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If you were among those without insurance, you either forwent care as long as you could, at a substantial risk to your life, or you asked for charity, never a pleasant task for an elderly person who has always taken pride in paying their bills. So many died from delaying care.
As a physician , I think that medicare is good for healthcare in general. We tend to get paid far less for medicare patients than we do for regular insurance, but so far we break even, so seeing these patients is a public service. When we start to lose alot of money on each one of these patients and our practices are threatened with insolvency as a result, it will be a different matter, as it will be akin to sinking the lifeboat. Certainly the old folks cannot be thrown out on the street.
What needs to be done?
1. Raise eligibility to age 72
2. exempt medicare patients from malpractice torts, like the VA system
3. institute VA style prescription "ladder" with emphasis on generic drugs
4. eliminate medicare HMOs
5. terminate care when the statiscal mortality of the patient exceeds 95%. The vast majority of medicare dollars are spent on patients in their last three months of life on heroics which are pointless.
6. eliminate medicare "disablity" for those under 72. It is widely abused by people who could work.
For Medicaid, a MUCH HIGHER deductible is needed. Far too many medicaid patients go to the ER for simple problems that could be addressed in the office. Make them pay a percentage of that and they would suddenly stop. Of the few medicaid patients we have, they will complain bitterly about a $10 out of pocket expense for a $2,000 procedure!
I agree that it would be nice if everyone paid their fair share. What I am trying to point out is that if insurance premiums are a burden, then do without the insurance.
Then you walk out of the hospital with a $100,000 bill that the hospital, their lawyers and collection agencies hound you to pay. It will kill your credit and if you have any assets, they'll take them.
I'm sorry, reneging on your due obligations is not a sound financial plan. As public policy, it's disastrous.
Then you walk out of the hospital with a $100,000 bill that the hospital, their lawyers and collection agencies hound you to pay. It will kill your credit and if you have any assets, they'll take them.
I'm sorry, reneging on your due obligations is not a sound financial plan. As public policy, it's disastrous.
No, it's not a sound financial plan. BUT it may be an option for those that find insurance premiums a big burden. Remember, we are talking about Medicare. Not the younger person. It's an entirely different aspect.
Anyone that leaves the hospital with a $100,000 bill and is unable to pay, seldom has "assets" or good credit. Lawyers and collection agencies are not dumb. They don't waste time going after those that have very little. Of that $100,000 bill, Medicare would probabally "approve" only a small amount. Leaving the patient leaving the patient owing only 20% of that APPROVED amount. There is a large difference.
There are many service organizations that could help many. Often they are for people that have NO ASSETS. If a person has assets, then, they should be expected to pay as much as they can.
As a physician , I think that medicare is good for healthcare in general. We tend to get paid far less for medicare patients than we do for regular insurance, but so far we break even, so seeing these patients is a public service. When we start to lose alot of money on each one of these patients and our practices are threatened with insolvency as a result, it will be a different matter, as it will be akin to sinking the lifeboat. Certainly the old folks cannot be thrown out on the street.
What needs to be done?
1. Raise eligibility to age 72
2. exempt medicare patients from malpractice torts, like the VA system
3. institute VA style prescription "ladder" with emphasis on generic drugs
4. eliminate medicare HMOs
5. terminate care when the statiscal mortality of the patient exceeds 95%. The vast majority of medicare dollars are spent on patients in their last three months of life on heroics which are pointless.
6. eliminate medicare "disablity" for those under 72. It is widely abused by people who could work.
For Medicaid, a MUCH HIGHER deductible is needed. Far too many medicaid patients go to the ER for simple problems that could be addressed in the office. Make them pay a percentage of that and they would suddenly stop. Of the few medicaid patients we have, they will complain bitterly about a $10 out of pocket expense for a $2,000 procedure!
Finally something I could (at least partially) agree with you on. However, the last para is questionable. How would higher deductible discourage people from using ER, and exclusively for Medicaid recipients? Having said that, you do realize that nearly 2/3 of all Medicaid spending is used by those on Medicare, right?
Then you walk out of the hospital with a $100,000 bill that the hospital, their lawyers and collection agencies hound you to pay. It will kill your credit and if you have any assets, they'll take them.
I'm sorry, reneging on your due obligations is not a sound financial plan. As public policy, it's disastrous.
Exactly, which proves that the for-profit private insurance model for healthcare does NOT work. Never did, never will
No, it's not a sound financial plan. BUT it may be an option for those that find insurance premiums a big burden. Remember, we are talking about Medicare. Not the younger person. It's an entirely different aspect.
Anyone that leaves the hospital with a $100,000 bill and is unable to pay, seldom has "assets" or good credit. Lawyers and collection agencies are not dumb. They don't waste time going after those that have very little. Of that $100,000 bill, Medicare would probabally "approve" only a small amount. Leaving the patient leaving the patient owing only 20% of that APPROVED amount. There is a large difference.
There are many service organizations that could help many. Often they are for people that have NO ASSETS. If a person has assets, then, they should be expected to pay as much as they can.
So then You are advocating FEDERAL intervention and socialism, in that this falls into the lap of the federal courts.
As a physician , I think that medicare is good for healthcare in general. We tend to get paid far less for medicare patients than we do for regular insurance, but so far we break even, so seeing these patients is a public service. When we start to lose alot of money on each one of these patients and our practices are threatened with insolvency as a result, it will be a different matter, as it will be akin to sinking the lifeboat. Certainly the old folks cannot be thrown out on the street.
What needs to be done?
1. Raise eligibility to age 72
2. exempt medicare patients from malpractice torts, like the VA system
3. institute VA style prescription "ladder" with emphasis on generic drugs
4. eliminate medicare HMOs
5. terminate care when the statiscal mortality of the patient exceeds 95%. The vast majority of medicare dollars are spent on patients in their last three months of life on heroics which are pointless.
6. eliminate medicare "disablity" for those under 72. It is widely abused by people who could work.
<snip> (Not talking about Medicaid here)
!
4. Def agree with eliminating those Medicare HMOs. They are corrupt.
5. I can go along with the first part of that, e.g. the 95% statistical mortality. You can't at that point eliminate ALL care, however. Not everyone dies as quickly or effortlessly, even w/o treatment, as expected. For the second part, I have seen various statistics (all a little different, mind you) asserting that the majority of medicare dollars are spent in the last (X) months of a patient's life. All that tells ME is that people are sicker the last (X) months of life. I don't know that it's all or mostly spent on heroics.
6. I think there needs to be some sort of disability system in place. Not everyone on disability is able to work. Maybe tightening up the system would be a better approach.
This is an interesting read published in the Economist:
Quote:
DAVID BROOKS had an op-ed in the New York Times yesterday that proclaimed the near impossibility of restraining costs in health care through centralised government efficiency evaluations, which is being justly ridiculed by people (Jon Chait, Jonathan Cohn, Ezra Klein) who note that every single one of the world's centralised government-regulated health-care systems is far cheaper than America's relatively decentralised private-sector one. Mr Brooks has surely had this explained to him a thousand times by now, and his failure to process the fact or incorporate it into his worldview seems to me most likely to reflect an absence of the ideological furniture on which the fact could sit. Mr Brooks doesn't seem to have an instinctive understanding of how it can be possible for unregulated free-market health-care systems to cost more and deliver inferior care than strongly regulated systems with heavy government involvement, and that's why, while he occasionally must have to acknowledge the existence of the French health-care system, he can't seem to retain it.
Here's one example among a million. The other day I went to the IPO announcement of a company that does some fairly state-of-the-art medical stuff. The company was spun off from a public institute a few years back to exploit this technology, but it's been unable to establish significant revenue or market share, or to get within shouting distance of breaking even. Meanwhile, competitors with similar technologies have gobbled up most of the market share, and one is already quite profitable. The company said it planned to raise some tens of millions of dollars with the share issue, many times its current annual expenditures and about a third of its overall market cap. And what would it do with this money? It was going to use half of it to finance a marketing drive, targeting key decisionmakers at American health-care providers and health insurers, and doctors.
Why hadn't this company been able to generate significant revenues? Were its technologies inferior? No, said an independent molecular biologist I talked to. Its product was certainly as good as the competition's. Moreover, it had actually gone to the trouble of getting its technology approved by the FDA, which the competition hadn't. (In this sub-sector FDA approval isn't yet mandatory.) But it hadn't marketed itself well. It hadn't established the relationships with providers and insurers that would ensure that its product was the one they selected. Doing so would require a marketing budget of tens of millions of dollars, in a sub-sector where the entire annual market is a few hundred million dollars.
Just think about this for a minute. A medical technology company is going public to generate the money it needs to advertise its products to hospital directors and insurance-company reimbursement officers. This entails significant extra expenditures for marketing, the new stocks issued to fund the marketing will ultimately have to pay dividends, banks will have to be paid to supervise the IPO that was needed to generate the funds to finance the marketing campaign (presumably charging the industry-cartel standard 7%)...and all this will have to be paid for by driving up the price the company charges to deliver its technologies. (Click to keep reading)
4. Def agree with eliminating those Medicare HMOs. They are corrupt.
5. I can go along with the first part of that, e.g. the 95% statistical mortality. You can't at that point eliminate ALL care, however. Not everyone dies as quickly or effortlessly, even w/o treatment, as expected. For the second part, I have seen various statistics (all a little different, mind you) asserting that the majority of medicare dollars are spent in the last (X) months of a patient's life. All that tells ME is that people are sicker the last (X) months of life. I don't know that it's all or mostly spent on heroics.
6. I think there needs to be some sort of disability system in place. Not everyone on disability is able to work. Maybe tightening up the system would be a better approach.
This post got you a rep point from me. It is more like the Kat I used to read and do so expecting to learn something. Try to keep up the good work.
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