Always a good strategy to have the tough part of legislation take effect years later under somebody else's watch.
How Much Will You Pay for Health Care Under Medicare for All?
- Thread starter What Would Jesus Do?
- Start date
Always a good strategy to have the tough part of legislation take effect years later under somebody else's watch.
I see no evidence of that. Might be true for some types of service, but I'm not seeing that when I look at what is charged and what is paid on my own bills and the bills of some friends. Anecdotal evidence, to be sure, but it's all I've got. Where are the real studies?
Which is why I approve that both Sanders and Warren have their medical plans phasing in during their first term.
Seems more honest than what we have been getting from most pols lately.
Revenue cycle management for a typical medical practice costs roughly 5-8% of revenue. So, yeah, paying people to bill and collect for your practice is expensive.
% of GDP is the percent of their gross domestic product they take in to the government total. So for less than 5% more in taxes they get cheaper universities and free to the patient healthcare.
I repeat. SIGN ME UP
You have no particular knowledge of the actual cost of medical services, so what "evidence" would you expect to see by looking at your bills?,... Enact Medicare for all at current reimbursement levels and you will get to watch the existing health care system collapse,... The only reason Medicare/Medicaid works at all right now is because these programs are being subsidized by the higher reimbursements currently paid by private insurance.
OK, now you are just repeating what I said, then going back to your position without any evidence.
What makes you believe "these programs are being subsidized by the higher reimbursements currently paid by private insurance"?
Do private insurers actually pay more than Medicare? How do you know?
For example, suppose you and I go to the same doc for the same treatment. Presumably the doc bills us the same. But my bill runs the Medicare gauntlet, while yours runs the private insurance gauntlet. Both payers knock down the doc's "opening bid." The question is, at the end of the day, how much does the doc receive?
Those are the data we need. And lots of that kind of data.
To continue....
If it turns out to be true that docs and hospitals can't make it on what Medicare for All will pay, then we probably need to adjust what MfA pays. We can do that. And yes, if that's necessary, then that will raise costs for the MfA program, unless there are also balancing reductions that can be made.
But here's the thing we keep hearing: other leading developed nations can do this. And they end up spending less than we do. See @Hoosierhawkeye's chart on the previous page. And despite the propaganda from the right, they do a pretty good job, while covering more people.
So . . . why don't you think the US can do this at least as well as other developed nations?
We can,.. but the result will either be a system that is forced to sacrifice quality in order to accommodate more participants at the current cost,... or a system that retains the current quality levels but becomes ultimately unaffordable because a majority of the added participants won't be contributing towards their coverage.
Yep.
And eliminate the 10% costs going to insurance execs and 'administrators'.
Why doesn't the " government ' just start up their own insulin manufacturing facility and sell it for cost?
Because the GOP is against "big government" doing anything.
Free markets, y'know....
I guess you're right. The GOP controls everything, yet somehow the ACA passed...
Maybe Tom Steyer could use his billions to finance an insulin facility to give it away at cost, with Oprah's help...
That won't go away either after you add back in normal governmental inefficiencies plus the increased administration costs associated with a drastically expanded Medicare program,... you can't make something out of nothing.
Since then, Mitch McConnell has blocked damn near anything on healthcare costs from going through. So, yeah, the GOP has prevented anything on this.
Yet, Iowa's state operated Medicare administration operated at a fraction of the cost of the "privatized" version. So, we have a solid data point indicating this is a complete red herring....
Off topic - but have you guys looked at Medicare Advantage? Medicare starts for me on December 1st, so I am looking at supplemental coverage. I'm still studying it, but the premiums are quite a bit less (like $140/mo). Of course, the deductibles are a little higher, but the total maximum cost works out close to the same. So, if you don't have any health issues in a given year, so can save a fair amount of money with the lower premium.
Also, Medicare Advantage comes with some free stuff, like some dental insurance and gym membership discounts.
We are now in the enrollment period for 2020. You should check it out.
Or, rather than continuing to cut reimbursement to people who actually provide the services, focus on trimming the fat off hospital and insurance administrators.
Over the past few decades, physician reimbursement rates have been stagnant. They aren't even keeping pace with inflation, let alone the huge increased overhead costs (EMR and associated technology expenses, compliance, administrative costs). Over the same time frame, the number of administrators (hospital and insurance) has skyrocketed and the compensation for those individuals greatly increased.
Currently in my specialty the average age of physicians is 55. There are 3-4 physicians retiring for every 1 new physician finishing training. New physicians are taking on huge amounts of education debt in addition to practice debt. It isn't uncommon for a new physician entering a private practice to owe $300,000+ in student loan debt in addition to needing a buy-in (sometimes an additional hundreds of thousands of dollars) to become a partner.
If reimbursement rates continue to decrease, why would anyone want to become a physician? Huge debt, taking call every few nights, endless administrative headaches, high burnout, increasing patient dissatisfaction due to problems created by administrators that you have no power to fix... If I see 25 patients in a clinic, I would prefer to spend 15-20 minutes with every patient. But, if I do that, it doesn't leave much time to finish the endless charting and documentation requirements that have been created by administrators, time to call patients back about test results, keep up on medical literature, and, God forbid, actually see my family. The alternative is to see fewer patients, but that makes paying the bills difficult when reimbursement rates continue to decrease. And, given the provider shortage, creates a situation where patients have to wait weeks (or even months) to see a physician.
Find me another occupation where a huge shortage of workers exists yet the solution is to continue paying them less. Doesn't sound very Republican of you to further drive physicians into the middle class. Why aren't we viewed the same as any other small business?
I think a major issue is that the public (i.e. you) and many politicians don't understand how health care reimbursement works, yet they have very strong opinions on how to fix the problem.
No other industry would stand for the type of controls that government imposes on health care....
Yep
Of course, PART of this is ensuring hospitals and providers are always guaranteed at least SOME compensation for services. One aspect of ACA, is that providers know they will not be out more than around $6-7k per patient or $12k per family for nonpayers (insurance will pay past the deductibles); that has the effect of limiting their liabilities AND allowing them to negotiate lower rates for services.
In the past, it has been those on private insurance subsidizing these costs. ACA tactic is to limit those unfunded liabilities to a fairly small amount.
There are other approaches, but the simple fact is that "Medicare for All" (either buy in or single payer) does eliminate entirely the risk of nonpayment (of course other risks/problems come into play with this).
But that's the issue with physicians and health care compared to other industries. Ethically, hands are tied. What should the physicians do? Go on strike until things are fixed and let patients die? Try to out lobby entities that have far more money, power, and influence?
I know, right? Things have been fantastic since we eliminated the NTSB and FAA....
EDIT: Or is it: All commercial airlines are shutting down until the NTSB and FAA eliminate all their pesky "regulations"....They ain't gonna stand for it no more!!!!
???
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What are other countries doing that make them so great?
I keep hearing how Europe has it so good. Do their doctors and nurses get paid as much as doctors and nurses here?
One article I found shows doctors in Europe make 1/2 or even a 1/3 of US doctors. Considering the high tax rates in Europe it is likely even less. So make medical school free and have a salary cap? Likely have to do same for nurses. Sure that will go over real well.
looks like we are doing a good job of importing doctors from India. My guess is they like it here.
you will not get very far it people are expected to pay a $10,000 tax and the costs will continue to go up. Very few voters that currently have employer subsidized plans are going to be in the mood for that.
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Physicians already practicing will be pretty much trapped given the large amount of student loan debt that most of them carry,... In the future, as word gets out, fewer and fewer young people will be choosing medicine as a career.
No, but their education is highly subsidized so they don't have new physicians entering the work force with half a million dollars in student loan debt...
From what I read they also get paid a lot less. A lot less.
I think artificial intelligence and full body scanners will eventually cut the cost of healthcare dramatically.
Where did I say I support government run health care? You're arguing with yourself, as usual.
No I am not. I am discussing what we have, what is possible, what others are doing, and what voters have the stomach for.
it’s complicated and that’s why nothing gets done. I don’t see anything changing and that’s why technology is the likely long term hope.
people suggest free medical school do they also accept 1/3 the salary for life? That’s what Europe seems to have going.
it’s easy to see all sides. Those that have good employer subsidized plans are not in a hurry to throw that away on vague promises short on details.
those that buy there own insurance and pay 100% of their premiums I can see why they are more willing to roll the dice.
the poors will not pay anything either way.
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So instead of being snarky James...what is the solution? Perhaps just let some diabetics die from no insulin?
It is stupid that “cost” of something so cheap and available keeps those in need from treatment.
It’s not like drug companies are not profitable and can’t afford some charity. The companies can set aside billions in cash to settle law suits for bad drugs....
What, exactly, is a "full body scanner"?
For some areas of health care, A.I. will be extremely beneficial. I'll use pathology as an example. It is already being used as an additional method to help decrease subjectivity involved in looking under a microscope and grading tumors. It cal also help pathologists identify small areas of cancer within a very large specimen that would take them days to do with high degree of human error. The clinical significance of this, however, is questionable versus the academic significance. That said, genomic testing probably will replace a lot of traditional pathology as understanding of tumor biology improves. Radiology is another area with potential for A.I. pattern recognition. Both of these areas are already very impersonal areas of medicine that are not direct patient care. It may also be able to help with physician efficiency in terms of charting or record keeping to reduce administrative time and increase face-to-face patient care.
What is yet to be determined is how A.I. will impact face-to-face medicine. Patients already dislike the impersonal nature of our current system. We are also a long, long, long way off from being able to have robots autonomously do complex surgical procedures (or even basic procedures, for that matter).
One last point regarding A.I. The overhead cost for technology is already very high to medical practices. Will adding a bunch of additional cost in that area truly save money while improving patient care?
Exactly correct. I think early on, the notion of a computer analyzing slides was both threatening to the field (pathology) and not considered viable/worthwhile.
But the value is exactly the opposite: makes them FAR more efficient and able to read many more slides and focus on the areas of actual risk (abnormal pathology) than waste 80% of their day looking at stuff that is all 100% "normal" and "boring".
AI and computers will have a role in improving efficiency, but not replacing expertise and hands-on/direct physician interventions.
I foresee a full body scanner hat can do the same as a hands on examination by a physician in seconds. AI will then compare the patients medical history and current measurables to millions of other databases cases and kick out a diagnosis and treatment plan with almost no involvement from anybody.
I see robots performing surgery. Laugh if you want but a driverless car has to deal with thousands of factors content out of its control like animals, pedestrians, ect. Surgery s the next logical step.
A 16-year-old can effectively drive a car with minimal training. Could they do surgery after taking a few weeks of instruction and some brief supervised on-the-job training?
Compare that to a cardiovascular surgeon who does four years of basic science undergraduate training and two years of medical school to understand pathophysiology, two years of clinical training in medical school, five or six years of general surgery training, and then three years of specific training in cardiothoracic surgery and then still experiences a learning curve when they begin independent practice.
Really nailed that analogy.
Go ahead and bet against technology. Super computer in your pocket ? Roflmao just 20 years ago. Today almost every man woman and child in developed world has one. Get a cheap one for about $100.
When AI hits a computer will be able to read all medical books in seconds and pass any test you give it.
I forgot the laser eye surgery guys are strapped in shooting lasers like Skywalker.
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Extremely simplistic viewpoint. I know surgeons who could pass any test you give them but they are not great surgeons. Adequate, sure.
Putting a "super computer" into your pocket is entirely different technology than A.I. Also, it was "ROFLMAO" for you 20 years ago because of your limited knowledge but not for experts in the field of computers.
A.I. will likely progress to the point of doing many things for us faster and more efficiently. But it is a long ways off from doing complex medical procedures and even replacing primary care physicians. Pattern recognition is one thing, but taking into account social factors, patient preferences, and the humanistic side of medicine is another. For A.I. to replace physicians, it needs to be good at both.
