We agree.
Given that there are a bunch of different people who don't all work for the same office/hospital/lab, and they all need to be paid, they all need to generate bills. I noticed that for my CT scans, the scans themselves and the radiologist's services were all billed through the hospital where I went to get the scans, because, I guess, the hospital owns the facility and employs the CT technicians and the radiologist. However, my mother had several CT scans at the same hospital, and the scans themselves were billed through the hospital, but her radiologist billed from some organization in Florida, thousands of miles away. And why shouldn't my local hospital offload radiologist interpretation, if that's cheaper or more convenient for them?
That said, however, a voucher approach to Medicare would not seem like such a disaster if it was proposed as part of a "fix" to Obamacare. If all Americans were insured from cradle to grave with guaranteed Government premium payments for seniors tilted toward the poor (which Ryan says his do) I would be more open to it. But this was advertised as round one with repeal of Obamacare to come. The GOP has become just as adamant on "no mandatory insurance" as they are on "no taxes." The only constitution approach the GOP would recognize would seem to be Medicare for all. I think that would be a better, easier fix
Large corporations (who have increasingly bought our government and institutions, IMO) may complain about health care and the dysfunctional nature of our system, but in reality it favors them. They can negotiate with insurers in ways small businesses can only dream of, making it easier to offer health insurance to employees and giving them a big advantage in recruiting and retention.
And we are. When we look at the total cost of care (paid by the insurer plus Medigap policies, plus out-of-pocket costs the patient pays), Medicare is doing a poorer job of controlling costs than private insurers are doing. (Ref). And, as a bonus, with Medicare you get poorer access to physicians, since fewer and fewer are seeing new Medicare patients. The proposed fix to this is lowering reimbursement rates. Yep, that should work well.
Agree 100%. The present system is a government gift to employers, allowing them to obtain quality workers more cheaply than they otherwise could.
This is something that needs to be remembered when people talk about Medicare being more "cost effective" and such. That's at least in part because of the cost shifting involved. Yes, with other insurance there is also cost shifting but with Medicare it's pretty dramatic because the reimbursement rates are quite a bit lower than most other insurance. When Medicare rates are so low, one of two things happen: either providers stop accepting new Medicare patients or everyone else pays more for services to subsidize the lower rates they get from Medicare.
I never said the alternative should be everyone thrown out into the individual health insurance market, and I hope your remarks aren't insinuating that I implied it.
I'm not sure I completely buy that. The real problem with "competition" in the insurance market is that it leads to cost shifting. I for one would welcome competition based on reducing the cost of fraud and paper pushing, but I don't think it should lead to different prices for the same procedure. I mean, should someone who has Megacorp "food insurance" (and a Megacorp job) be able to pay $2.50 for a gallon of milk while an "unemployed" shopper with no "food insurance" pays $6 for the same thing? It just feels rotten to me and perhaps even a little "regressive".
I think you'll do better if you decide to either a) not read the article at all or b) read enough to understand it.
Yes. Read the article and you'll see that your point is the one they are making. Now, this is just about administrative costs, and Medicare proponents point out that, as a percentage of total payments, Medicare (admin) costs are lower than private insurance. The article points out that this is because Medicare patients are sicker, and their care is longer-term. Private insurers (in general) treat patients for shorter periods. 75 yo Ms Quigly shows up twice per week for her very expensive dialysis. She does it regularly, and the admin costs can be low (expressed as a percentage of the bill). For the same amount of billing, a private insurer might need to see 10 different patients with sniffles, a broken arm, a difficult-to-diagnose sore back needing several referrals and paperwork, etc. Which do you suppose will have higher admin costs expressed as a percentage of the total bill?
There are other factors as well. Fraud prevention, for example, is an administrative expense. If a "low administrative costs" facilitates rampant fraud, is it necessarily a positive and is it going to necessarily result in a lower cost product? I mean, we're not talking about index funds here where lower administrative expense is always better.
Agreed. If cutting admin costs results in higher overall costs, then it's no bargain. And the definition of "admin costs" is notoriously slippery. The Medicare "admin costs" usually don't include all the costs incurred by doctors/providers to do the billing/rebilling of Medicare, for example. They just include the costs Medicare pays to write checks to the providers. Obviously, that's only the tip of the admin cost iceberg.
I think we'd agree that even calling what we have a "system" is a bit of a stretch. We have an "extant construct" (most of it publicly funded) that surely needs improvement.
