No Politics, HC big issue for FIRE

[ShokWaveRider]

I know it's fashionable in some quarters to criticize the government, but for any given medical procedure, who do you think pays the provider more - Medicaid/Medicare or a commercial insurer? Having had occasion to see the comparative rates, I can tell you that it's virtually always the commercial insurer who pays more. The government drives a hard bargain in buying healthcare services.

Very true, also a lot more people on it to bargain with.

Funny how people "Long" to be on Medicare but are dead set against a Single Payer system before they are eligible. Add that to the Existing Medicare clientele and imagine the bargaining power. It just makes sense....

 

[travelover]

.........Funny how people "Long" to be on Medicare but are dead set against a Single Payer system before they are eligible...........

People fear change. Look at some old newspaper editorials from the time Medicare was proposed and see what doom and disaster was predicted.

 

[Alan]

I know it's fashionable in some quarters to criticize the government, but for any given medical procedure, who do you think pays the provider more - Medicaid/Medicare or a commercial insurer? Having had occasion to see the comparative rates, I can tell you that it's virtually always the commercial insurer who pays more. The government drives a hard bargain in buying healthcare services.

I also believe that by law Medicare can not negotiate lower bulk pricing with pharmaceutical companies. That is a big disadvantage, and in comparison the VA, who don’t have this restriction, typically negotiate drug prices 10 to 20% lower than many US private insurance groups.

Pharmaceuticals cheaper abroad because of regulation - CNN

 

[Senator]

We're all paying for indigent care in the form of jacked-up hospital billing, doesn't matter how it gets factored out. As long as the law mandates that all comers will be cared for, we're going to pay for it.

So I don't understand why mandated universal coverage is a bad solution to fix the problem, with the necessary taxes to pay for it of course. It could be a combo of provided basic coverage + subsidized extra coverage picked from a marketplace, which is pretty much Medicare today and has already been done in many countries. So the hospital always gets paid and doesn't play all these silly cost-shifting games to stay afloat.

And yes that means some will get extra coverage and won't be paying taxes for that because they're poor, but how is this worse than today? They're already not paying.

No matter what, wealthier people will always have better healthcare than the average Joe. That will cause concern when someone wealthy pays for a treatment that the poor Joe has to wait, and possibly die while waiting.

Universal care requires much more money that we have today. A sales tax is what it takes to pay for it in Europe. That way, everyone who spends money pays. Right now, taxes are a huge disincentive to work. That is one reason I quit.

Poor is relative. There are millionaires that get free healthcare because they are low-income.

 

[youbet]

I know it's fashionable in some quarters to criticize the government, but for any given medical procedure, who do you think pays the provider more - Medicaid/Medicare or a commercial insurer? Having had occasion to see the comparative rates, I can tell you that it's virtually always the commercial insurer who pays more. The government drives a hard bargain in buying healthcare services.

I agree. When I see the amounts Medicare pays for DW's health issues, I'm amazed at how little (low percentage of the billed amount) it is.

I'd like to see all payers (including individual private payers) restricted to paying the amount that Medicare pays. Having docs, hospitals and pharmaceutical companies have their revenues slashed to the amount they would receive under a "Medicare for All" system would send them a message.

 

[6miths]

No matter what, wealthier people will always have better healthcare than the average Joe.

Universal care requires much more money that we have today.

From the outside looking in, I find these two very interesting statements. Having worked in the US though I have some insights to the former.

The idea that wealthier people get 'better' healthcare in a private pay system is an amusing one to me. Many healthcare providers say all the extra tests are being done because of 'CYA' medicine (ie too many lawyers and too many medicolegal actions) but the truth is that most often when an MRI or surgical robot is purchased in the US the main motive is profit, not improving the delivery of medical care. That there is an 'Urgent Care' centre (often labelled as an 'Emergency') on almost every major block in some affluent US cities does not improve the quality of medical care. They are there to generate billings and profit. Many times they reduce the quality of care by diluting and misdirecting it. People that can pay for tests (and drugs) get them 'marketed' to them and frequently get them unnecessarily and at their peril. Direct marketing commercials for drugs border on insanity. A testament to the power of lobbying. The average wealthy person in the US probably does not get better health care than the average Joe in France or Germany. It is a common mistake to equate 'immediate' and 'on demand' and 'everything including the kitchen sink' to high quality. And bear in mind, that in America, even the 'wealthy' can be bankrupted by a serious personal or family illness.

Meanwhile the US currently expends almost double the amount of money on healthcare (% GDP) than the other OECD countries do. Most of these countries have better healthcare indicators than the US does. (And before someone says that it is the 'poor' people in the US who make these numbers bad I will call BS - sorry - the greatest country in the world - seriously!) So really? You don't have the money? Mr Buffet's 'shavers of the golden crumbs' (ie insurance middlemen and healthcare executives - and they aren't taking crumbs anymore) are killing you - literally.

The solutions are fairly straightforward, implementation is a completely different matter.

 

[MRG]

.
Snip...
Health insurance has to change. After our experience, I can't imagine what others do and it makes me sad people have to choose between paying bills and medical care.

A mentor of mine experienced this first hand. He watched his DW pass in a well known cancer center. They knew their outcome in advance, the stay was about comfort for the one passing.

Everyone in that facility had insurance. Many of them didn't eat because they couldn't pay for their medical bills and food. That's a situation I don't want to be in.

 

[ceciledian]

Health care is a huge issue. I decided to go back to work.[emoji853]

Same here. New plan: get a job, quit after a few months, take COBRA for 18 months. Rinse, repeat until we are both 65 (7 years from now).

 

[Senator]

I agree. When I see the amounts Medicare pays for DW's health issues, I'm amazed at how little (low percentage of the billed amount) it is.

I'd like to see all payers (including individual private payers) restricted to paying the amount that Medicare pays. Having docs, hospitals and pharmaceutical companies have their revenues slashed to the amount they would receive under a "Medicare for All" system would send them a message.

It would be nice if the Government could just tell the insurers that the most a policy can cost is ~$300 a month. Then, the insurers can negotiate prices with hospitals, and healthcare professionals accordingly.

Allowing 10X+ the number of people in medical and nursing schools would go a long way towards reducing costs. Lowering the standards of what it takes to get into medical school, forging student loans, and requiring anyone with a medical license to take the government rates would help.

Allowing people to purchase any drug they wanted through the mail, without a prescription, would free up many doctors. There are a lot more dangerous things out here than most prescription drugs.

Just having someone else pay for your healthcare does not make it cheaper or more cost effective.

 

[garyt]

No matter what, wealthier people will always have better healthcare than the average Joe. That will cause concern when someone wealthy pays for a treatment that the poor Joe has to wait, and possibly die while waiting.

Universal care requires much more money that we have today. A sales tax is what it takes to pay for it in Europe. That way, everyone who spends money pays. Right now, taxes are a huge disincentive to work. That is one reason I quit.

Poor is relative. There are millionaires that get free healthcare because they are low-income.

If we do go single payer, I like the idea of a national sale tax to pay for it. That way everyone has some skin in the game. Plus it gets all the illegal money in the game. Drugs, gambling, whatever.

 

[Hopeful]

There was a tidbit in consumer reports this last month that illustrates how screwed up things are. It talked about a “new” prescription medication for migraines that is just a combination of two drugs that are generic and off patent. The medication is called Treximet, and is a combination of naproxen and sumatriptan. The cost is $695 for nine tablets! The cost for the the same two medications in separate form is $16 and $5.

 

[ChiliPepr]

Allowing 10X+ the number of people in medical and nursing schools would go a long way towards reducing costs. Lowering the standards of what it takes to get into medical school, forging student loans, and requiring anyone with a medical license to take the government rates would help.

Lower the standards of getting in will not increase the number of doctors unless they lower the standards of getting out.

So, you want the government to force people to take a specific rate? Maybe the government should also tell lawyers, plumbers, electricians and contractors how much they can charge?

Allowing people to purchase any drug they wanted through the mail, without a prescription, would free up many doctors. There are a lot more dangerous things out here than most prescription drugs.

Agreed, but there are a lot of prescription drugs out there that I would not even know I need and a lot on TV that I certainly do not need.

 

[Senator]

Lower the standards of getting in will not increase the number of doctors unless they lower the standards of getting out.

So, you want the government to force people to take a specific rate? Maybe the government should also tell lawyers, plumbers, electricians and contractors how much they can charge?

More in, would equal more out. We do not need eight years of training+ to be a doctor for most things. More specialization at more common things could be done with less. You do not need eight years of training to set a bone, or diagnose most common ailments. Most nurses can do many things that now require a doctor, and most dental hygienists can do the work of a dentist.

The Doctors and Nurses would take the rate if they wanted to have free medical school. Remember, those people would be the competitors of the private paying doctors, and would lower prices overall.

Agreed, but there are a lot of prescription drugs out there that I would not even know I need and a lot on TV that I certainly do not need.

You would still be able to get a prescription if you wanted, and the hypochondriacs could get their meds without wasting a doctors time. Eventually, Darwinism may play out.

There was a tidbit in consumer reports this last month that illustrates how screwed up things are. It talked about a “new” prescription medication for migraines that is just a combination of two drugs that are generic and off patent. The medication is called Treximet, and is a combination of naproxen and sumatriptan. The cost is $695 for nine tablets! The cost for the the same two medications in separate form is $16 and $5.

And if a person could just go online and order it, it may be $1.00. Maybe even a compounding pharmacy could make it.

 

[DEC-1982]

I was reading the Wall Street Journal a few days ago, and most/all the letters to the editor that day were from Canadians. One worth mentioning (and I quote from memory):

"In Canada there are 5 General Practitioners for 1 specialist. In the US there are 5 specialists for 1 GP."

That may be an exaggeration, but you get the idea. The money is in specialization.

 

[Dawg52]

Very true, also a lot more people on it to bargain with.

Funny how people "Long" to be on Medicare but are dead set against a Single Payer system before they are eligible.

Good point.

 

[Mr._Graybeard]

Still think this is all fantasyland, though, as long as employer-provided insurance is ruining any chance of real reform. The 10% or so of us that don't have it are political footballs at this point.

I know of more than one small business (employing fewer than 50 people) that has stopped offering employees a health insurance benefit. Here's a Forbes article that says that's an accelerating trend.

 

[ShokWaveRider]

I think the Key Takeaway from this is that in a capitalist environment, bargaining power is in the numbers.

Simply put, the Government, in adding the individual market to the VA, Medicare & Medicaid pools would have as much if not more leverage to "Control" or even mandate pricing. As they are not in it to make a profit, but to be fiscal, Insurance company profits would not be a concern. Sooner or later Employers would only offer "Additional" supplemental benefits such as private rooms, better drug copays etc. This is how most other Countries do it. This will save companies from the healthcare burden, regulate costs and hopefully provide more citizens with care.

Sorry to keep on about it, but Single Payer just makes sense and works (Forget the perceived, ideological and political concerns for a minute). We are doing it now with the services mentioned above already. Why have 2 systems to reach the same goal (Insurance & Single Payer) when making the existing services better, more solvent and stable makes more sense? This way no ones has to loose their home or go bankrupt because of a major health issue because All citizens have at least basic coverage. Not to coin a fraise but "Medicare for All". VA, Medicare, Medicaid & The Individual Market AllInOne.

 

[68bucks]

I just wish we could have the option of paying a premium to join Medicare prior to 65. I would at least like to know what such a premium might cost. I mean we are all (or nearly all) going to end up on medicare so why not let those that would like to, pay the cost prior to reaching 65? How many people here would do that if the cost was much better? This is also know as the public option in the political arena and is looked on just about as favorably by some parties as single payer, which as stated, is what Medicare basically is. I'm sure the private insurance industry lobby is one of the main obstacles preventing a public option.

 

[MRG]

Very true, also a lot more people on it to bargain with.

Funny how people "Long" to be on Medicare but are dead set against a Single Payer system before they are eligible. Add that to the Existing Medicare clientele and imagine the bargaining power. It just makes sense....

I think that makes sense in a way. Most Americans know someone on Medicare and it's familiar to them. Single payer? Many folks don't know really what it is, therefore it's not good. "Billy Bob said he heard people far away have to wait to see a specialist." Never mind, he has to wait months for an appointment that he can't afford to pay for, or needed treatment.

 

[LARS]

I was reading the Wall Street Journal a few days ago, and most/all the letters to the editor that day were from Canadians. One worth mentioning (and I quote from memory):



"In Canada there are 5 General Practitioners for 1 specialist. In the US there are 5 specialists for 1 GP."



That may be an exaggeration, but you get the idea. The money is in specialization.

Fascinating... and one can only imagine all the extra tests that specialists order because they have to justify their existence to themselves and the GP's that refer to them.

 

[Senator]

This way no ones has to loose their home or go bankrupt because of a major health issue because All citizens have at least basic coverage.

I have always wondered about people going bankrupt because of medical bills. I understand the 'old' days where insurance only covered up to $1M and you had to buy over that.

Assuming you have coverage, and you use a in-network facility, you have a max OOP. AKAIK, youy can never be asked to pay more in that calendar year. If you are prepared for the OOP expense, you should be fine. If you are not prepared, you were probably destined to go bankrupt anyway.

I have a friend that uses a out-of-network facility (Mayo) because he thinks it's better. He is worried about going broke. I do not know if there are any studies that say life expectancy is better getting care at the Mayo or not. Either way, going broke would be his choice, no different than if I buy a larger home than I can afford.

I know there is an issue with in-network facilities using out-of-network doctors working there, but I think that is not all that common. And I think a refusal to pay would be in order.

How and why do people go bankrupt with the ACA and OOPs in place?

 

[USGrant1962]

I just wish we could have the option of paying a premium to join Medicare prior to 65. I would at least like to know what such a premium might cost. I mean we are all (or nearly all) going to end up on medicare so why not let those that would like to, pay the cost prior to reaching 65? How many people here would do that if the cost was much better? This is also know as the public option in the political arena and is looked on just about as favorably by some parties as single payer, which as stated, is what Medicare basically is. I'm sure the private insurance industry lobby is one of the main obstacles preventing a public option.

In 2016 there were 57 million people covered by Medicare, and Federal outlays were $588 billion. Neglecting state expansions, that is $10,315 per person. Even unsubsidized ACA plans are not that expensive, but Medicare has the adverse selection of age built in.

 

[Chuckanut]

I have always wondered about people going bankrupt because of medical bills. I understand the 'old' days where insurance only covered up to $1M and you had to buy over that.

<snip>
How and why do people go bankrupt with the ACA and OOPs in place?

Just a few guesses on my part:

1.) They get an 'experimental' treatment that is not paid for by insurance.

2.) They don't get an Rx plan while on Medicare and need a very expensive drug for a long time.

3.) They would have gone broke anyway. Blaming medical costs is easier than admitting they managed their money foolishly.

 

[explanade]

There was a tidbit in consumer reports this last month that illustrates how screwed up things are. It talked about a “new” prescription medication for migraines that is just a combination of two drugs that are generic and off patent. The medication is called Treximet, and is a combination of naproxen and sumatriptan. The cost is $695 for nine tablets! The cost for the the same two medications in separate form is $16 and $5.

I recently had a prescription for two different pills but my doctor initially wrote a prescription for a combination of the two.

My insurance wouldn't cover it so I would have to pay hundreds out of pocket.

So the pharmacy suggested we ask the doctors to ask for prescriptions individually, which he did, and the two prescriptions were fully covered.

 

[LARS]

I recently had a prescription for two different pills but my doctor initially wrote a prescription for a combination of the two.



My insurance wouldn't cover it so I would have to pay hundreds out of pocket.



So the pharmacy suggested we ask the doctors to ask for prescriptions individually, which he did, and the two prescriptions were fully covered.

That kind of experience makes me think the Government couldn’t do much worse than the Private sector when it comes to managing the healthcare system...