Executive Order to "expand" Medicare. Your thoughts?

Dear Worried, I share your concern. About 10 years ago a plan was discussed to offer incentives for RN's to become nurse practitioners & to encourage nursing students & med students to become physician's assistants instead. The idea being a medical practice could consist of one or two physicians supervising a large group of trained professionals thereby seeing more patients for less cost.

Tort reform was also part of the discussion as lawsuits & juries awarding enormous monetary damages for malpractice were considered a factor in doctors leaving medicine.

Our local university has a medical school, school of pharmacy & nursing school. The area community colleges offer classes for LPN's & CNA's & lab techs.

Our doctor's office has one MD, several NP's, several LPN's & 2 or 3 lab techs. Medical students rotate through. This setup seems to work out. How to make it work in areas without the training resources so readily available?

The doctor who repeatedly misdiagnosed my DH (as well as our neighbor who was entering acute renal failure when he sent her home with Tylenol) was quietly encouraged to leave the practice a year ago. The medical community does need to examine itself & maybe some hard decisions are in order.

So very complex with so many moving parts!

Longears, actually to me a bigger problem is the shortage of doctors. Can’t speak for other states but California is experiencing a shortage of doctors and it’s supposed to get worse.

so what happens if Medicare for all becomes reality? What good is having insurance if there aren’t enough doctors to treat everyone?

Something else I'd like to see addressed, or at least introduced into the short and long term care Medicare discussions are  nonmedical alternatives, especially to medication.

I assume most of you have read about the problems with BP meds.    One of the posters on an organic gardening site does a lot of research, is meticulous about it, and has discovered a tasty alternative to BP meds:  watermelon.   Another person on the site has confirmed that eating watermelon has lowered her BP.  

You don't need to eat a whole watermelon though.   Moderate amounts serve the purpose.

And imagine how much safer and healthier it is vis a vis harmful if not contaminated medicines.

I'd also like to see more alternatives to PT that involved getting outside and in the fresh air.   Trips to nature preserves or gardens could substitute in Senior Center plans for trips to casinos or plays, or other events held indoors.

Good luck getting this implemented! The government better increase how much they reimburse doctors or make it mandatory that all doctors accept Medicare patients who don't have supplemental insurance.

My in-laws, in their late 70's, moved to be closer to family & could not get a new primary care physician. MIL called every one in town only to be told "We are not accepting any Medicare patients at this time." She was baffled as she thought doctors HAD to accept Medicare. As she searched the near area, someone asked if they had secondary insurance. No one would accept Medicare without a secondary payer. Turns out they had a fabulous supplemental plan. After that she called her first choice again, leading with we have Medicare & XYZ supplement. They had appts in no time.

Techie, thanks for your insights; these are the kinds of issues I was hoping to discuss.    

And I do think that a different way of thinking needs to apply to elder care, but I'm not sure of an effective way to address it.  AARP is trying to spearhead extension of services into communities, which is helpful, but I think it would be helpful for more support at a grass roots level, in order to gain more attention at the legislative level.  

I think Senior Centers are valuable resources, but they also depend on volunteer support for funding.  

My father's SC was very well  and professionally managed; the one in my city is just getting started and still focusing on expensive trips as opposed to basic needs.   And it's VERY clear that the governing body and some municipal staff have absolutely no comprehension of how to support seniors.  It's an insulting approach of "find someone yourself but you'll be fined if you don't comply."  

This focus is one which I think can be the difference between an effective senior support center or one which doesn't really understand what seniors need. 

I think the chore services such as lawn mowing and snow clearance could be some of the easiest if a group of seniors (I hate to use the term Board of Directors b/c it conveys so much more control) agreed on selection; a company that can handle a community as opposed to driving around various subdivisions would I think be interested in such a contract.

My parents wintered in  RV parks in SE Texas, and found some very nice ones, with good activities planned beyond the usual bingo games.    They had seasonal celebrations and dinners but they also had art shows.  There can be a lot of crafting, woodworking and other resources available in a senior population, and they help bind the residents as a community.   That's what I'd like to see in a good, viable senior center.

I also think it would be helpful if Medicare covered more for retirement communities, in part b/c it would be an incentive for seniors to move there.   Frankly, I wouldn't at this stage consider one b/c I don't want to live in a community run by people who think Bingo is challenging, although I do understand that Bingo can be helpful to certain segments of a population.

I'd instead start crafting groups, ranging from the needle arts to garden crafting.   Grapevines would provide fruit for some of the residents and material for wreaths, which could be sold at a Senior holiday sale.   So could art work.   And participating in charities which needed quilts and similar items would create links between those charities and the senior community.   Those are the kinds of things I think would make a community more viable, and not just  a group of older people living together w/o purpose.

I'd also have a community garden, adapted for those who are disability challenged.   Growing their own food would not only link them to the basics of life, it provides excellent social activity as well.    Families or even Scout groups could help with the more movement challenged work.  

I think also that the adaptive contractors could gain as well by focusing on senior communities.  Not all contractors are familiar with modifications, so those who are could benefit from participating in building these communities, LASTING communities, as opposed to high end, device intensive communities that might end up as candidates for foreclosure during a recession.

I also agree that Medicare review needs to consider covering some of the service fees (at least medication management and weekly housekeeping) in these communities because (1) it's less expensive to help people remain as independent as possible for as long as possible in their own homes, and (2) if more services are available in these communities it would provide incentives for seniors to move into them and for more of them to be built.

Thanks for sharing your insights.   I look forward to more from the community here.

As a society, we are going to need to shift our thinking on elder care too. So many people want to remain in the home where they raised their children even after they need some help. It's not nearly as efficient to have a care workers travel through our communities rendering an hour of needed care. Yet a lot of people really don't want apartment living either. We need affordable retirement communities of both smaller stand alone homes and duplexes, as well as apartment options.

After my uncle died, his widow moved into a retirement community of ranch homes with a garage or carport on small lots. Her home was a 2BR 2BA with an open kitchen, dining, living room area; one bath was basically a powder room with a shower but the other was sized for easy wheelchair use; both bedrooms had space and wide doors, about 900sf. Services included basic yard work, leaf and snow removal, and a daily check in (phone or in person). Grocery shopping, housekeeping, weekly and daily medication management as well as meal prep services were offered too at very reasonable fees. It's much more cost effective for a LPN or CNA to move from house to house on the same or a nearby street to visit and check medication boxes (or deliver a daily dose). My aunt never needed more than daily medication management and housekeeping, but she did appreciate other services were easily available if she did need them. My cousins appreciated that someone was checking on her daily.

In my opinion the Medicare review needs to consider covering some of the service fees (at least medication management and weekly housekeeping) in these communities because (1) it's less expensive to help people remain as independent as possible for as long as possible in their own homes, and (2) if more services are available in these communities it would provide incentives for seniors to move into them and for more of them to be built.

Tacy, I'm stunned at the situation you describe.   I suppose I'm not surprised that people are taking advantage of situations, but I'm shocked at the extent of control an individual can create, as well as the opportunity to create an extensive monopoly.    

Yet I can understand that in some areas, especially more rural ones, that kind of situation can occur, and there's not a lot that can be done when someone's created a network in a field that needs more reliable and responsible options.

This is the first I've ever heard of such a literal monopoly.   Thanks for enlightening me. I'll take those areas out of ones to which I might retire!   I guess there's something to be said for a large metro area after all.

Thanks for the responses, especially the ones specifically addressing terms and conditions of policies.  

I wasn't very clear in my original post, and for that I apologize.  Perhaps I was thinking of more detail, which obviously isn't possible at this time since the EO merely establishes directives.

Perhaps I missed it, but I also didn't see any mandate to involve the medical community, which I think needs to be an integral part of any changes to Medicare.  They're the on-the-ground experts, not the politicians, so they see Medicare and its effects in a different light.

My thoughts were on subjects such as those which are raised often here, as well as the ones in my OP.  There are a number of questions that can only be answered with sympathy expressions; there just aren't any viable solutions to the situations of some people, especially when financial issues constrain those families.

Some questions I considered are whether plans should cover rehab for longer periods, at facilities or for home rehab?    My feeling is yes; I've seen real challenges develop b/c facility and home rehab was too limited.

Should medical transport be established and paid for, w/i certain limitations?   E.g., some Senior Centers in my area provide very, very reasonable coverage for transit not only to medical facilities but to grocery stores.   I'm inclined to think that local SCs can do a good job of this, but some are in smaller communities and are just getting involved in point to point transit.   So application and availability are uneven.  

Another issue that arose for us is the issue of home care reimbursement.  Obviously it would be costly for Medicare to pay for the kind of private duty care we have now, but it's also obviously too challenging for many families to meet.  

What better solutions are there?   The same issues of cost feasibility apply to AL and memory care.   But ARE there ANY solutions to these issues?   From what I've read, dementia rates are increasing, world wide.   

What options are there for, say, the WHO to work in conjunction with medical communities throughout the world to provide additional levels of service to dementia sufferers?  I can see legitimate reason for international cooperation on addressing pesticides as well as special food ingredients (e.g., sugar) as causal factors.  

There's already good research on this, but it also needs to be delivered to the populace.    And, I would love to see action on a local and national level to address the whole junk food and high sugar sections of food supplies.

I apologize if I was too vague, which may have been a contributor to the some of the thread drift that's developed.  

TNtechie - thanks for posting the actual executive order. I am going to read it and see for myself what it says, and not rely on news outlets with political agendas.

Mikkimball0664, Please revisit your prejudices. I have lived and chose to continue living in the Bible belt. The small town I was raised in has 14 churches down two miles of country road and only one is evangelical. Evangelicals are less than 15% of us. Your entire "overturn Roe vs, Wade, anti gun control, zenaphobia, the whole nine yards" is an insulting today as it was when Obama labeled us rednecks or Hillary deplorables.

For the record, I'm a Christian and a independent libertarian, college educated, pro-choice, pro Constitution (including the 2nd Amendment), pro legal immigration, pro marriage equality, pro-military (even back in the early 80s when is wasn't cool) and so non-racist I didn't include it in the description of a young man I asked my parents' permission to give a ride to music practices when I was 16 years old. I became aware of that fact when an older lady called my mother to inform her I was driving around town with a black boy, so yes there was racism in the air.

I'm a pure product of the Tennessee public education system and scored in the 99th percentile in every educational measurement and among all wage earners during my working career. My grandfather, who demanded I use my brain for independent thinking instead of letting anyone else tell me what to think, was a very major influence in my life. As was my redneck father who quit high school at age 15 and went to work in construction supporting his parents and siblings, yet got a GED, took college classes related to engineering and construction, became a vocational school teacher, general contractor and a building engineer for a major utility. My homemaker mother who graduated from high school at 16 and taught Bible verses from her memory was also a major influence. Their house was full of books and tools; they took their kids to the library and church every week. We also sang together, watched the evening news together, read and discussed books together, worked in the garden together, played cards together on Sunday afternoons and in pleasant weather often shot various firearms from the back porch or skeet over the garden after supper every Saturday.

In my life experience, which has included traveling and working across the entire US, many to most people who use the "redneck" or "zenaphobia" words are the MOST prejudice people around, somehow thinking their chosen "lifestyle" and the opportunities life has included makes them superior to "others", dismissing instead of accepting people who had different opportunities or made other life choices.

Mikkimball0664, the very best person I have ever known was an old woman with a 3rd grade education. Sarah quit school in 1916 to work a farm so her younger siblings could eat. She sewed and washed their clothes and took care of her siblings and ill mother until she was 28. She married a widower and raised his children with devotion while never having children of her own due to a tubal pregnancy. Sarah cooked a lunch and walked 1/2 mile to the stone quarry where her husband worked in all kinds of weather so her man had a good hot meal instead of a sandwich. She worked in the community: sewing, cooking, visiting the sick and taking produce and/or flowers from her garden and yard into her 80s. She was kind, unless you mistreated a person or a animal, and then her voice would burn your ears off. She supported herself and gave to others all her life. She was a Christian and she walked the walk. Yet she was just another ignorant redneck hillbilly living a valueless life to all the educated big city people wasn't she? Damn shame she had a right to vote and just didn't realize how better off she could be if she would just rubber stamp all those progressive programs "better" people wanted.

To truly value people, you must value them as you find them, not just when when they look like you, or share your politics, or make the same life choices you have.

I enjoy this board more when people don't get so political.

I read it. It does nothing. It's just a political stunt. It's an order to look into maybe doing something. In other words, continue doing what the government always does anyways regardless of whether this order exists or not.

It's not the only Trump executive order that doesn't do anything. Most of Trump's executive orders are meaningless. There are no policy changes. It's just a photo op.

https://www.washingtonpost.com/news/monkey-cage/wp/2017/01/30/most-of-trumps-executive-orders-arent-actually-executive-orders-heres-why-that-matters/
https://www.politico.com/magazine/story/2017/04/28/trumps-executive-orders-are-mostly-theater-215081

The devil's in the details. There are no specific policy changes implemented that I see in this executive order, just lengthy criticism of Medicare for All and then several sections instructing Secretary of Health and Human Services Azar to study and/or propose regulations or reforms, due in 6-15 months. It seems the deadlines are the only specifics mentioned in this order, and some of the deadlines are after the election.

The supposed changes were described verbally by "officials," per the MSN article:
"The executive order is intended to bolster Medicare Advantage, private Medicare insurance for seniors, senior officials said on a call with reporters. The plan would also offer more affordable plan options, increase use of telehealth services and bring payments in Medicare fee-for-service program in line with payments for Medicare Advantage, officials said." "Intended" is a big qualifier there.

There is a lot of emphasis on deregulation and then a few other nods and winks to business. That's all I'm getting from the actual order.

It may well be politically timed, but the "overhaul" is quite good for Medicare, & overdue. (Lots of red tape was making it hard to keep costs down & catch fraud). This overhaul makes things more efficient, & simpler for the seniors it serves. (P.S.Lots of other good things done also,...just underpublicized). And no Bernie for me.

Medicare for all and the inclusion of long term care for seniors is why I am voting for Bernie Sanders. 2020 isn't that far away.

Here's a link to the actual executive order: https://www.whitehouse.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/

Reading the executive order, it looks to me like Trump has set guidelines for Medicare to reduce burdensome overhead and administration rules (and the costs to follow them) in much the same manner he has over the business community. One "feature" I really like is making updating Medicare to include coverage for new treatments and devices a faster and more streamlined process. Hopefully this will help with simple things like wheelchairs. Currently Medicare covers one kind of basic wheelchair and will not cover options like leg lifts or light frame chairs regardless of medical need (learned this the hard way when my mother needed a chair with leg lifts so her legs do not swell so much when she sits in the chair). Her private supplement insurance did.

There is definitely some politics involved; however, at least one statement in the political boilerplate is true. The Democratic plans all include more government control of healthcare and reducing Medicare services in order to provide more Medicaid funding for groups not currently eligible like working age adults and illegal aliens. The Republican based plans want to preserve coverage for seniors and cut costs by reducing administrative requirements, loosing rules to allow private plans and supplements to offer more options and to provide more cost information to consumers. This executive order requires cost savings be passed on to Medicaid recipients.

Since my life experience is that private companies operate with much better efficiencies than government, I tend toward the Republican plans. I want government to be a referee, making sure a basic level of service is offered and actually provided, rather than a service provider itself.

Medicare Advantage (MA) operates a lot like a HMO, a straight fee for a plan with greater focus on more preventative services/treatments so people are healthier and don't need more expensive treatments later. For example, it's a lot less expensive to provide multiple types of insulin, food plan training, and health club memberships for a little basic exercise than it is to treat the heart disease and kidney issues (among other problems) not treating diabetes causes. One MA plan in our area has even started running transport vans to healthcare appointments and health clubs. Since one local Senior Center includes health club equipment and programs, MA is funding their transportation services for each one of their plan members who uses them.

Just a comment. I have Plan F High Deductible which is much the same as Medicare Advantage. The cost of my plan is low but so is the coverage. I am fearful of having any kinds of tests or x-rays because I may have to pay half of a high bill. And, as I understand it, even with Advantage, you still have to pay Uncle Sam for Medicare. I use a company called Remedigap and plan to call them again this year. The owner is a sweet and helpful person and she is very knowledgeable about every plan out there.

I regard all such ideas in election years with a lot of skepticism. I think it's about timing - courting the grey haired set just as they're re-assessing their Medicare plans for the next year. What would be helpful is if they used the power of numbers to negotiate the prices of pharmaceuticals (Part D), as they do with other medical items in Parts A and B. I realize much of Congress gets funds from the pharma lobby but if they truly wanted to help seniors, this would a good start.