Health Care Reform

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Xan
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Re: Health Care Reform

Post by Xan » Fri Sep 28, 2018 10:10 am

MangoMan wrote:
Fri Sep 28, 2018 9:09 am
If anyone wants to read some clever insight on how to fix the mess that is our US health care system:
https://www.whitecoatinvestor.com/health-care-reform/
Some fantastic ideas and points there. One tweak: I'm not sure the death panels would be necessary if the other points were implemented.
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Re: Health Care Reform

Post by Mountaineer » Fri Sep 28, 2018 10:43 am

MangoMan wrote:
Fri Sep 28, 2018 9:09 am
If anyone wants to read some clever insight on how to fix the mess that is our US health care system:
https://www.whitecoatinvestor.com/health-care-reform/
Interesting article. When I entered the workplace permanently 50 years ago, our medical costs were for "major medical" and out-of-pocket routine medical and dental treatment, both reasonably priced as determined by the ratio of medical expenses to my salary. "Major medical" was catastrophic insurance and was also very reasonably priced. Ratio then was about 5%. Today the ratio is about 10%. One data point that I clearly remember: my first gold crown for a molar, including all prep, was $55. My last, late last year, was over $1000.
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Re: Health Care Reform

Post by jacksonM » Fri Sep 28, 2018 11:53 am

Interesting article with some good suggestions but I would have to disagree with the basic premise that the fault for out of controls costs lies with the patient. Just like doctors we're just cogs in a wheel we have very little control over.

The next time your doctor tells you that you need test X, Y, or Z and they want to see you back in the office in 3 months, try disagreeing with them and see what happens. I know because I've done it. Today I get all my health care at the urgent care clinic.

Same with comparing costs of procedures. Just how is a patient supposed to do this any way?
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Re: Health Care Reform

Post by WiseOne » Sat Sep 29, 2018 8:09 am

Great article on the utility (or lack thereof) of preventive care:

https://lithub.com/barbara-ehrenreich-w ... tive-care/
“A cynic might conclude that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.”
The endless parade of tests and and medications that people are subjected to with increasing frequency as they age - and one might say, coerced - generally have a vanishingly small possible benefit (e.g. reducing risk of a heart attack by 0.001% or catching a tumor a year early, with zero proof that this increases survivability) that's often overblown when presented to the patient. Conversely, the risks (falling down the stairs because the drug makes you dizzy, undergoing surgery, chemo and radiation for a cancer that would never have become clinically relevant) are ignored.

Preventive care can be helpful in some situations, e.g. when you're high risk for a given condition due to family history, past medical history, or a genetic abnormality. Applying prevention to the general, healthy population is different - and when you think about it, kind of a weird concept.

Still think billing, documentation, prior auths etc are the #1 major driver of health costs, but overzealous preventive care is #2.
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Re: Health Care Reform

Post by Maddy » Sat Sep 29, 2018 8:29 am

I'm not sure this anecdote is exactly on point, but it does go to show how myopic the system can be when it comes to coercing patients into needless preventive care. Just yesterday I managed to fall onto a barbed wire fence and sustained a deep puncture wound. It's been eons since my last tetanus vaccination, so reason prevailed over my usual tendency to just let things go, and I headed into town in search of a simple tetanus shot. Well it seems that that the simple tetanus vaccine has been pulled from the market, and that the only way of getting it is in combination with either the diptheria vaccine, the pertussus vaccine, or both. I've been dealing with some autoimmune stuff recently, so the last thing I need is some needless antigen in my system. But after spending nearly the entire day looking for some alternative, it seems that you either get the "full meal deal" or you don't get treated. The only other choice, it seems, is to wait to see if symptoms develop, and if they do, get the anti-toxin or immunoglobulin. (It's possible those options would be available to me now; I plan to figure that out today.) My experience is a little tangential to the discussion of health care reform because, in this case, the motivations are probably not financial, but it does illustrate how treatment standards designed by bureaucrats with an agenda can ignore real risks (in my case, of contracting tetanus) in favor of an abstract benefit. And, yes, it is extremely coercive.
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Re: Health Care Reform

Post by WiseOne » Sat Sep 29, 2018 10:18 am

Maddy, just my 2 cents:

I understand your frustration, but if I were you I would get the DPT booster - this is a high risk situation where prevention actually makes sense.

I'm not sure how to quantify the risk of tetanus (might help to know if there have been cases in your area), but it is a disease that can progress quickly. If you don't get the vaccine at least arrange for a neighbor to come look in on you a few times a day, ok? And, now I'm going to be watching extra carefully for your posts!
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Re: Health Care Reform

Post by Maddy » Sat Sep 29, 2018 1:52 pm

Thanks for your thoughts on this, WiseOne! I was secretly hoping you might send a kernel of advice my way! Fortunately I've got nothing else tugging at me today, so I'll get this squared away one way or another. I did take a look at the CDC stats on tetanus--200-something cases in the U.S. in 7 years, and when you think of the number of people who get punctured, torn, and sliced on a daily basis and never think anything of it, some of whom have never been vaccinated, it's a bit less concerning.
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Re: Health Care Reform

Post by Maddy » Tue Feb 19, 2019 6:36 am

I recently became aware that DirectLabs offers a tetanus titer blood test for approximately $30, no requisition required. Had I known about this option at the time I was dealing with this, I would have jumped on it as a reasonable first step. It's kind of amazing, in retrospect, that I could spend the better part of two days running around the county in search of an unadulterated tetanus toxoid and not a one of the clinics or pharmacies I spoke with ever mentioned this very reasonable, affordable approach to determining whether I already had sufficient immunity.
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Re: Health Care Reform

Post by Maddy » Tue Feb 19, 2019 6:41 am

P.S. Mods, Would it be appropriate to move the last few posts to the recently-started vaccine thread?
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Re: Health Care Reform

Post by WiseOne » Tue Feb 19, 2019 12:36 pm

Sure, let's take up this thread.

I was just checking my junk mail over lunch, and saw something about a letter to Congress about the dreaded out of network payment surprises. It's linked through a professional organization website, so I'm copying the main text here. Most interesting!
Dear Chairman Neal and Ranking Member Brady:
Patients, physicians, and policymakers are deeply concerned about the impact that
unanticipated medical bills are having on patient out-of-pocket costs and the patient-physician
relationship. Health insurance plans are increasingly relying on narrow and often inadequate
networks of contracted physicians, hospitals, pharmacies, and other providers as one mechanism
for controlling costs. As a result, even those patients who are diligent about seeking care from
in-network physicians and hospitals may find themselves with unanticipated out-of-network bills
from providers who are not in their insurance plan’s network, simply because they had no way of
knowing and researching in advance all the individuals who are ultimately involved in their care.
Physicians and other providers are limited in their ability to help patients avoid these
unanticipated costs because they, too, may not know in advance who will be involved in an
episode of care, let alone other providers’ contract status with all the insurance plans in their
communities.
As Congress develops potential legislation to provide relief to patients from health care
costs that their insurance will not cover, we urge your consideration of the following policies.
• Insurer accountability. Since overly narrow provider networks contribute significantly
to this problem, strong oversight and enforcement of network adequacy is needed from
both federal and state governments. Robust network adequacy standards include, but are
not limited to, an adequate ratio of emergency physicians, hospital-based physicians, and
on-call specialists and subspecialists to patients, as well as geographic and driving
distance standards and maximum wait times. Provider directories must be accurate and
updated regularly to be useful to patients seeking care from in-network providers. In
addition, insurers should be held to complying with the prudent layperson standard in
existing law for determining coverage for emergency care, so that insured patients are not
liable for unexpected costs simply because they were unable to accurately self-diagnose
ahead of time whether their symptoms were, in fact, due to an emergency medical
condition.
• Limits on patient responsibility. Patients should only be responsible for in-network
cost-sharing rates when experiencing unanticipated medical bills.
• Transparency. All patients who choose in advance to obtain scheduled care from outof-network physicians, hospitals or other providers should be informed prior to receiving
care about their anticipated out-of-pocket costs. When scheduling services for patients,
providers should be transparent about their own anticipated charges, and insurers should
be transparent about the amount of those charges they will cover.
• Universality. In general, any federal legislation to address unanticipated out-of-network
bills should also apply to ERISA plans.
• Setting benchmark payments. In general, caps on payment for physicians treating outof-network patients should be avoided. If pursued, guidelines or limits on what out-ofnetwork providers are paid should reflect actual charge data for the same service in the
same geographic area from a statistically significant and wholly independent database.
They should not be based on a percentage of Medicare rates, which have become
increasingly inadequate in covering overhead costs, nor should they be based on innetwork rates, which would eliminate the need for insurers to negotiate contracts in good
faith. Any prohibition, whether state or federal, on billing from out-of-network providers
not chosen by the patient should be paired with a corresponding payment process that is
keyed to the market value of physician services.
• Alternative dispute resolution. Legislation should also provide for a mediation or
sequential alternative dispute resolution (ADR) process for those circumstances where
the minimum payment standard is insufficient due to factors such as the complexity of
the patient’s medical condition, the special expertise required, comorbidities, and other
extraordinary factors. ADR must apply to states and ERISA plans. Arbiters should not
be required to consult in-network or Medicare rates when making final determinations
regarding appropriate reimbursements.
• Keep patients out of the middle. So that patients are not burdened with payment rate
negotiations between insurers and providers, physicians should be provided with direct
payment/assignment of benefits from the insurer.
The problem of unanticipated out-of-network bills is complex, and requires a balanced
approach to resolve. In addition to providing strong patient protections, we believe the principles
set forth above would improve transparency, promote access to appropriate medical care, and
avoid creating disincentives for insurers and health care providers to negotiate network
participation contracts in good faith.
We appreciate your consideration of these policies and look forward to working with you
on these matters.
It's signed by virtually every specialist organization.

A few observations:

Two of the bullet points are self contradictory: "Limits on patient responsibility" and "Setting benchmark payments". Effectively there will have to be caps on charges, since the current status quo is that the patient gets to pay the full bill and that's the problem to be solved, right?

Most of the problem is anesthesiologists and radiologists - both of whom are incentivized NOT to join insurance plans, since they get paid more if they aren't in-network. The value to physicians that meet patients face to face is that they will get more patients coming in if they're in-network, but that value does not apply to specialties whose services are purely ancillary, and who don't attract patients directly.

As per usual, no individual person or organization is being evil. It's just the logical adverse effects of a poorly put together system. The whole concept of in vs out of network is what needs to go.
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Re: Health Care Reform

Post by WiseOne » Sun Mar 03, 2019 4:48 pm

This article about a ridiculously expensive ER bill for treating a cat bite came up on the Apple news feed:
Total bill: $48,512, with $46,422 of that total for one preventive medication

Medical service: Parker's wound was examined, and she received the first in a series of rabies shots, as well as an injection of 12 milliliters of rabies immune globulin, an antibody that kick-starts the immune system to provide protection from the virus until the vaccine kicks in.

...

Alvarez also noted that the month after Parker was treated, Mariners revamped its full price list, known as a "chargemaster." The hospital lowered its charge for rabies immune globulin to $1,650 per 2 milliliters, which would have made Parker's bill about $9,900 — still high, but not sky-high.

Hospitals revisit their chargemasters periodically. But it should be noted that this particular 79 percent cut came shortly before January, when new rules required all hospitals for the first time to post those previously hidden charge lists publicly on websites, part of the Trump administration's interpretation of the Affordable Care Act.
https://www.npr.org/sections/health-sho ... lls-48-512

So nice to see price transparency doing its job. Simply making it embarrassing for hospitals to mark up items to indefensible levels is going to work wonders. There are now articles directly comparing prices for procedures among nearby hospitals, which might well result in people choosing hospitals accordingly.

I might also point out that, even though I share everyone's worst opinions of Donald Trump as a person, the fact is that his unsung accomplishments like requiring that hospitals post their charge lists comes as part of the package. Correct me if I'm wrong, but I don't remember anyone else in Washington seriously talking about hospital price transparency.
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Re: Health Care Reform

Post by ochotona » Sun Mar 03, 2019 8:40 pm

There is a bipartisan bill in the Texas Legislature to outlaw surprise billing by out of network providers.

------------------------------------------

.... sweeping bipartisan legislation was introduced by Sen. Kelly Hancock, R-Fort Worth, and Rep. Trey Martinez Fischer, D-San Antonio, to pull patients from the middle of billing disputes in the state’s existing mediation process and prohibit out-of-network doctors from charging them for any portion of a bill that insurers don’t pay.

“Enough is enough,’ Hancock said as he announced the effort.

For a decade, Hancock has battled surprise billing in the state, dating back to his 2009 creation of the state’s mediation process to settle medical bills. In the years since, though, he said many involved have found ways around the protections.

Senate Bill 1264 takes the toughest stance so far, not only protecting all patients in emergency room care, but also those who go to an in-network facility only to find themselves saddled with substantial medical bills from an out-of-network doctor they did not choose.
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Re: Health Care Reform

Post by Kbg » Sun Mar 03, 2019 9:06 pm

My sense, let’s say the next 5 yrs, is that something major is going to happen with healthcare in the US. The system is simply not sustainable as it is and people, for good or bad, are willing to go with something radical.
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Re: Health Care Reform

Post by Kriegsspiel » Mon Mar 04, 2019 7:22 pm

The current Medicare-For-All bill reportedly proposes to ban private health insurance, which even the Canadian Supreme Court ruled was a human rights violation. A former aide for Chuck Schumer went on Tucker's show and argued that that was just a starting point, because Americans used to "meet in the middle" LOL.

When your starting point in a negotiation has been ruled a human rights violation. ^-^ ^-^ ^-^ ^-^
You there, Ephialtes. May you live forever.
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Re: Health Care Reform

Post by D1984 » Mon Mar 04, 2019 11:13 pm

WiseOne wrote:
Sun Mar 03, 2019 4:48 pm
This article about a ridiculously expensive ER bill for treating a cat bite came up on the Apple news feed:
Total bill: $48,512, with $46,422 of that total for one preventive medication

Medical service: Parker's wound was examined, and she received the first in a series of rabies shots, as well as an injection of 12 milliliters of rabies immune globulin, an antibody that kick-starts the immune system to provide protection from the virus until the vaccine kicks in.

...

Alvarez also noted that the month after Parker was treated, Mariners revamped its full price list, known as a "chargemaster." The hospital lowered its charge for rabies immune globulin to $1,650 per 2 milliliters, which would have made Parker's bill about $9,900 — still high, but not sky-high.

Hospitals revisit their chargemasters periodically. But it should be noted that this particular 79 percent cut came shortly before January, when new rules required all hospitals for the first time to post those previously hidden charge lists publicly on websites, part of the Trump administration's interpretation of the Affordable Care Act.
https://www.npr.org/sections/health-sho ... lls-48-512

So nice to see price transparency doing its job. Simply making it embarrassing for hospitals to mark up items to indefensible levels is going to work wonders. There are now articles directly comparing prices for procedures among nearby hospitals, which might well result in people choosing hospitals accordingly.

I might also point out that, even though I share everyone's worst opinions of Donald Trump as a person, the fact is that his unsung accomplishments like requiring that hospitals post their charge lists comes as part of the package. Correct me if I'm wrong, but I don't remember anyone else in Washington seriously talking about hospital price transparency.
Technically it wasn't Trump that did it; I believe Seema Verma and Alex Azar (which since they were his appointees...credit to Trump where where credit is due) were the ones behind this. With that said; IIRC what happened was that CMS simply issued a regulatory reinterpretation of a section of the Affordable Care Act that had since 2014 required hospitals to make available a list of their chargemaster prices upon request; the new interpretation of this part of the ACA by Trump's CMS says that as of 1-1-2019 hospitals have to post it online or at least make it available in machine-readable format and they have to do so pre-emptively, without first being asked.

See: https://healthpayerintelligence.com/new ... ary-1-2019 and https://www.sheppardhealthlaw.com/2018/ ... inal-rule/

I also don't have your confidence that merely requiring them to post the chargemaster prices will do much. It may work somewhat in places like NYC where there are many hospitals competing in a very small area but (for example) where I live there is one hospital system that is a monopoly until you go around 32-60 miles (depending on which cardinal direction you head in) and even when you go to one of those other cities that are 35 or 41 or 59 miles away the hospital systems in those cities are virtual monopolies too (the one at almost 60 miles away does have a small private hospital competing with it but they are rather picky about what insurance they accept and if I recall correctly have limited ER facilities). Not particularly helpful if you have a medical emergency and need to get to the closest facility ASAP, or are a single parent working two or three jobs with very limited time to travel almost an hour, or don't have a car, etc.

What would help more is a bill like ochotona suggested...or barring that do what Maryland does and mandate that Medicare, Medicaid, private insurance, the uninsured who pay cash, etc, all pay the same rate, or at least do what New Jersey does and don't allow hospitals to charge any of the uninsured--or at least those uninsured who make up to 500% of the poverty line anything more than Medicare rates + 15%.

Of course, what would REALLY help would be single-payer Medicare-for-all and use the government's negotiating clout and monopsony buying power to get rates down to as low as possible but where hospitals can still at least break even.
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Re: Health Care Reform

Post by D1984 » Mon Mar 04, 2019 11:21 pm

Kriegsspiel wrote:
Mon Mar 04, 2019 7:22 pm
The current Medicare-For-All bill reportedly proposes to ban private health insurance, which even the Canadian Supreme Court ruled was a human rights violation. A former aide for Chuck Schumer went on Tucker's show and argued that that was just a starting point, because Americans used to "meet in the middle" LOL.

When your starting point in a negotiation has been ruled a human rights violation. ^-^ ^-^ ^-^ ^-^

They wouldn't actually need to ban private insurance; simply do what New York did (and Oregon did at one time too) and mandate that all private health insurance be guaranteed issue and community rated with little or no limited open enrollment period (i.e. people can enroll right before going to the ER, enroll as soon as they find out they are pregnant, enroll as soon as they find out they have cancer, etc). For the cherry on top do like some states did with LTC policy rates (I'm looking at you, Pennsylvania) and refuse to allow premium increases even when actuarially completely justified. Voila, within a few years at most you have an adverse selection actuarial death spiral and soon there will be no private insurance.

In all seriousness, though, It seems the Dems have finally gotten the lesson that you don't start negotiating from where you want to finish at; you start with a pie-in-the-sky "If I was king of the world this is what I'd do" progressive's wet dream and you negotiate down from there. If you start from the absolute center on healthcare and negotiate down from there, you end up with.....<drumroll for effect>.....Obamacare.
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Re: Health Care Reform

Post by WiseOne » Tue Mar 05, 2019 7:54 am

Good for Texas, indeed!!! Hope other states take note. And D1984, if you read the article I posted (and the quote from it) you'll see that the chargemaster posting requirement has already resulted in a large cut to a clearly indefensible charge by that hospital. I also read a local news article directly comparing prices for a common procedure among several nearby hospitals - which is a great thing for journalists to do, if they can take time away from their People magazine-like treatment of the US government.

Medicare for all seriously needs to happen, but I'll be interested to see the proposals for how to pay for it. Adding 4% to the current Medicare tax is probably a fair way to do it and certainly the simplest and most logical, but unfortunately the Dems seem determined to bind this already hot button issue up with the recent manic desire to sock it to the rich. Which brings up the question of how you define "rich".

This document on Bernie Sander's website gives at least his answer to that question: Rich = $250,000 "household" income, which I take to mean married filing jointly. That would presumably translate to an income of $125,000 for a single person. Doesn't sound rich to me, but it's all so subjective. In NYC that gets you a comfortable but not luxurious middle class lifestyle. In Vermont it may be regarded as rich.

https://www.sanders.senate.gov/download ... nline=file
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Re: Health Care Reform

Post by Xan » Tue Mar 05, 2019 9:45 am

One big thing for me with your "Medicare for all" plan, WiseOne, is whether or not people can use some of that money to go find and pay for their own care.

In other words, if it's like public schools, where everybody has to pay for the public schools and then on top of that pay for a private school if you want, then no thanks.

If it's like a school voucher system, where I can use the money I would have paid the public school towards whatever education I choose, then maybe.
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Re: Health Care Reform

Post by Kriegsspiel » Tue Mar 05, 2019 9:50 am

Xan wrote:
Tue Mar 05, 2019 9:45 am
One big thing for me with your "Medicare for all" plan, WiseOne, is whether or not people can use some of that money to go find and pay for their own care.
From what I've seen, the bill bans private plans that duplicate Medicare's coverage.
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Re: Health Care Reform

Post by jacksonM » Tue Mar 05, 2019 12:18 pm

Kriegsspiel wrote:
Tue Mar 05, 2019 9:50 am
Xan wrote:
Tue Mar 05, 2019 9:45 am
One big thing for me with your "Medicare for all" plan, WiseOne, is whether or not people can use some of that money to go find and pay for their own care.
From what I've seen, the bill bans private plans that duplicate Medicare's coverage.
I think somebody needs to define "Medicare for all" when they talk about this.

There is Medicare part A which is free at age 65 and pays a portion of hospital bills only, part B for which a premium is paid and includes doctors visits with co-pays. Then there is part D which includes coverage for prescription drugs, also with a premium and co-pays. My parents also had a medicare "advantage" policy which I don't know much about except that it paid nearly all but $2,500 of the $660k bill my mother accumulated during her recent 3 week end-of-life stay in the hospital.

So what do they actually mean when they say Medicare for all? My guess is that they don't really mean to put everybody into this system. I'm guessing what they are really talking about is free health care for all which is not medicare as we know it. And I think those who are proposing it probably know it too and are just trying to trick us.
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Re: Health Care Reform

Post by Xan » Tue Mar 05, 2019 12:31 pm

jacksonM wrote:
Tue Mar 05, 2019 12:18 pm
Kriegsspiel wrote:
Tue Mar 05, 2019 9:50 am
Xan wrote:
Tue Mar 05, 2019 9:45 am
One big thing for me with your "Medicare for all" plan, WiseOne, is whether or not people can use some of that money to go find and pay for their own care.
From what I've seen, the bill bans private plans that duplicate Medicare's coverage.
I think somebody needs to define "Medicare for all" when they talk about this.

There is Medicare part A which is free at age 65 and pays a portion of hospital bills only, part B for which a premium is paid and includes doctors visits with co-pays. Then there is part D which includes coverage for prescription drugs, also with a premium and co-pays. My parents also had a medicare "advantage" policy which I don't know much about except that it paid nearly all but $2,500 of the $660k bill my mother accumulated during her recent 3 week end-of-life stay in the hospital.

So what do they actually mean when they say Medicare for all? My guess is that they don't really mean to put everybody into this system. I'm guessing what they are really talking about is free health care for all which is not medicare as we know it. And I think those who are proposing it probably know it too and are just trying to trick us.
No doubt. I'm sure the phrase "Medicare for all" is simply the version of "nationalized healthcare" which focus-grouped the best.

Also keep in mind that your mom's sticker price is not anywhere close to what the actual cost was: it isn't what Medicare paid, nor is it what she would have paid without insurance. The real cost was probably on the order of $66k. Okay, that number is a wild guess; maybe somebody else more knowledgeable could come up with a better one.
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Re: Health Care Reform

Post by boglerdude » Tue Mar 05, 2019 11:23 pm

> Loooong waits to see specialists and have surgery are the norm there.

Thats good, as long as you have the option to buy private insurance for faster service (but they cant). Freeways should be the same, slow free lanes and fast toll lanes
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Re: Health Care Reform

Post by WiseOne » Wed Mar 06, 2019 6:45 am

It's supposed to be an "expanded Medicare program with improved and comprehensive benefits". So presumably all parts.

Xan, what care do you think you can get now but can't under a plan like this? Currently if you're not paying cash, you have to seek permission from your insurance company (it's called "prior authorization") in order to get certain tests, procedures, and medications. Medicare is much less restrictive than private insurance, in fact. It doesn't do prior auth. Its main tool for controlling costs is to limit reimbursements. I expect boutique/concierge practices will not change under a Medicare for all system.

Everybody always brings up Canada which is a completely silly comparison. First, I happen to know several Canadian physicians. Yes, the wait for routine specialist care can be long, but urgent/emergent stuff happens as quickly as it does here. And, routine care here is often delayed so much by insurance company red tape that you effectively have wait times here too. Second, in Canada health care spending is constrained to less than half of what we spend per capita here in the US. They've got fewer doctors, way fewer specialists, and fewer facilities. If they increased their spending to US levels, that would take care of the bottlenecks.

There's no proposal here to decrease our medical spending, though of course that could happen later. It's a separate debate that may one day be worth having. Instead, the goal is to save money (about $600-700 billion) by eliminating the administrative inefficiencies built into our current system. Medicare's overhead is a tiny fraction of what private insurance companies have and inflict on the rest of the system.

One thing that I hope will change also: Medical care here is increasingly focused on milking as much money as possible from every patient, to the point where I really question whether anyone is getting "medical care" as opposed to "oh goodie, you have symptom/condition X. I can order you up a pile of treatments and tests that will mollify the bean counters who are on me every day to work harder for the same pay to earn more money. Never mind if you actually need them." I'm not sure this would change, but having fewer administrators to deal with couldn't hurt.
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Re: Health Care Reform

Post by WiseOne » Wed Mar 06, 2019 8:00 am

I think that may have been true years ago, but that's not what's driving it now. It's a combination of top-heavy administrations trying to squeeze more productivity from the proletariat (i.e. doctors) because that's your standard business model, and a "the customer is always right" mentality.
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Re: Health Care Reform

Post by Xan » Wed Mar 06, 2019 8:57 am

WiseOne wrote:
Wed Mar 06, 2019 6:45 am
Xan, what care do you think you can get now but can't under a plan like this?
The concern I'm raising isn't one about not being able to get care, it about (like the public schools) having to pay for BOTH the bad, "free" care AND the good care I would actually want. Instead of (like the school vouchers) being able to take [some of] the amount I contributed to the "free" care and use it towards the good care.
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