The current situation with healthcare in the USA needs to improve, and simplifying the system is essential. The problem is, hospital systems who are a huge part of the cost problem will fight anything that reduces their revenue. Due to the predatory activities of insurance companies who have harmed individual hospitals financially by lowballing reimbursements or creating tiered systems such as Horizon Omnia, many of the smaller hospitals have joined with large hospital systems to protect their reimbursements and their turf. The result is that we are all paying more for healthcare.
According to a recent article in the NY times, hospitals will lose large amounts of revenue for common procedures if we only had Medicare as an insurer.
What they are not saying is that currently, Medicaid underpays for care, Medicare is in the middle, and commercial carriers will pay the most.
While many of the proposals being introduced add things to the current Medicare model that is enjoyed by millions of seniors, Obamacare merely created exchanges so the public can purchase commercial insurance more easily. Unfortunately, people who wanted to buy insurance if their incomes exceeded 90 thousand were shown high priced plans, with high deductibles while those who were entitled to a government supplement were able to purchase better plans on the exchange for less. Those who did not require a government supplement could go to a private insurance broker and often found better plan options off of the exchange which is something I experienced. In our situation, we joined NJBIA (NJ business and industry) to join their self-insured group plan which was much cheaper for better as compared to the insurance exchanges. Those who have students enrolled at major Universities often find that purchasing student insurance often costs less and insures better as well. So much for exchanges and competition.
Insurers were taking on millions of people under Medicaid participants. They made money both ways, from the commercial end with fully insured groups and self-insured groups as well as through Medicaid expansion. Medicare pays everyone less, other than Federal Qualified Health Centers, while hospitals had some negotiating clout for their Medicaid fees.
The current system is basically Peter robbing to pay Paul, something you have never heard but it was one of the largest cost drivers for those of us purchasing off insurance exchanges. As more people came into Medicaid and purchased the mandatory high deductible plans, many people who have waited for years now visited doctors and a cost explosion in healthcare occurred. Luckily, it was a short term phenomenon, however, insurers continued to raise premiums on plans like Omnia. The constant manipulation of the market place by the healthcare industrial complex which was led by insurers, hospital systems, and large practices are living off the fractionalization of healthcare which is the largest cost driver. The expansion of healthcare services has been huge for both insurers as well as for hospital systems, who are making more money than they ever did.
Some of the conflicting messages currently being heard from political types may be messages that have been paid for by the Hospital lobby who has benefitted greatly by the current market place..
As a member of the public who is fed up with high prices for drugs, hospitalization, ER visits, and other things medical, I take offense when I hear things that as a healthcare provider, make little sense. Our current system is an inefficient pig. It needs to be modified and the easiest way to do this is to fix Medicare part D (the drug portion) and allow people to buy it on the exchange. It should cost much less than commercial insurance however, we have never been allowed to price it for our benefit.
True, some specialists may be underpaid if we moved to a Medicare for all type of system. This can be easily fixed. It is also true that some of the watchdog type methods used to go after billing fraud that regular insurers use can also be implemented.
It is also true that at least 50% of those who are insured by large companies are self-insured, and these companies may want a choice of whether to continue with the current scheme of traditional insurance or to purchase a public Medicare option. It has been suggested that people over 50 should be able to purchase Medicare as their primary insurance if they want to.
If the insurance marketplaces were truly competitive, we should have the option to purchase Medicare if we wanted to. If Medicare on the exchange were to cost 30% less, guess which I would purchase? Guess what would happen if large corporations saw this? Wouldn’t they want to have this choice as well?
Who is paying the politicians to offer messages as to why Medicare, an easily scalable system that works well for seniors cannot be rolled out to others who want to buy in. Most doctors take Medicare, and practically all hospitals do as well. Do you choose as an American to have fewer choices that are overpriced, have high deductibles and smaller networks, or Medicare for considerably less, with a low deductible and a 50 state network?
New York Magazine in a recent article believes Medicare for All should hurt some hospitals and doctors. They are part of the reason costs are so high and over-testing as a profit-making business cannot continue to be paid for by the public who has been taught to be afraid of their own health.
Another excuse commonly used is that doctors are subject to malpractice if they do not exhaust all the tests to make sure the person is not going to die from their symptoms.
Tort reform is essential, however, in today’s system when you have several doctors specializing in parts of the body, instead of one doctor taking a primary care approach which can be time-consuming will increase the rate of errors that occur. This increases liability which is not fair to the doctor or the patient. This, of course, is a result of insurance carriers underpaying doctors while large healthcare systems push doctors to see more people under quotas they have established.
If we took Medicaid and rolled those people also into Medicare, revenues for hospitals will go up and the pricing on commercial insurance should be reduced to offset the Medicaid underpayment.
Problem solved. Wake up America, our politicians need to begin to work for us.
Unfortunately, the billions that insurers, large specialist groups, and hospital systems are making are now showing up as messages to fight the expansion of Medicare or Medicare for all. Just because you heard it in a political message, or on television or on your Facebook feed, it does not mean it is not coming from biased sources. It is time for us to do our own research and nobody is happy with the current system unless you are a senior under Medicare.
No, Medicare is not a socialist system. It is a social system in effect since the 1990s that is scalable. Ask seniors if they like Medicare and you will hear an overwhelming yes. Ask them if they like their Medicare Advantage plan and you will hear varied opinions about plans that take your Medicare dollars, and make a profit from paying doctors less while giving you a discounted gym membership. On the other hand, Medi-gap plans work well and are an affordable way to have Medicare pay a larger part of your healthcare bills.
Check out the article that was featured in the NY Times below
Hospitals Stand to Lose Billions Under ‘Medicare for All’
Proponents held up signs as Senator Bernie Sanders introduced the Medicare for All bill in Washington this month.
Aaron P. Bernstein/Reuters
Proponents held up signs as Senator Bernie Sanders introduced the Medicare for All bill in Washington this month.CreditCreditAaron P. Bernstein/Reuters
By Reed Abelson
April 21, 2019
For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.
Or take another example: One hospital would get about $4,200 from Medicare for removing someone’s gallbladder. The same hospital would get $7,400 from commercial insurers.
The yawning gap between payments to hospitals by Medicare and by private health insurers for the same medical services may prove the biggest obstacle for advocates of “Medicare for all,” a government-run system.
If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers.