Article: Would ‘Medicare for All’ really save money?

[BLADEMDA]

The USA already has a 2 tiered system in place today. The problem is the govt doesn’t reimburse some physicians fairly for their services so they shun Medicaid and to a lesser extent Medicare.

Hospitals charge private insurance plans and self pay patients more money to make up for the poor levels of govt reimbursement.

The fact remains that no candidate has come up with a way to pay for Medicare for all which is estimated to cost 50 trillion dollars. This fact is why Warren is losing support among mainstream democrats across the country. This issue has literally derailed Warren’s Presidential campaign.

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[BLADEMDA]

The Medicare enrollment impacts are the key reason the share of health care spending sponsored by federal, state, and local governments is expected to increase by 2 percentage points over the projection period, reaching 47 percent by 2027

 

[BLADEMDA]

Per person personal health care spending for the 65 and older population was $19,098 in 2014, over 5 times higher than spending per child ($3,749) and almost 3 times the spending per working-age person ($7,153).

 

[BLADEMDA]

If you read my last 2 posts it is quite clear that the US govt already funds a great deal of healthcare system. Since the passage of the ACA govt involvement is even greater.

If Medicare is expanded then the only way to control costs is to limit Medicare spending by the US govt. That reduction will occur by reducing elective procedures, reducing reimbursements to hospitals and providers and charging Medicare enrollees more money.

I know some of you think that the US govt can just double our national debt to pay for the existing increase in govt spending but eventually that ponzy scheme won’t work

 

[d9sccr]

If you read my last 2 posts it is quite clear that the US govt already funds a great deal of healthcare system. Since the passage of the ACA govt involvement is even greater.

If Medicare is expanded then the only way to control costs is to limit Medicare spending by the US govt. That reduction will occur by reducing elective procedures, reducing reimbursements to hospitals and providers and charging Medicare enrollees more money.

I know some of you think that the US govt can just double our national debt to pay for the existing increase in govt spending but eventually that ponzy scheme won’t work

I don’t disagree with you, but the esteemed AOC, among others, are starting to talk about Modern Monetary Theory. I don’t think it’s far fetched to believe we’re a few more election cycles away from this becoming a “mainstream” view of the Democratic base. Already the current candidates are paying homage to the Green New Deal despite AOC’s Chief of Staff admitting the entire thing was about restructuring the economy—as is evidence by not supporting nuclear or natural gas, the only viable and realistic sources of “green” energy we currently have

 

[Spikebd]

Would Medicare for all save the USA money? Yes. But, would the middle class or upper middle class see any of that savings? No. The rich would still pay cash or have private insurance while the poor get an upgrade to Medicaid. Overall, healthcare expenditures go down as does GDP.

Physicians get slashed and some specialties get crushed. Innovation gets obliterated and many hospitals go out of business. I do think the system would adjust back to the middle and politicians along with the public would come to accept a two tier healthcare system. The best I could hope for is that my future Medicare card would pay for 1/2 of my healthcare expenses when I am admitted to a private hospital. The public system would be a disaster with long wait times and heavily rationed care.

Rather than opine on "right vs wrong" the fact remains the elderly would no longer get their current version of medicare. Their care would be heavily rationed and those on demand knee/hip replacements vastly reduced annually. This would occur across the board as society no longer has the money or sees the need to pay for retirees to ski in Vail or play pickle ball at the taxpayer's expense. Retirees would be seen as the expendable citizens they are to the overall country.

Honestly, this scene from “the Joker” is what I think of when Bernie Sanders prattles on about Medicare for All.

 

[nimbus]

Honestly, this scene from “the Joker” is what I think of when Bernie Sanders prattles on about Medicare for All.View attachment 288198

Impressive.

 

[PieOHmy]

Im not against Medicare for all per se.
Im against this government being in charge of and administering health care.
The United States govt is a complete and utter disaster and its racing towards the cliff. They cannot do ANYTHING efficiently.
What makes you think that given the task for adminstering healthcare they would even remotely get it right?
It would be a bigger **** show than this obama care is.
Look at the waste, fraud and abuse going on in every single government entity. They are raping the US taxpayers anally and everyone is letting them. They are not accountable for anything and cover ups are the order of the day. Leave paving roads and filling pot holes to the government. They cant even get that right...

BUt healthcare absolutely should be out of the government hands

Everybody knows that competition is the answer. Competition everywhere. But what do we see? ****in consolidation and we are wondering why things are so expensive..

 

[10KHertz]

First Of all, it should be “Medicaid -for-all” not “Medicare for all”... let’s get the true terminology straight. I hate when the politicians lie.
Secondly, we don’t not have a true two-tiered infrastructure yet. Once private “luxury” insurance plans and private “luxury” hospitals compete/coexist directly with medicaid-for-all “governmental” hospitals , then we have reached our socialized nirvana ...

 

[GravelRider]

Im not against Medicare for all per se.
Im against this government being in charge of and administering health care.
The United States govt is a complete and utter disaster and its racing towards the cliff. They cannot do ANYTHING efficiently.
What makes you think that given the task for adminstering healthcare they would even remotely get it right?
It would be a bigger **** show than this obama care is.
Look at the waste, fraud and abuse going on in every single government entity. They are raping the US taxpayers anally and everyone is letting them. They are not accountable for anything and cover ups are the order of the day. Leave paving roads and filling pot holes to the government. They cant even get that right...

BUt healthcare absolutely should be out of the government hands

Everybody knows that competition is the answer. Competition everywhere. But what do we see? ****in consolidation and we are wondering why things are so expensive..

I don’t necessarily disagree with your assessment of the government’s ability to administer large programs. Although they have had a lot of success over the years in various things. However, let’s not pretend that there isn’t “waste, fraud, and abuse” in the corporate world either. The U.S. healthcare system has been “raping the public” (your words) for decades and we’ve been letting them. Meanwhile costs are out of control, healthcare is the number one cause of bankruptcy, but the pharmaceutical companies and hospital conglomerates are seeing record profits. So let’s not pretend that the healthcare system we currently have is a good one. I’m not sure “Medicare for all” is the answer, but I do know the current system is not the answer.

 

[kmurp]

First Of all, it should be “Medicaid -for-all” not “Medicare for all”... let’s get the true terminology straight. I hate when the politicians lie.
Secondly, we don’t not have a true two-tiered infrastructure yet. Once private “luxury” insurance plans and private “luxury” hospitals compete/coexist directly with medicaid-for-all “governmental” hospitals , then we have reached our socialized nirvana ...

Isn’t this the system they use in Australia ? Medicare for all, with longer wait for joint replacement etc but immediate care in an emergency. Many (most?) working people buy an add on policy which allows quicker access to elective healthcare.

 

[BLADEMDA]

Hospitals Sue Trump to Keep Negotiated Prices Secret

 

[pgg]

Should all vegans go live on an island together somewhere?

If they can fit the crossfitters onto Ark B with them, that could work out nicely.

 

[nimbus]

Hospitals Sue Trump to Keep Negotiated Prices Secret

I could see how this can be a problem for them unless they have set prices across all their contracts. Typically higher volume contracts get better prices. If the prices are published, it will quickly become a race to the bottom. Why would Aetna want to pay more than united healthcare? Same goes for professional fees like anesthesia.

I suppose they could publish different rates for different volume tiers.

Airlines have more price transparency these days. Guess we’ll get more no frills outfits like Spirit and Frontier in healthcare. Maybe not a bad thing.

 

[nimbus]

Im not against Medicare for all per se.
Im against this government being in charge of and administering health care.
The United States govt is a complete and utter disaster and its racing towards the cliff. They cannot do ANYTHING efficiently.
What makes you think that given the task for adminstering healthcare they would even remotely get it right?
It would be a bigger **** show than this obama care is.
Look at the waste, fraud and abuse going on in every single government entity. They are raping the US taxpayers anally and everyone is letting them. They are not accountable for anything and cover ups are the order of the day. Leave paving roads and filling pot holes to the government. They cant even get that right...

BUt healthcare absolutely should be out of the government hands

Everybody knows that competition is the answer. Competition everywhere. But what do we see? ****in consolidation and we are wondering why things are so expensive..

If I could work VA hours at VA pace for VA pay, I wouldn’t complain too much. Definitely not efficient but I would put forth an effort commensurate to my pay.

Consolidation is a result of winner take all competition we have across all major industries.

 

[pgg]

Libertarians just have to stop using all the government benefits they complain constantly about.....or stfu about it.

I feel compelled to point out here that any two libertarians don't necessarily mirror each other's thoughts any more than any two random Democrats or Republicans. Probably less so.

Our diverse and moderately dysfunctional party attracts anarchists, pot smokers, Ayn Rand book club members, but the majority of us are simply just actual fiscal conservative small government social liberals who generally place high value on actual honest individual freedom than the Democrats' "we know what's best for everybody" or the Republicans' pseudo religious moral leash. The vast majority of us accept taxes, the need for public roads, a military, courts, law enforcement, environmental protection laws that don't completely trample individual property rights, etc. We like civilization and accept that there are some costs to accept and compromises to be made in order to live in one.

 

[deleted480308]

I could see how this can be a problem for them unless they have set prices across all their contracts. Typically higher volume contracts get better prices. If the prices are published, it will quickly become a race to the bottom. Why would Aetna want to pay more than united healthcare? Same goes for professional fees like anesthesia.

I suppose they could publish different rates for different volume tiers.

Airlines have more price transparency these days. Guess we’ll get more no frills outfits like Spirit and Frontier in healthcare. Maybe not a bad thing.

Not with certificate of need laws you won’t

 

[bronx43]

I could see how this can be a problem for them unless they have set prices across all their contracts. Typically higher volume contracts get better prices. If the prices are published, it will quickly become a race to the bottom. Why would Aetna want to pay more than united healthcare? Same goes for professional fees like anesthesia.

I suppose they could publish different rates for different volume tiers.

Airlines have more price transparency these days. Guess we’ll get more no frills outfits like Spirit and Frontier in healthcare. Maybe not a bad thing.

The problem is that volume doesn’t always correlate to the price. In my neck of the woods, the highest volume insurer pays by far the most. If prices became transparent, healthcare systems would not be able to maintain those prices.

 

[nimbus]

The problem is that volume doesn’t always correlate to the price. In my neck of the woods, the highest volume insurer pays by far the most. If prices became transparent, healthcare systems would not be able to maintain those prices.

We wouldn’t be able to maintain current prices either which is the intended effect.

 

[BLADEMDA]

We wouldn’t be able to maintain current prices either which is the intended effect.

Why is that? Medicare doesn't Reimburse fairly and your rates simply need to reflect your billing unit. If you listed it at $120 per unit why would that be a problem since that is the listed price and not the negotiated price.

 

[BLADEMDA]

We found that in the period 2007–14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent.

https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05424

 

[nimbus]

Why is that? Medicare doesn't Reimburse fairly and your rates simply need to reflect your billing unit. If you listed it at $120 per unit why would that be a problem since that is the listed price and not the negotiated price.

“The nation’s hospital groups sued the Trump administration on Wednesday over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.”

The hospitals are suing to keep their negotiated discount prices with insurers private. That’s like us publishing our unit rates with Aetna, United, and blue cross. Not the fictitious 120/unit.

 

[Ho0v-man]

I have a question. Does anyone know what percentage of national healthcare spending is midlevel compensation? I couldn’t find it in my 3 minute google search but there’s plenty of pie charts showing physician fees and services. If their pay is lumped in with physician compensation, it’s really crappy to say it’s our say our salaries are too high when a large sum of it goes to them while claiming they’re the solution.

 

[BLADEMDA]

“The nation’s hospital groups sued the Trump administration on Wednesday over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.”

The hospitals are suing to keep their negotiated discount prices with insurers private. That’s like us publishing our unit rates with Aetna, United, and blue cross. Not the fictitious 120/unit.

It's not fictitious for USAP or some members here because that's their rate. The legislation does not require one to disclose specific contractual rates but rather your typical charge for the service. For some practices that is $100 per unit while for others it is $80 per unit. This would be non CMS rates so consumers could compare

 

[nimbus]

It's not fictitious for USAP or some members here because that's their rate. The legislation does not require one to disclose specific contractual rates but rather your typical charge for the service. For some practices that is $100 per unit while for others it is $80 per unit. This would be non CMS rates so consumers could compare

Quoting from the article you posted.....

“new federal rule that would require them to disclose the discounted prices they give insurers”

Is that not the specific contracted rate?

 

[Mikkel]

Quoting from the article you posted.....

“new federal rule that would require them to disclose the discounted prices they give insurers”

Is that not the specific contracted rate?

I thought it was the actual rate paid by insurers to hospitals and physicians, not fake chargemaster rates.

 

[nimbus]

I thought it was the actual rate paid by insurers to hospitals and physicians, not fake chargemaster rates.

Yes that’s my interpretation of the proposed rule too.

 

[Mikkel]

It will be serious bad news for the AMCs because their paid rates are above average but with no real improvement in quality of service. It will be great news for independent groups who will be able to negotiate higher rates to be more in line with better paid groups. (Rates will be more average across the board with less outliers).


It will be bad news for insurers because consumers will be allowed to see where their insurance premiums actually get them, and it will allow uninsured people to get cheaper services. (It might make sense to actually stop paying for insurance.)

 

[nimbus]

It will be serious bad news for the AMCs because their paid rates are above average but with no real improvement in quality of service. It will be great news for independent groups who will be able to negotiate higher rates to be more in line with better paid groups. (Rates will be more average across the board with less outliers).


It will be bad news for insurers because consumers will be allowed to see where their insurance premiums actually get them, and it will allow uninsured people to get cheaper services. (It might make sense to actually stop paying for insurance.)

As far as I know, the new rule will only apply to hospitals and not doctors. Still your points illustrate why hospitals would oppose the new rule.

 

[BLADEMDA]

Quoting from the article you posted.....

“new federal rule that would require them to disclose the discounted prices they give insurers”

Is that not the specific contracted rate?

My point is that this rate could be the highest insured contract like $100 per unit or a blended unit of all private insurance contracts. Either way most non AMC groups wouldn’t be hurt much as long as govt payers are left off