Medicare for everyone.

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physasst

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Well, that's Rahm Emanuel's stance.

Scary huh?

Obama has publicly said that he would like to see a public plan that will compete with private insurance. This, depending on the structure, sounds like a good idea.

Problem is, according to my sources, Orzag and Ezekiel Emanuel are on side with a single payor plan, and Rahm has specifically said that he wants Medicare for EVERYONE.

Well, what would that mean? Good thinking. The Lewin group is a non-partisan think tank, and they took up this task.

Initially, the report indicates that reimbursements will only fall 5-7%, but that is only in 2010, as the program progresses, and more people switch to the "government" plan, and abandon private insurance, the reimbursements will fall even more. Private insurers will need to reduce their payments or raise rates dramatically to make up for the loss of volume. This will have an economic tsunami effect, and patients will suffer for it.

I understand Mr Obama's intentions, and I think they are admirable, but this is just not the right way to go about this. Cost controls need to be implemented, and those providers/institutions who are billing fraudulently, and/or providing unnecessary services SHOULD see their reimbursements cut, but this will create a blanket effect, that will affect everyone.

Basically, there are better ways to go about this.

Oh yeah, and Bob's right, what the hell is up with democrats wanting a two-tiered plan? I thought that was anathema to them?

My friend Bob Laszewski posted about this on his blog.

http://healthpolicyandmarket.blogspot.com/2009/04/public-plan-option-for-under-age-65.html

The respected and non-partisan Lewin Group recently issued a report evaluating the idea, “The Cost and Coverage Impacts of a Public Plan: Alternative Design Options.” It looks to me to be a credible job. They made the assumption providers would be paid at Medicare rates—a logical conclusion if the objective is lowering costs.

Among Lewin’s findings:


“If the public plan is opened to all employers…at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people. This would be a two-thirds reduction in the number of people with private coverage (currently 170 million people).”
The study also examined what the proposed plan might do to provider reimbursement rates. Lewin says that if current Medicare payment rates were to be used for a public plan option, physicians would see their net income drop by $33 billion (-7%), and hospitals would see their revenue fall by $36 billion (-5%) in just 2010.
“If Medicare payment levels are used in the public plan, premiums would be up to 30 percent less than premiums for comparable private coverage. On average, the monthly premium in the public plan for a typical benefits package would be $761 per family compared with an average of $970 per family in the private market for the same coverage.”
“If as the President proposed, eligibility is limited to only small employers, individuals and the self-employed, public plan enrollment would reach 42.9 million people. The number of people with private coverage would fall by 32.0 million people. If private payer reimbursement levels are used by the public plan, enrollment would be lower, with only 10.4 million people switching to the public plan from private insurance.”
Medicare premiums would be lower than private premiums because of the exceptional leverage Medicare has with providers. Medicare pays hospitals about 30 percent less than private insurers pay for the same service. Physician payments are about 20 percent less than under private coverage. Also, because Medicare has no allowance for insurer profits or broker/agent commissions, administrative costs for this population are about one-third of administrative costs in private health plans.

Here's a link to the Lewin report itself, if you are so inclined.

http://www.lewin.com/content/public...ctsofPublicPlan-Alternative DesignOptions.pdf

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physasst,

It almost sounds as if you are coming around to a different (more what your core / gut tells you) way of thinking... it is this dangerous path that has all of us fearful for not only our livelihood, but the overall approach to business and problems taken by this administration.

We all have to speak with a unified voice of opposition against any single governmental payor system. Universal access is a noble and lofty goal, but we cannot sink the lifeboat in order to save everyone. Until we can find a way to have enough lifeboats, we will be stuck rationing in some form or another.

I applaud your efforts in keeping everyone informed.
 
Oh, BTW, it will not likely be "MC for all" -- it will really be Medicaid for all. Everything falls to the lowest common denominator. This is form fruste Hillarycare, FWIW.
 
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Physassist,

Whether I agree with you (Like this time) or I don't (Like most of the other times) your up to date information on these developments is invaluable. Wherever you fall in this debate, this issue will eventually impact everyone in the medical community, and I for one would love to see you continue to come back here and let us all know about it.
 
physasst,

It almost sounds as if you are coming around to a different (more what your core / gut tells you) way of thinking... it is this dangerous path that has all of us fearful for not only our livelihood, but the overall approach to business and problems taken by this administration.

We all have to speak with a unified voice of opposition against any single governmental payor system. Universal access is a noble and lofty goal, but we cannot sink the lifeboat in order to save everyone. Until we can find a way to have enough lifeboats, we will be stuck rationing in some form or another.

I applaud your efforts in keeping everyone informed.

For the record, I am not against a single payor governmental system, but I am definitely against this one.

Depending on how it is structured, funded, and managed, a single payor system could be a great thing.

Rahm's notions however, are not a good idea in the least.

So, I guess I would say. I am against SOME single payor government ideas.
 
I think health care should be provided to everyone without any discrimination.
I'm all for the single payer government idea.

I'm going to think it over, and provide my input later.
 
What is so difficult about choosing the country that we like, who has a health plan we like, and trying to "drop" it in place?

I knooow...
 

Among Lewin’s findings:

Medicare premiums would be lower than private premiums because of the exceptional leverage Medicare has with providers. Medicare pays hospitals about 30 percent less than private insurers pay for the same service. Physician payments are about 20 percent less than under private coverage. Also, because Medicare has no allowance for insurer profits or broker/agent commissions, administrative costs for this population are about one-third of administrative costs in private health plans.

Am I missing something there? That seems like a pretty big point to overlook. Not that I'm against the alternative you and Ezekial are proposing, but I'm not sold yet. What are your reasons for being against the above plan? I understand that if you keep medicare payments the same, then hospitals and healthcare workers end up being paid less, but theoretically, can't you use the savings mentioned above to up medicare payments to compensate, rather than spending more money on a bloated system?
 
Am I missing something there? That seems like a pretty big point to overlook. Not that I'm against the alternative you and Ezekial are proposing, but I'm not sold yet. What are your reasons for being against the above plan? I understand that if you keep medicare payments the same, then hospitals and healthcare workers end up being paid less, but theoretically, can't you use the savings mentioned above to up medicare payments to compensate, rather than spending more money on a bloated system?

UMED--

Research the effects of cost shifting in healthcare. You will then get a better understanding of why "Medicare for all" is a bad, bad thing for all providers.

Cost shifting will continue to take place regardless of single payer or not; instead of the direct dollar cost shift that is common today, there will be a "dollar per unit effort and risk" cost shift, whereby the truly sick and complicated will get dumped onto CHC's, hospitals, universities, etc -- even more so than they are today.

The real point that you are getting it is regarding the administrative costs associated with private health plans. Another term to understand is "medical loss ratio" -- that is the % of premium dollars that are "lost" due to being paid out in claims. Insurance, in general, is a racket -- it is organized gambling and they hold all of the cards. If we were to impose regulations on the health insurance industry that mandated a minimum "medical loss ratio", this administrative cut would be more acceptable. Casinos are legally obligated to pay out a certain percentage of their take, I'm not sure why insurance companies are not regulated to do the same.
 
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Am I missing something there? That seems like a pretty big point to overlook. Not that I'm against the alternative you and Ezekial are proposing, but I'm not sold yet. What are your reasons for being against the above plan? I understand that if you keep medicare payments the same, then hospitals and healthcare workers end up being paid less, but theoretically, can't you use the savings mentioned above to up medicare payments to compensate, rather than spending more money on a bloated system?


Sure, the problem is Medicare's administrative costs are false. They do not advertise or count many of their costs against the "administrative" bottom line..

Here's a great paper.

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

Also, because of their lax administrative functions, there is more fraud, waste and abuse present than with any other insurer. Some estimates claim about 60 billion per year in fraudulent claims. Yet Medicare, in an effort to keep their cost structure down, doesn't deal with this.

So, IF Medicare were to address fraud and abuse, and REALLY report their administrative costs, they would likely be very comparable to private insurance.
 
Sure, the problem is Medicare's administrative costs are false. They do not advertise or count many of their costs against the "administrative" bottom line..

Here's a great paper.

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

Also, because of their lax administrative functions, there is more fraud, waste and abuse present than with any other insurer. Some estimates claim about 60 billion per year in fraudulent claims. Yet Medicare, in an effort to keep their cost structure down, doesn't deal with this.

So, IF Medicare were to address fraud and abuse, and REALLY report their administrative costs, they would likely be very comparable to private insurance.

Fraud is also so rampant, because so much of it is accidental. Medicare, with other health insurance companies following suit, is the only form of insurance that dictates the price to the individuals providing the service and then forces them to bill above the head of the person receiving the service, leaving every provider to attempt to figure out, through a complex coding system, how to bill for what already happened and how much they might get for it. If they do go after you, it is usually with demands for way more money than the actual error that took place, and they back it up with threats of criminal charges and jail time.
 
Echo what Miami said.. the current CPT system is fraught with ambiguity, difficult to interpret guidelines, and is open to individual carrier interpretation. E&M coding, even what constitutes a consultation is problematic. Many procedural codes are open to interpretation as well. To make matters worse, even if one bills correctly according to current CCI edits, they can still be found guilty of abusive or fraudulent billing through the "medical necessity" interpretation. It is a bastardized hybrid system, created by the AMA in conjunction with CMS input, with the said intention of having an independent organization valuing medical services. That is a joke -- CMS clearly has dictated to the AMA, and continues to do so, RVU valuation reassessments based on nothing more than expenditures. If a code has greater than a 10% increase in utilization over three running years, it is automatically flagged for "reassessment". This "reassessment" interprets into the English language as "cut its value". It has happened before, and will happen again. The AMA's RVURUC willingly does so in order to offer up annual sacrificial lambs at CMS' altar in order to prevent more painful across the board cuts.

These are among the many reasons why some of us have great difficulty with those not intimately familiar with the system driving the "reform" discussion. If you want to see a glimpse of the future if these programs come to pass, look no further than the medicare recovery audit program. Fun times.
 
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These are among the many reasons why some of us have great difficulty with those not intimately familiar with the system driving the "reform" discussion. If you want to see a glimpse of the future if these programs come to pass, look no further than the medicare recovery audit program. Fun times.


This is exactly why I, with the Mayo Health Policy Center, have become more involved. I am in the trenches. I know what is at the heart of many of these issues, and I want to make sure that the change that is coming, is done, carefully, thoughtfully, and is deliberate. Not haphazard, randomized ideas that have not passed careful scrutiny. We all, patients and providers, deserve better than that.

MOHS, you and I may disagree on the final solution, but I think we both agree, that as clinicians, we have a responsibility to be more involved in this arena.
 
Sigh...I already have an "Operation: Valkyrie" contigency in place should single payor Medicare suddenly become the law of the land. My goal would be to net 2-3 million USD and head for hills ala DeNiro's plan in Heat.

1.) Step 1: PASSIVE MOVEMENT
SIGN NOTHING. Realize they can only get this plan to work IF providers sign up to provide the care. If they try to sneak this into current Medicare contracts (whoops, you are now providing care for 10x more people with these crappy rates), you dump it and FULL BILL patients. You "bonkers bill", you bill like Dr. Al Capone in Old Chicago. Im serious, youre goin f'ing nuts like with 2xThompson machine guns.

2.) Step 2: ORGANIZATION
Get every doctor you know to dump Medicare. Crash the bloody *****, deep deep into the sea. Yeah some docs are going be weak and whine like little lil' girls about their mortgage payments and kids' college tuition or some strip club they owe 10 grand to but you beat them down. Im talking old school Labor Union stuff, threaten walk outs, work outs, sick outs. Demand large cash payments to do ANYTHING and then simply not show up.

3.) Step 3: FAINT MOVE
Once Medicare is burning and Im talking Biblical sh-t: EDs closed for 300+ miles, Medivac flights offline, no surgeons in whole portions of states, no gas, chaos, National Guard trying to piece together random motor vehicle accidents, dead lying in the streets from swine flu etc...that is the time for step 3. Here you move back slowly into the market, maybe working 1-2 days a week and always getting paid in cash up front. By late step 2 -early 3, people in general will have started giving up on insurance PERIOD and horde what cash they can for emergencies. The goal of step 3 is really to accelerate this to maturation.

4.) Step 4: RESPONSE
By the end of step 3, politicians will be going f'ing nuts-n-butter crazy. Hopefully some of 'em will have actually perished as the result of this and those that remain will be pure piss and vinegar angry at the medical community. The goal will be turn that anger directly against them. There could be not better response than have televised beatings and shootings of scrub-clad docs and surgeons send the entire population into a frenzy. Here the anger of the masses becomes directly focused on HHS and its politicians.

If people think this is far fetched or absurd, I would HIGHLY suggest you brush up on both US history and early 20th century European history. While Europe had WW2 to soften the medical community up to accept government control, we are well prepared for it here.

References:
1. Postal Service Strike, United States, 1970 http://en.wikipedia.org/wiki/U.S._postal_strike_of_1970

2. Unternehmen Werwolf, Germany, 1944

3. Eugene V. Debs, United States, 1900-1926

4. Ayn Rand, Atlas Shrugged, 1957.


Tradite Numquam
 
2.) Step 2: ORGANIZATION
Get every doctor you know to dump Medicare. Crash the bloody *****, deep deep into the sea. Yeah some docs are going be weak and whine like little lil' girls about their mortgage payments and kids' college tuition or some strip club they owe 10 grand to but you beat them down. Im talking old school Labor Union stuff, threaten walk outs, work outs, sick outs. Demand large cash payments to do ANYTHING and then simply not show up.

I don't know about Medicare, but if you try this with any of the private insurers, they can come after you with the Sherman Anti-trust Act. One of the large insurers in our attending's town came after him because he and the 3 other specialists were not preferred providers on their plan. None of them had ever conferred with each other about the issue, all 4 had independently decided they didn't want to join this plan. The insurance company thought this was impossible and went after all 4, but the specialists were able to prove they had not conspired anything.

The thought of health insurance companies makes me mad and the idea of medicare for all makes me shudder. I'm all for fair billing and payment for what you've done without 3rd party involvement. But those weak whiny docs will ruin it for the rest of us unless they can be eliminated.

And if something like Medicare for all did happen, I am opting myself out as a provider and opting my family out as subscribers.
 
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Ah,

I missed LADOC

You and me both. The interesting play will be the in legal repercussions... restraint of trade accusations on the part of physicians, collusion amongst physicians, etc. How long will it take them to tie licensure to public health plan participation I wonder? Or, better yet, force hospitals to have x% of their staff participating providers? Tie credentialing to hospital privileges?
 
I don't know about Medicare, but if you try this with any of the private insurers, they can come after you with the Sherman Anti-trust Act. One of the large insurers in our attending's town came after him because he and the 3 other specialists were not preferred providers on their plan. None of them had ever conferred with each other about the issue, all 4 had independently decided they didn't want to join this plan. The insurance company thought this was impossible and went after all 4, but the specialists were able to prove they had not conspired anything.

The thought of health insurance companies makes me mad and the idea of medicare for all makes me shudder. I'm all for fair billing and payment for what you've done without 3rd party involvement. But those weak whiny docs will ruin it for the rest of us unless they can be eliminated.

And if something like Medicare for all did happen, I am opting myself out as a provider and opting my family out as subscribers.

LMAO..come after us for anti-trust and do what exactly? What??

Put every surgeon, internist, pediatrician, orthopod and pathologist into the slammer?

How bout WE go after THEM? Hows them apples? How bout we reopen Gitmo in Cuba and put every single US congressman in it? And their families too. We will feed them of course and give them basic bare bones medical care.

The weak can be brought into line. That is how organized labor works. Pressure, massive pressure. And we arent making cars in Detroit people, you even get most of a single speciality to revolt and the party is OVER, the government will collapse.
 
LMAO..come after us for anti-trust and do what exactly? What??

Put every surgeon, internist, pediatrician, orthopod and pathologist into the slammer?

Just saying what the argument against it is, not everyone knows. I sure didn't when I was a student. Organizing against third parties sounded good to me till I was informed of why it was illegal. I have no idea what could be done if an entire specialty went to straight cash in a town. I'd imagine the insurance company's lawyer army and deep pockets and lobbyist tentacles could strongarm consequences faster than 10 specialists in a town who drop out. 100 specialists and the stakes are higher. Angry patients not finding any specialists on their plans will be call their insurance companies and be sent to voicemail. Angry patients storming their elected officials, maybe something will happen. The media could end up spinning it either way though. NYTimes has been running lots of doctor-hate and patient sob stories lately.
 
LMAO..come after us for anti-trust and do what exactly? What??

Put every surgeon, internist, pediatrician, orthopod and pathologist into the slammer?

How bout WE go after THEM? Hows them apples? How bout we reopen Gitmo in Cuba and put every single US congressman in it? And their families too. We will feed them of course and give them basic bare bones medical care.

The weak can be brought into line. That is how organized labor works. Pressure, massive pressure. And we arent making cars in Detroit people, you even get most of a single speciality to revolt and the party is OVER, the government will collapse.
I would love to see Nancy Pelosi in Gitmo!!!!! Maybe some water boarding would straighten her out.
 
I would love to see Nancy Pelosi in Gitmo!!!!! Maybe some water boarding would straighten her out.

And while that is going on, be sure to ask her if she remembers the CIA briefings.
 
Private insurance can never successfully compete with the government because government has an essentially infinite amount of taxpayer money to subsidize their costs and a complete lack of profit motive since nobody in the government benefits from it if it works or not.

Check this article out: http://online.wsj.com/article/SB124208383695408513.html?mod=googlenews_wsj

Basically Obama wants to give everyone medicare and **** doctors in the ass so we get paid as much as the administrators whose jobs exist solely to satisfy the law instead of do anything useful. The government bloat is spilling over into healthcare and now they want to make it a law....
 
The topic of this thread will NEVER happen. Why? See the news today:

http://finance.yahoo.com/news/Social-Security-and-Medicare-apf-15219531.html

Medicare is in even worse shape. The trustees said the program for hospital expenses will pay out more in benefits than it collects this year, just as it did for the first time in 2008. The trustees project that the Medicare fund will be depleted by 2017, two years earlier than the date projected in last year's report.
 
The topic of this thread will NEVER happen. Why? See the news today:

http://finance.yahoo.com/news/Social-Security-and-Medicare-apf-15219531.html

Medicare is in even worse shape. The trustees said the program for hospital expenses will pay out more in benefits than it collects this year, just as it did for the first time in 2008. The trustees project that the Medicare fund will be depleted by 2017, two years earlier than the date projected in last year's report.


at current spending. Obama wants to radically reduce spending, and reimbursements. He has not said that he opposes the 21% SGR reduction scheduled for the end of this year.

If they can offer this as a public plan option, and believe me, Rahm Emanuel wants to. Then other third party insurers will be forced to reduce their spending/reimbursements in order to remain competitive. I have no problem with a well funded, well structured, responsible single payer system. Medicare is none of these.
 
The topic of this thread will NEVER happen. Why? See the news today:

http://finance.yahoo.com/news/Social-Security-and-Medicare-apf-15219531.html

Medicare is in even worse shape. The trustees said the program for hospital expenses will pay out more in benefits than it collects this year, just as it did for the first time in 2008. The trustees project that the Medicare fund will be depleted by 2017, two years earlier than the date projected in last year's report.

at current spending. Obama wants to radically reduce spending, and reimbursements. He has not said that he opposes the 21% SGR reduction scheduled for the end of this year.

If they can offer this as a public plan option, and believe me, Rahm Emanuel wants to. Then other third party insurers will be forced to reduce their spending/reimbursements in order to remain competitive. I have no problem with a well funded, well structured, responsible single payer system. Medicare is none of these.

More like at current income than at current spending. Medicare isn't going anywhere, and cost controls aren't going to save it, at least not in the long run. The writing is already on the wall. Taxes are going up, way up, even if we only want to cover the population that currently qualify for MC/MA. This will likely be accompanied by massive cuts in physician reimbursement. Like it or not, we are going to be making a lot less and taxed a lot more on that income. Thank the baby boomers' incompetence and self-entitlement for this mess.
 
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More like at current income than at current spending. Medicare isn't going anywhere, and cost controls aren't going to save it, at least not in the long run. The writing is already on the wall. Taxes are going up, way up, even if we only want to cover the population that currently qualify for MC/MA. This will likely be accompanied by massive cuts in physician reimbursement. Like it or not, we are going to be making a lot less and taxed a lot more on that income. Thank the baby boomers' incompetence and self-entitlement for this mess.

:(
Entitle me with free medical school, please.

In all seriousness, cpants, you could be right. Everyone has been talking for some time now about how the current system is unsustainable and that there is going to be some big shake up in health care soon.... and soon seems to be VERY SOON.
 
You do realize it will only be Medicare Part A which will go bankrupt. Part B and Part D will be fine because they have premiums. They will just raise the premiums to break even. All they would have to do to make Part A fiscally solvent is to either get rid of the maximum salary at which they can charge the tax and/or start charging premiums.
 
You do realize it will only be Medicare Part A which will go bankrupt. Part B and Part D will be fine because they have premiums. They will just raise the premiums to break even. All they would have to do to make Part A fiscally solvent is to either get rid of the maximum salary at which they can charge the tax and/or start charging premiums.

Wrong. Thanks for playing.

Medicare taxes do not phase out -- all "ordinary income" is subject to MC tax. Yeah, of course they could raise it -- the problem is that there is not enough revenue in the entire tax base to pay for its unfunded liabilities. LBJ's "Great Farce" was the pornocracy that started this mess; BHO's will be the pornocracy that rings the practice of medicine's death knell.... and the "progressively" slanted half-wits, along with the frankly ignorant amongst even our own ranks will applaud the tolling of the bell......
 
"along with the frankly ignorant amongst even our own ranks will applaud the tolling of the bell"......


We do seem to have our fair share of idiots amongst our own ranks!
 
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