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I see you must be a provider as well. We don't even take medicaid (except those collected by our neurosurgeons on call). We are a part of the same spine group and I have to see all of those patients. Thankfully, there are not many.
Many of these "free", "medicare for all", "single payer" systems sound great to the public. However, as Obamacare has shown (and clearly illustrated by rational providers prior to its implementation) nothing is "free" and "projected cost savings" never seem to happen.
The bottome line:
1. Healthcare is expensive
2. You get what you pay for
3. Most of the innovation in medicine in the world comes from the US
4. R&D and product development costs money
5. Rationing healthcare and using generics is part of the answer to cut costs
6. Americans are unwilling to give up "Cadillac" medicine, yet want a "Yugo" price
7. Procedure rates in America are partially driven by a "fee for service system"
8. Imaging is over used, but is demanded by patients
9. Few, if any, relatives will allow "grandma" to die, even when she is 89 years old and has conditions for which there is a 99% mortality.
Actually Hawk, I worked for a huge payor for years... Started as a claims adjuster and ended as a finance trend consultant before getting into contracting. (Actually helped build the 'Hawkeyes' dental turfing reports for your states Medicaid dental Mco last year).
Much of my work was contract resolution, then fixing our ma plans... Much of which was spent explaining to cmms how their documentation was wrong. But I also wrote our 5010 crosswalk for all clearinghouse a and paper transactions, did 90% of the icd 10 gem by myself (our coders were bewildered), etc... I left because I knew we were going to get bought because we had the second largest ma pop in the country (that should tell u who I worked for . Went to Medicaid when mco's moved into this state then got thoroughly disgusted.
Trying to explain to the Lay person can't be done. I've come to that conclusion. They won't understand when you say 'deemed'.
When the Medicaid subsidies hit the states in 2019, you and I both know how quick the mco's will pull the options out of the Aca.
I don't blame you on the Medicaid aspect. It costs your practice money to see a patient, many times looking for a script to continue their lifestyle.
You also hit the nail on the head with 9.: utilization! People use insurance as maintenance vs 'in case stuff happens'. The analogy I give is this: if the dryer breaks in the house, one doesn't call their homeowners insurance. Yet, through the indemnity plans offered from the 50s till the mid 80s, that is the common perception of what healthcare is for. And then kaiser started hmos... A group of docs in cal yet everyone blames payors.
You are confusing Medicare with *Medicaid* and SSDI
The first is an entitlement program; unless you (or spouse) have paid into and otherwise qualify you don't get benefits. Medicaid and SSDI are essentially welfare programs paid for out of general tax revenue and in the case of the former shared costs with states.
Medicare actually is one of the most efficient "health insurance" plans in the USA. Yes, there is fraud, waste and abuse but it does the job intended better and for less cost than private.
Where you would see any fight in expanding Medicare would likely come from physicians and hospitals who are already moaning over the low reimbursement rates for providing care to seniors. Ask them to expand that "loss" to younger patients and there likely will be all out war.
I had to chuckle at the contention in that individuals position about Medicare and efficiency vs private. Medicare is private. Lol MAC contracts goes to the lowest per claim bidder.
Not sure I am following the logic of any perceived cost savings by allowing the "young and healthy" to be covered by Medicare. Medicare is financed through a 2.9% payroll tax, 1.45% split between employers and employees. So your average person works their entire adult life to age 65, pays in over than period, then is covered (not counting the many other additional out of pocket costs for supplements, etc.) Young, healthy persons being enrolled would not do anything to bring downs costs, in fact, it would have the opposite effect, and would dramatically escalate costs. You would have the young/healthy folks using a system they have not paid into over a 45 year period.
The young and healthy pay premiums for private insurance. Why not use those premiums to buy Medicare insurance? We know the Private Insurance folks make billions in providing insurance to the young. One would think Medicare could also make money by insuring these folks.
The government lends money to college kids and charges them a high interest.
Quote:
The federal government made enough money on student loans over the last year that, if it wanted, it could provide maximum-level Pell Grants of $5,645 to 7.3 million college students.
The $41.3 billion profit for the 2013 fiscal year is down $3.6 billion from the previous year but it's a higher profit level than all but two companies in the world: Exxon Mobil cleared $44.9 billion in 2012, and Apple cleared $41.7 billion.
Why not provide more choices to the citizens like they do in many European countries.
Quote:
The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Some individuals choose to completely pay for their care privately. WIKI
What is wrong with competition?
This is not single payer, this free market competition.
Private healthcare insurance is regulated at the state level by governor appointed insurance commissions. No two states have the same regulation, mandatory inclusions and exclusions beyond the " Essential Service" federal mandate. The ACA respected ( capitulated ? ) state rights to self determine state minimum coverage beyond " Essential Services".
Without understanding state specific inclusions/ exclusions, it is not reasonable to compare premiums between states.
In the individual plan market, a " fill in the blank" metal plan in one state is not the same as a " fill in the blank" metal plan in another state, beyond the federally mandated " Essential Services".
Some states do not mandate inclusion of outpatient surgery.
Some states allow adult children to remain on their parent's plan beyond age 26.
Covered treatments vary state to state.
Some states allow insurers to exclude certain medical specialists from their networks.
Drugs included are highly variable, state to state.
Premiums for the same plan/ same insurer can vary within a state based upon region. Premiums depend ,in part , on the competitiveness or lack thereof, of the local healthcare market in a given region. Then there's the insurer's healthcare provider networks. Some plans have wider/ deeper healthcare provider networks than others.
When politicians use the " talking point" about enabling the sale of healthcare insurance across state lines as a means of creating more competition and reducing premiums, they show their ignorance.
They, like so many consumers, assume all healthcare insurance is alike.
You just described a complex system design to maximize profits. These folks see health care as a perennial cash cow even thou they provide ZERO health care. All the work private insurance do could be contracted out for a service fee.
Given that most of those country's governments with a single-payer or universal healthcare plan do not "OWN" the facilities, do not "employ" the doctors, and do not dictate to the consumer who, what, where or how you attain your routine or specialist care...can we agree to put that "socialist" meme on a back burner for a bit until you people come to your senses and stop comparing yourselves to other, more civilized, countries who actually shive-a-git about their fellow citizens welfare.
On here at least, all you people seem capable of is determining who is getting a freebie in your eyes and then refer to that individual as a "socialist" a "leftie" a "liberal" a "democrat" or some other disparaging adjective that does nothing whatsoever to disguise the "I'm all right jack; fugg you" nature of today's average American.
It is quite frankly amazing how many of you do not identify with the middle class that most of you belong to, but instead pattern all your thinking based upon 'aspiring' to be a member of those guys featured in the links above. You (figuratively) would deny your fellows an affordable and basic life necessity purely because you believe it might improve your odds while reaching for that "golden ring" on the merry-go-round of life with a less than .001% chance of actually grabbing it.
That is a sad indictment indeed. Greed and avarice brought Rome to it's demise.
8. Imaging is over used, but is demanded by patients
9. Few, if any, relatives will allow "grandma" to die, even when she is 89 years old and has conditions for which there is a 99% mortality.
Excellent point! The lawyers play a big role in increasing the price of health care.
Given that most of those country's governments with a single-payer or universal healthcare plan do not "OWN" the facilities, do not "employ" the doctors, and do not dictate to the consumer who, what, where or how you attain your routine or specialist care...can we agree to put that "socialist" meme on a back burner for a bit until you people come to your senses and stop comparing yourselves to other, more civilized, countries who actually shive-a-git about their fellow citizens welfare.
On here at least, all you people seem capable of is determining who is getting a freebie in your eyes and then refer to that individual as a "socialist" a "leftie" a "liberal" a "democrat" or some other disparaging adjective that does nothing whatsoever to disguise the "I'm all right jack; fugg you" nature of today's average American.
It is quite frankly amazing how many of you do not identify with the middle class that most of you belong to, but instead pattern all your thinking based upon 'aspiring' to be a member of those guys featured in the links above. You (figuratively) would deny your fellows an affordable and basic life necessity purely because you believe it might improve your odds while reaching for that "golden ring" on the merry-go-round of life with a less than .001% chance of actually grabbing it.
That is a sad indictment indeed. Greed and avarice brought Rome to it's demise.
Great post!
Those conservative Republicans that support the elite CEOs are often struggling blue collar men that see socialism everywhere and despise gays, non-whites, and the Arab world.
While being preoccupied with this they fail to realize they are being taken for a ride.
No, I want the government to sell a health plan where maximizing profits is not the goal. I want the plan to be administered for a fee. It would also be nice to give the private insurance industry a bit of competition. Competition is always a good thing, a very Republican point of view.
Competition IS a good thing. But inserting government is NOT making it competition. It's making it socialism. Getting government out of the way will created competition.
So you want the government to sell health plans. I guess you answered my question - you ARE a Sanders supporter.
I see you must be a provider as well. We don't even take medicaid (except those collected by our neurosurgeons on call). We are a part of the same spine group and I have to see all of those patients. Thankfully, there are not many.
Many of these "free", "medicare for all", "single payer" systems sound great to the public. However, as Obamacare has shown (and clearly illustrated by rational providers prior to its implementation) nothing is "free" and "projected cost savings" never seem to happen.
The bottome line:
1. Healthcare is expensive
2. You get what you pay for
3. Most of the innovation in medicine in the world comes from the US
4. R&D and product development costs money
5. Rationing healthcare and using generics is part of the answer to cut costs
6. Americans are unwilling to give up "Cadillac" medicine, yet want a "Yugo" price
7. Procedure rates in America are partially driven by a "fee for service system"
8. Imaging is over used, but is demanded by patients
9. Few, if any, relatives will allow "grandma" to die, even when she is 89 years old and has conditions for which there is a 99% mortality.
When you drop the partisan thing, you make a lot of sense.
May I add:
Healthcare is rationed, everywhere. How it's rationed is the variable.
The other day a poster posted about how Medicare does not pay for knee replacements unless you slip a nurse $ 5,000. Reality is joint surgery is the most common surgery covered by Medicare.
The other day a poster posted about how Medicare patients were dying. I responded that all Medicare patients die.
No clue where people ger their misinformation from.
No two countries do Universal Healthcare the same. Some rely entirely on a public option. Some rely entirely on private insurance and mandate insurers cover the elderly. A 20 year old and a 90 year old pay the same premium. Some countries require employers to contribute and some do not. All countries subsidize low/ no income.
Focusing on Germany, most babies are delivered by mid wives in birthing centers. Hospitals impose sur charges for linens, TV and WIFI. Hospital rooms typically contain 6-12 beds while the trend in the US is standard private rooms. One is not going to find lattes in the lobby, cable TVs everywhere, commercial dining franchises, valet parking, therapy dogs and so on.
Instead, German hospitals focus on getting people well and they do so at comparable or better rates to the US.
The cost of the extras is not embedded into overhead , as it is in the US.
With the exception of New Zealand, no other country allows drug manufacturers to advertise and urge consumers to ask their doctor about XYZ drug, as they do in the US. The cost of that advertising in the US is embedded in the cost of prescription medication.
And lastly, no where else will you find as a litigious population as you will in the US, subject to state law caps. No where else will you find a population that declines to take personal responsibility for themselves to the extent that occurs in the US.
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. Went to Medicaid when mco's moved into this state then got thoroughly disgusted. 
