Medicare For All: Ramifications for Managed Care Companies (Kaiser Permanente, etc.), AMCs (Envision, USAP, Somnia, etc), and billing companies (Abeo)

[apoondoc]

I am not trolling or hoping to start a heated political discussion. And I don't wish to debates the merits of the proposal, nor its chances of passing. But Medicare For All is going to put Kaiser out of business, correct? I mean, they will still own their hospitals and clinics and patients will still engage with their Permanente physicians, but all the fat will be trimmed. Same thing for the Mayo Clinic, IHC, and all the others, correct?

Is the reason nobody talks about this is because it's so obvious? Or is this one of the obvious truths that only becomes obvious once you think about it, and nobody pauses to think about it? (I will say that it is terrible how journalists have let the insurance companies control the dialog, without ever mentioning their incentive to engage in half-truths, scare tactics, and flat out lies.)

It is not up for debate that insurance companies will be one tiny step above worthless. Yes, a second tier will likely develop, as well as supplemental plans. But buh-bye to 90% or more of their business (and good bloody riddance).

Now, Envision, USAP, Somnia, and all the other tedious anesthesia management companies will no longer be able to act like their market size is going to allow them more favorable reimbursement rates. True, they can still peddle their "secret sauce" nonsense, but nobody buys that now, and I imagine that without the empty promise of better reimbursement rates to hope for, their salespitch will have to evolve significantly if they are going to survive. Again, good bloody riddance.

Similarly, with administrative costs at 3% versus 30% for insurers, Medicare for All is going to put a lot of billing specialists out of business. Buh-bye.

Abeo and all the other blood-sucking leeches might still eke out an existence promising regulatory compliance, but their margins are going to be thinner. With only one set of hoops to jump through, a lot of groups are going to keep billing in-house. Or, more likely, hospitals will take over billing for the anesthesia groups. Again, more fat to be trimmed that simply won't be missed.

Am I missing something here?

I would particularly like to hear from docs who work for big management companies and wonder how scared they are. Their stock is going to be worthless. Is this a discussion taking place behind closed doors?

---

Members don't see this ad.

 

[deleted50478]

I am not trolling or hoping to start a heated political discussion. And I don't wish to debates the merits of the proposal, nor its chances of passing. But Medicare For All is going to put Kaiser out of business, correct? I mean, they will still own their hospitals and clinics and patients will still engage with their Permanente physicians, but all the fat will be trimmed. Same thing for the Mayo Clinic, IHC, and all the others, correct?

Is the reason nobody talks about this is because it's so obvious? Or is this one of the obvious truths that only becomes obvious once you think about it, and nobody pauses to think about it? (I will say that it is terrible how journalists have let the insurance companies control the dialog, without ever mentioning their incentive to engage in half-truths, scare tactics, and flat out lies.)

It is not up for debate that insurance companies will be one tiny step above worthless. Yes, a second tier will likely develop, as well as supplemental plans. But buh-bye to 90% or more of their business (and good bloody riddance).

Now, Envision, USAP, Somnia, and all the other tedious anesthesia management companies will no longer be able to act like their market size is going to allow them more favorable reimbursement rates. True, they can still peddle their "secret sauce" nonsense, but nobody buys that now, and I imagine that without the empty promise of better reimbursement rates to hope for, their salespitch will have to evolve significantly if they are going to survive. Again, good bloody riddance.

Similarly, with administrative costs at 3% versus 30% for insurers, Medicare for All is going to put a lot of billing specialists out of business. Buh-bye.

Abeo and all the other blood-sucking leeches might still eke out an existence promising regulatory compliance, but their margins are going to be thinner. With only one set of hoops to jump through, a lot of groups are going to keep billing in-house. Or, more likely, hospitals will take over billing for the anesthesia groups. Again, more fat to be trimmed that simply won't be missed.

Am I missing something here?

I would particularly like to hear from docs who work for big management companies and wonder how scared they are. Their stock is going to be worthless. Is this a discussion taking place behind closed doors?

I’m not a fan of those companies and sellouts either, but it’s not going to happen. Those companies make up a huge portion of gdp, investment portfolios, employers, etc. Medicare for all would start The Great Depression II.

 

[AdmiralChz]

I’m not a fan of those companies and sellouts either, but it’s not going to happen. Those companies make up a huge portion of gdp, investment portfolios, employers, etc. Medicare for all would start The Great Depression II.

Yeah, and that doesn’t even discuss the impact on healthcare.

If this passes as Bernie wants it (keep reimbursement rates the SAME for all citizens at Medicare and in some cases Medicaid numbers), most hospitals as you know will close. All the ones that are sort of marginal or losing money now will absolutely be gone, and many of the big fish as well. You’ll probably see some sort of separate private hospitals pop up for cash-paying boutique type setups, but for most of the population it’ll be a real problem. It’ll be exceptionally expensive and it will probably drive the country towards government-controlled hospitals and a total government healthcare system. You’ll see rationing of care, long waits, and great difficulty obtaining subspecialty care. If you’ve worked around a VA you sort of know what this looks like, only imagine on a much larger and less well-funded scale.

Everything will probably be government run, so HCA and all the AMCs would probably fold or maybe get somehow absorbed into the fed? I dunno. Not a good thing for them at all.

It’s a dystopian picture for sure, it’s easy to buy off votes by saying “free insurance for all!” But those of us in the field know what that means. Even the awful AMA is against Medicare of All, or at least was but i saw some article that said they might be reconsidering... again useless.

 

[BLADEMDA]

The idea that Medicare for all will happen soon is pure fantasy. That concept is at least 4-5 years away if not 8-12 years.

What we may see (and I stress may) is a Medicare Option buy in on the Federal exchange. Only after this buy in passes and only after the liberals prove the Option won’t bankrupt the country will Medicare for all gain traction.

Don’t put the cart before the horse.

 

[apoondoc]

But, on the other hand, hospitals do make money on Medicare. I know they attempt to say they don't, but it's simply not true. Drive around this country. Outside of metropolitan hotbeds, the only construction cranes you'll see are building hospitals and colleges, two of the few remaining growth industries we have, both of which are underwritten by the federal government.

If Medicare rates were so ruinous, hospitals (and CEOs, administrators, stockholders) would be looking to parse their Medicare patient populations, not specifically cater to them.

 

[scoopdaboop]

didn't medicare for all happen in a state already, and it was a proved failure? I forget what state, it was mentioned in a democratic debate, maybe vermont. If it failed there, imagine it in the nationwide scale. There is no way it's happening anyways. The much more likely scenario is 'public option' which is similar to obama care, and if i recall correctly, the AMA supported public option but not medicare for all.

 

[apoondoc]

It's very difficult to make predictions about the future, but I would say that gay marriage and marijuana decriminalization caught fire much more quickly than most people would have predicted. Had Hillary won, I would have agreed that M4A is 10+ years away. But in just the two years since she lost, M4A went from a fringe idea to a staple of every serious democratic presidential candidate.

But I'm trying not to discuss the merits or the odds, but rather the fact that whole swaths of inefficiency will be out of work, for better or worse.

 

[Mman]

But, on the other hand, hospitals do make money on Medicare. I know they attempt to say they don't, but it's simply not true. Drive around this country. Outside of metropolitan hotbeds, the only construction cranes you'll see are building hospitals and colleges, two of the few remaining growth industries we have, both of which are underwritten by the federal government.

If Medicare rates were so ruinous, hospitals (and CEOs, administrators, stockholders) would be looking to parse their Medicare patient populations, not specifically cater to them.

hospitals that accept Medicare are also taking in privately insured patients. They make their margin on the insured patients, not the Medicare patients. If 100% of their patients were on Medicare, they would be insolvent financially. As a ballpark figure, I believe the median operating margin for hospitals is somewhere in the neighborhood of 2%. Medicare for all would remove the uninsured no pay patients, but would drastically cut back the spend from the insured patients. Hospitals would need to massively drive down costs across the board to remain standing. Imagine the political fun when they announce 10% cuts to nurses salaries.

 

[DM27]

I actually had a similar thought about the medicare for all concept as well and what it would do to the salaries of administrators at different health care facilities.

 

[AdmiralChz]

But, on the other hand, hospitals do make money on Medicare. I know they attempt to say they don't, but it's simply not true. Drive around this country. Outside of metropolitan hotbeds, the only construction cranes you'll see are building hospitals and colleges, two of the few remaining growth industries we have, both of which are underwritten by the federal government.

If Medicare rates were so ruinous, hospitals (and CEOs, administrators, stockholders) would be looking to parse their Medicare patient populations, not specifically cater to them.

You’re wrong on this. Look at hospitals with large majority CMS patients - they are usually in the worst shape and in danger of closing. Hospitals don’t want MORE Medicare they undoubtably want less (unless it’s an affluent population with solid private secondary insurance).

But don’t take my word for it, Bernie.

 

[ryanjmy]

But I'm trying not to discuss the merits or the odds, but rather the fact that whole swaths of inefficiency will be out of work, for better or worse.

And be replaced by even more inefficiencies. Think VA level inefficiencies. I’d love to see all the leaches die off but not at my own detriment.

 

[AdmiralChz]

And be replaced by even more inefficiencies. Think VA level inefficiencies. I’d love to see all the leaches die off but not at my own detriment.

Or at the patients detriment. This will NOT be good for our country and a lot of people will go without care if this happens. You can put a stamp on that.

 

[apoondoc]

If we take knee replacements (only because we can Google the costs of TKA and find a popular study) as a proxy for Medicare patients, I think we can all agree that the hospitals do very well, even at Medicare rates. (Let's stop parroting the AHA Kool-Aid that they lose money on Medicare patients or, at best, realize a razor-thin 2% margin. Yes, I understand why hospitals want people to believe it. But it's not true.)

TKA is not a bad target case. Most TKA patients are on Medicare. It is a very common procedure, done at almost every hospital in the USA.

Average cost, $10,500: Outline - Read & annotate without distractions
Average MEDICARE reimbursement: $13,500: How much does a knee replacement cost? Medicare average: $13,464. - Clear Health Costs

 

[apoondoc]

Using the VA as a scare tactic is disingenuous.

The VA has grown fat because it has no competition. Once Medicare For All is the law of the land, every hospital (the VA included) will have to compete for patients, because patients will be free to take their business to the hospital of their choice...not the hospital thrust upon them from the breadwinner's human resources department, who chose the network.

 

[VA Hopeful Dr]

I am not trolling or hoping to start a heated political discussion.

So you were lying when you said this

 

[apoondoc]

I should not have continued the political discussion. That much is true.

So, can we then agree that there is no room for debate about the central argument I'm trying to make? That Mayo, Kaiser Permanente, Intermountain Healthcare, Beaver Medical Group, Ascension, Providence, and all the other "multi-specialty groups" with insured lives, hospitals, and physician contracts are going to be the big losers, followed by the huge hospital chains (Dignity, Tenet, HCA, Mercy, Partners, Sutter, Adventist...).

 

[AdmiralChz]

If we take knee replacements (only because we can Google the costs of TKA and find a popular study) as a proxy for Medicare patients, I think we can all agree that the hospitals do very well, even at Medicare rates. (Let's stop parroting the AHA Kool-Aid that they lose money on Medicare patients or, at best, realize a razor-thin 2% margin. Yes, I understand why hospitals want people to believe it. But it's not true.)

TKA is not a bad target case. Most TKA patients are on Medicare. It is a very common procedure, done at almost every hospital in the USA.

Average cost, $10,500: Outline - Read & annotate without distractions
Average MEDICARE reimbursement: $13,500: How much does a knee replacement cost? Medicare average: $13,464. - Clear Health Costs

LOL I’m rolling laughing. You took a top 5 highest paying procedure as a surrogate for how Medicare pays for things? Bernie, is that you? I can’t even take you seriously.

This population is MUCH, MUCH healthier than the rest of General medicine admits. Sure some have their issues but if they have major problems surgeons won’t touch them.

Look more at MICU non surgical admits and get back to me.

To everyone else:

:troll:

 

[apoondoc]

Everything will probably be government run, so HCA and all the AMCs would probably fold or maybe get somehow absorbed into the fed? I dunno. Not a good thing for them at all.


I don't think that is true. Right now, is is fair to say that the government runs the VA. But Medicare doesn't run hospitals. Permanente runs Kaiser hospitals, yes. But Medicare only pays the bills. Doctors who accept Medicare are no more governmental employees than are Dunkin Donuts baristas when they sell doughnuts to cops.

Again, I'm not trolling. But nobody is suggesting that government take over ownership of hospitals. This isn't socialism, where the government (or the people) own the means of production. Medicare merely pays private doctors on behalf of the patients.

 

[apoondoc]

This population is MUCH, MUCH healthier than the rest of General medicine admits.


Medicare patients are healthier than regular patients? You can't be serious!!

Why do we trust the the government to insure our least healthy citizens (the elderly, the dialysis-dependent, and the very poor), but not to insure our healthy citizens?

Do you realize that if Medicare for All is passed, that all the healthy 18-45 year olds (on whom the insurance companies are making their profits) will be added into the pool. The average acuity will go down. Way down. Way below that of the average TKA recipient. AINEC.

 

[apoondoc]

didn't medicare for all happen in a state already, and it was a proved failure? I forget what state, it was mentioned in a democratic debate, maybe vermont.

It was on the ballot in Vermont, but it didn't pass. That's much, much different from saying that it "was proved a failure."

Is everybody aware that Canada's healthcare system started in a single province, then spread from there? There is no "national healthcare system" in Canada, but rather ten provincial healthcare systems.

Had it been a total disaster in the first province, I guess I would listen to my Yankee Chicken Littles. But since it spread country-wide like virtual wildfire (from a single province to all ten in 11 years), I think that the historical precedent is on comrade Bernie's side in this argument.

 

[AdmiralChz]

This population is MUCH, MUCH healthier than the rest of General medicine admits.


Medicare patients are healthier than regular patients? You can't be serious!!

Total knee replacement patients will, on the whole, undoubtably be healthier. I was using your horrendous example to try to make a point.

Easy post to ignore.

 

[VA Hopeful Dr]

I should not have continued the political discussion. That much is true.

So, can we then agree that there is no room for debate about the central argument I'm trying to make? That Mayo, Kaiser Permanente, Intermountain Healthcare, Beaver Medical Group, Ascension, Providence, and all the other "multi-specialty groups" with insured lives, hospitals, and physician contracts are going to be the big losers, followed by the huge hospital chains (Dignity, Tenet, HCA, Mercy, Partners, Sutter, Adventist...).

Everyone on the providing end of health care services is going to lose. Big hospitals, little hospitals, HCA, TeamHealth and the like, private practice, everyone.

Medicare generally speaking pays less than private insurance, sometimes exceptionally so. For places that run lean (ie. most hospitals), that's going to cause problems.

 

[Vandalia]

hospitals that accept Medicare are also taking in privately insured patients. They make their margin on the insured patients, not the Medicare patients. If 100% of their patients were on Medicare, they would be insolvent financially. As a ballpark figure, I believe the median operating margin for hospitals is somewhere in the neighborhood of 2%. Medicare for all would remove the uninsured no pay patients, but would drastically cut back the spend from the insured patients. Hospitals would need to massively drive down costs across the board to remain standing. Imagine the political fun when they announce 10% cuts to nurses salaries.

The factor that you are missing is that there will also not be "freeloading patients" where there is care provided without compensation.

Dentists are a good example. I had a tooth extracted by an oral surgeon and the charge was in the ballpark of what our chargemaster is for a venipuncture. They charge far, far less than equivalent "medical" surgical procedures (I am talking about oral surgeons here to keep things on the same level) but have similar income because they also don't have the three or four other patients in a row paying nothing.

You can make a lot of money on medicare rates, if everyone is paying medicare rates. The reason hospitals and physicians currently need the higher paying "private" insurance is because of the large number who pay $0.

 

[deleted171991]

You can make a lot of money on medicare rates, if everyone is paying medicare rates. The reason hospitals and physicians currently need the higher paying "private" insurance is because of the large number who pay $0.

The Medicare rates for many anesthetics are just ridiculous, as in I wouldn't get out of bed for them ridiculous, and I am just an employee. The only reason we don't get paid peanuts for our work is private insurance.

Gods forbid we have to work at Medicare rates only. FYI Medicare pays about $22 per unit.

MEDICARE FOR ALL and Anesthesiology - The anesthesia consultant

Medicare for All would decimate the specialty of physician anesthesiologists in America, and cause an exodus from the specialty of anesthesiology.

theanesthesiaconsultant.com

 

[apoondoc]

OK, here's a related question that should not be controversial:

Since ~1984 anesthesiologists have gotten screwed by Medicare (and, even worse, Medicaid) worse than our surgical and medical colleagues. Medicare pays surgeons and internists about 80% of typical private pay/insurance reimbursement. They pay us ~33%. How do we change that? When Medicare For All passes (and it will, eventually. We can't continue to be the only industrialized country without a baseline guarantee of healthcare; nor will we remain competitive when we are paying twice as much as our international peers and getting worse results for it.), how do we go about making sure that we get that same 80% as other doctors?

 

[deleted171991]

OK, here's a related question that should not be controversial:

Since ~1984 anesthesiologists have gotten screwed by Medicare (and, even worse, Medicaid) worse than our surgical and medical colleagues. Medicare pays surgeons and internists about 80% of typical private pay/insurance reimbursement. They pay us ~33%. How do we change that? When Medicare For All passes (and it will, eventually. We can't continue to be the only industrialized country without a baseline guarantee of healthcare; nor will we remain competitive when we are paying twice as much as our international peers and getting worse results for it.), how do we go about making sure that we get that same 80% as other doctors?

We don't. Because we can't. The other specialties will also see serious drops in reimbursements. Why? Because we've been training our replacements for decades (unlike those other developed countries), so we're f-cked. Why did I suggest the Aussie doc who wanted to move to the US to pursue anesthesia that he was basically a *****?

I can already foresee the new Medicare For All motto: there are many diseases we can't cure, for everything else, there is a midlevel.

 

[deleted50478]

“Medicare For All” doesn’t really mean Medicare for all. It’s short hand for single payer healthcare that makes for a better sound bite than a long explanation about a single payer system.

I assume once we have a public option or single payer all costs and payments will be reset and new payments will be decided. Hopefully we’ll have a more reasonable payment than under Medicare.

At least I hope they aren’t stupid enough to actually mean Medicare for all.

I think Medicare for all would result in immediate retirement for 10s of thousands of doctors and emigration for a smaller but significant number of doctors.

 

[deleted162650]

I think Medicare for all would result in immediate retirement for 10s of thousands of doctors and emigration for a smaller but significant number of doctors.

Not to mention decreased med school enrollment unless they make it free (or pretty close to free).

 

[Mman]

The factor that you are missing is that there will also not be "freeloading patients" where there is care provided without compensation.

Dentists are a good example. I had a tooth extracted by an oral surgeon and the charge was in the ballpark of what our chargemaster is for a venipuncture. They charge far, far less than equivalent "medical" surgical procedures (I am talking about oral surgeons here to keep things on the same level) but have similar income because they also don't have the three or four other patients in a row paying nothing.

You can make a lot of money on medicare rates, if everyone is paying medicare rates. The reason hospitals and physicians currently need the higher paying "private" insurance is because of the large number who pay $0.

No, I specifically mentioned the removing of no pay patients. For the overwhelming majority of hospitals, however, that is a relatively minor issue at least compared to the drastic cuts from losing private insurance.

 

[Mman]

“Medicare For All” doesn’t really mean Medicare for all. It’s short hand for single payer healthcare that makes for a better sound bite than a long explanation about a single payer system.

I assume once we have a public option or single payer all costs and payments will be reset and new payments will be decided. Hopefully we’ll have a more reasonable payment than under Medicare.

At least I hope they aren’t stupid enough to actually mean Medicare for all.

I think Medicare for all would result in immediate retirement for 10s of thousands of doctors and emigration for a smaller but significant number of doctors.

The current politicians basically do want Medicare for all because they have data on what it costs per patient so they like to extrapolate it out to entire populations. Telling them they need to potentially double or triple the reimbursement for some things would make their heads explode.

 

[BLADEMDA]

If we take knee replacements (only because we can Google the costs of TKA and find a popular study) as a proxy for Medicare patients, I think we can all agree that the hospitals do very well, even at Medicare rates. (Let's stop parroting the AHA Kool-Aid that they lose money on Medicare patients or, at best, realize a razor-thin 2% margin. Yes, I understand why hospitals want people to believe it. But it's not true.)

TKA is not a bad target case. Most TKA patients are on Medicare. It is a very common procedure, done at almost every hospital in the USA.

Average cost, $10,500: Outline - Read & annotate without distractions
Average MEDICARE reimbursement: $13,500: How much does a knee replacement cost? Medicare average: $13,464. - Clear Health Costs

Medicare just announced reimbursement rates for Total Knee Replacements at an ASC for 2020: $8600.
Yes, that is correct. So, $8600 is all the ASC is going to get from Medicare.

CMS proposed a payment rate of $8,639.97 for total knee arthroplasty in its 2020 outpatient and ASC prospective payment system proposed rule.

 

[BLADEMDA]

Medicare rates for "anesthesia" means Nurse Anesthesiologist pay at best. For those that think politicians are going to fix the Anesthesia problem when it comes to Medicare reimbursement they are mistaken. The ANNA will argue their members of Doctor Nurse Anesthesiologists are more than happy to practice independently and accept the current Medicare rates. After all, the AANA thinks this is a Nursing level profession with Physician colleagues engaged in the practice of their profession.

Why pay an M.D./D.O. a high reimbursement to do a Nursing level job? The Liberals will just allow the Nurse Anesthesiologists to practice at the top their licenses. We will get the privilege of being allowed to work alongside our Nursing colleagues while paying 3 X their malpractice premiums on average. They are the safer and better trained group of providers so their rates are lower.

 

[BLADEMDA]

I am not trolling or hoping to start a heated political discussion. And I don't wish to debates the merits of the proposal, nor its chances of passing. But Medicare For All is going to put Kaiser out of business, correct? I mean, they will still own their hospitals and clinics and patients will still engage with their Permanente physicians, but all the fat will be trimmed. Same thing for the Mayo Clinic, IHC, and all the others, correct?

Is the reason nobody talks about this is because it's so obvious? Or is this one of the obvious truths that only becomes obvious once you think about it, and nobody pauses to think about it? (I will say that it is terrible how journalists have let the insurance companies control the dialog, without ever mentioning their incentive to engage in half-truths, scare tactics, and flat out lies.)

It is not up for debate that insurance companies will be one tiny step above worthless. Yes, a second tier will likely develop, as well as supplemental plans. But buh-bye to 90% or more of their business (and good bloody riddance).

Now, Envision, USAP, Somnia, and all the other tedious anesthesia management companies will no longer be able to act like their market size is going to allow them more favorable reimbursement rates. True, they can still peddle their "secret sauce" nonsense, but nobody buys that now, and I imagine that without the empty promise of better reimbursement rates to hope for, their salespitch will have to evolve significantly if they are going to survive. Again, good bloody riddance.

Similarly, with administrative costs at 3% versus 30% for insurers, Medicare for All is going to put a lot of billing specialists out of business. Buh-bye.

Abeo and all the other blood-sucking leeches might still eke out an existence promising regulatory compliance, but their margins are going to be thinner. With only one set of hoops to jump through, a lot of groups are going to keep billing in-house. Or, more likely, hospitals will take over billing for the anesthesia groups. Again, more fat to be trimmed that simply won't be missed.

Am I missing something here?

I would particularly like to hear from docs who work for big management companies and wonder how scared they are. Their stock is going to be worthless. Is this a discussion taking place behind closed doors?

AMCs know their stock is basically worthless in 10 years. The goal is to convince private equity to keep playing the game as long as possible. This means moving the money around and hiding the likely declining reimbursement rates to come.
Anyone holding AMC stock is well aware of the high risk venture of such stock. I'm sure the older guys have a plan to divest themselves from the stock over the next few years.

 

[dhb]

Medicare just announced reimbursement rates for Total Knee Replacements at an ASC for 2020: $8600.
Yes, that is correct. So, $8600 is all the ASC is going to get from Medicare.

CMS proposed a payment rate of $8,639.97 for total knee arthroplasty in its 2020 outpatient and ASC prospective payment system proposed rule.

If it gets any cheaper you might attract medical tourism to the US!

 

[anbuitachi]

i dont understand why insurance reimburse ortho cases SO much more than other cases. the ortho docs are most commonly the millionaires among the surgeons..

 

[ChiDO]

Medicare just announced reimbursement rates for Total Knee Replacements at an ASC for 2020: $8600.
Yes, that is correct. So, $8600 is all the ASC is going to get from Medicare.

CMS proposed a payment rate of $8,639.97 for total knee arthroplasty in its 2020 outpatient and ASC prospective payment system proposed rule.

You have a link? I'd be interested to read it.

 

[Impromptu]

Honest question about Medicare, and hence Medicare for all.

Medicare includes a monthly premium, and parts A and B include a deductible and co-insurance. Can we honestly expect that most of the nation who is expecting to have "free" healthcare will sit still and not holler once they find out that they have a premium, deductible, and co-insurance to pay? It is probably be less than most working people pay for their coverage and their deductibles, but it is more than many others pay, which is nothing.

 

[kmurp]

Medicare is under great financial pressure so I don’t see that program increasing reimbursement. Hospitals would close, no doubt, and large hospitals would get larger. Likely, there would be a growth in private wards in these hospitals to accommodate those with a supplemental private policy for elective procedures. I don’t see a Canadian or British system happening.
For anesthesia I don’t know how it would shake out, but the care team would not be viable under Medicare only rates. 220-240k per room wouldn’t support it. Just a huge dislocation though from providers to facilities to insurance companies.

 

[ambiturner]

Medicare includes a monthly premium, and parts A and B include a deductible and co-insurance. Can we honestly expect that most of the nation who is expecting to have "free" healthcare will sit still and not holler once they find out that they have a premium, deductible, and co-insurance to pay? It is probably be less than most working people pay for their coverage and their deductibles, but it is more than many others pay, which is nothing.

People will absolutely complain because they won’t look at their paychecks and realize that there is no longer a big line item for private insurance premiums. What people really care about is having to write checks to the man.

In a similar phenomenon, I was talking to some of our techs the other day about how they thought their taxes went up with the new tax plan because they owed money at the end of the year. Turns out they were withholding less, but hadn’t complained when their paychecks got bigger.

 

[Mikkel]

People will absolutely complain because they won’t look at their paychecks and realize that there is no longer a big line item for private insurance premiums. What people really care about is having to write checks to the man.

In a similar phenomenon, I was talking to some of our techs the other day about how they thought their taxes went up with the new tax plan because they owed money at the end of the year. Turns out they were withholding less, but hadn’t complained when their paychecks got bigger.

No, people will be pissed when they see their payroll taxes skyrocket.

Save $20k dropping private insurance, in exchange for $40k in more payroll tax..... For MEDICARE level quality.....

 

[Obnoxious Dad]

Is Medicare for All the Answer to Sky-High Administrative Costs? (Published 2018)

It would save money compared with private plans, but would also probably shed features that some might miss.

www.nytimes.com

Per Austin Frakt

"But let’s get back to the main question we posed at the top: Are Democrats right that Medicare’s administrative costs are below those of private insurers? The answer is yes. But that’s in part because private plans do things that Medicare doesn’t. Whether those things are worth higher administrative costs is a value judgment on which reasonable people can disagree. "

 

[Obnoxious Dad]

2017 GAO Report on Medicare Fraud

https://www.gao.gov/assets/700/693156.pdf

 

[Mman]

It was on the ballot in Vermont, but it didn't pass. That's much, much different from saying that it "was proved a failure."

I think they were referring to the Medicaid experiment 10 years ago in Oregon that didn't exactly live up to the hype.

 

[Hoya11]

i dont understand why insurance reimburse ortho cases SO much more than other cases. the ortho docs are most commonly the millionaires among the surgeons..

This is one of the biggest problems that I have with our current system. Orthopods, Neurosug,GI, Optho are making millions - why? they bring in the patients but not really the patients have to go somewhere and somewhere is referring them the patients. They are just the benefactors of this weird system we have - needs to change.

 

[VA Hopeful Dr]

This is one of the biggest problems that I have with our current system. Orthopods, Neurosug,GI, Optho are making millions - why? they bring in the patients but not really the patients have to go somewhere and somewhere is referring them the patients. They are just the benefactors of this weird system we have - needs to change.

The same can be said of any consultant-heavy field.

The bigger question to my non-surgeon mind is why some procedures pay way more.

For example, it looks like Medicare pays the surgeon around $1500 for a total knee which from what I've read here a decent surgeon can do in about an hour.

Medicare pays around $2000 for a total colectomy which (please correct me if I'm wrong since I'm taking this number from Google while y'all see this procedure done frequently) takes close to 3 hours on average.

That's only 33% more money for 3 times as long of a procedure. Plus, I would suspect the colectomy has a much more involved post-op course which is bundled with that procedure fee.

 

[nimbus]

The same can be said of any consultant-heavy field.

The bigger question to my non-surgeon mind is why some procedures pay way more.

For example, it looks like Medicare pays the surgeon around $1500 for a total knee which from what I've read here a decent surgeon can do in about an hour.

Medicare pays around $2000 for a total colectomy which (please correct me if I'm wrong since I'm taking this number from Google while y'all see this procedure done frequently) takes close to 3 hours on average.

That's only 33% more money for 3 times as long of a procedure. Plus, I would suspect the colectomy has a much more involved post-op course which is bundled with that procedure fee.

A colectomy and knee replacement are comparable. Faster surgeons do both in an hour. Slow surgeons take 2-3hours. The difference is that an orthopedist will have 5-6 joint replacements in a lineup. A general surgeon will more typically have 1 or 2 colectomies plus some lumps, bumps and hernias. Bariatric surgeons will have a lineup of RYGBs and sleeves and their income and lifestyle is similar to an orthopedist. Busy general surgeons do generate lots of revenue, it’s just that many of them are not that busy.

 

[VA Hopeful Dr]

A colectomy and knee replacement are comparable. Faster surgeons do both in an hour. Slow surgeons take 2-3hours. The difference is that an orthopedist will have 5-6 joint replacements in a lineup. A general surgeon will more typically have 1 or 2 colectomies plus some lumps, bumps and hernias. Bariatric surgeons will have a lineup of RYGBs and sleeves and their income and lifestyle is similar to an orthopedist. Busy general surgeons do generate lots of revenue, it’s just that many of them are not that busy.

That makes sense, thanks

 

[narcotics999]

The same can be said of any consultant-heavy field.

The bigger question to my non-surgeon mind is why some procedures pay way more.

For example, it looks like Medicare pays the surgeon around $1500 for a total knee which from what I've read here a decent surgeon can do in about an hour.

Medicare pays around $2000 for a total colectomy which (please correct me if I'm wrong since I'm taking this number from Google while y'all see this procedure done frequently) takes close to 3 hours on average.

That's only 33% more money for 3 times as long of a procedure. Plus, I would suspect the colectomy has a much more involved post-op course which is bundled with that procedure fee.

Does the 1500$ include pre-op consultation and post-op follow-ups?

 

[ChiDO]

Does the 1500$ include pre-op consultation and post-op follow-ups?

Medicare reimburses closer to $1200 for a primary and $1500 for a revision knee (which can take 2-3x longer). That's why no one likes to do revisions. Reimbursement sucks.

That fee covers the 90 day global postop. Most surgeons will see patients 1-4 times in that time frame,howver if the patient shows up 15 times or calls the office 80 times, it's all included.