Its suit has landed on the Court’s shadow docket, a mix of emergency motions and other expedited matters that the justices sometimes decide without full briefing or oral argument.

Oklahoma raises two arguments to justify its preferred outcome, one of which could potentially sabotage much of Medicare and Medicaid. Briefly, the state claims that federal agencies may not set the rules that states must comply with when they receive federal grant money, even if Congress has explicitly authorized an agency to do so. Taken seriously, Oklahoma’s proposed limit on federal agencies’ power would profoundly transform how many of the biggest and most consequential federal programs operate. As the Justice Department points out in its Oklahoma brief, “Medicare’s ‘Conditions of Participation’ for hospitals alone span some 48 pages in the Code of Federal Regulations.” All of those rules, plus countless other federal regulations for Medicare, Medicaid, and other programs, could cease to function overnight if the justices accept Oklahoma’s more radical argument. (Oklahoma’s second argument, which contends that the call-in rule is contrary to a different federal law, is less radical and more plausible than its first.)

This fight over whether Title X grant recipients must provide some abortion-related information to patients who seek it will be familiar to anyone who closely follows abortion politics. In 1988, the Reagan administration forbade Title X grant recipients from providing any counseling on abortion, and the Supreme Court upheld the Reagan administration’s authority to do so in Rust v. Sullivan (1991). Since then, the policy has sometimes changed depending on which party controls the White House. The Reagan-era policy was eliminated during the Clinton administration, and then revived in 2019 by the Trump administration. Biden’s administration shifted the policy again during his first year in office.

[...] Oklahoma, however, argues that Congress cannot delegate this kind of rulemaking power to a federal agency. If it wants to impose a condition on a federal grant, Congress must write the exact terms of that condition into the statute itself. The implications of this argument are breathtaking, as there are scads of agency-drafted rules governing federal grant programs. The Medicare rules mentioned in the Justice Department’s brief, for example, cover everything from hospital licensure to grievances filed by patients to the corporate governance of hospitals receiving Medicare funds. The rules governing Medicaid can be even more complicated. These are more vulnerable to a legal challenge under Oklahoma’s legal theory because Medicaid is administered almost entirely by states receiving federal grants. Oklahoma, in other words, is asking the Court to fundamentally alter how nearly every single aspect of hospital and health care administration and provision works in the United States — and that’s not even accounting for all the federal grant programs that are not health care-related.

[...]

If the justices are determined to rule in Oklahoma’s favor, there’s a way to do it without breaking Medicare and Medicaid

Oklahoma does raise a second legal argument in its suit that would allow it to receive a Title X grant, but that would not require the Court to throw much of the US health system into chaos. The Biden administration’s requirement that Title X providers must give patients seeking abortion information a call-in number arguably conflicts with a federal law called the Weldon Amendment.

The Weldon Amendment prohibits Title X funds from being distributed to government agencies that subject “any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.” The three appellate judges who previously heard the Oklahoma case split on whether the Weldon Amendment prohibits the Biden administration’s rule. Two judges concluded, among other things, that providing a patient with a phone number that will allow them to learn about abortion is not the same thing as referring a patient for an abortion, and thus that the Biden rule was permissible. One judge (who is, notably, a Biden appointee) disagreed. In any event, Oklahoma’s Weldon Amendment argument gives this Supreme Court a way to rule against the Biden administration’s pro-abortion access policy without doing the kind of violence to Medicare and Medicaid contemplated by Oklahoma’s other argument. If the justices are determined to rule in Oklahoma’s favor, anyone who cares about maintaining a stable health system in the United States should root for the Court to take this less radical option.

The Oklahoma v. HHS case could be very big regarding Title X impact, along with Medicare and/or Medicaid.

[iheartvelma]

Here’s the thing.

Yes, it’s possible for a single-payer or government-run system to be imperfect.

But the current US private healthcare system is a nightmare even if you have “good” coverage. Navigating providers, dealing with deductibles, etc. You still wait months to see a specialist or get tests.

Overall it’s a huge economic drain, because:

People don’t get routine preventative care and end up disabled or dying of treatable illnesses at younger ages

Medical debt is the #1 cause of bankruptcy, causing people to lose savings and homes.

Having healthcare tied to your job means you can’t just quit, or start a new business, or move to a different state, etc.

Poor health is a massive drain on productivity, to the tune of $575 billion a year

I waited over a year to get non-critical surgery in Canada (deviated septum). That said, on the day, I went to a state-of-the-art facility, I was very well taken care of, I was back home that evening, and I paid zero dollars out of pocket.

In the US, I might have had to pay upwards of $12,000 for the procedure, and probably more, depending on all the line-item nickel-and-diming that hospitals do.

I’ve gone to urgent care and waited a long time. But if I had a true, life-threatening emergency, I’d be seen immediately.

Nobody says a future US system has to be run exactly like any other country’s, but the basic economics of single-payer systems are sound - just look at Medicare and the VA.

I don’t know if it’s possible to have zero waiting times for specialists, because by definition they are rarer, but it’s certainly possible to shorten waiting times and address the shortage of specialists in less populated areas.

For instance, in exchange for tuition reimbursement, new graduates could be required to serve rural areas in the same state for 3-5 years, and there could be other incentives to get incoming students to take up certain specialties.

Sometimes I see people from countries with public healthcare systems post videos that are like “This is the reality of socialized medicine. I had to wait in the ER with my sick baby for 4 hours.” “I had to wait 8 months to see a specialist. That’s egregious.” or “They didn’t have a bed for my loved one in mental health treatment.” and it’s like. Come to America babygirl. You can experience all of this and have your insurance deny it and pay thousands and thousands of dollars for it. Like I know healthcare systems in countries with public health can be bad but when I see someone imply they’re bad because the healthcare is universal, I want to jump through the screen and put my elbow on their throat. “The NHS is deeply flawed, therefore we should abolish it and go back to private healthcare. That will definitely make healthcare in this country better!” I am going to Kill You.

[12inchmotion]

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