i would hope that many of the community health centers would do that. host: brian in pittsburgh, massachusetts. independent color. go ahead. caller: it is tough to even talk about stuff like this when the country is going broke. we have to worry about more -- we have to worry about china more than anything. they still $400 billion of technology every are. they tap into our biggest health care provider. 80 million people. you know why they talk about that? the republican jack a they don't care about that. host: you think the whole debate that will happen today, the debate that may continue to happen in the fall, you think it is politics and not what they should be focusing on? caller: no, i don't. i think they should talk about the unfair trade deals we have and the illegals and the people overstaying visas. they are causing rent to go up and destroying the country. in the bible, revelations

chapter 11 first 18, dodd said he would destroy anybody who destroys the earth. do you hear christians talking about that? host: one more phone call on this. independent from indiana. caller: good mine. there is really no choice deal here. we have a budget problem. a deficit problem. we have severe spending problems. less and less and less taxes coming in. consequently, we are going to be facing the sorts of issues on all sorts of these projects. such as the epa, family planning, all of these things. these things are going to start coming at us and we are not going to have the money to pay for them is what is going on.

we can kick and scream about the right and wrong, but the reality is these things may not get totally defund it, but i bet you they all get cut back. lawmakers don't have much choice. host: that is dan in things montana. an independent color. we will leave it there. up next, switching topics. medicare. last month marked the 50th anniversary. we will talk about two leaders who oversaw the per -- program about the success and future of it. later, we will turn our attention to alzheimers and research dollars for. we will be right back. ♪

question on the communicators cyber security issues and how to combat recent data issues. >> we have seen attack after attack. the most recent attack on the office of personnel management. also in private industry. target, home depot, so many other private corporations have had customer information stolen. what we have realized is we can try very hard to keep ahead of the hackers. but we need to think to -- what we need to do is think about how we minimize the need for customers to put their private information on two websites. >> right now, there are a legal

observations from the government sharing classified information with the private sector. there are legal prohibitions of the private sector sharing private information back to the government termed as acting as agents of the government. it is not allowed. what we want to do is allow those barriers to be removed so that you could share information on threat signatures narrowly defined. you are talking about ones and zeros, technical information. of the various hacks that have taken place other. for example. if we could broadly share that information, when one hack occurs at network speed we can widely share that vulnerability and more broadly protect everyone. >> tonight at 8:00 eastern on the communicators on c-span2. >> the republican presidential candidates are in manchester new hampshire for the first

presidential forum today at 7:00 p.m. eastern. c-span is providing love -- live coverage of the forum on c-span radio and c-span.org. following the live forum, you can provide your input by joining our call-in program or adding your comments on facebook and twitter. road to the white house 2016 on c-span, c-span radio, and c-span.org. washington journal continues. host: in july, medicare marked its 50th anniversary. here to discuss that, the former administrator of the center of medicare and medicaid services served from 1990 to 1992. and the acting administrator serving from 2002 2001.

-- 2000-2001. i want to share with the viewers about what lyndon johnson is had to say. >> more than 18 million americans over the age of 65, most of them have low income. most of them are threatened by medical expenses. through this new law, every citizen will be able to have insurance against the ravages of old age. this entrance will help pay for caring and hospitals and nursing homes. under a separate plan, it will help meet the fees of the doctors. here is how the plan will affect you. during your working years, you will contribute to the social security program a small amount each payday to hospital

insurance protection. the average worker in 1966 will contribute $1.50 per month. the employer will contribute a similar amount. this will provide funds to pay 90 days of hospital care diagnostic care. and 100 health visits after you are 65. beginning in 1967, you will be covered for up to 100 days of care in a nursing home. under a separate plan, when you are 65, you may be covered for medical and surgical fees whether you are in or out of the hospital. you will pay three dollars a month after you are 65 and the government will contribute an equal amount.

it will be as varied and broad as marvelous modern medicine itself. host: lyndon johnson on july 30, 1965 signing into law medicare. here to discuss is to former administrators of the program. his medicare working -- is medicare working like explained their? guest: in general, yes. medicare was designed to meet an important need for the older population of america. to make sure they have access to insurance coverage for hospitals and physicians. something that was a challenge to most seniors, even those who were not low income had a great travel getting insurance. it has changed enough. coverage has broadened. 55 million people on medicare now, almost 10 million of whom are disabled and under 65. broadened that way. preventative services are now covered.

health patient prescription drug coverage was expanded in 2003 through legislation. the financing has changed significantly. the need that medicare was designed to respond to, making sure that seniors would have access to care, has indeed been met. host: your thoughts? guest: i agree, and i would assess a couple other items. one is that health care delivery has changed radically since he gave that speech. in those days, most people got their care and hospitals by physicians. over the years, there has been a great need for a bunch of new sources of care, new kinds of providers, skilled nursing facilities hospices, all of that has been added to medicare. it creates a challenge to reorient the program. i think the program has met those challenges over the last

30 years with new payment models, new delivery. the current focus is to address quality. quality has not been as good as it should be in u.s. health care generally and in medicare specifically. the program was taking some steps to try to address that. host: we want our viewers to weigh in on the situation. this is how we have divided the lines very if you are a medicare beneficiary, 202-748-8000 doctors dial in at 202-748-8001 all others 202-748-8002. that me ask both of you this. how would you fix it? guest: you asked the first question of did it meet the directive that the president johnson laid out? yes. in terms of providing ready access. as health care is evolving significantly, not just the

focus on quality but on value as well, the delivery system has changed a lot. medicare has been slow in that area. it is somewhat joining the movement in terms of trying to promote value and better quality. physicians are expressing frustration, although less than they had been, because the " dactics" was passed in april. it was not perfect, but it's all day frustrating problem for many physicians which was not knowing what happened to their fees every january with threats of reductions as high as 31%, although they never happened. even more dysfunctional in the sense that it did not reward those clinicians who were providing higher-quality, better value care. they can movement in general to give patients more knowledge and

let them be more active participants in their own health care. medicare solves the racial problem it was designed to solve. there is so much more that we need to do to make sure that the program improves. most important is a run for our children and grandchildren and those beyond them. that will be another discussion. host: what changes would you make? guest: caller: we need to establish that something is happening that is producing better results. we are not sure what that is. in the last five years, per capita medicare spending has been flat are going up at the rate of the gdp. it is unprecedented. in the history of medicare, it has been said that the actuaries are wrong. we spend more than is pretty. now we are spending less than is predicted. we will probably end up talking

this morning about whether this is sustainable or not. something good has been going on. there have been recent studies demonstrating a decreased mortality of medicare beneficiaries, decreased hospitalization rates. there have actually been progress is. my point would be there are reforms. we are not at the point where we need to take a dramatic departure for restructuring. we can continue to of all. the final point i would make here is that we now how options for medicare beneficiaries which include getting medicare from private insurance companies. 30% of medicare beneficiaries currently take that option. we have more choice in this program than we used to. that is a very positive impact and it gives everybody on their toes because we are moving to a

competitive health system. host: let's take one of your points. decrease in mortality rates -- efficiency of the success of the medicare program. is that because the government negotiates that rate? is a because of the way medicare is set up? guest: in some specific places you can point to medicare as the leader of change and certain payment methods. how we pay hospitals -- something called diagnosis related groups. instead of paying for each individual item, they pay the case rate for the whole hospitalization. in some other areas hospice and others, medicare has been. the general point is the delivery system is changing. medicare in some cases has led and in some cases has followed. we are increasingly understanding that medicare and other actors in the health care system have to be

host: do you have some thoughts. guest: you asked specifically is it happening because the government negotiates or administers prices. the answer is no. i can say that with some certainty because it was happening in the private sector even earlier and happens in the private sector as well where the government is not doing the negotiation. i agree with a number of things that bob just said, which is there is some areas where medicare traditionally has led and other areas where the private sector has led and both have roles in which they can take the lead. but we need to understand that what has been going on in medicare has been going on in the private sector and started even earlier. it started around 2006 or 2007, the slowdown. i think that bob anticipated one point i want to make, which is we don't know why we've seen this dramatic slowdown. there's no question some of it

has to do with the very heavy recession that we are just starting to come out of. 2015 is the first year anybody might say we are seeing something that feels like a real recovery. >> people saw the doctor less because they didn't have as much money? guest: it is part of that. it is part they had less money that they were uncertain. they had a big hit in their wealth. the insurance for seniors of course is more stable because of medicare. but their wealth was hit because the places that took the biggest hits were husbandousing values and 401-k's and that is is under 65 and over 65 and something us economists call permanent income, not just the annual income that you receive. that has an impact on how you spend. there's a lot of change that is being tried right now again

actively in the private sector in the under 65 and public and accountable care organizations have been going on the private sector sense 2007 and 2008. just started in medicare officially in 2011. the question of whether the changes that we are seeing will be sustained and what happens when we're in a real robust economy and economic growth which thank goodness we appear to be going into is something we don't know. we are seeing already some indication this year of a bump up in spending in healthcare. host: we have calls waiting for always. anne in dallas, texas, medicare beneficiary. go ahead anne. caller: good morning. i'm 74 and it has been a wonderful program for me. i have multiple sclerosis and i'm low income. and i have the q.m.b. which the

federal government and state of texas pay my part b and then the wraparound and it has been a wonderful program. it upset me when i heard jeb bush said he wanted to do away with it. for people like me i have had to go to the hospital twice in the last say, nine years since i had the program and i have a great doctor and living on $900 a month, even my part d might pay like $2 per prescription for my prescriptions and i don't know what i would do without it. it has blessed me. host: let me jump it. dr. berenson, what do you make of what you heard from anne? she said it is successful and likes her doctors, paying $2 for prescription drugs. guest: that is a good story. i think it does bring up the

issue of whether or not the program is broken and needs to be fundamentally restructured or working pretty well and needs to be tweaked at the margins. i believe candidate bush has been one of the republicans saying it is broken and needs to be overhauled and i'm with the caller who thinks that it is working pretty well. host: i will give eric the second call to you. a doctor in tillson, new york. you are on the air. caller: good morning. i'm a primary care doctor in upstate new york. i know pedestrian care has done -- medicare has done many good things. however, what is going on now under the auspices of quality is really a disaster. it is called meaningful use. anyone who does it knows it is neither meaningful or useful t. is computers and checking boxes and driving us crazy. it is killing us.

can you please comment on this. anyone involved with the program is not paying attention it the fact that it is a disaster. host: ok, eric. guest: the meaningful use provisions had to do with legislation passed in 2009 meant to encourage physicians to adopt the use of electronic medical records, which is a very important part of trying to make sure that information is readily available on people when they change where they receive care, if they are in emergencies elsewhere, to avoid having repetition of tests or information lost in terms of transmission. now, has in worked as well as it should have? sounds like for this physician not. i don't know what kind of system he bought. there was a lot of opportunities to choose the kind of system

that would work well for individual physicians. my main concern about the promotion of the use of electronic medical records is different from this physician's and that is we don't do anything to really assure inter interoperability between the kind of electronic medical systems he might use versus what is in use at the community hospital where he lives or if the patient goes to manhattan or is spending the winter in florida to make sure that the physician physicians that his patients might see might be able to pull up the records electronically. i'm concerned about the specifics. but we need to move off the paper charts that were being used. it has a lot of down sides including not being able to transmit information. he hope he is sharing with his medical society what exactly it is about meaningful use that is

making his life more difficult as primary care physician. that's not what we want to see. guest: i'm with the doctor. i have written about the offense -- we have this term called value based purchasing, the idea we can pick a few quantitative measures and reward or penalize doctors that the doctor is going to move based on incentives doctors moved into better behavior. it is misconceived and is back firing because doctors are reacting the way this physician did. it is not just meaningful use. there is something called the value based payment modifier and physician quality reporting system. these are quality measures that purport to be able to assess the quality or value actually of a physician. the behavioral economists tell us that it is probably a mistake to go in this direction.

for professionals who have complicated jobs who ro doing lots -- who are doing lots of different things that are all valuable to pick a handful of measures and reward and penalize may get better performance on those particular measures but their overall intrinsic motivation is compromised. there is no evidence this approach works for teachers or other segments of the economy, about you in healthcare both parties -- there is bicameral bipartisan endorsement. it just passed the congress in the recent legislation that we are going to move in a big way toward value based payments to doctors based on a handful of quality measures is wrong and should be reconsidered. host: sally from olympicaolympia, washington on medicare. caller: i was a recent medicare patient and i'm of that age and

i had excellent care. i recovered from something that my doctor was even surprised about. but one thing i would like to pass along to people is the alternative practitioners. we have to pay attention to them them too. it is up to us to heal our bodies through proper food, proper exercise knowing that we are in charge of our own healing. it is not up to anybody else. i don't want to spend those extra dollars. i would rather spend my money on something else. host: we will take alternative medicine. gail, is that allowed under medicare? guest: some of it it. it depends on the system you choose. bob mentioned earlier almost a third of people on medicare choose to receive it through private plans rather than traditional medicare. many of those include

alternative providers as part of the plan. but of course you can -- and i do -- interpret the commenter's comments in a broader sense which is that we need to be responsible for our own health. we know we need to exercise and eat properly and drink alcohol in moderation if at all. and that we are also responsible for our bodies. this is not something we just can farm out to the physicians and hospitals or nurses and think that will resolve all of our medical issues. host: next call for dr. berenson from newark, california. on medicare as well. caller: my question actually has two parts because first of all traditional medicare in my opinion would give me much more

choice because i can decide which providers i go to. but the problem is the 20% co-pay co-pay. all it takes is one major illness or accident and that 20% co-pay can create a real financial burden on a retiree like myself. and then the second part of that is is, given that we pay so much out f pobgtof pocket for our services, how is it that other countries seem to pay so much less and have such better out koplscomes? guest: let me take the first one first. one of the problems medicare has is it doesn't cover catastrophic

costs. it never has. people have essentially unlimited financial liability. for anybody who can, they purchase or receive supplemental insurance to fill those gaps and they often cover the co-payments. almost 90% of medicare beneficiaries have some form of supplemental coverage for that 20% co-pay. the caller apparently doesn't. that is one problem is that low income individuals but before the medicaid level often can't afford supplemental coverage and are exposed to those kinds of expenses. it is one of the advantages, or one of the appeals let's say of medicare advantage plans is they do provide catastrophic coverage and put an annual limit on what somebody can pay. so, some of us have suggested that the basic benefits structure needs to be

overhauled. on the question of why don't we do as well as other countries that is a complicated one and i wish i had a simple answer. we have -- i won't even jump into that right now. host: you were taking notes, gail. guest: the point bob mentioned and the woman mentioned are really the issues that most seniors need to understand. first, almost everyone has something besides medicare. 90%, retire yes coverage, purchase medicine gap medicaid or private sector alternative medicare advantage. yes, the woman is correct you give up some choice to get more benefits. but it is a much better economic deal if you are feeling pinched and that is why many of the people who have chosen medicine cache advantage are -- medicare advantage are low low income not qualified to get medicaid but not able to buy their own

medigap. they get to make it every year. so that they don't need to make the decision once and feel like they are locked in as bob said, the question about how other countries do it is a big topic and either at the end of this session or in another session you can explore it. host: we will go to anita in n. on medicare -- in florida on medicare. caller: i'm 74 years old and i have lived in florida since 2011. i had never heard of medicare advantage advantage, couldn't believe it when i first heard about it. but i selected it. and my question to you is i might as well tell you up front i'm an old retired nurse so therefore we have a tendency to look at things a little differently.

but as i go to doctors here in that. -- here in florida, which is not very often because i take care of my own health -- i see senior citizens wanting their bodies to become a bionic body being healed by a doctor who is making money off of things that i think is unrealistic at 90 years of age. therefore, it concerns me whether or not we are addressing properly taking care of and what is our real goal. what is quality? what is our real goal. host: dr. berenson. guest: i think the caller has put her finger on one of the issues and is the reason we are having a conversation about value based payment. we have payment systems. in fact most countries do. they are called fee for service

for physicians which rewards them for doing more. and it doesn't reward for for keeping people healthy. so, we are trying in a whole bunch of demonstrations that were set up in the affordable care act to develop new payment models and new delivery approaches that would reward physicians and hospitals and others who participate in that delivery system for keeping people healthy so they don't need to come in for all sorts of high tech tests and procedures. we are really at the beginning of that and that is one of the good things about the slowdown in spending. we can take the time to figure out how to do this right. but she's right that there's a basic fundamental problem when you reward somebody for doing too much, they will do too much and even physicians succumb to

those incentives. we can do a much better job of fixing some of the distortions in the payment levels within the medicare fee schedule that really exaggerate the negative impact of fee for service by overrewarding tests and procedures and not paying enough for time spent with patients to talk about wellness. host: we're talking about medicare, the program. the feature of it 50 years ago on july 30, 1965 president johnson signed it into law. what are your thoughts on it? we divided the lines by medicare beneficiaries, doctors and all others. we will continue getting your thoughts on it. here is a tweet from a viewer. there is a poll recently continue millennial attitudes. 60% of them agree with this statement. i expect social security to go

bankrupt before i retire. talking about social security, medicare. what do people think about medicare as well? the treasury secretary recently was discussing the release of the annual reports on social security and medicare. [video clip] >> social security and medicare are the most successful social insurance programs in the history of our nation. every year they keep millions of older americans out of poverty and give those 65 and older abscess it affordable healthcare. the programs fulfill a promise made from one generation to the next and embody the values of fairness and opportunity. today's reports confirm that both social security and medicare are secure today and will remain secure in the years to come. consistent with previous years, today's reports also show that these programs are facing challenges that need to be addressed. the short-term projections for

social security and medicare are little changed from last year while the long-term projections have significantly improved. when considered on a kpweupbd basis social security's retirement and disability programs have dedicated funds sufficient to cover benefits for nearly two decades. one year longer than was projected last year. after that time as was true last year it is projected that tax income will be sufficient to finance about three-quarters of the scheduled benefits. in addition, as we expected beginning in late 2016, social security's disability program alone will have dedicated funds sufficient to cover about 80% of scheduled benefits. the president's proposed common solution to improve the solvency of the fund in the short run so americans will 10 to receive the benefits they need. host: that is the treasury secretary talking about the latest report on social security and medicare. what did you hear, gail

wilensky? guest: what i heard is that as well as we have been doing for the present generation that is on medicare and we have heard comments of people experiencing medicare, we will have challenges going forward and the treasury secretary didn't really hit all of the challenges that will come up. some of them are further off. the disability fund is in dire straits. it is somewhat of a lesson of what happens when you wait until the 11th hour to do something. if there is not an infusion much funds people will not receive the fund they are scheduled it receive next year. we have different funding that is used for medicare and we have two main pieces. one is the wage tax that funds part a, the hospital and nursing

home. it is scheduled to be solvent until 2030, which is a good way off off, although precise years are rarely regarded as very accurate but it is not in an immediate problem. the more serious issue is roughly half of the medicine dare -- medicare is funded by general revenue and that is where we will feel pressure earlier. right now as bob mentioned, we are seeing very slow growth in medicare per person. how far, we are in a position where we are in the process of dubbing the population on medicare. i think that it is highly un likely the very slow spending level we have been experiencing will continue. the real question is, how much more rapidly will it grow? will it grow one and a half times the rate of the economy? will tit go back to the more traditional twice as fast as the

economy? we don't know but we need to be mindful. as i mentioned earlier this is the first year of anything that remotely resembles economic growth and we are beginning to see a bump up in spending. we need to be very mindful and understand even without that we have a doubling of the population and we will have to do something to shore up the financing. host: dr. berenson what do you think? guest: let me make two points. one is i agree with gail's number, 2030 is the projected date for the solvent any of the part a which pays for hospital care. when president clinton was directed the projected date was 1998. we have continually push it out and people still get benefits so for those that don't think medicare will be around, it will be around. that doesn't mean we don't have some serious issues here but

when people sort of raise medicare going bankrupt that doesn't happen. and it won't happen. i agree with gale, the problem we are facing is a near doubling of the beneficiary population. we have a baby boom that started, i was in year one of it, born in 1946. bill clinton george bush and now i find out donald trump were born within two months of me within 1946. host: lucky you. guest: there is 18 years' worth of baby boomers coming on about a 3% increase a year. and that is the pressure on finances and medicare. per capita spending is under pretty good control i agree with-game we don't know what the future is but i don't think you can solve a problem of doubling of the population by ratcheting down more on spending. one has to put revenues into the discussion.

if we are daringcaring for that many more people shouldn't be we providing revenues? host: where do the revenues come from dr. berenson? guest: you can have modest increase in the payroll tax contribution that individuals make but i think most of it would be from general taxes and more progressive tax. host: where do they come from? guest: some will come from additional taxation. the problem is that should be the last thing we fix, not the first thing we fix. because we know, living in washington, that if you ease the pressure in terms of making sure you have solvency by adding more review congress is unlikely to do anything else. so if you double the population you will need to add more revenue. the likelihood we will continue what we are seeing right now is as close to zero as anything i can imagine. we have to be very mindful this is year one coming out of a

recession. we are already seek a bump up in spending. lets not think we've got this part of the problem solved. host: mike is next from clearwater florida, also on medicine carry. caller: organic.good morning. earlier a caller called railing against the electronic medical records. i would like to note the importance of electronic medical records to patients. my paper records were lost and that is basically it. now my doctor fumbles with a computer but there is another doctor this lost the earlier records but they were important and critical in my care. very important. host: i will move on to john to get another call in. port st. lucie, florida. good morning, john. caller: good morning. i have a question but there is the 50th anniversary of unintended consequences which mr. valenti who was an aid to

president johnson who said wes passed so many bills in 1965 we didn't take time to think of the consequences of the bills. my mother wound up in the hospital this year for about two months. she received about 127 separate invoices. i went through some of them and discovered that a lot of these doctors are saying they saw her for 25, 35 40 minutes and i was with her every day and the most they do is five minutes and walk in. i know they had to go back on the computer but i'm sure they didn't spend another 20 to 30 minutes putting in information after organic, how are you rbgs ma'am and how do you feel. i had to call in on some of these invoices and the double trouble is when you do an appeal the people that are answering for medicare read from a script and you can't get them to answer anything specific because the

lawyers have taken over and tkpwo forbid they should say -- god forbid they should say the wrong thing. then you get a letter back from a contractor like novitas or we have first choice in jacksonville and they don't give you any specifics. for instance my mother -- this is the question. she almost had a stroke in the emergency room and had a cat scan done and they came back and said it was a routine examination so i had to appeal that and when i appealed it i talked to the people at medicare and we don't have the correct code number. don't worry, we will send off to the provider sofor the correct information. i get the her -- i get the her become and it is a routine exam. why do they read from a script? we are subsidizeing medicine and when you subsidize something you don't get the true cost. why are these people reading

from a script? host: dr. berenson. guest: i think the call are raises an interesting issue. there is no question that there sis -- well there's fraud and abuse in the medicare program. there is also elsewhere. we have a very complicated -- the most complicated system in the country partly because we have all of these different payers with different rules, different bureaucratries feel people are just as unhappy often with the private insurance defending them a service or denying a claim as well. i'm with the caller that we have what is called waving at the door consultations. that is one of problems with a fee for service payment system and you have to put in all sorts of rules to prevent the gaming and abuse of the payment system. so i don't have a simple solution. i can't tell you why people are reading from a script. in fact, we want to move the payment system so organizations

have responsibility for that spending and they are in a better position to work with -- to sort of determine why the physician is billing for things he or she may not have provided that some person in a call center can. host: how is it that we see the headline that a doctor or group got away with millions in fraud how is that possible? guest: it is not clear to me how to is possible. it is an enormous source of frustration. the agency is pulled in two different directions. it is very mindful that spending the taxpayer's money and it is frustrated by physicians and other clinicians, durable medical equipment people that rip off the system. when they get aggressive, going after physicians, many of the congressmen scream because they say either you are harassing the physicians in our community or

you are keeping my patients from being able to see their physician. so there is a lot of tension when the agency attempts to become too aggressive going after physicians and other providers who are extreme although-- other providers who are extreme. they now have the authority to go after those are stream. -- extreme. as callers may remember, there was really is -- there was a release of billing information by medicare physicians. there are a lot of things that are wrong or unhelpful with that information. many people entered the wrong number. it did not include some of the expensive pharmaceutical part d drugs for oncology. it begins to put pressure on exposing those that receive very

high amounts and at least allowing like to sign on that -- allowing light to shine on that to see whether it is something inappropriate. i agree with the comment that made in passing, -- that made in passing -- that bob made in passing. iterated delivery systems -- they come in all forms. they are likely to be much more effective than the government trying to decide whether particular service was necessary and appropriate. host: dr. berenson? guest: gail to the release of data for physicians -- gail po inted to the release of data for physicians. i was stunned that office visits aret level 5 are all that they

build for -- they billed for. it took the public release to figure out that we've got a problem. let me make one additional point. there are currently about the same number of employees at the center for medicare and medicaid as there were in 1980. we have recently not provided the -- we have basically not provided the infrastructure for the people we want to be policing these claims. in a fee-for-service system, you need a large infrastructure stuff, to get it right -- large infrastructure to police stuff to get it right. if we fund it more, we would wind up saving more money. guest: terrible information systems. 11 what the credit -- a lot of

what the credit card companies do -- i had my wallet stolen. two hours later, the credit card company called saying i had fraudulent activity. medicare can't seem to figure it out in weeks. a lot of it has to do with how it pays. it doesn't do immediate, on-time payment, in terms of right now in information systems. that would -- that kind of fraudulent monitoring does not exist. host: we want to get more calls. if you add inadequate staffing and information systems that are not of the are -- not up to par and then the baby boomers coming onto medicare -- guest: it is a challenge. host: to say the least. anna good morning. caller: good morning, greta. i was widowed at the age of 45.

i reached the age of 60, when i could get my socialistic really -- my social security, due to my husband's death. i've been a hairdresser for 49 years, but recently retired. we have no benefit. my comment on the medicare and medicaid program and the prescription drugs -- i have medicare advantage. for five years, i paid almost $500 insurance payments to cigna. i stayed with cigna went on medicare advantage, and i'm still with them. one of my prescriptions -- i have a nerve disorder. i was diagnosed 17 years ago. i had to take all kinds of different medications.

but the other issue was not that. it was a prescription that was written by a gynecologist for a test. he ordered a prescription and i had to pay $75 for a tube of hormone cream. recently in the past year and a half, i applied for the state of arizona access insurance and h elp through the department of economic security. the state of arizona picks up my medicare part b. and now i have no copays and i get cancer screenings and bloodwork because i was told i was prediabetic -- host: i have other calls waiting period what is your question -- waiting. what is your question? caller: some of these

pharmaceutical companies the $75 -- host: i'm going to take that. i'm a suitable companies -- pharmaceutical companies. guest: part d has a lot of choice. it is possible some seniors need help doing this. if you put in the drugs you been prescribed -- you have been prescribed, it will tell you the best plan for you. frequently, they are very low cost, especially to people who have a relatively prescribed set of pharmaceuticals. people need, when they are in both the m.a., medicare advantage, and their own part d if they are seeing a change in the pricing they are facing, they need to look at their other choices again. if they don't need -- know how to do that, they need to ask a son or daughter, grandson or

granddaughter. there are lots of people who will help them find something that works. the access in arizona is the state program. they have all of their programs in match care form. they were the last in, but ended up coming up with a very good medicare program. host: go ahead. caller: this is a wonderful subject. i was born into a medical family. some of the trouble, i think, is the wrong documentation. and the other thing started in the 1980's. they were promoting how to build your practice. a lot of it was doing more procedures to get your practice built up and more dollars coming

in, your accounts receivable. that's when doctors started getting all these things in their office thomas that they could build -- in their office, so they could bill for more -- guest: doctors have a financial benefit if they bring lots of equipment in. i heard a few years ago at a meeting in the cardiology group when 11 doctors had their own pet scan, ct scan, ct angiography, which is not even approved for coverage through medicare, and their own mri machine, they were complaining that medicare would reduce the payment rates for those procedures. there had been an ongoing discussion for two decades about whether the medicare fee schedule is tilted too much for

procedures and not enough for time spent with patients. we had a good start in 1992. it gets into the whole issue of where cms gets its information from. there is a committee sponsored by the american medical association. it is dominated by specialists and results in services that are -- where the fees are ready distorted, in the sense of paying too much for some procedures. host: robert on twitter said this, "let's call it for what it is, it's not health care, it's disease care." karen says "i've heard that the majority of medicare payments are made in the last two months of a senior's life. is that true?" guest: no. let's start there. it is neither the majority nor

the last two months. some gremlin is out spreading information like that. the other one effort noted is that 60% -- the other one i have heard quoted is that 60% of your medicare is in the last few months of your life. we have no data. there is a concentration that goes on because health care tends to be provided mostly to a relatively small number of people who are very sick. that has not changed over time and it's more concentrated in the under 65 than the over. host: we would go to brooksville, florida, also on medicare. caller: i would like to know, as you get a monthly statement when you go that month and say, a doctor charges you $75. medicare will only give these

people $40. where is the fraud in that? two years ago, i had breast cancer. they told me to go on a supplement. i went on the supplement and i was paying, like $300 a month and something extra, which was very hard for me. within that year, i had my breast cancer done, i had my foot done. i had a pin in it. i have a lot of trouble with feet. i had my eyes done. i had cataracts. when i went back and took off the supplement, they said, well, with medicare, all you do is go up to $3500 and then you don't pay it anymore. i was paying more with the supplement than with just the medicare. host: dr. berenson, any thoughts on this? guest: one thought i had is that

the charges that health care facilities have -- they no longer bear any relationship to the underlying cost of producing the service because we do not have a retail market. individuals aren't paying for it. there are a lot of incentives to jack up those charges. the fact that medicare may pay relatively small percentages of that is not necessarily -- it does not mean that medicare is not paying their share of that. host: patricia in fairborn, ohio, also on medicare. guest: good morning -- caller: good morning. host: you are on the air. caller: i am a medicare recipient. it's been -- done very well by me. i pay $261 for my supplement. my real question is, the medicare prescription drug plans, i've never been able to use it. i have it through anthem.

they have a $360 deductible, which i certainly understand. but i'm told that i cannot drop that, that if i drop it, there are all kinds of ramifications for dropping that. i pay $32 to $37 a month for 16 years now and i've never been able to use it. host: were shaking your head, -- you are shaking your head gail. guest: there will be an open enrollment period coming up. go online. have someone help you. check to see what other plans are available. want to have a -- yo uwant t -- you want to have a plan, but you don't have to have that plan. look for a plan that has better coverage for the drugs you use. there are all kinds of premiums.

put in the drugs you have how much it would cost you, and what the deductible is. for sure, you can find something better than that. don't let anthem or anyone else scare you. there is a penalty if you don't have a plan. host: in ohio, good morning. caller: good morning to you. why doesn't medicare raise their unions so they could -- their premiums so they could offer more services? and whow can cuba, after 50 years of embargoes, still offer free health care and free education to their people? thank you. guest: i will do the first and let gail answer the second. basically, the premium actually does go up every year, according to sort of a formula. but the congress, a couple of times now has developed a

policy where well-endowed or relatively affluent seniors pay more. there is a significant increase in the premium, up to $43335 a month, i believe, for somebody at the height and -- the high end of the income bracket. the premiums for relatively rich people can be higher than they have been. host: let's wrap up. what's your take away for viewers on the medicare program? guest: final thoughts coming it has been a huge -- final thoughts, it has been a huge success. i don't think there is any mixed report card on medicare. it has been successful. it has growing pains because health care is very complicated. it has evolved ove