2020 Policy Talk: Healthcare

[David Dennison 18661]

42 minutes ago, Nice Guy Eddie said:

Medicare and Medicaid really only work BECAUSE of the private commercial insurance plans.  Providers basically break even (at best) with Medicare reimbursement and lose money for Medicaid patients.  Private insurance makes up the rest of the costs and profits for most medical providers.   

In many cases large employers have had it with placing the entire system on their backs. They're finding other solutions for their employees where possible. The end result will be more pressure on employers/employees that don't have the buying power to do so.

Those large employers have no obligation whatsoever to provide health insurance for their employees. It would be wonderful if they all just got out of the business completely.

EDIT: WRONG!!!! Derp.

Edited April 17, 2019 by David Dennison

[bad_teammate 13132]

EPIC FAILURE OF SOCIALISMMM

[Incredulity 11555]

4 minutes ago, David Dennison said:

Those large employers have no obligation whatsoever to provide health insurance for their employees. It would be wonderful if they all just got out of the business completely.

Yes they do. The employer mandate still stands

[David Dennison 18661]

1 minute ago, Incredulity said:

Yes they do. The employer mandate still stands

My bad. Thought that went the way of the individual mandate.

[Enchubben 5509]

2 hours ago, Iconoclast Texan said:

Copying this post of mine from the Bernie thread

Great counter to the supposed greatness of Canadian style Berniecare. His draft legislation compels everyone to government care destroying my private health insurance along with hundreds of millions of others. Our system of private insurance needs a new generation of Republican Gen-Xers like myself to come up with a way to keep private insurance and help subsidize basic, no frills care for the non-Medicaid qualifying lower class. Republicans need to get on the ball and counter with reform to the private health insurance model. We need to hammer away at the awful wait times for appointments and procedures in Canada and the U.K. and how in the U.K. the doctors in the NHS are mostly 3rd world foreigners with real British doctors available for pricey concierge care. Note that that even that wasn’t good enough for Mick Jagger and other wealthy Brits who come here to get the best medical care in the world. 

https://www.wsj.com/articles/europes-alternative-to-medicare-for-all-11555457596

Not so fast. The experience of Canada, which follows the Sanders model, shows that single payer is not the best way to achieve the goal of access to timely care. Its single-payer program is universal, funded by taxpayers without deductibles or copayments, and excludes premiums for most users. Objective measures of performance show it’s a comparatively expensive system whose results are mediocre—and sometimes very poor.

A Fraser Institute study published in November examined 28 universal health-care systems across 45 indicators of performance. After adjusting for differences in the proportion of seniors, Canada ranked among the top spenders—fourth-highest as a percentage of gross domestic product and 10th-highest per capita. Yet it had less medical resources available for patients and painfully long wait times for specialists. Canada ranked 26th out of 28 for number of physicians, 22nd out of 27 for MRI units, and 25th out of 26 for hospital beds.

Overall, Canada performs worse than other universal-coverage countries, particularly Switzerland, the Netherlands and Germany. Why? Unlike Canada’s single-payer system, the Swiss, Dutch and German systems rely on private insurers, whether nonprofit or for-profit. Government helps the needy make premium payments.

German enrollees can use a public system composed of 145 competing independent nonprofit “sickness funds” or buy insurance from 43 companies or nonprofits. In the Netherlands and Switzerland, residents must select a standard insurance package from private insurers, of which both countries have dozens.

 Unlike the U.S., with Medicare and its massive trillion-dollar unfunded liabilities, these countries cannot pass unreimbursed current expenses onto future generations. If the expenses of private insurers exceed their revenues, they face bankruptcy.

 

 

I’m up here in Ontario this week for work and on the local news here this morning they announced that one of the rural area hospitals has to close down for like a month and a half because they literally ran out of doctors or nurses that could staff it. They said it was the only ER clinic for like 40 miles. 

[GHOSTUSER 361]

2 hours ago, Enchubben said:

I’m up here in Ontario this week for work and on the local news here this morning they announced that one of the rural area hospitals has to close down for like a month and a half because they literally ran out of doctors or nurses that could staff it. They said it was the only ER clinic for like 40 miles. 

It’s no coincidence that the best doctors all over the world, including my own father who was world renowned in his field have come to practice in the US. Are there issues with private health insurance? Yes. Obamacare has killed the middle class with its premium costs and and deductibles. We would have been better off having the government give tax credits to subsidize buying private insurance instead of a host moronic things we have done like subsidizing people buying Teslas to the tune of $7,500.  People that think that doctors in this country are just going to take a massive pay cut which no doubt will happen with single payer are stupid. My shrink doesn’t even deal with insurance. I have to pay up right there with cash or check. That’s the future if M4A happens. Those at the top of the food chain like me can afford getting seen by the best. The rest have to wait and get seen by chumps. That’s much worse for the majority on employer based plans  

Edited April 17, 2019 by Iconoclast Texan

[bad_teammate 13132]

2 hours ago, Enchubben said:

I’m up here in Ontario this week for work and on the local news here this morning they announced that one of the rural area hospitals has to close down for like a month and a half because they literally ran out of doctors or nurses that could staff it. They said it was the only ER clinic for like 40 miles. 

Such is the nature of rural healthcare.

 

[David Dennison 18661]

30 minutes ago, Iconoclast Texan said:

It’s no coincidence that the best doctors all over the world, including my own father who was world renowned in his field have come to practice in the US. Are there issues with private health insurance? Yes. Obamacare has killed the middle class with its premium costs and and deductibles. We would have been better off having the government give tax credits to subsidize buying private insurance instead of a host moronic things we have done like subsidizing people buying Teslas to the tune of $7,500.  People that think that doctors in this country are just going to take a massive pay cut which no doubt will happen with single payer are stupid. My shrink doesn’t even deal with insurance. I have to pay up right there with cash or check. That’s the future if M4A happens. Those at the top of the food chain like me can afford getting seen by the best. The rest have to wait and get seen by chumps. That’s much worse for the majority on employer based plans  

Riiiiiiiiight. Because everything in Murica is the bestest.

[Incredulity 11555]

32 minutes ago, Iconoclast Texan said:

It’s no coincidence that the best doctors all over the world, including my own father who was world renowned in his field have come to practice in the US. Are there issues with private health insurance? Yes. Obamacare has killed the middle class with its premium costs and and deductibles. We would have been better off having the government give tax credits to subsidize buying private insurance instead of a host moronic things we have done like subsidizing people buying Teslas to the tune of $7,500.  People that think that doctors in this country are just going to take a massive pay cut which no doubt will happen with single payer are stupid. My shrink doesn’t even deal with insurance. I have to pay up right there with cash or check. That’s the future if M4A happens. Those at the top of the food chain like me can afford getting seen by the best. The rest have to wait and get seen by chumps. That’s much worse for the majority on employer based plans  

Well, well, well..... we will just make private practice illegal./surlylibtard

[Incredulity 11555]

4 hours ago, David Dennison said:

My bad. Thought that went the way of the individual mandate.

Totally understandable, no on could possibly keep up with the shifting sands foundation of Obamacare.

 

But it totally would have worked if not for those darn Republicans in the minority(who couldn’t do anything).

[David Dennison 18661]

Just now, Incredulity said:

Totally understandable, no on could possibly keep up with the shifting sands foundation of Obamacare.

But it totally would have worked if not for those darn Republicans in the minority(who couldn’t do anything).

It's working. Most people in this country support the ACA.

[Incredulity 11555]

1 minute ago, David Dennison said:

It's working. Most people in this country support the ACA.

That’s  not a remotely tangible/factual/honest measure of “it working”.  

 

But, you do you.

[GHOSTUSER 361]

1 hour ago, David Dennison said:

Riiiiiiiiight. Because everything in Murica is the bestest.

Yes the US is the greatest country in the world. Get a little perspective like those of us whose parents immigrated legally from shitholes like Iran. Live overseas in a country like that for a few months. You’re tune would change.

[Captainant 27468]

37 minutes ago, Iconoclast Texan said:

Yes the US is the greatest country in the world. Get a little perspective like those of us whose parents immigrated legally from shitholes like Iran. Live overseas in a country like that for a few months. You’re tune would change.

The US is so great, you'd want to shoot people trying to get into it seeking a better life! Isn't that right, you little racist ding dong?

[GHOSTUSER 361]

4 minutes ago, Captainant said:

The US is so great, you'd want to shoot people trying to get into it seeking a better life! Isn't that right, you little racist ding dong?

Not everyone who wants to come here can.

[Enchubben 5509]

4 hours ago, bad_teammate said:

Such is the nature of rural healthcare.

 

Certainly may play a part. I just looked at a few of those examples on that link and each of the ones I looked at have alternative hospitals that are still open in the area. Some of them look pretty new, so maybe those closures are related to newer facilities being opened rather than lack of trained professionals which is what’s happening in Canada.

[TDunk 590]

3 hours ago, Iconoclast Texan said:

Yes the US is the greatest country in the world. Get a little perspective like those of us whose parents immigrated legally from shitholes like Iran. Live overseas in a country like that for a few months. You’re tune would change.

*your.  You shithole.

[Nice Guy Eddie 13414]

Two areas of healthcare that most patients refuse to take advantage of is price shopping in advance and negotiations. And you don’t have to wait until you’re behind on your bills and in trouble to do this.  

Research options to buy cheaper drugs especially one time prescriptions. Sites like goodrx can give you codes for lower drug prices than your own insurance. (FYI May not count towards your deductible so paying more via insurance might be better sometimes)

for minor issues you can see doctors online or even have them come to your house, possibly for less than going to their office. On that note, seeing a non-MD is ok for some visits.

and i get that everyone wants to see their own doctor regardless of cost.  I want Capital Grille for steak every night but nothing wrong with torchys one night.

 

EDIT: if possible get involved with your company’s healthcare plan selections. The plans may have been selected because the ins company treated the benefits VP to a great trip to NYC. Ask to be on the committee that reviews next years plans.  When the ceo tells you what committee is that, it’s the one he’s going to create and put you on it.

 

 

Edited April 18, 2019 by Nice Guy Eddie

[JimmyHoffa 1188]

18 hours ago, bad_teammate said:

The unavoidable consequence of forcing everyone into the inefficient and corrupt nightmare that is private health insurance.

You and I agree: ACA is right-wing garbage

 

It was an awful bill that did nothing to solve the actual problem with HC. COST OF CARE. 

And there would have been a hell of an easier way to get the 5% that needed coverage covered without screwing the other 95%. 

 

Edited April 18, 2019 by JimmyHoffa

[Nice Guy Eddie 13414]

1 hour ago, JimmyHoffa said:

 

It was an awful bill that did nothing to solve the actual problem with HC. COST OF CARE. 

And there would have been a hell of an easier way to get the 5% that needed coverage covered without screwing the other 95%. 

 

Politics are preventing those issues from being resolved.

[David Dennison 18661]

1 hour ago, JimmyHoffa said:

 

It was an awful bill that did nothing to solve the actual problem with HC. COST OF CARE. 

And there would have been a hell of an easier way to get the 5% that needed coverage covered without screwing the other 95%. 

 

The bill served its purpose. Health care is now viewed as a right in this country. We are only going to move further to the left now. There will be no going back.

[David Dennison 18661]

12 hours ago, Iconoclast Texan said:

Yes the US is the greatest country in the world. Get a little perspective like those of us whose parents immigrated legally from shitholes like Iran. Live overseas in a country like that for a few months. You’re tune would change.

It's one of the greatest countries in the world. THE greatest is a bit of a stretch. But that's the myth.

[Dropout 355]

13 hours ago, Iconoclast Texan said:

Yes the US is the greatest country in the world. Get a little perspective like those of us whose parents immigrated legally from shitholes like Iran. Live overseas in a country like that for a few months. You’re tune would change.

 

15 hours ago, Iconoclast Texan said:

It’s no coincidence that the best doctors all over the world, including my own father who was world renowned in his field have come to practice in the US. Are there issues with private health insurance? Yes. Obamacare has killed the middle class with its premium costs and and deductibles. We would have been better off having the government give tax credits to subsidize buying private insurance instead of a host moronic things we have done like subsidizing people buying Teslas to the tune of $7,500.

As usual I’m just not following your thought process. When your parents left Iran are you insinuating if M4A had been in place at the time in America your father would not have chosen America? W all due respect and without knowing your father let me suggest he still would have chosen America if M4A had been in place at the time. America is still viewed by many as the greatest country in the world bc of the sum of America not just one part.

 

15 hours ago, Iconoclast Texan said:

People that think that doctors in this country are just going to take a massive pay cut which no doubt will happen with single payer are stupid. 

Opinions are like assholes everyone has one. These doctors seem more concerned with idk actually providing healthcare.

 

15 hours ago, Iconoclast Texan said:

My shrink doesn’t even deal with insurance. I have to pay up right there with cash or check. That’s the future if M4A happens. Those at the top of the food chain like me can afford getting seen by the best. The rest have to wait and get seen by chumps. That’s much worse for the majority on employer based plans  

Describing the present and then project that onto your M4A prediction and then call your future prediction the bad thing? Is that what just happened there?

[JimmyHoffa 1188]

42 minutes ago, David Dennison said:

The bill served its purpose. Health care is now viewed as a right in this country. We are only going to move further to the left now. There will be no going back.

 

To some including yourself sure. But that sure as hell wasn't the reason why it was passed. It was access to coverage for all those people that couldn't get it, which has failed miserably with the number of people that still don't have coverage even though in most cases it would be free. And if you view it as a success by screwing over the middle class well my hats off to you. 

But I do agree there is no going back, I think the most logical option will be catastrophic cap based on income and employers and private insurance companies being allowed to offer/sell plans to fill in gaps like we currently have with the current Medicare setup.   

[Incredulity 11555]

Anyone want to wager on whether or not Congress exempts itself from Single Payer if that happens?

 

[JimmyHoffa 1188]

19 minutes ago, Dropout said:

 

Opinions are like assholes everyone has one. These doctors seem more concerned with idk actually providing healthcare.

 

 

I don't disagree, but would be interesting to see if those same doctors would be OK with having their income capped at $75K a year because of "Medicare for all" reimbursement rates. And that is only primary care doctors not even including specialists, surgeons, etc. 

And I love the paperwork and "arguing with insurance companies complaints" They either have no Medicare patients or are fine with being told what treatment they can and can't give their patients because, wait for it............................. "medicare won't approve this".

It's the same shit just packaged in a different box. Some believe it will be better, I just like with the ACA think it will be worse for a lot of people. Get ready for Public vs. private care as it will be coming if Medicare for All ever does pass. 

 

 

Edited April 18, 2019 by JimmyHoffa

[David Dennison 18661]

56 minutes ago, JimmyHoffa said:

 

I don't disagree, but would be interesting to see if those same doctors would be OK with having their income capped at $75K a year because of "Medicare for all" reimbursement rates. And that is only primary care doctors not even including specialists, surgeons, etc. 

And I love the paperwork and "arguing with insurance companies complaints" They either have no Medicare patients or are fine with being told what treatment they can and can't give their patients because, wait for it............................. "medicare won't approve this".

It's the same shit just packaged in a different box. Some believe it will be better, I just like with the ACA think it will be worse for a lot of people. Get ready for Public vs. private care as it will be coming if Medicare for All ever does pass. 

Does this happen to geriatricians? I'm guessing they don't see many people under the age of 65.

[GHOSTUSER 361]

1 hour ago, Dropout said:

 

As usual I’m just not following your thought process. When your parents left Iran are you insinuating if M4A had been in place at the time in America your father would not have chosen America? W all due respect and without knowing your father let me suggest he still would have chosen America if M4A had been in place at the time. America is still viewed by many as the greatest country in the world bc of the sum of America not just one part.

 

Opinions are like assholes everyone has one. These doctors seem more concerned with idk actually providing healthcare.

 

Describing the present and then project that onto your M4A prediction and then call your future prediction the bad thing? Is that what just happened there?

The private health care system we have is the foundation on which a place like the Medical Center could exist. The agglomeration of universities, health care producers, drug companies plus all the great private hospitals and doctors. It has drawn doctors from all over the world. Compare that to the Canada and the UK which do not have the quality hospitals, med schools, talent and cutting edge procedures that we do. That’s why my Dad came here and he didn’t go to the U.K. or Canada. Being a doctor is a pain in the ass as it is but one of the upsides is that you can potentially make high 6 figures or millions if you’re good. Do you think you’ll have the same quality of people going into medicine when doctors will be making a government level salary.

Edited April 18, 2019 by Iconoclast Texan

[Anastasis 23394]

1 hour ago, JimmyHoffa said:

I don't disagree, but would be interesting to see if those same doctors would be OK with having their income capped at $75K a year because of "Medicare for all" reimbursement rates. And that is only primary care doctors not even including specialists, surgeons, etc. 

And I love the paperwork and "arguing with insurance companies complaints" They either have no Medicare patients or are fine with being told what treatment they can and can't give their patients because, wait for it............................. "medicare won't approve this".

It's the same shit just packaged in a different box. Some believe it will be better, I just like with the ACA think it will be worse for a lot of people. Get ready for Public vs. private care as it will be coming if Medicare for All ever does pass. 

I am from the government and I am here to reduce your paperwork.

All the fucking paperwork in healthcare is the direct result of government involvement.  The claim forms have fucking CMS in the title. 

 

[David Dennison 18661]

2 minutes ago, Anastasis said:

I am from the government and I am here to reduce your paperwork.

All the fucking paperwork in healthcare is the direct result of government involvement.  The claim forms have fucking CMS in the title. 

Yeah, all of the paperwork would magically disappear but for the government.

 

[Dropout 355]

25 minutes ago, Iconoclast Texan said:

The private health care system we have is the foundation on which a place like the Medical Center could exist. The agglomeration of universities, health care producers, drug companies plus all the great private hospitals and doctors. It has drawn doctors from all over the world. Compare that to the Canada and the UK which do not have the quality hospitals, med schools, talent and cutting edge procedures that we do. That’s why my Dad came here and he didn’t go to the U.K. or Canada. Being a doctor is a pain in the ass as it is but one of the upsides is that you can potentially make high 6 figures or millions if you’re good. Do you think you’ll have the same quality of people going into medicine when doctors will be making a government level salary.

The advancement of the medical field in America will not come to a halt bc of M4A. I fail to see how private insurance is solely responsible for any of those advancements.

Same quality of people? Yes I do. If only there was some way to differentiate between someone who wants to be a doctor and someone who is an actual doctor. I believe an argument could be made that an even better quality of people driven only by their passion to be doctors.

[TwiceHorn 31293]

1 hour ago, Anastasis said:

I am from the government and I am here to reduce your paperwork.

All the fucking paperwork in healthcare is the direct result of government involvement.  The claim forms have fucking CMS in the title. 

 

Fucking Ross Perot.  Fucking Darwin Deason.

[GHOSTUSER 361]

37 minutes ago, Dropout said:

The advancement of the medical field in America will not come to a halt bc of M4A. I fail to see how private insurance is solely responsible for any of those advancements.

Same quality of people? Yes I do. If only there was some way to differentiate between someone who wants to be a doctor and someone who is an actual doctor. I believe an argument could be made that an even better quality of people driven only by their passion to be doctors.

Having to pay back $100s of thousands in school loans while having your earning potential curtailed by government care is going to have an impact on smart kids who have options on what career they get into when they’re in college. You’re deluding yourself if you think the mundane paper-pushing would reduce with Berniecare. I do appreciate the whole “passion to be doctors”, deny yourself and take up the cross of having your earning potential neutered bit on Maundy Thursday

[Dropout 355]

16 minutes ago, Iconoclast Texan said:

Having to pay back $100s of thousands in school loans while having your earning potential curtailed by government care is going to have an impact on smart kids who have options on what career they get into when they’re in college. You’re deluding yourself if you think the mundane paper-pushing would reduce with Berniecare. I do appreciate the whole “passion to be doctors”, deny yourself and take up the cross of having your earning potential neutered bit on Maundy Thursday

We can talk about tuition free and affordable public college in another thread. Not like Bernie has an opinion on that but go ahead and make that a part of your argument.

No one said deny yourself. Like you stated smart kids have options. Either you do or don’t want to be a doctor. No problem if you don’t and money is an influential factor. That’s cool I get it. The medical field may no longer be for those types.

And that’s me accepting your opinion as fact on how doctor pay would be affected for the sake of argument. Some have a different view.

http://pnhp.org/news/medicare-for-all-and-the-myth-of-the-40-physician-pay-cut/

 

[JimmyHoffa 1188]

29 minutes ago, Dropout said:

We can talk about tuition free and affordable public college in another thread. Not like Bernie has an opinion on that but go ahead and make that a part of your argument.

No one said deny yourself. Like you stated smart kids have options. Either you do or don’t want to be a doctor. No problem if you don’t and money is an influential factor. That’s cool I get it. The medical field may no longer be for those types.

And that’s me accepting your opinion as fact on how doctor pay would be affected for the sake of argument. Some have a different view.

http://pnhp.org/news/medicare-for-all-and-the-myth-of-the-40-physician-pay-cut/

 

 

assholes and such. Everyone has one. Works both ways-

 

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

In 2015, $58.7 billion in Medicaid and Medicare reimbursement shortfalls and high uncompensated care costs affected hospital revenue cycles, the AHA found.

https://revcycleintelligence.com/news/medicaid-medicare-reimbursement-57.8b-below-hospital-costs

 

 

 

 

[JimmyHoffa 1188]

2 hours ago, David Dennison said:

Does this happen to geriatricians? I'm guessing they don't see many people under the age of 65.

No, it's offset by the rest of the "market". In the same way some doctors cap the number of Medicare patients they take on or refuse to take Medicare at all. 

 

[Dropout 355]

23 minutes ago, JimmyHoffa said:

 

assholes and such. Everyone has one. Works both ways-

 

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

In 2015, $58.7 billion in Medicaid and Medicare reimbursement shortfalls and high uncompensated care costs affected hospital revenue cycles, the AHA found.

https://revcycleintelligence.com/news/medicaid-medicare-reimbursement-57.8b-below-hospital-costs

 

 

 

 

I certainly agree and used his terms to begin the discussion. Let’s not pretend to know how much doctors pay will be affected just yet.

[JimmyHoffa 1188]

1 minute ago, Dropout said:

I certainly agree and used his terms to begin the discussion. Let’s not pretend to know how much doctors pay will be affected just yet.

 

If Medicare for All ever is to become a thing- everyone will be taking a haircut. You, me, doctors, hospitals, and every company that has a hand in our current health care system. How much? Nobody knows but it will be affected and for it to even have a shot at working that means less of the pie to go around for EVERYONE. That will certainly include doctor's pay along with every other healthcare professional. 

 

 

[Johnny Sack 8397]

3 minutes ago, JimmyHoffa said:

 

If Medicare for All ever is to become a thing- everyone will be taking a haircut. You, me, doctors, hospitals, and every company that has a hand in our current health care system. How much? Nobody knows but it will be affected and for it to even have a shot at working that means less of the pie to go around for EVERYONE. That will certainly include doctor's pay along with every other healthcare professional.  

 

 

Going to screw the rest of the world too.  Which gets a free ride on the USA's R&D in medicine.

[JimmyHoffa 1188]

Just now, Johnny Sack said:

Going to screw the rest of the world too.  Which gets a free ride on the USA's R&D in medicine.

Yep. 

[David Dennison 18661]

7 minutes ago, JimmyHoffa said:

If Medicare for All ever is to become a thing- everyone will be taking a haircut. You, me, doctors, hospitals, and every company that has a hand in our current health care system. How much? Nobody knows but it will be affected and for it to even have a shot at working that means less of the pie to go around for EVERYONE. That will certainly include doctor's pay along with every other healthcare professional. 

Well, it's not like they don't know it's coming.

[JimmyHoffa 1188]

Here is a little article explaining how those in the U65 market subsidies those over 65 that are on Medicare. I am not saying it can't change but the whole system would need to be overhauled (as it should) but not as easy as just repeating the great political talking point- "MEDICARE FOR ALL!!!!"

Medicare also pays less than private-sector insurance, which has troubling implications for the availability of many types of care. Many hospitals, for instance, have thin profit margins, and wouldn’t be able to stay in business if Medicare covered everybody and paid 40% less than private-sector plans, as it does now. At the same time, more people would have coverage, meaning an increased supply of patients would have fewer facilities to choose from.

 

https://finance.yahoo.com/news/medicare-and-social-security-report-164819544.html

[Captainant 27468]

4 minutes ago, JimmyHoffa said:

Here is a little article explaining how those in the U65 market subsidies those over 65 that are on Medicare. I am not saying it can't change but the whole system would need to be overhauled (as it should) but not as easy as just repeating the great political talking point- "MEDICARE FOR ALL!!!!"

Medicare also pays less than private-sector insurance, which has troubling implications for the availability of many types of care. Many hospitals, for instance, have thin profit margins, and wouldn’t be able to stay in business if Medicare covered everybody and paid 40% less than private-sector plans, as it does now. At the same time, more people would have coverage, meaning an increased supply of patients would have fewer facilities to choose from.

https://finance.yahoo.com/news/medicare-and-social-security-report-164819544.html

Analysis based on insurance payouts is dumb. Costs are so absurdly high because that's how anastasis insurance companies makes their money - there's a limit on the percentage upcharge they can apply, so they just balloon the costs to get the right bottom line they want. Medicare payments being lower is indicative that they're commanding lower costs for their care because you don't have leeches skimming off the top.

Any healthcare talk is dumb when the people who hold the power of life and death don't care to share the prices they charge until you have no ability to negotiate.

[bad_teammate 13132]

10 minutes ago, Captainant said:

Costs are so absurdly high because that's how anastasis insurance companies makes their money

 

 

[JimmyHoffa 1188]

10 minutes ago, Captainant said:

Analysis based on insurance payouts is dumb. Costs are so absurdly high because that's how anastasis insurance companies makes their money - there's a limit on the percentage upcharge they can apply, so they just balloon the costs to get the right bottom line they want. Medicare payments being lower is indicative that they're commanding lower costs for their care because you don't have leeches skimming off the top.

Any healthcare talk is dumb when the people who hold the power of life and death don't care to share the prices they charge until you have no ability to negotiate.

I don't disagree but it's no secret that Medicare pays significantly less then what doctors and hospitals negotiate with the private insurance companies. 

Just so we are clear here are you saying that at the current Medicare reimbursement rates the doctors, hospitals and facilities would be fine with only receiving that for services rendered? 

[Captainant 27468]

3 minutes ago, JimmyHoffa said:

Just so we are clear here are you saying that at the current Medicare reimbursement rates the doctors, hospitals and facilities would be fine with only receiving that for services rendered? 

Nope, I'm saying using payout rates as an indicator is flawed because insurance companies are incentivized to pump up insurance payouts so they can charge a larger premium to their "customers" and reap a larger bottom line - because they are capped at what percentage they can charge to their customers for their "services". I've no doubt that medicare reimbursement isn't covering all costs, but we shouldn't be using such a heavily gamed and manipulated figure to argue policy.

Take a look at healthcare costs in the country, even for basic shit that we've had figured out for a while. Like epipens or fucking insulin. It's not weird to you how those prices are increasing at a geometric rate while in every other industry, existing products and services tend to get cheaper to produce over time? 

[American Swindle 102]

On 4/10/2019 at 9:00 AM, JimmyHoffa said:

 

Yes and No. The whole "buy private insurance across state lines" is a talking point that has no basis in reality other than sounds really good to people that have no knowledge of how health care/health insurance works. (that isn't a slight at you just an annoyance that keeps coming up because idiots in DC keep saying it because it sounds like a legit option that would make everyone happy)

All insurance companies, doctors, hospitals, companies in ALL states are saving money by limiting networks which makes it easier for all parties to have a better grasp on total costs. It's why pretty much every ACA plan is either a HMO or some other limited network. That is done to keep costs down.

 

 

 

Medicare for all- Medicare currently has different reimbursement rates in every state. Getting an MRI in New York or Texas costs a hell of a lot more than getting one in South Dakota or Mississippi. The overhead costs and a million other factors are accounted for in the reimbursement rate for every single coded claim. 

I am all for changes but until someone in DC actually comes up with a plan to tackle cost of care it's really just repackaging a pile of shit. 

 

 

[Anastasis 23394]

 

18 minutes ago, Captainant said:

Nope, I'm saying using payout rates as an indicator is flawed because insurance companies are incentivized to pump up insurance payouts so they can charge a larger premium to their "customers" and reap a larger bottom line - because they are capped at what percentage they can charge to their customers for their "services".

 

The best way to move the bottom line in a competitive market is adding head count.  You do this by setting the most competitive premium, based on what your actuaries model out, hoping that they don't forget to carry the 1. The other good way to move the bottom line is by shaping utilization trends to reduce unnecessary or avoidable utilization. You do this by promoting preventative treatments, for example ensuring that appropriate glycemic monitoring, treatment, and screenings are being conducted for individuals with diabetes. You build predictive models to try to identify high risk cases and try to engage the provider. You try to reduce costs by achieving better outcomes, in particular for medically complex patients, and by moving your provider groups to at-risk arrangements or outcomes based care model and providing them with data driven insights on their practice to ensure that there is alignment of financial interests with good medical outcomes.

The vast majority of healthcare dollars are consumed by the top 10% of medically complex patients.  When you look at the quality of care esp for these complex cases in a similar context, private plans outperform Medicare on both costs and outcomes. I am not on plan side operations, but I have interacted with a good number who are. And while it is an interesting theory regarding MER caps putting upward pressure on pricing, I have never once seen or heard anybody articulate a financial strategy remotely based on increasing spend, probably cause it doesn't make sense in a model that is trying to compete on premium price and quality measure performance. OTOH, I have heard a lot of people talking strategies to increase medication compliance, reduce avoidable hospitalizations, prevent adverse drug outcomes, and improve quality measure performance.  But those are things that people like Ant want to call administrative waste.

I've laid out my thinking about how to best implement universal coverage, incorporating a national backstop and the benefits of market forces, reforming regulatory agencies, patent law and investing in the right types of policy and outcomes research.  I won't belabor it (for once) by outlining it again.

[Anastasis 23394]

48 minutes ago, Captainant said:

Like epipens or fucking insulin. It's not weird to you how those prices are increasing at a geometric rate while in every other industry, existing products and services tend to get cheaper to produce over time? 

Drug pricing is an area of significant institutional dysfunction. At risk of being called a trumpkin by the bobble heads, this is actually an issue that HHS is showing some balls on under the current administration.  I posted about it back on the drug pricing thread.  Now that we got that out of my system, I am going to go find some kids with cancer so I can kick 'em in the gut and call them names. 

 

 

On 2/1/2019 at 8:33 AM, Anastasis said:

HHS proposes a new rule to revise the way that rebates flow. Will be interesting to see how this plays out.  There is a complex dynamic at plan in terms of financial impact to CMS. This will likely have impacts on out of pocket (positive), premiums (negative), and CMS expenditures (negative). Should bring gross prices down, more in line with net prices. Pharma loses a major tool that they use to negotiate formulary placement, which may impact access. All in all, I think that this is a good move as it could remove one of the big clouds in Rx price transparency to the consumer.  

Proposed rule: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-01026.pdf

Reuters: https://www.reuters.com/article/us-usa-healthcare-rebates/u-s-government-proposes-rule-overhauling-drug-industry-rebate-system-idUSKCN1PP30W

 

[Captainant 27468]

 

20 minutes ago, Anastasis said:

OTOH, I have heard a lot of people talking strategies to increase medication compliance, reduce avoidable hospitalizations, prevent adverse drug outcomes, and improve quality measure performance.  But those are things that people like Ant want to call administrative waste.

No, I'm saying I'm not dumb enough to trust that people (you) looking to make a buck off of sick people will have their best health outcomes at heart. 

My dad, an advanced Parkinson's patient, has to fight tooth and nail to get fucking physical therapy so be he doesn't regress more than he already does. I'm sure your little sales pitch goes over great with people who don't have to live with and fight against insurance companies though.  What you're describing should be covered by the doctors and people who actually take an oath to do no harm, not by the fucking accountants in the back and doublespeaking sales douchebags in the front like yourself.