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Medicare

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Bonnie Burns is a training and policy specialist consultant for California Health Advocates, a nonprofit organization working on education and advocacy efforts on behalf of Medicare beneficiaries and the pre-retirement population in California. Burns is a consumer advocate with more than two decades of experience working with county and state counseling programs. She assists seniors with Medicare, Medicare supplemental insurance and long-term care insurance.

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Dr. Alan Garber is the founding director of both the Center for Health Policy (CHP) and the Center for Primary Care and Outcomes Research (PCOR) at Stanford University, where he is the Henry J. Kaiser Jr. Professor; a professor of medicine; and professor, by courtesy, of economics and of health research and policy. His research focuses on methods for improving health care delivery and financing, particularly for the elderly, in settings of limited resources.

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The increasing number of people without insurance -- an estimated 47 million in 2008 -- and growing health care costs are fostering more interest in and movement toward overhaul of the health care system. At the national level and state levels, dozens of proposals are on the table, offered by candidates, businesses, consumer advocates and many others. The proposals range from national health insurance modeled on Medicare to private market options based on tax breaks. Many policy analysts expect substantial movement on the issue in 2009.

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About 70 percent of the elderly will require some type of long-term care services during their lifetimes, and more than 40 percent will need nursing home care. At any given time, about 1.5 million people live in one of the nation's 15,000 nursing homes. Nursing homes are heavily regulated by the federal and state governments, which pay for about two-thirds of all residents through the Medicaid and, to a lesser extent, Medicare programs (pricetag: $75 billion a year.) Assisted living, however, is governed by different rules in each state and is generally paid for with private dollars.

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Whether they involve wrong-site surgeries, poor physician handwriting or prescription dose miscalculations, medical errors are rampant in America’s health care system. Following up on its landmark 1999 study,“To Err is Human,” the Institute of Medicine in 2006 found that a hospital patient is the victim of a medical error every single day he or she is hospitalized.

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In 2002, health care costs, particularly for cancer treatments, were soaring for seniors in some Medicare HMOs. After negative publicity about one HMO's drastic increase in chemotherapy copayments, the HMO agreed to reduce the cost to make it more affordable for patients.

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