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Medicare reimbursement rates would bankrupt MANY hospitals and physician practices in the US. For my specialty, Medicare pays 1/4th to 1/5th of regular insurance. We are able to see medicare patients as the loss we have on them is offset by private insurance patients.
When one talks about physician and facility reimbursement, everyone forgets about OVERHEAD. If rates are cut dramatically, we still have fixed overhead costs (staff, lease, equipement, disposeables) that must be paid.
Bankrupting MANY practices in the US does little to alleviate the current physician shortage. How could "single payer" work? If physicians were put on salaries. However, then you have a situation like the VA, in which salaried physicians see about 1/4 the number of patients that private practice physicians see in one day.
That is the problem with socialism.......................................
I am on Medicare and have been for the past 5 years. I don't see my doctors that much. Once to see my GP and twice to a specialist (every 6 months) re an on-going infection (which is very much under control) last year.
Anyway, I get a copy of every bill as well as the amount paid by Medicare. I have to tell you that total (along with the supplemental) pays far, far more to my doctors than you imply. In fact, its much more than 1/2 of what the doctors billed.
Perhaps its their specialty. Maybe its the location.
In any event, my experience (looking at the amount billed vs paid on my last statement) is vastly different than what you post. And if I were to multiply that amount paid by 4 or 5 the results would be beyond preposterous and far above the billed amount. NO insurance company would even remotely pay that multiplied amount. Not ever.
These are liberal idiots who do not work as providers in the healthcare field.
We see medicare patients (even though we lose money on every one of them) due to the fact that private insurance profits allow us to do so.
In my practice, I limit the number of medicare patients to 20% per day and do not take new Medicare patients. Medicare patients in our area generally have waits of 3-4 months to see a physician. If you have private insurance- 1-2 weeks. If we opened our doors to all medicare patients, we would be broke.
In healthcare we have expenses:
1. I employ four nurses, two nurse practioners, two receptionists and a biller coder
2 I have $1 million in overhead per year
3. If I only had medicare patients, I would generate $400K per year and would lose $600K per year with ZERO income.
4. Medicare "managed care" takes regular medicare and makes it worse by restricting payment and access
5. Drug companies and equipment makers could not survive if reimbursed for medicare rates (contacted)
If you want "single payer" you would:
1. have "expected" costs of $1.3 trillion per year
2. above costs do not take account of the fact that 1/3 of medical practices would be bankrupt
3. above costs do not take into acccount the actual overhead costs in seeing patients
4. the above costs do not take into account that physicians will not work for free
5. the above costs do not take into account that innovation from the drug and equipment companies would come to a standstill.
6. remove trillions of dollars from the private economy- what do you suppose would happen to consumer demand/jobs, the economy?
keep in mind that the same "geniuses" that are advocating "single payer" are the same ones that were cheering "Obamacare" (which is collapsing, as it is just an expansion of medicaid).
Nothing is free- WAKE UP- Are you really that dumb? Perhaps MTA-Tech (who was a big advocate of the cost savings of Obamacare) could spin you some fables about how all this would work without MASSIVE increases in US taxes?
Being in the industry so long, I couldn't agree more. But even as we outline how things work, it just falls on deaf ears, unfortunately.
I am on Medicare and have been for the past 5 years. I don't see my doctors that much. Once to see my GP and twice to a specialist (every 6 months) re an on-going infection (which is very much under control) last year.
Anyway, I get a copy of every bill as well as the amount paid by Medicare. I have to tell you that total (along with the supplemental) pays far, far more to my doctors than you imply. In fact, its much more than 1/2 of what the doctors billed.
Perhaps its their specialty. Maybe its the location.
In any event, my experience (looking at the amount billed vs paid on my last statement) is vastly different than what you post. And if I were to multiply that amount paid by 4 or 5 the results would be beyond preposterous and far above the billed amount. NO insurance company would even remotely pay that multiplied amount. Not ever.
What you are referring to is known as the billed, allowed, and paid amount - copay, co insurance, deductible. Everyone that sees a provider gets what you do as its the law... It's called an 835 transaction it eob to you (explanation of benefits), eor to the provider (explanation of remittance). The 'write-off' is called overhead.
This has also been explained before. Docs contract above the med fee schedule with group insurance to make up the deficit of Medicare and Medicaid.
An office visit, 99201 as an example reimburses like...
Medicare = 50
Medicaid = 35
Group = 70
There is also something called the wage index based off either the msa (med service area) or cbsa (core based service area) determined by rural or metropolitan area. Same thing for institutional (hospitals) that are paid by a 'pps' prospective payment system. Same principle. In short, most providers have to contract at a higher rate than Medicare reimbursements to even be able to operate, or they will be paying their own money to keep their doors open.
And, again, the AMA sets the rvu (relative value unit) of each procedure (overhead, etc...) but... They make their money from cmms. That is what dr participation in that organization is so low (less than 20% last I checked), why practicing physicians and surgeons are not keen on it. Most that work for the AMA are no longer practicing physiciabs. Their income comes from cmms, so it's in their interest, the org, to look out for, not those in practice (that's also why many new techniques will be covered privately but take a few years with Medicare. That's a coding aspect)
I actually think Medicare could make money by insuring young healthy people. Why not?
How do you figure that? I'm not 65 or retired yet. They are making money on me to the tune of $906 a year. On the plus side, it might save someone their home if catastrophe strikes at 45.
Exactly. That's what people don't understand about Medicare. People pay premiums (Medicare tax) for decades before they ever become eligible for benefits, and even when they DO become eligible, they STILL have to pay premiums.
I don't disagree with the intent... Just technically FICA is meant for the working to fund traditional Medicare (more employed, more FICA) and the deductibles and coinsurance if those on Medicare is the member cost share. Your summation is still relevant... It doesn't cover the outlay (utilization = payments) of the program
Do you remember who your mac was? Just curious... Some were seen as favorable for the providers I helped, some not so much.
You must be using terms from the admin or payment side that I am just not familiar with. As I recall Aetna had been in there at some time with payments. But details I never dealt with. 2 other docs I'm skiing with this week, one retired, one partly don't know these terms either.
Exactly. That's what people don't understand about Medicare. People pay premiums (Medicare tax) for decades before they ever become eligible for benefits, and even when they DO become eligible, they STILL have to pay premiums.
This is correct, but still the average beneficiary ends up receiving 2-3X more in HC dollar returns in their lifetime.
This is correct, but still the average beneficiary ends up receiving 2-3X more in HC dollar returns in their lifetime.
Some pay way more over the decades of their working careers than they'll ever receive in benefits, and some pay much less than even the 1/3 to 1/2 you state.
That's like charging some $100 for a bandage, while charging others only 10 cents for a bandage. That's why any socialistic program disincentivizes productivity and achievement.
Exactly! Cut the middle MAN out. For example medical centers could offer health plans and the patient would buy the plan directly from the people that actually provide the care. IN Uruguay anyone can buy cheap health insurance directly from medical centers and group of doctors. In fact expats retirees love the plan and to top it off they will gladly accept Blue Cross if you are not a member. Why do you think Kayser is growing?
This might work in larger areas, but not rural. HMO's were to be the big thing back in the '90's. Kaiser does still seems to do well.
I still support a public option and let the privates do as they may.
We may end up with a system with large HC coverage concerns closer to utilities. Moving forward I foresee more central controls as the money needs continue to climb.
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Cut the middle MAN out. For example medical centers could offer health plans and the patient would buy the plan directly from the people that actually provide the care. IN Uruguay anyone can buy cheap health insurance directly from medical centers and group of doctors. In fact expats retirees love the plan and to top it off they will gladly accept Blue Cross if you are not a member. Why do you think Kayser is growing?
