[Rich66]

I agree that there is a significant lack of understanding of what Medicare is, how it works and how it fits into the larger health care situation. A significant portion of Medicare recipients had health care promised for their retirement packages and wound up on Medicare when the employer realized there was a public option that got them off the hook. But saying Medicare pays 80% misses the larger issue that Medicare usually decides a billed service is worth much less than what the provider bills. So Medicare often cuts the provider submitted bill in half or more and pays 80% of that. This is what I see in the CMS billing paperwork. A Medigap policy to cover the 20% is optional. It can be surprising to see how manageable that 20% is in many cases since the it's 20% of a hugely discounted amount.
There is talk of reducing Medicare reimbursements to providers yet further. The reductions fall disproportionately on Cardiology and Oncology services. I am receiving numerous oncology e-newsletters aimed at providers and they are clearly concerned about this. I know of one cancer facility that limits Medicare patients to 50% of its load...meaning they need a balance to make a go of it. I know of one local hospital that has gone on the record saying that if all reimbursements were at Medicare authorized levels, they would have to shut down. This is before proposed reductions in reimbursements.
I guess my sense is that there is a lot to consider in terms of how the current system works or doesn't work. Will a public option initially offered to augment private insurance eventually remove choices due to the ability to be as insolvent as Medicare? Will service options that currently exist due to a mix of reimbursement levels shut down if this happens. I am all in favor of dealing with pre-existing condition denials and premium/cost of care increases. But it seems major issues aren't even being factored into the discussion or understood at this point..yet there is a push to move things quickly.