Most people are too busy with their lives to pay attention to what is happening with the health-care legislation. The baby boomers are just starting to enroll in Medicare and are experiencing savings in their coverage. HOLD ON. This will change. I promise you that.

President Obama promised changes in Medicare spending. This would help fund the uninsured. That savings comes in the form of cuts to capitation. Now what is that? There are two different ways to cover gaps in the Medicare program. Most seniors do know that Medicare alone will leave you with some unpaid medical bills. Two plan designs help fill those gaps. The original was called Medigap insurance and the second is now called Advantage plans. The Medigap is often called alphabet soup because it is named by letters. My personal favorite is plan F. Medigap plans follow MediCare. Right now I want to focus on the Advantage plans.

Advantage plans are like HMO plans. Under a HMO agreeement, physicians and physician groups are paid a “head fee” per person who picks that physician group. A portion of the premium goes to the physician group each month.  The physician group pays for much of the services that person needs.  When the HMOs first came to the market, doctors loved them because of the guaranteed money per month.  The members do not see any bills. The members have lower office visit co-pays. The physicians soon realized they may not be making enough to offset bills for expensive illnesses such as diabetes. Some physician groups would negotiate to increase this “head fee” aka capitation. Some groups would just say we won’t take those contracts anymore. This is where members would lose their doctors. Doctors would blame the insurance companies.

Fast forward. The Medicare HMOs now called Advantage programs have many names. Secure Horizon, Scan, Kaiser, Pearl and so on. The most popular has been Secure Horizon from United/PacifiCare. This also is the chosen plan of AARP.  The Social Security department pays the advantage plan a set capitation fee per person. That fee is about $800 per month per person. In return the Advantage plan covers most of the services the senior requires. The advantage plan insurance company shares that capitation with the physician group. Some plans charge more to accommodate and include certain physician groups.  CUTTING CAPITATION is the easiest way to save money without evaluating medical cost.  Common sense dictates that when an insurance company receives less money, they will trim benefits. This will happen. By 2011 Federal Government will be trim $195 per month per person on the Advantage plans. By 2012 this will increase to $585. These cuts are predicted by the National Center for Policy Analysis and the Congressional Budget Office.

I have tried to hit the high points of the information. The old saying; “Follow the Money” should be easier for you if you have read this. Please email me if you want to know more! You may also go to www.ncpa.org for more information on these upcoming CUTS.

Why would a respected representative yell this out at a congressional  meeting with our President at the podium? Personally I would have applauded him. But then perhaps all  conservatives should have taken some mood leveling prescriptive medicine before going to this farce.  First of all when the President saunters in 15 minutes  late, it sets a tone.  The President  doesn’t seem to worry about anyone’s time and network coverage.  Being late creates attention. He also doesn’t worry about espousing mistruths about our current coverage issues.

For those that think Representative Wilson went off the deep end last night. You are right.   Call me crazy but I think a whole lot of people wouldn’t have died at the hands of the Nazis if Joe Wilson had been around.