Medicare for all — net costs

I'm really not enough of an expert to debate it - there's plenty of indirect subsidies like money for roads etc. but I'm not aware of direct subsidies to keep gas prices low and I don't think they exist. But I could be wrong.

I don’t think the refinery end of the biz receives much. And we buy the fuel in USD so there’s the exchange on top of the taxes for us. But subsidy in exploration and extraction of the raw certainly exists. But that’s a whole different market.

https://www.nrdc.org/experts/daniell...fuel-subsidies

It seems the only G7 country that ranks worse than the US for fossil fuel production is CA according to the link.

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Originally Posted by MagnificentUnicorn

An MRI isn't necessary for MCL tear diagnosis. It can be diagnosed with a physical exam. Often the MRI is ordered because the insurance company won't authorize the treatment without one. Of course this is in the States.

Another example of this is appendicitis. It's a best practice to get a CT for all patients with suspected appendicitis. We still have many patients come into surgery with sub acute appendicitis or a normal appendix because the radiologist reads the CT and says he suspects appendicitis. This happens even if all other clinical signs indicate no appendicitis. It's a liability thing and the push is to remove any critical thinking. Our system is broken in this regard. Some surgeons are brave enough to buck this trend but they are dwindling in number.

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Defensive medicine is a function of the lack of tort reform in the US.

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Originally Posted by 4matic

30% of California on Medi-Cal, a form of Medicaid. I can tell you first hand that it is excellent insurance. Much better than the corporate scam. Frees up a lot of money that gets spent on the economy.

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As someone who works in the field of medicare and medicaid reimbursement for hospitals, I can assure you that if 100% of providers and doctors were paid medical rates. there would be no providers or doctors to go to.

What a load of shit. A doc buddy of mine says he gets reimbursed at least as much and often more by medicare.

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Originally Posted by dunfree

Ah yes Obamacare, the name people love to hate, but they actually like what's in the law for the most part. So much so that the Republicans who'd campaigned against it for years couldn't actually repeal it because they lacked the votes.

In the current environment rural, or more rural, hospitals and healthcare providers are going to continue to close. Eventually that might produce pressure upon rural congresspeople to change things. Or not.

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Not wanting to get into a pissing match but Obamacare is a disaster for americans and a profit generator for insurance companies. I could care less what it was called.
The problem is you have to think about whether you look at healthcare as a basic right like or a privilege. Obamacare mandated the purchase of profit generating product where the provider, in this case insurance companies still have a profit motive. Look at the M&A deals, stock returns and paychecks at Aetna, Cigna etc. Then you add on mandates like EHR systems which has hospitals spend upwards of a billion dollars for software(Epic and Cerner) etc. and you have rampant cost and motives to keep spending more. Partners hospital spent 1.2 billion on Epic. https://www.bostonglobe.com/business...dkK/story.html
Think of it this way, would you prefer the Federal government mandate everyone must purchase a car from Ford or GM or build a mass transit system that is essentially subsidized and you could ride anywhere for "free". We got the mandate to buy the car.
http://time.com/money/4839017/judy-f...lionaire-epic/
Americans do need to tear it down at some point but even your doctor is not going to be happy when he/she thinks of his/her paycheck looking like their canadian counterpart.
Every time I go to a conference at a giant urban hospital tower or meet with C suite execs at "not=fr Profit" hospitals, I always think along the lines of Walt Disney, "To think, this was all built upon sick people"

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Originally Posted by mcski

What a load of shit. A doc buddy of mine says he gets reimbursed at least as much and often more by medicare.

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I'm sorry to say that I have millions of lines of actual patient data sitting on servers in my office for claims and I can tell you Medicare pays almost nothing compared to private insurance. Perhaps on something as mundane as a simple office visit, but for spine heart oncology and ortho, the reimbursement rates for private insurance are 5-10 times more than medicare. many if not all doctors try to limit the influx of medicare patients as a percent of their visit for this very reason. I am sure I will be told I'm wrong despite have the actual claims and working with hundred of hospitals in the US and an entire IT department focused on comparisons, but sadly its true.

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Originally Posted by ncskier

The problem is you have to think about whether you look at healthcare as a basic right or a privilege."

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sez it all^^ we have rights to HC but it ain't free googling around

"In 2016, the average unattached (single) individual, earning an average income of $42,914, will pay approximately $4,257 for pub- lic health care insurance. An average Canadian family consisting of two adults and two chil- dren (earning approximately $122,101) will pay about $11,494 for public health care insurance."

https://www.fraserinstitute.org/site...rance-2016.pdf

taxpayers pay a % of their income so the more you make the more you pay, if you only make 14K a year you pay 410$ , if you make 280K you pay 37,000

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Originally Posted by reckless toboggan

https://s-i.huffpost.com/gen/1371807...OMIC-570.jpg?3

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Awesome.

Sure pal, whatever you say. I've yet to encounter the practice or specialist that didn't accept medicare. Not even a blink.

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Originally Posted by ncskier

I'm sorry to say that I have millions of lines of actual patient data sitting on servers in my office for claims and I can tell you Medicare pays almost nothing compared to private insurance. Perhaps on something as mundane as a simple office visit, but for spine heart oncology and ortho, the reimbursement rates for private insurance are 5-10 times more than medicare. many if not all doctors try to limit the influx of medicare patients as a percent of their visit for this very reason. I am sure I will be told I'm wrong despite have the actual claims and working with hundred of hospitals in the US and an entire IT department focused on comparisons, but sadly its true.

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I think there is a bit of a logical leap to say that just because the reimbursement rates are lower, it would mean that nobody could stay in business if everyone was on it. I think worst case it's fair to assume that doctors overall would take ~10% cut from now. I'm sure that different specialities would feel it more and places like emergency rooms would feel it less.

Overall, I believe that MFA is a more moral choice in that we as citizens shouldn't have to stake our financial future on never getting sick or hurt. If millionaire surgeons need to take a 15% pay decrease, then I think that's fair price to pay.

{/polyassrant]

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Originally Posted by mcski

Sure pal, whatever you say. I've yet to encounter the practice or specialist that didn't accept medicare. Not even a blink.

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Are you a troll.
Sure doctors take it, the same way a certain percentage of housing in an apartment is section 8 or subsidized. However, without private insurance to pay the lions share of the bills, most if not all docs and hospitals would close given their current cost structures. I am not saying it right, I'm saying thats the way it is currently. Obamacare just kept it going longer.

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Originally Posted by Supermoon

I think there is a bit of a logical leap to say that just because the reimbursement rates are lower, it would mean that nobody could stay in business if everyone was on it. I think worst case it's fair to assume that doctors overall would take ~10% cut from now. I'm sure that different specialities would feel it more and places like emergency rooms would feel it less.

Overall, I believe that MFA is a more moral choice in that we as citizens shouldn't have to stake our financial future on never getting sick or hurt. If millionaire surgeons need to take a 15% pay decrease, then I think that's fair price to pay.

{/polyassrant]

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I don't disagree with anything you said. but its much more complex. You are correct not everyone would go out of business, but just about every urban hospital would. It's private insurance that paid for those shiny giant towers and parking decks with LEED certified modern marvel buildings and free wifi. You'd probably have more mom and pop type docs like years ago. Duo nurse doctor combos working out of store fronts.
I'm not saying its wrong or right, it just is.
Cost in american healthcare is universally the problem not how the payment mechanism is administered. Wringing profit out of the system was not done with Obamacare.
It's not just doctor take a haircut and its fixed. Executives and Aetna, Cigna, Philips GE health etc make tens of millions. Not for profit hospitals sponsor entire football stadiums and have suites. I have skied with execs from hospitals with homes in Deer Valley that would blow your mind.
It does not exist from what I can tell in Europe. doctors and their facilities while nice are somewhat more modest. Efficient would be the proper word.
I'd be all for basic coverage for all. In Germany their is basic coverage sort of like the free clinic and rich germans pay for private insurace. That would be possible here. It would also mean "poor" people would be in group rooms to deliver a baby, while a rich woman has a private suite.
Our current system is too expensive and too inefficient and no-one should die from a simple infection. But we also want 80 years to get heart transplants.

Yeah, I'm not sure very many people would shed a tear if the health insurance companies all had to close up shop. Those guys are fucking evil.

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Originally Posted by Supermoon

Yeah, I'm not sure very many people would shed a tear if the health insurance companies all had to close up shop. Those guys are fucking evil.

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Evil is an apt description

You said lots of docs and specialists won't take medicare. Seems like I would have met one by now if it were that pervasive. Like I said, I bought that party line mostly too until my specialist buddy said it was pretty much bs smoke and mirrors. Anyway, this is getting a bit too polyass. The point is medicare should be open to all. How to fund and control costs are just details that need to be sorted without lobbyists mucking it uplike ACÁ

As a doc, I’ve met a single provider who didn’t accept Medicare. It’s not “lots”.


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Originally Posted by ncskier

The problem is you have to think about whether you look at healthcare as a basic right like or a privilege.

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The problem with US healthcare is we have to make a choice between those finally. For years we've chosen both and so like most things in the US we privatized the gains (health co. towers) and socialized the losses (out of control spending). I'm for MFA, but if we don't choose to treat it as a right, we have to reform the system so it'll function as a privilege.

As I know people who were able to get non-employer health insurance because of O-Care I can't call it a disaster for all americans, though it is deeply flawed.

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Originally Posted by mcski

You said lots of docs and specialists won't take medicare. Seems like I would have met one by now if it were that pervasive. Like I said, I bought that party line mostly too until my specialist buddy said it was pretty much bs smoke and mirrors. Anyway, this is getting a bit too polyass. The point is medicare should be open to all. How to fund and control costs are just details that need to be sorted without lobbyists mucking it uplike ACÁ

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Please show me where I said docs won’t take it. I said docs and hospitals can’t have the majority of their patients on it with their current cost structure.

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Originally Posted by dunfree

The problem with US healthcare is we have to make a choice between those finally. For years we've chosen both and so like most things in the US we privatized the gains (health co. towers) and socialized the losses (out of control spending). I'm for MFA, but if we don't choose to treat it as a right, we have to reform the system so it'll function as a privilege.

As I know people who were able to get non-employer health insurance because of O-Care I can't call it a disaster for all americans, though it is deeply flawed.

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Have you seen the horrible policies they were able to get. I’ve worked with and in hospitals forever. We had employees cry when the plan was switched to a high deductible family plan. Just because you have some coverage doesn’t mean it’s good coverage.
I agree though the two tier system we have is deeply flawed

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Originally Posted by detrusor

As a doc, I’ve met a single provider who didn’t accept Medicare. It’s not “lots”.


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Did we all fail reading comprehension. I didn’t say they don’t take it. I said if all rates paid the Medicare rate or Medicaid rate doctors would have some serious problems given their current cost structure.
Would you have a practice with 100% governmental payers? Of course not, your private payers make up the difference currently
Example
Your run a T-Shirt shop. You need $500 per week to keep the lights on and pay your staff. You get $12 from tourist and $2 from the federal government for locals. You can sell 50 T-shirts per week keeping up your current staff and ability to service those people so each week so you sell 40 shirts to the tourist for $480 and you sell 10 shirts to the locals and you get $2 from the federal government. Your happy because you grossed $500.
The next year they propose that in order to have everyone get a new T-shirt they would be paying $2 for all the shirts in america however, in order for the numbers to work they have to pay the federal rate, they can't pay the fat cat $12. You are now selling 50 shirts a week in our fictional tourist town, but only getting $100 for what you used to get $500 for. Thats how the math for Medicare for all is working out. They are proposing paying the federal rate to everyone. It's a bit too rosy of a prediction in that article.
Listen I am not saying its right or wrong. Just don't be surprised when the AHA or doctors lobby or pharma companies don't lobby for this.
In fact, all your local congressman cave and don't even let medicare or medicaid programs negotiate as a block with pharma companies now. Its a joke.
We just signed a nearly trillion dollar defense bill and hospitals are getting payment reductions in many federal programs such as outpatient payment rates to hospital owned practices to save money for medicare. Our priorities are screwed up, but it would take a massive reorg is all I'm saying

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Originally Posted by ncskier

I'm sorry to say that I have millions of lines of actual patient data sitting on servers in my office for claims and I can tell you Medicare pays almost nothing compared to private insurance. Perhaps on something as mundane as a simple office visit, but for spine heart oncology and ortho, the reimbursement rates for private insurance are 5-10 times more than medicare. many if not all doctors try to limit the influx of medicare patients as a percent of their visit for this very reason. I am sure I will be told I'm wrong despite have the actual claims and working with hundred of hospitals in the US and an entire IT department focused on comparisons, but sadly its true.

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I can back that up. I see the medicare and medicaid numbers... low + MANY extra hoops to jump through. Plenty won't take VA or TriCare either because of insane hoops to jump through and drastically delayed reimbursement. It is sad.

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Originally Posted by ncskier

You'd probably have more mom and pop type docs like years ago. Duo nurse doctor combos working out of store fronts. .

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ACA killed the single practice doc (and really all small practices). And it was by design. ACA intentionally place compliance structures in place that make it so onerous for small practices that they had no choice but to sell out to the big boys. The idea in crafting that sort of system design is that bigger practices will be more efficient. But it turns out that isn't necessarily so, and larger organizations are certainly less agile and less personal.

And before someone starts screaming that their doc still is a solo practitioner, well yes, there are some holdouts, but the massive trend is solo practice and small practices are selling out.

It's sad... more money for the middle managers and corps, and healthcare practitioners are employees instead of entrepreneurs.

One of the architects of this feature of ACA wrote a mea culpa in the WSJ: https://www.wsj.com/articles/i-was-w...are-1469997311

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Originally Posted by ncskier

Did we all fail reading comprehension. I didn’t say they don’t take it. I said if all rates paid the Medicare rate or Medicaid rate doctors would have some serious problems given their current cost structure.
Would you have a practice with 100% governmental payers? Of course not, your private payers make up the difference currently
Example
Your run a T-Shirt shop. You need $500 per week to keep the lights on and pay your staff. You get $12 from tourist and $2 from the federal government for locals. You can sell 50 T-shirts per week keeping up your current staff and ability to service those people so each week so you sell 40 shirts to the tourist for $480 and you sell 10 shirts to the locals and you get $2 from the federal government. Your happy because you grossed $500.
The next year they propose that in order to have everyone get a new T-shirt they would be paying $2 for all the shirts in america however, in order for the numbers to work they have to pay the federal rate, they can't pay the fat cat $12. You are now selling 50 shirts a week in our fictional tourist town, but only getting $100 for what you used to get $500 for. Thats how the math for Medicare for all is working out. They are proposing paying the federal rate to everyone. It's a bit too rosy of a prediction in that article.
Listen I am not saying its right or wrong. Just don't be surprised when the AHA or doctors lobby or pharma companies don't lobby for this.
In fact, all your local congressman cave and don't even let medicare or medicaid programs negotiate as a block with pharma companies now. Its a joke.
We just signed a nearly trillion dollar defense bill and hospitals are getting payment reductions in many federal programs such as outpatient payment rates to hospital owned practices to save money for medicare. Our priorities are screwed up, but it would take a massive reorg is all I'm saying

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Actually, all the hospitals and doctors would have to do is get more efficient. Not that hard.

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Originally Posted by rod9301

Actually, all the hospitals and doctors would have to do is get more efficient. Not that hard.

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There is a lot of ignorance in this thread, but this takes the case. Many of not all md’s barely have time to spend with patients. Now my dentist work 3.5 days a week, but we all now that.


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But isn’t that, like, their one job? To see patients?

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Originally Posted by ncskier

There is a lot of ignorance in this thread, but this takes the case. Many of not all md’s barely have time to spend with patients. Now my dentist work 3.5 days a week, but we all now that.


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My doctor practice in Tahoe has a bunch of assistants, nurses, biking clerks, receptionists, at least 15 admin.

When I was in France last year, the clinic I went to had about 8 doctors and one admin.

There's a lot of room to cut costs, but there is no incentive to do it.

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Originally Posted by rod9301

Actually, all the hospitals and doctors would have to do is get more efficient. Not that hard.

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Not saying you're right or wrong but would love to hear how. I work in healthcare on the $$$ end and have a few ideas myself.

edit: Sorry...I'm late

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Originally Posted by rod9301

My doctor practice in Tahoe has a bunch of assistants, nurses, biking clerks, receptionists, at least 15 admin.

When I was in France last year, the clinic I went to had about 8 doctors and one admin.

There's a lot of room to cut costs, but there is no incentive to do it.

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That's anecdotal evidence, and if you think there's no incentive to cut costs in the US then you don't know what you're talking about.

Am I brainwashed or is it possible that this thread title should be "Medicare-for-all----net-savings"...?

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Originally Posted by rod9301

My doctor practice in Tahoe has a bunch of assistants, nurses, biking clerks, receptionists, at least 15 admin.

When I was in France last year, the clinic I went to had about 8 doctors and one admin.

There's a lot of room to cut costs, but there is no incentive to do it.

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The administrative overhead is an artifact of our fucked up insurance scheme.

What ncskier is missing is that in a single-payer system where everyone takes Medicare reimbursement rates, the docs retain 80 or 90 percent of their current take-home and he gets laid off, with the patients and the docs splitting the savings. It's not the docs who are out on their asses in that transition, it's the administrative overhead that gets axed.

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Originally Posted by Sirshredalot

The administrative overhead is an artifact of our fucked up insurance scheme.

What ncskier is missing is that in a single-payer system where everyone takes Medicare reimbursement rates, the docs retain 80 or 90 percent of their current take-home and he gets laid off, with the patients and the docs splitting the savings. It's not the docs who are out on their asses in that transition, it's the administrative overhead that gets axed.

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Please explain how this works...I'd love to hear it.

how much time does an md spend dicking around with insurance companies ?

I heard it could be 2 hrs out of a 10 hr day?

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Originally Posted by XXX-er

how much time does an md spend dicking around with insurance companies ?

I heard it could be 2 hrs out of a 10 hr day?

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Unless it's a very small practice MD's don't dick around with insurance companies or other 3rd party payers (the federal gov't) which is why you have clerical people. Do you really want your doc worrying about Medicare documentation while he's lancing your hemorrhoid?

well the clerical people ^^ don't work for nothing

The dicking around is mostly indirect, in the form of endless documentation, although IME there are increasingly frequent episodes where docs have to deal directly with the insurance company for denied treatments, which can often take up considerable amounts of time. I would say that 20% of needless dicking aroud work could easily be a reasonable estimate in terms of dealing with our current system.

On top of that, there are the clerical people whose job it is to directly dick around with the insurance dicks. What I'm talking about is the above and beyond dicking around docs have to do despite the dedicated dicking around staff.

There's armies of admin people to ensure compliance with CMS (Center for Medicare/Medicaid Services), to deal with their auditors, to code charts so that Medicare will pay extra, people who make sure doctors write their notes so that medicare/medicaid pays more, make sure all the boxes are checked by the nurses for reimbursement and regulatory compliance, shuffle the e-papers, handle reimbursement, fight payors... yes having additional insurance companies adds some more admin overhead over the government, but probably not that much more. The entire CMS/private insurance system causes massive admin overhead, and it isn't just the private insurance companies that are to blame.

[QUOTE=ncskier;5421450]
Think of it this way, would you prefer the Federal government mandate everyone must purchase a car from Ford or GM or build a mass transit system that is essentially subsidized and you could ride anywhere for "free". We got the mandate to buy the car.
http://time.com/money/4839017/judy-f...lionaire-epic/

To be fair, it's like mandating that everyone buy a ferrari not a ford. Epic is great, but where the govt screwed up was not mandating that every hospital use CPRS. Free. Well-developed and with a long track record of being effective.

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Originally Posted by FLS

Can't get rid of McConnell soon enough, so we can get back to...


"DEMOCRATIC SUPERDELEGATE, IN ROOM FULL OF HEALTH INSURANCE EXECUTIVES, LAUGHS OFF PROSPECT OF SINGLE PAYER"


"ACTIVISTS ACROSS THE COUNTRY have provided real momentum to the idea of a single-payer health care system, pressing the issue in California and among leading figures in the Democratic Party.


The mere prospect of single payer, however, has elicited swift derision from some corners of the party, with Dick Gephardt, the former Democratic House minority leader, laughing off the idea at a health insurance conference earlier this month.


“Not in my lifetime,” scoffed Gephardt, when asked if the United States will ever adopt such a system.


Gephardt, who serves as a Democratic “superdelegate” responsible for choosing the party’s presidential nominee, was asked about the possibility of single payer at the Centene Corporation annual investor day conference at The Pierre, a ritzy five-star hotel in New York City."

Looking forward, to getting back, to dick.

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And I was feeling so good about the day.... Time to reboot!