Friends. Having read many of thoughtful comments here, I can only add that the USA remains the only “developed” (aka wealthy) country that denies its citizens health care as a human right which in the short and long term benefits ALL society’s members. Please Note: 1) HR 676 to establish “Expanded Medicare for All” after decades is languishing in both chambers whose elected officials enjoy the BEST health insurance at our expense and 2) for research and fact driven data, please do visit the referenced PHYSICIANS FOR A NATIONAL HEALTH PROGRAM AND the NATIONAL NURSES UNITED websites. The concept is simple: health care for humans beings NOT for profit and greed.
When the Detroit General Acocunting Office studied the HIllary Clinton univerasl healthcare plan, it also found that single payor cut costs by 26%, due to administrative savings.
Docs don't spend their itme and money writing appeal letters when there is only one payor, and one schedule.
Nobel laureate Kenneth J. Arrow’s seminal article "Uncertainty and the Welfare Economics of Medical Care," published in 1963 pointed out that free markets are not likely the best solution to providing universal health care. Free market advocates argue otherwise, but political ideology aside, it is clear history comes down in Arrow's favor.
Get the profit out of health care. Healthcare can not be treated like a market because of the risk/uncertainty inherent. Trying to make it a market has been a horror for many citizens.
Medicare for all just requires a few in gov't who will take a stand after seeing the ACA repeal/replace play out. The donors won't be pleased but the citizenry is erupting.
Medicare for all just requires a few in gov't who will take a stand after seeing the ACA repeal/replace play out. The donors won't be pleased but the citizenry is erupting.
"but middle class seniors, and those who spent or gave their wealth away years ago, to avoid having to pay for nursing home care."
why save if the government is going to take it all away. the middle class should do everything in its power to avoid government seizures of their assets.
if it means spending to enjoy myself why not?
why save if the government is going to take it all away. the middle class should do everything in its power to avoid government seizures of their assets.
if it means spending to enjoy myself why not?
1
How about allowing people to buy into FEHB, the nationwide coverage for Federal Government workers? The premium cost (that is, the actual cost, not the subsidized rate offered to employees) is already known and the infrastructure is already in place nationwide. No, this is just too obvious a solution...
4
My brother is a doctor and does not take any government medical insurance customers. He does not like the paperwork and payment for service is too low. He thinks the problem of expensive medical care could be solved by just producing more doctors.
1
As a physician, I disagree with your brother. MediCare records and billing is not that different from commercial insurance and may be easier because the forms are consistent. The pay rate may be a bit lower- and this is important- so what? I love my job and love helping people and learning something every day. I will not get rich but still do ok, and I am grateful that America paid a big hunk of my education, so a pay-back seems more than fair.
Let him know the patients are still fun regardless of insurance.
1
@Charlie Jones
My medicare patients, medicaid patients, and veterens make up the majority of my patients. They are often fascinating, inspiring, challenging patients. They are as deserving of good medical care as any patients who are insured other ways.
Though I don't personnally identify as a Christian, it bothers me how unChristian and how unfair, unkind, selfish, and ungrateful it would be of me to exclude government medical insurance customers from my practice. At the end of my day, and the end of my life, it is oneself we must all live with.
We absolutely need more doctors, but maybe not of the type your brother is. We as a society need to develop pathways for lots more of the right type of people to be trained, and then incentives should be conferred on those who are willing to keep seeing the vulnerable, elderly, and/or disabled among us.
I would gladly use an expanded Medicaid or Medicare for my own health insurance coverage, and my kids', so as to be able to keep helping my patients for as long as I can, in spite of my own health conditions (rheumatoid arthritis and degenerative discs.)
Transition!
Fee for service should become fee for value in two or three steps. Its the single biggest solution for our ailing system.
With widely opened eyes a patient can clearly see greenbacks in surgeons' eyes, especially when a patient over 65 visits their office for the first time.
Fee for service should become fee for value in two or three steps. Its the single biggest solution for our ailing system.
With widely opened eyes a patient can clearly see greenbacks in surgeons' eyes, especially when a patient over 65 visits their office for the first time.
1
The logical extreme of the Democrats march towards socialism is the VA Healthcare system. Anyone want to buy into that wasteland?! (And, yes, it is horrible that that is what we offer our veterans...).
The Dartmouth Atlas of Health Care (look it up with an internet search engine) has been documenting the tremendous variation in quality, quantity, and cost of Medicare across America for years. They have found that 20-30% of health care costs could be saved if all regions of the country could reduce care to the level observed in low-spending regions with equal quality. Consistent with Mr Frakt’s article, they found that hospitals and regions that provide more care to Medicare patients also provide more care for their non-Medicare patients.
There is enormous scope for improving the efficiency and quality of US health care by instituting new models of payment that reward providers for improving quality, managing capacity wisely, and reducing unnecessary care. The Federal government is the worst entity to implement this change – it will only come from economically motivated entrepreneurs freed of government regulations.
The Dartmouth Atlas of Health Care (look it up with an internet search engine) has been documenting the tremendous variation in quality, quantity, and cost of Medicare across America for years. They have found that 20-30% of health care costs could be saved if all regions of the country could reduce care to the level observed in low-spending regions with equal quality. Consistent with Mr Frakt’s article, they found that hospitals and regions that provide more care to Medicare patients also provide more care for their non-Medicare patients.
There is enormous scope for improving the efficiency and quality of US health care by instituting new models of payment that reward providers for improving quality, managing capacity wisely, and reducing unnecessary care. The Federal government is the worst entity to implement this change – it will only come from economically motivated entrepreneurs freed of government regulations.
2
Not quite sure why you're proceeding from a utilitarian perspective. Health care is not a "normal" or"efficient" market. Focusing on the distortions rather than fairly ludicrous assumptions that we know aren't applicable seems like a waste of time.
5
What doctors do is limit the number of Medicare patients they take, so that they can get enough revenue to pay their bills and make a good living. If every patient paid at the Medicare rate, doctors would go broke - they'd spend their entire revenue on rent, malpractice insurance, supplies, and front-officer employees.
So doctors treat Medicare patients as well as everyone else only because they are a small part of the practice, and bring down the average revenue per patient only slightly. They defend their revenue by refusing to take more than a small number of Medicare patients, usually patients who already had a relationship with them before turning 65.
So doctors treat Medicare patients as well as everyone else only because they are a small part of the practice, and bring down the average revenue per patient only slightly. They defend their revenue by refusing to take more than a small number of Medicare patients, usually patients who already had a relationship with them before turning 65.
5
Jonathan, this has not been my experience. My primary care physician has told me that he would have to retire if Medicare was eliminated. The majority of his patients are covered by Medicare and he provides high quality care for all of them.
4
The fact that physicians provide the same quality of care regardless of reimbursement speaks to the solid ethics of our physician workforce. This reflects exactly what I have observed of my teachers and colleagues throughout medical training and afterward, and stands in stark opposition to the constant drumbeat of complaints about 'greedy doctors' that routinely fills the NYT comment sections.
13
Look at North Carolina for how not to practice medicine. WalletHub objective assessment rates North Carolina #50/51 in Cost and #47 in overall care (Cost + Access + Outcomes. The following are perhaps contributors:
1) No expansion of Medicaid
2) Corrupt, incompetent administration of Medicaid
3) Politicians much more obsessed with bathrooms than health care
4) Hostility by rural folk toward the ACA
5) "What us worry" attitude of medical schools toward rural care
6) Large underinsured, underdoctored, chronically ill rural population
7) VA hospital directors divert funds intended for rural care
8) DHHS programmed in "object COBOL" denying Medicaid claims
9) Medicare ineptitude in supporting rural physicians & pharmacies
10) BCBS only rural insurer of ACA care
11) Lack of NC Board of Medicine focus on Telemedicine
12) Chargemaster EPICally driven facility coded excessive pricing
13) CFO's in Hospital Systems inflating rural care costs
14) Poor rural care value & high premium increases
15) Total lack of cost-effectiveness research in rural areas
16) Abysmal / non-existence of state-wide viable HIE
17) Legislature cut backs in rural research & innovation
18) Youth flight from rural areas & lack of fight for rural justice
19) OBSCENE price increases in generic drugs
20) Lack of rural access to non-profiteering 340B drug pricing
21) Anti-government congressmen (Meadows) from NC
22) Lack of 24 x 7 non-ER care
23) Cost of rural EMT services
24) 60% bonus Critical Access Hosp care
1) No expansion of Medicaid
2) Corrupt, incompetent administration of Medicaid
3) Politicians much more obsessed with bathrooms than health care
4) Hostility by rural folk toward the ACA
5) "What us worry" attitude of medical schools toward rural care
6) Large underinsured, underdoctored, chronically ill rural population
7) VA hospital directors divert funds intended for rural care
8) DHHS programmed in "object COBOL" denying Medicaid claims
9) Medicare ineptitude in supporting rural physicians & pharmacies
10) BCBS only rural insurer of ACA care
11) Lack of NC Board of Medicine focus on Telemedicine
12) Chargemaster EPICally driven facility coded excessive pricing
13) CFO's in Hospital Systems inflating rural care costs
14) Poor rural care value & high premium increases
15) Total lack of cost-effectiveness research in rural areas
16) Abysmal / non-existence of state-wide viable HIE
17) Legislature cut backs in rural research & innovation
18) Youth flight from rural areas & lack of fight for rural justice
19) OBSCENE price increases in generic drugs
20) Lack of rural access to non-profiteering 340B drug pricing
21) Anti-government congressmen (Meadows) from NC
22) Lack of 24 x 7 non-ER care
23) Cost of rural EMT services
24) 60% bonus Critical Access Hosp care
8
Any hope of changing #4?
Part A Medicare is free for seniors as those on it pay no premium for it, so adding those younger will not help finance it, as the hospitals and doctors are not reimbursed enough to even keep many hospitals open, or doctors practicing.. America has for years been spending 3 dollars for every 2 dollars it takes in in revenue each year, plus we are $20 trillion in debt, do not pay on the principal, only interest. Medicaid is basically free, bankrupt as a program, running on empty as it pays for the nursing home care of not only the poor, but middle class seniors, and those who spent or gave their wealth away years ago, to avoid having to pay for nursing home care. Medicaid has added people to its program without requiring much of anything in premiums on the ACA. Medicaid should only be for the very poor, not those who are working. America should of done a sliding scale Single Payer System years ago, like Switzerland, but made people actually pay their fair share. Obviously, Austin Frakt is neither a doctor, works for a hospital, or is dependent on a salary from the medical industry, otherwise, he would not be writing a piece like this.
7
Overall Medicare is decent and more efficient in use of premiums and other monies in paying for health care. But there are serious issues and sometimes huge waste that needs to be fixed. An easy fix - allow Medicare to negotiate for drug costs (under Part A and Part B) - the GOP / Congress prohibit it. Next one is weird; patient gets treatment X, where the doctor's office only gets Medicare reimbursement for about 90% or so of the cost. Get the same treatment in a nearby hospital - the hospital is paid about 10 x what the doctor got. A $10k treatment, paid at $9k in an office (less that the cost of the med) , hospital gets paid $80 to $90k. Great for the hospital, lousy for patient and Medicare. Also, Medicare still hates preventative, such as the shingles hot. Another oddball - Medicare has different rule sets in every region. You get treated in region A, move to C, and get denied treatment. Oops - you shouldn't have moved! Finally, let's say you need treatment X - but you don't know if Medicare will pay - and won't know until you get the treatment. So maybe they do, and maybe you go bankrupt. They refuse to predetermine or even tell you what the rules are. Oh, forgot to mention one more. Doctor Y won't accept Medicare. Ok - so reimburse the patient what Medicare would have paid. But no, they won't. Very painful.
If Medicare cleans up its act, I'd love it NOW, not some years from now.
If Medicare cleans up its act, I'd love it NOW, not some years from now.
7
My experience tells me that no physician has any idea who is paying for the services they perform and the tests that they order. The office staff takes care of those items. After seeing my doctor and scheduling a next appointment the office staff person cautioned me not the schedule an appointment at a certain date because medicare doesn't allow it that quickly. I suppose that physicians can figure out that if a 70 year old is being treated, Medicare will pay for services but otherwise scheduling and coverage is handled by the staff. Maybe there is some method used to inform physicians the financial responsibility for payment for each patient but I don't think it would make any difference in diagnosis or treatments.
5
All public and private plans pay less for primary care and basic services which are 90% of local services where half of the American population is found. High deductible and Veteran plans force patients to avoid local care or leave for care. Public and private plans pay 15% less for the same services where 40% of Americans most need care. These variations are destroying small practices, primary care, mental health, and care where needed. It is sad to see debates distract our nation from true reforms - the equity in payment that will support basic health access, primary care, mental health, women's health, and basic surgical services where 50% of Americans will be found in 2800 lowest physician concentration counties in 2040. No training design can address these deficits because the financial design is broken and has been for decades and was made worse in the 2010 "reforms."
3
There are other powerful reasons why doctors prescribe "low value care" ....patient expectations and demands, fear of malpractice litigation and lack of time, For example, it is not easy but often quite time consuming to convince the weekend warrior who twisted his knee, ankle or back that no radiology tests are necessary if there are no signs of severe derangement by history and physical exam. Many doctors, especially those on the front lines of busy primary care and emergency room practices find sending off patients for extra tests is more efficient and provides the often false sense of security that this will protect from claims of malpractice.
4
I am all for challenging the costs charged for health care by using Medicare or Medicaid data, or reimbursement to providers, to reveal how much range and ripoff there is in US health care delivery. But to hold up Medicaid or Medicare as complete models of insurance is not a good standard.
Medicare is incomplete without supplemental plans; and the random overpricing of drugs is still a large issue for seniors. But I particularly take issue with characterization of Medicaid as anything other than basic health insurance plans that do not cover many surgeries and care that routinely most private plans do. State by state, health care is rationed by procedure and care groups, much as insurers and plan sponsors target expenses to avoid and save--but in a private plan you have recourse and a better plan, though deductibles are a factor. In Medicaid, you have no recourse. And as anyone who's ever experienced private health care plans and Medicaid can tell you, the administration of Medicaid is woeful and designed to frustrate and deny care.
Medicare is incomplete without supplemental plans; and the random overpricing of drugs is still a large issue for seniors. But I particularly take issue with characterization of Medicaid as anything other than basic health insurance plans that do not cover many surgeries and care that routinely most private plans do. State by state, health care is rationed by procedure and care groups, much as insurers and plan sponsors target expenses to avoid and save--but in a private plan you have recourse and a better plan, though deductibles are a factor. In Medicaid, you have no recourse. And as anyone who's ever experienced private health care plans and Medicaid can tell you, the administration of Medicaid is woeful and designed to frustrate and deny care.
2
AARP provides supplemental coverage for Medicare. It also provides prescription plans. I have both. Perhaps the government can provide subsidies for seniors who cannot afford the premiums for supplemental care and prescription coverage. If we can afford to subsidize profitable oil companies and big agriculture combines, we can afford to subsidize seniors who need that extra coverage, and prescriptions. Not to mention a bloated Pentagon budget, a secret CIA budget, and God knows how much on travel junkets for Congress critters.
3
Are you basing your statement on actual experience with Medicaid? I have been helping a homeless man for many years who, just last year underwent hip replacement surgery covered by Medicaid. The surgery was quite successful and Medicaid covered all expenses.
2
I love this article for the doors that it opens. I'll avoid the incendiary suggestion of single-payor and just say that "health" is a life-long undertaking for individuals and their health coaches (doctors, dietitians, etc.). The influences and habits of very early life - including parents' behaviors during gestation - turn into lifelong outcomes.
Loading as many people as possible into a single database is the Holy Grail of building healthy, productive populations. If we could have everyone in a single database - preferably Medicare over the fragmented Medicaid programs - and then start to plan care based on the lifelong as well as procedure-specific value derived from personal and assisted health management activities, we'd be able to use that information like no other nation.
In addition, as much as Medicare in particular may seem like it has a long way to go, it has made incredible progress with very large-scale initiatives since the 80's. It is the leader in health insurance innovation, and most of the commercial insurance companies follow its lead. The faster we can introduce more people to Medicare (merge Medicaid into the national program ASAP and eliminate that separate overhead and double-dipping) and manage the large numbers based on better data and lower overhead cost per person, the faster we can get to measurable health goals.
Loading as many people as possible into a single database is the Holy Grail of building healthy, productive populations. If we could have everyone in a single database - preferably Medicare over the fragmented Medicaid programs - and then start to plan care based on the lifelong as well as procedure-specific value derived from personal and assisted health management activities, we'd be able to use that information like no other nation.
In addition, as much as Medicare in particular may seem like it has a long way to go, it has made incredible progress with very large-scale initiatives since the 80's. It is the leader in health insurance innovation, and most of the commercial insurance companies follow its lead. The faster we can introduce more people to Medicare (merge Medicaid into the national program ASAP and eliminate that separate overhead and double-dipping) and manage the large numbers based on better data and lower overhead cost per person, the faster we can get to measurable health goals.
5
Actually, many countries with single payer have data bases that include all of the patients in the country. These countries have been able to do excellent outcomes research for this reason. As far as I am concerned, for many, many reasons, we can't get to single payer fast enough. And, yes, we will need to pay doctors and hospitals for the true cost of care, and work on reducing that cost of care in rational ways. Just the fact that insurance companies take 20% of the health care dollar for administration and profits, compared to 3% for Medicare and Medicaid, is enough to show us that there is money in the system to pay for health care for the currently uninsured and underinsured. (And, by the way, that 20%, which used to be 30-36% before the Affordable Care Act put limits on it, does not include the time and money spent by providers' offices and patients of referrals, paperwork, etc.) Please, all readers, if you don't understand single payer, please learn about it by consulting such websites as Physicians for a National Health Plan.
25
1. There are no countries that have simple single-payer systems.
2. Your figures on overhead are also awry.
2. Your figures on overhead are also awry.
2
As a senior of 73 years old, I have enjoyed being covered by Medicare for the past 8 years, having had one hip and two knee replacements. "Medicare for All" !
4
I challenge the author's sense of relationship between cost and quality with my experience getting auto repair service over 60 years. For the past 20 years, I have principally used one of two independent repair shops to get service at least as good as that provided by dealer shops, and at lower cost than the dealers. Further, I have twice been conned into buying dubious or worthless services at dealers, but never at the independent shops.
3
Oh, for heaven's sake! Do you not recognize an analogy when it is presented? I'm very glad that you have found a good place to get your car serviced. But Mr. Frakt is talking about the billions of dollars involved with getting your body serviced. And, if you are still quibbling about his way of leading into the discussion, he never mentioned "dealer shops" vs. independent repair shops.
5
Dr. Frakt neglects to mention that in the current fee-for-service model, higher reimbursement from private payers allows providers to see Medicaid and Medicare patients through what is essentially cross-subsidization. If we expand fee-for-service Medicare and Medicaid, tilting the payer mix towards public payers with lower reimbursement, then provider groups will be forced to increase the number of patients seen per day, i.e. shorter visits like in the UK. Perhaps the way forward may be a means-tested public insurance option for all, with supplemental private insurance, like different seat classes offered in the airline industry based on willingness to pay. Despite grumblings about air travel these days, individuals don't seem mind entrusting their lives to low cost airline carriers as long as they're FAA approved and offer cheap tickets.
3
Naive, cynical or misguided health economists apply traditional incentive theory to clinical practice. They are wrong. Low fees do not promote poor care. You don't get what you pay for- like with quality tires vs discount ones.
Physicians treat patients the same way, regardless of payment.
Excess supply of specialists can increase needless interventions or low yield procedures, but this is a market - not practice- differential.
Healthcare is unlike any commodity or business and must be organized uniquely.
National health insurance, opening low overhead public plans like Medicare are the only sensible solution to America's problem.
Physicians treat patients the same way, regardless of payment.
Excess supply of specialists can increase needless interventions or low yield procedures, but this is a market - not practice- differential.
Healthcare is unlike any commodity or business and must be organized uniquely.
National health insurance, opening low overhead public plans like Medicare are the only sensible solution to America's problem.
22
Not true. Certain treatments are not given if your ins. Will not pay. I have witnessed gamma knife treatment not offered for brain cancer since the patient could not pay.
2
Funny article. Seems to confuse several concepts. 1. Because Medicare and Medicaid pay less than many private plans is the care lower? and 2. What incentives does a particular health plan reimbursement rate do to pervert care (e.g. unneeded services)?
On 1. It's a bit odd. I am going to the same doctors now on Medicare as I did with my private insurance plan. So unless the doctor is saying to himself or herself - hey, here's a Medicare patient - I'll give them less care my care is the same.
On 2. This is a general problem across all of US healthcare.
On 1. It's a bit odd. I am going to the same doctors now on Medicare as I did with my private insurance plan. So unless the doctor is saying to himself or herself - hey, here's a Medicare patient - I'll give them less care my care is the same.
On 2. This is a general problem across all of US healthcare.
7
This isn't rocket science. You don't need studies of dubiously-defined constructs like "low-value care" to figure this out. The head of CMS is not taking home tens of millions of dollars in compensation per year. The ~15% profiteering scoop off the top is a bigger drain on the system than any "bureaucratic inefficiency" (which is itself a myth), and that's before we even get to the administrative costs of private insurance. Anyone who's ever had to get any remotely expensive treatment knows the battle of getting authorizations.
Private insurers employ an army of personnel whose job it is to deny people care whenever possible. This is more efficient in producing positive quarterly and yearly earnings reports, but it's not more efficient in providing people healthcare -- which is a right, not a "market".
Private insurers employ an army of personnel whose job it is to deny people care whenever possible. This is more efficient in producing positive quarterly and yearly earnings reports, but it's not more efficient in providing people healthcare -- which is a right, not a "market".
26
Absolutely, Seb. The true cost of health care needs to be calculated *without* the deadweight of all the people employed to deny claims - as well as those employed on the other side to fight them.
5
Seb, Medicare employees the same army of personnel - private insurers actually implement administration of the benefits. Which is why PNHP claims of lower administration overhead are bogus.
http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than...
http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than...
This is absolutely true, as one who administered benefit for a large corporation for 33 years. The insurance companies are middle men, not necessary. Medicare can hire those who are qualified and will do an honest job of monitoring claims. Medicare at least gives basic care, and that is more than those without Medicare get. Employer paid health insurance is going the way pensions went. Help employers transition over to a national Medicare system; they will be happy to hand over the cost of managing various Plans. Insurers are profit centered corporations; they do not provide health care; they act as gate keepers to care.
How can you determine value in the healthcare industry when:
1. You cannot predict ahead of time the outcome of a treatment or test and,
2. You have no idea what the cost of the service or product is at the time of its delivery.
Tell me which other industry functions like that? Tell me what other industry has become less efficient (In terms of time and money) over time.
1. You cannot predict ahead of time the outcome of a treatment or test and,
2. You have no idea what the cost of the service or product is at the time of its delivery.
Tell me which other industry functions like that? Tell me what other industry has become less efficient (In terms of time and money) over time.
3
My experience from managing a small medical practice is that the doctor rarely knows or cares about the patients' insurance status. He/she treats each patient according to the individual need as is required. The office staff concern themselves with treatment authorizations, insurance coverage, billing and collections. This is as it should be.
13
In "normal markets" two conditions exist that don't often exist in the healthcar market.
The buyer doesn't have to buy and the seller doesn't have to sell.
The buyer doesn't have to buy and the seller doesn't have to sell.
3
It's simple: Medicare/Medicaid operate with 3%-4% administrative overhead costs, while private insurance companies always have the same that always is greater than 20%. I've never had a doctor facing me who considered my insurance status (although I have never been without it), so I cannot impute any costs to doctors. Before ACA, larger private insurance overhead paid for armies of drones instructed to disapprove everything possible. That was tempered but not eliminated by the ACA.
An ACA "public option" (buy into Medicare at real actuarial cost) would allow another choice for citizens. Data gathered could guide further tweaks to ACA. In the US an incremental approach is the only one that can realistically work to keep us on the road to universal coverage.
An ACA "public option" (buy into Medicare at real actuarial cost) would allow another choice for citizens. Data gathered could guide further tweaks to ACA. In the US an incremental approach is the only one that can realistically work to keep us on the road to universal coverage.
12
Claims of lower administration cost for Medicare are inaccurate and reflect the bias of PNHP. They don't account for the fact that private insurers administer medicare plans.
http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than...
http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than...
I practice neurology and pain management in the Bronx
In NY straight Medicaid coverage for medical services is pretty much obsolete.
Most Medicaid HMOs reimburse a specialist visit as much (or more) than GHI or BCBS. The reimbursement for an EMG is the same, in the range of 300 dollars.
The author failed to clarify that when a patient is admitted to the hospital, there is a "physician fee" for consultants services, interpretation of studies etc, that is billed and reimbursed outside the bulk of the hospitalization (another reason why most doctors do not want to remove the fee -for -service concept).
Medicare B (not to be lumped with medicare-advantage care plans) does NOT require any prior authorization for CTs, MRIs etc, unlike most private plans.
It is interesting that when patients have no medical coverage (and have to pay for the services), we actually use our clinical skills, rather than ordering everything "just in case"
In NY straight Medicaid coverage for medical services is pretty much obsolete.
Most Medicaid HMOs reimburse a specialist visit as much (or more) than GHI or BCBS. The reimbursement for an EMG is the same, in the range of 300 dollars.
The author failed to clarify that when a patient is admitted to the hospital, there is a "physician fee" for consultants services, interpretation of studies etc, that is billed and reimbursed outside the bulk of the hospitalization (another reason why most doctors do not want to remove the fee -for -service concept).
Medicare B (not to be lumped with medicare-advantage care plans) does NOT require any prior authorization for CTs, MRIs etc, unlike most private plans.
It is interesting that when patients have no medical coverage (and have to pay for the services), we actually use our clinical skills, rather than ordering everything "just in case"
5
"t is interesting that when patients have no medical coverage (and have to pay for the services), we actually use our clinical skills, rather than ordering everything "just in case"
What's your point? That no medical insurance coverage and gigantic bills are better?
What's your point? That no medical insurance coverage and gigantic bills are better?
5
Medical malpractice insurance is expensive. If a Physician were sued, and discovery by the plaintiff found a systematic "bias" in treatment based on the patients insurance payer, that Doctor may never practice medicine again. The insurance premium would be prohibitive.
It's not clear from the article whether these studies took into consideration the length of time of a patient history with a Physician. Rates of migration, inside the US, have declined over the years, so Doctors would face the ethical crisis of dropping a long time patient (on private insurance) when they transition to Medicare or Medicaid.
It's not clear from the article whether these studies took into consideration the length of time of a patient history with a Physician. Rates of migration, inside the US, have declined over the years, so Doctors would face the ethical crisis of dropping a long time patient (on private insurance) when they transition to Medicare or Medicaid.
1
Medicare has great preventive services. Free too.
8
Nothing is free, my friend
2
Medicare preventive care is free for the recipient, and a great deal for overall costs to society. Deal with it, my friend.
11
Elephant in the room alert ...
What are the differences applied to each system in profit and advertising?
What are the differences applied to each system in profit and advertising?
2
I was hopeful that the "Public Option" would be adopted years ago and was disappointed that the best Congress would adopt was the ACA. Being self employed I was paying $2000/month for 2 people in a high deductible plan, which put a serious strain on our cash flow. Now we're both on Medicare and paying far less and continue to receive fine care.
I hope the Democrats present a viable plan for people under age 65 to buy into Medicare and eliminate the complexities and profits of the insurance industry from the process of getting and paying for medical care.
I hope the Democrats present a viable plan for people under age 65 to buy into Medicare and eliminate the complexities and profits of the insurance industry from the process of getting and paying for medical care.
17
Good thought....but wait. Medicare is underfunded and running out of cash. How do you propose we fund Medicare expansion?
1
People who would buy into medicare are, for the most part, currently paying private health insurance premiums (or their employers are). That money could go into medicare instead. Since younger people are on average more profitably, this would actually improve Medicare's funding status, not make it worse.
5
@ Grace Debold,
Like we fund the military,of course.
Like we fund the military,of course.
2
It is good news that everyone receives the same level of care once they get into see a doctor. The bad news is the patient doesn't always know if the doctor they are seeing is in network or not. This is really problematic during a surgery where multiple doctors will bill the patient. The difference can be tens of thousands of dollars the patient will get bill for and not reimbursed by insurance.
8
The article does not touch the important point, such as the Medicare and Medicaid not only medical treatment, but also pay room& board, adult cares/entertainments. Private medical cares do not get any where near to these payments. As a result, the Medicare and Medicaid will continue to go up
Medicare does not pay for services that are not medically necessary, such as but not limited to "entertainments," as you describe. Most inpatient hospital stays are paid to hospitals on a per diem payment rate and are based on, with few exceptions, DRGs (diagnosis related groups). "Room & board" is rolled into the the per diem rate. Outpatient/observation services are also only eligible if they are considered to be medically necessary and a covered benefit. Residential nursing home stays are not covered by Medicare unless the beneficiary is admitted for medically necessary skilled nursing care and are only covered within the scope of the beneficiary's Skilled Nursing Facility (SNF) benefit. Once the patient is "discharged" from the SNF services or (s)he has used the maximum SNF benefit for the diagnosis and time period, Medicare no longer pays for the patient's residential (unskilled) nursing home stay.
13
Those who are served by Medicaid, especially the developmentally disabled, are discriminated against in trying to find a Doctor in Psychiatry. This specialty is terribly in need of more doctors. Many simply do not accept Medicaid and it is about reimbursement. This is shameful.
4
So we should pay more in taxes to increase fees to attract doctor participation. Easy.
We have no problem funding our annual blank check to the Pentagon, so we can also fund doctors.
We have no problem funding our annual blank check to the Pentagon, so we can also fund doctors.
12
People should be provided only with services they can afford.
If you can't afford a car - walk. If you can't afford medical treatment - die.
That's what this great country of ours is all about!
If you can't afford a car - walk. If you can't afford medical treatment - die.
That's what this great country of ours is all about!
2
Any doctor who would provide inferior service to a patient based on how much they are paid should not be in the business. Surely there are doctors that cater only to the wealthy but most of us don't need to worry about them.
5
I refute the conclusions of this study, because low-value service ratios is only one (odd) measure of efficiency and cost effectiveness. I'm now on Medicaid...
My only choice for seeing a neurologist for hand tremors was a hospital Medicaid clinic. I had to wait weeks just to get an APPOINTMENT, for a visit that was several months in the future.
My neurologist ordered an expensive brain MRI, one that I probably would have argued if I had a copay. The alternative is to try a prescription for beta-blocker meds; quite inexpensive. Instead I believe Medicaid was bilked.
It has been 2 months and I'm still trying to get the results of the MRI and get next steps (obviously to try the beta blocker meds). I have not gotten a call-back with results nor a call-back with an appointment (you read correctly, no appointment date given when I call but instead: "we'll get back to you").
So, not only would a higher Medicaid reimbursement bring in more providers, it surely would increase quality of care.
Lastly, why is this article in Politics section, not Health section?
A study based on high/low-valued service ratios is a job for a curious statistitian, not for a policy maker. A study for quality of care would be a valid study.
My only choice for seeing a neurologist for hand tremors was a hospital Medicaid clinic. I had to wait weeks just to get an APPOINTMENT, for a visit that was several months in the future.
My neurologist ordered an expensive brain MRI, one that I probably would have argued if I had a copay. The alternative is to try a prescription for beta-blocker meds; quite inexpensive. Instead I believe Medicaid was bilked.
It has been 2 months and I'm still trying to get the results of the MRI and get next steps (obviously to try the beta blocker meds). I have not gotten a call-back with results nor a call-back with an appointment (you read correctly, no appointment date given when I call but instead: "we'll get back to you").
So, not only would a higher Medicaid reimbursement bring in more providers, it surely would increase quality of care.
Lastly, why is this article in Politics section, not Health section?
A study based on high/low-valued service ratios is a job for a curious statistitian, not for a policy maker. A study for quality of care would be a valid study.
3
"Lastly, why is this article in Politics section, not Health section?"
Because the GOP has been playing politics with senior health since LBJ.
Have any other questions?
Because the GOP has been playing politics with senior health since LBJ.
Have any other questions?
9
Taking the profit out of healthcare and providing care to everyone such as Medicare/Medicaid/Veterans care.
Most countries provide a two tier system where there is universal healthcare, and a privatized tier for those that can afford it.
The system we have in place is a cartel-dictating it's own prices, that has nothing to do with a free market. When was the last time hospitals or insurance posted pricing and a breakdown of costs.
The other problem with healthcare is that Americans want it all, but are not willing to pay what it takes to provide universal high quality services, like Finland or Sweden.
Most countries provide a two tier system where there is universal healthcare, and a privatized tier for those that can afford it.
The system we have in place is a cartel-dictating it's own prices, that has nothing to do with a free market. When was the last time hospitals or insurance posted pricing and a breakdown of costs.
The other problem with healthcare is that Americans want it all, but are not willing to pay what it takes to provide universal high quality services, like Finland or Sweden.
27
"there is universal healthcare, and a privatized tier for those that can afford it":
a common misconception which, like many lies spread by you-know-who, became a gospel.
Most developed countries have private insurance for ALL. The guvmnt sets the required standard of care, pays insurance companies for the members they enroll out of HORROR OF HORROS ... taxes. Yes, you can buy additional insurance, e.g. if you're travelling out of EU, but all your healthcare needs are met by any health insurer you choose.
a common misconception which, like many lies spread by you-know-who, became a gospel.
Most developed countries have private insurance for ALL. The guvmnt sets the required standard of care, pays insurance companies for the members they enroll out of HORROR OF HORROS ... taxes. Yes, you can buy additional insurance, e.g. if you're travelling out of EU, but all your healthcare needs are met by any health insurer you choose.
3
The U.S. ALREADY pays more than those two countries per capita and gets subpar results on top of the confusion and chaos of its bureaucratic setup. The U.S. doesn't need to pay more; it needs to pay LESS and DEMAND results. The way American healthcare works, it's a shell game and a crap shoot.
4
How do you define profit? Most of the money spent in the medical sector goes to salaries - huge numbers of doctors, nurses, aides, nutritionists, insurance clerks, drug company employees, medical device employees, radiology technicians, lab analysts, etc, etc. Many of these people are have high salaries and are living well.
If so, then it’s not a market: it’s a racket.
4
This is indeed good news. It means that providers do their best to deliver quality care regardless of what they are being paid for the service. It also begs the question why then are we not moving aggressively forward to standardize reimbursement amounts per procedure or pharmaceutical product to reduce our way above average medical spend? Maybe because of the amount of money spent by those involved in these segments to stop such initiatives.
11
I live in a very rural part of northern California, have Medicare, and cannot even get assigned to a Primary Care Physician. Why? Because there aren't enough of them in the area. Even if I didn't have Medicare, I wouldn't be assigned a PCP, because there aren't enough of them in the area. Quite a large number of people here are on Medicare or Medi-Cal, or both. But, again, there are not enough PCPs in coastal northern California.
5
A lack of physicians is not Medicare's fault.
Moreover, you don't get "assigned" a primary care doctor; you can go directly to a specialist.
Moreover, you don't get "assigned" a primary care doctor; you can go directly to a specialist.
2
David Henry- many Medicare plans do in fact assign you a PCP, who may be miles away if you live in a medically underserved area. Many plans require a referral to see a specialist, and many specialists will not see a patient who has not been referred, because lack of referral may mean the specialist will not be paid.
1
Canadá effectively deals with this problem via their single payer system. They pay the vast majority of expenses for students to go to medical school. Thus no one is discouraged from being a doctor by having to take out $250,000 or more in student loans. Canada encourages doctors to become PCPs rather than specialists by paying them more and by having more residency positions for generalists. They then pay doctors a premium for working in underserved areas. Want to work in Toronto? As a doctor you'll get paid more to live in a rural underserved area. Also, equipment needs are planned. An MRI machine is purchased for a hospital or region when there is a need, rather than as a money-making proposition for the hospital.
4
Thank you for this article
3
Why are these low-value services being provided so often. People want them. Paps every year. Vit d Carotid Ultrasounds Bone densities. MRI at the first sign of back or knee problems. Patients are asking for them. Every time there is an article in the Times or other publication "Tests you must have" Make sure your Doctor orders these test" More unnecessary money gets spent
4
Not necessarily true. Yes, some patients do want them. Others, however, are told to get them by their physicians. Some people comply because they believe the "doctor knows best". Others refuse--and then sometimes are given a hard time by their doctor for refusing. I know this for a fact because I myself have refused some as have other members of my family. I really don't think we're unique.
5
Single payer is used throughout the rest of the world. Why don't researchers look to what's going on at a macro level around the world instead of these small one-off studies? Is America truly so different than anywhere else? From my view it works everywhere else so why not here?
24
It may be because your claim isn't true: around the world, industrialized countries have some version of UNIVERSAL health insurance, but they generally do not have simple single payer.
The commonest form seems to be a "mixed," system, not terribly different from Obamacare...which isn't accidental, by the way.
England has true socialized medicine, not single payer. Canada has single-payer...but generally requires you to buy your own prescription and dental coverage.
Please learn the words.
The commonest form seems to be a "mixed," system, not terribly different from Obamacare...which isn't accidental, by the way.
England has true socialized medicine, not single payer. Canada has single-payer...but generally requires you to buy your own prescription and dental coverage.
Please learn the words.
13
Germany and Switzerland have good coverage using a model that is essentially what Obamacare was supposed to be. There are many ways to achieve universal coverage, I'd be happy with single-payer, but it's not the only way.
7
Given the percentages of public vs private pay involved in other countries, that's within the realm of statistical error.
"But the bad news is that the study results imply that the value of care is hard to influence by adjusting prices."
That's the GOOD news!!! We want everyone treated equally, irrespective of their ability to pay! Healthcare decisions should be made on the basis of effectiveness, not profitability to anyone: providers, drug companies, private insurers. We need single payer, public insurance for all! If we had that, maybe we could really find out which treatments are effective, instead of having profitability-biased research.
That's the GOOD news!!! We want everyone treated equally, irrespective of their ability to pay! Healthcare decisions should be made on the basis of effectiveness, not profitability to anyone: providers, drug companies, private insurers. We need single payer, public insurance for all! If we had that, maybe we could really find out which treatments are effective, instead of having profitability-biased research.
43
No type of insurance will establish which treatments are effective or rid us of profitability-biased research. Only clinical trials can establish efficacy. Most are very costly and are unlikely to be carried out without government funding unless there is a profit motive. We require regulations that directly or indirectly impose limits on profitability. This might be through graduated tax rates or perhaps a requirement that drug companies must spend equally on profitable and orphan drug development and sales. Costs can be further reduced by prohibiting advertisements to the public as was done in the past. Hospital costs can be reduced by applying strict cost/benefit analyses to expensive rules and procedures.
3
Fee-for-service, whether Traditional Medicare or private insurance, is exploited, especially by specialists who own their own practices and labs.
Medicare Advantage and Medicaid managed care plans provide the opposite, an incentive to keep enrollees healthy and to keep chronic care patients out of the ER and hospital.
The Dartmouth Health Atlas shows the disparity in Medicare cost per enrollee, adjusted for health risk factors, twice as expensive in Miami as Seattle.
"...studies comparing similar patients have found that those in higher-spending regions are more likely to be admitted to the hospital, spend more time in the hospital, receive more discretionary tests, see more medical specialists, and have many more different physicians involved in their care. The extra care does not produce better outcomes overall or result in better quality of care."
From Dartmouth Health Atlas.
Medicare Advantage and Medicaid managed care plans provide the opposite, an incentive to keep enrollees healthy and to keep chronic care patients out of the ER and hospital.
The Dartmouth Health Atlas shows the disparity in Medicare cost per enrollee, adjusted for health risk factors, twice as expensive in Miami as Seattle.
"...studies comparing similar patients have found that those in higher-spending regions are more likely to be admitted to the hospital, spend more time in the hospital, receive more discretionary tests, see more medical specialists, and have many more different physicians involved in their care. The extra care does not produce better outcomes overall or result in better quality of care."
From Dartmouth Health Atlas.
5
Specialists who work for hospital systems are paid more per service. They are more skilled in upcoding, so get even more revenue for the same services. The hospitals also own laboratories, and are reimbursed at higher rates than those owned by small doctor groups. That is true of Medicare as well as of private insurance.
If you received services from a specialist whose practice was later purchased by a hospital system and then needed the same services, you and your insurance, or Medicare and its 20% co-pay, would be charged more for the same service.
Obamacare, and the hospital consolidations it imposed, allowed hospitals systems to increase their bargaining position with insurer and negotiated higher rates. Obama declared big medicine the winner and small medicine the loser. Perhaps that was in gratitude for the $350,000 a "charity" hospital paid his wife for a part time gig while he was a Senator. That was double the $175,000 she was paid for the same part time gig while he was a mere state legislator.
Traditional Medicare pays 30% for unnecessary, duplicative or unprovided care. You are correct that MA plans are more efficient and effective, as evidenced by the fact that they provide care. The much maligned Ryan proposal, was to convert everyone to MA private sector plans with premium support so that the subsidies would be income tested.
The problem with rising medical costs under the Obama regulations is because the big boys know how to game the system.
If you received services from a specialist whose practice was later purchased by a hospital system and then needed the same services, you and your insurance, or Medicare and its 20% co-pay, would be charged more for the same service.
Obamacare, and the hospital consolidations it imposed, allowed hospitals systems to increase their bargaining position with insurer and negotiated higher rates. Obama declared big medicine the winner and small medicine the loser. Perhaps that was in gratitude for the $350,000 a "charity" hospital paid his wife for a part time gig while he was a Senator. That was double the $175,000 she was paid for the same part time gig while he was a mere state legislator.
Traditional Medicare pays 30% for unnecessary, duplicative or unprovided care. You are correct that MA plans are more efficient and effective, as evidenced by the fact that they provide care. The much maligned Ryan proposal, was to convert everyone to MA private sector plans with premium support so that the subsidies would be income tested.
The problem with rising medical costs under the Obama regulations is because the big boys know how to game the system.
4
If you look at the numbers, most Medicare Advantage plans cost the federal government 10%-15% more than traditional Medicare. It's true that Medicare Advantage plans have created some savings in certain regions of the US, but overall they have been a bad deal for taxpayers.
7
The inference of political views shows a bias so heavy, that your opinion is not trusted. Try looking at things more broadly. People aren't looking for blame or more political declarations, only solutions.
2
I am an anesthesiologist and critical care physician. For the vast majority of my patients I cannot treat differently based on insurance status. I rarely know what type of insurance a patient has and I never ask if they have private insurance or not. That lack of knowledge may explain why there do not appear to be differences in care. If insurance status is blinded you can't treat differently based on said status.
39
I would hope that any ethical doctor would not base the level of care that they provide on money.
3
Interestingly, many CC physicians and anesthesiologist do not "contract" or "participate" in commercial health insurance plans and are, therefore, likely to balance bill patients, regardless of the patients' healthcare coverage. This could be another (yes, cynical) reason that the patients are not treated differently base on their coverage.
1
Cynical or not, blinding physicians is probably the most effective way to prevent differences. It would be a forcing function that would make differing care based on insurance possible.
Maybe Austin Frakt should read Kenneth Arrow's seminal paper from 1963 that explains why healthcare doesn't not function like other markets. Healthcare is governed by risk and uncertainty, both of which are virtually impossible to quantify.
34
Risk and uncertainty are not impossible to quantify for large populations, which is why health insurance is an effective financial strategy for mitigating risk for middle class people with income and assets.
Medical care in the US is plagued with opacity toward both quality and price, which makes it impossible for someone needing services to make a free market decision based on cost/benefit. If the federal government, or states for that matter, wanted to improve quality and reduce costs, one of the most effective strategies would be to provide some transparency to quality and costs. However, the vested interests mean that even when Medicare/Medicaid have access to data, they do not publish it.
A structural problem for Obamacare, in its objective that all people have insurance coverage, was that it set its objective inappropriately. A higher level objective would be that all people have access to quality affordable health care.
People who have low income and few assets should not be paying insurance premiums. Insurance protects future income and assets against seizure by a hospital if high costs are incurred. They lose if they don't get paid for services rendered, and they are the target beneficiaries of O'care. Hospital services charges have increased 33% while the CPI increased 10%, while their uncompensated care has declined.
Rather than have everyone insured, have Medicaid stand as a backstop for the poor, for both their routine and catastrophic care.
Medical care in the US is plagued with opacity toward both quality and price, which makes it impossible for someone needing services to make a free market decision based on cost/benefit. If the federal government, or states for that matter, wanted to improve quality and reduce costs, one of the most effective strategies would be to provide some transparency to quality and costs. However, the vested interests mean that even when Medicare/Medicaid have access to data, they do not publish it.
A structural problem for Obamacare, in its objective that all people have insurance coverage, was that it set its objective inappropriately. A higher level objective would be that all people have access to quality affordable health care.
People who have low income and few assets should not be paying insurance premiums. Insurance protects future income and assets against seizure by a hospital if high costs are incurred. They lose if they don't get paid for services rendered, and they are the target beneficiaries of O'care. Hospital services charges have increased 33% while the CPI increased 10%, while their uncompensated care has declined.
Rather than have everyone insured, have Medicaid stand as a backstop for the poor, for both their routine and catastrophic care.
1
The PPPACA--Obamacare, ebmem--mandates:
1. A simple, clear EOC document that explains what your cost-sharing amounts to;
2. Publication of cost for the "Top 100," medical services from every hospital and prvider in the country.
Might want to look a few things up, first.
1. A simple, clear EOC document that explains what your cost-sharing amounts to;
2. Publication of cost for the "Top 100," medical services from every hospital and prvider in the country.
Might want to look a few things up, first.
2
Austin Frakt is shocked, SHOCKED, to discover that, "the fact that price apparently does not influence doctors’ decisions is just another way in which health care does not seem to function like other markets."
Every other developed nation on the face of the earth, plus several industrializing nations, operate health care systems that have taken the profit motive entirely out of health insurance, in the process delivering health care superior to America's, and at a fraction of the price of America's. Yet Austin Frakt is only now beginning to figure out that health care just doesn't seem to function "like other markets"?
Medicare for all- now.
Every other developed nation on the face of the earth, plus several industrializing nations, operate health care systems that have taken the profit motive entirely out of health insurance, in the process delivering health care superior to America's, and at a fraction of the price of America's. Yet Austin Frakt is only now beginning to figure out that health care just doesn't seem to function "like other markets"?
Medicare for all- now.
71
Medical Practice involves the practitioner, (e.g. medical doctor, nurse, psychologist, social worker), diagnostic evaluation (e.g. lab tests), and treatment recommendation (e.g. medication, referral to specialist).
Assume Medical Training is very consistent, then MDs practice would also be consistent. (To simplify, I'll only focus on MDs. The same logic applies to the other professionals.)
Costs, like appointments & procedures with one's Primary Care Physician, is more dependent on the location of the MD's practice than on training.
Then, there are the costs for diagnostic tests & treatment recommendations, which are dependent on other institutions, like labs & pharmaceutical companies.
Assume Medical Training is very consistent, then MDs practice would also be consistent. (To simplify, I'll only focus on MDs. The same logic applies to the other professionals.)
Costs, like appointments & procedures with one's Primary Care Physician, is more dependent on the location of the MD's practice than on training.
Then, there are the costs for diagnostic tests & treatment recommendations, which are dependent on other institutions, like labs & pharmaceutical companies.
2
Traditional Medicare does not eliminate the profit motive from healthcare. Fully 30% of payments go for unneeded, duplicative, up-coded or un-provided care.
Medicare Advantage plans, operated like private sector programs with premium support, provide better outcomes at lower cost. Even after the insurers take a profit.
If you look at countries that have single payer systems, they pay doctors around the same salaries as school teachers for more work hours. In Great Britain, more than have of the physicians employed by the NHS are junior doctors. The equivalent in the US is residents. Almost half of their ERs are closed late at night and on weekends because they cannot find a sufficient number of physicians who are willing to work for what they pay, even with overtime and weekend premiums. Wealthy and middle class people buy supplemental insurance plans and have a separate network of providers so they do not have to wait for routine, maintenance, urgent and emergency care.
US health care has not been a free market for decades. Government regulations and tax incentives have created a system that has no visibility to quality or price. Government's solution to the inefficiency and ineffectiveness they have introduced is to introduce additional complexity that benefits only the big boys who can extract additional profits. Eliminating the private insurers and replacing them with Medicare bill processors increases costs.
Medicare Advantage plans, operated like private sector programs with premium support, provide better outcomes at lower cost. Even after the insurers take a profit.
If you look at countries that have single payer systems, they pay doctors around the same salaries as school teachers for more work hours. In Great Britain, more than have of the physicians employed by the NHS are junior doctors. The equivalent in the US is residents. Almost half of their ERs are closed late at night and on weekends because they cannot find a sufficient number of physicians who are willing to work for what they pay, even with overtime and weekend premiums. Wealthy and middle class people buy supplemental insurance plans and have a separate network of providers so they do not have to wait for routine, maintenance, urgent and emergency care.
US health care has not been a free market for decades. Government regulations and tax incentives have created a system that has no visibility to quality or price. Government's solution to the inefficiency and ineffectiveness they have introduced is to introduce additional complexity that benefits only the big boys who can extract additional profits. Eliminating the private insurers and replacing them with Medicare bill processors increases costs.
2
There is a substantial variation in regional medical costs that results from variations in local treatment practices. The rate of C-sections varies, which affects average delivery costs. Some areas tend to use a higher rate of stents in cardiac care vs. bypass surgery, which increases costs because of the high rate of stent failures and complications.
Your theories, like the theories of the authors of the article may be valid for low value low paid services, but they are not consistent with the total of health care.
Your theories, like the theories of the authors of the article may be valid for low value low paid services, but they are not consistent with the total of health care.
The author mentioned, and then forgot about , one critically important point here: "Both Medicare and Medicaid pay lower prices to health care providers compared with private market plans offered by employers and in the Affordable Care Act marketplaces. " For physicians, those lower prices are less -- in the case of Medicaid in a state like Texas, significantly less -- than the cost of providing that care. Like any business, a medical practice can't stay open for long -- can't pay the staff or the rent or the overhead -- when costs are greater than income.
9
....and this is how the medicare/Medicaid system cost shifts to private insurance. The docs stay in business by billing more to the private insurers...to make the math work in their practices.
4
Docs can bill whatever they want to private insurers, but the insurers pay their contracted rate, regardless. Physicians and providers do not set reimbursement.
5
All the more reason for a national system with a simple universal one service, one price model. Across a large population, the expensive and cheap cases cancel each other out.
4
Another factor in the equation is the cost to the MD of their office staff who spend hours on the phone getting "authorizations". In single payer systems, like the one in Canada, there is no need for that additional cost. Administrative cost differences would probably pay for a lot of coverage.
63
There is no need to get authorizations. The high cost alternatives are not covered. If you need treatment, services are rationed by delay. No administrative time is wasted obtaining permission for reimbursement for a cat scan. But you will wait six weeks to get your diagnosis and another six weeks before treatment will begin.
If you're in an accident or seriously ill, you move to the head of the line for imaging and treatment services.
Canada has lower survival rates for most cancers because of diagnosis and treatment delays. They have limited neonatal services because they do not even count as live births low birth weight premies.
Socialized medicine does a very efficient job of providing a uniform level of care for its population. It does not do as well as US medicine for high cost/high tech illnesses and injuries. An oil prince will come to the US for specialized care rather than Canada or Great Britain.
The US does not provide a uniform level of care and there is more variability here. Kennedy received and McCain is receiving the best possible care in the world for their brain tumors. Someone covered by Medicaid or O'Care insurance is out-of-network for world class centers of excellence for diagnosis and treatment.
Many individuals with employer provided coverage get the same world class treatment for complex illnesses that the oil prince receives. They are not going to be satisfied with the NHS as a substitute.
If you're in an accident or seriously ill, you move to the head of the line for imaging and treatment services.
Canada has lower survival rates for most cancers because of diagnosis and treatment delays. They have limited neonatal services because they do not even count as live births low birth weight premies.
Socialized medicine does a very efficient job of providing a uniform level of care for its population. It does not do as well as US medicine for high cost/high tech illnesses and injuries. An oil prince will come to the US for specialized care rather than Canada or Great Britain.
The US does not provide a uniform level of care and there is more variability here. Kennedy received and McCain is receiving the best possible care in the world for their brain tumors. Someone covered by Medicaid or O'Care insurance is out-of-network for world class centers of excellence for diagnosis and treatment.
Many individuals with employer provided coverage get the same world class treatment for complex illnesses that the oil prince receives. They are not going to be satisfied with the NHS as a substitute.
4
ebmem, you said, "There is no need to get authorizations. The high cost alternatives are not covered. If you need treatment, services are rationed by delay. No administrative time is wasted obtaining permission for reimbursement for a cat scan. But you will wait six weeks to get your diagnosis and another six weeks before treatment will begin."
That depends on where you live. My doctors' offices around here get authorizations for things like CT scans and MRIs within a week. If they have to fight for it and submit more documentation, it might take 10 days. Appointments for those tests are usually available within the same timeframe, and results are sent to both me and my doctors within 3 business days.
I'm not rich; I have a Silver plan that I bought on the marketplace. But I do have several conditions that require monitoring with those advanced imaging tests at least once a year. As I wait for someone at the desk to make the appointments for me, I observe a great deal of administrative time being spent by office staff parsing which insurance plans cover what services and at what rate and at which facility, depending on what level each facility is considered within each plan.
All facilities in my area, for example, are considered in-network, but some are "standard" and some are "enhanced" and the difference in cost can be substantial. Certain tests are only done at certain facilities -- one does breast MRIs but doesn't do bone scans. Another does both, but is standard.
That depends on where you live. My doctors' offices around here get authorizations for things like CT scans and MRIs within a week. If they have to fight for it and submit more documentation, it might take 10 days. Appointments for those tests are usually available within the same timeframe, and results are sent to both me and my doctors within 3 business days.
I'm not rich; I have a Silver plan that I bought on the marketplace. But I do have several conditions that require monitoring with those advanced imaging tests at least once a year. As I wait for someone at the desk to make the appointments for me, I observe a great deal of administrative time being spent by office staff parsing which insurance plans cover what services and at what rate and at which facility, depending on what level each facility is considered within each plan.
All facilities in my area, for example, are considered in-network, but some are "standard" and some are "enhanced" and the difference in cost can be substantial. Certain tests are only done at certain facilities -- one does breast MRIs but doesn't do bone scans. Another does both, but is standard.
3
Health care is not a market.
It's an essential service that a complex society like this one needs to provide to all ts members.
Pretending it is a consumer item distorts the power levers inherent in a situation at whose core are vulnerability, pain and physical danger.
It's an essential service that a complex society like this one needs to provide to all ts members.
Pretending it is a consumer item distorts the power levers inherent in a situation at whose core are vulnerability, pain and physical danger.
69
None of what you said negates the fact that there is a market for health services. It is, however, a highly inelastic market, as indicated by relatively small changes in services purchased/provided relative to changes in price.
2
Pretending health care is "not a market" is simply putting your head in the sand.
2
It really isn't essential
You just want it to live longer or better
You just want it to live longer or better
But we thought doctors took a vow to "do no harm" so this should not be a surprise.
They didn't take a vow about doing no harm unless a patient's insurance pays less. Then it would be ok? Sad.
No wonder people equate healthcare treatment with money these days. I worked for a doctor, when I was a young woman, who had been paid with chickens and produce from some of his patients in his early days of practice. I loved his stories.
I can assure you - his patients were all treated the same no matter the payment, or even in some cases, no payment at all.
They didn't take a vow about doing no harm unless a patient's insurance pays less. Then it would be ok? Sad.
No wonder people equate healthcare treatment with money these days. I worked for a doctor, when I was a young woman, who had been paid with chickens and produce from some of his patients in his early days of practice. I loved his stories.
I can assure you - his patients were all treated the same no matter the payment, or even in some cases, no payment at all.
26
Did you read the article? The upshot is that doctors DO treat patients the same, regardless of insurance.
The oath doesn't say doctors have to treat you if you can't pay. They didn't take a vow of poverty.
You have no right to their knowledge
You have no right to their knowledge
The labeling of services as high- or low-value is a relatively new thing. I think it is premature to use it to grade disease coverage programs.
It is based on retrospective analysis of groups of patients. There have been many disagreements in the characterization of some tests as low value (consider mammography in women under some age cut point, and PSA screening for example).
In I individual patients, the benefit of a screening or diagnostic test or a procedure may turn out to be anywhere from life-saving to less than worthless.
The clinician is supposed to use judgement when choosing when to recommend testing, procedures or treatments, rather than automatically following "guidelines" or insurance coverages.
In my view, we shouldn't at this time, use "value" categories in comparing insurors.
It is based on retrospective analysis of groups of patients. There have been many disagreements in the characterization of some tests as low value (consider mammography in women under some age cut point, and PSA screening for example).
In I individual patients, the benefit of a screening or diagnostic test or a procedure may turn out to be anywhere from life-saving to less than worthless.
The clinician is supposed to use judgement when choosing when to recommend testing, procedures or treatments, rather than automatically following "guidelines" or insurance coverages.
In my view, we shouldn't at this time, use "value" categories in comparing insurors.
5
The rich will always get better services whether in this country or in other countries.
Having said that, the goal in this country (that the rest of the civilized world has figured out) is too allow all non rich people universal, affordable, quality health care.
If the millionaire is getting get a 10 care, let the minimum wage worker afford a 6-7 care.
Having said that, the goal in this country (that the rest of the civilized world has figured out) is too allow all non rich people universal, affordable, quality health care.
If the millionaire is getting get a 10 care, let the minimum wage worker afford a 6-7 care.
8
It is absolutely false that the rich get better medical service in this country or in other countries. In Japan, in France, in Switzerland, and elsewhere there is a system of national health care, everyone is treated equally. In the UK, just 3% of medical services are delivered by the private sector. Overwhelmingly the British people are treated by the national health service, and the nation of Britain is intensely proud of that system's success. Even Margaret Thatcher, the queen of conservatism, never breathed a sentence suggesting that Britain privatize the NHS.
In most civilized countries, health care is the right of all citizens, and it is delivered equally to all citizens. Americans need to tune out the falsehoods of conservatives like Frakt and this writer, who are just plain wrong.
In most civilized countries, health care is the right of all citizens, and it is delivered equally to all citizens. Americans need to tune out the falsehoods of conservatives like Frakt and this writer, who are just plain wrong.
32
Thank you for your reply Sean....maybe I should have said the super rich. If Bill Gates comes down with cancer, he will go to the finest doctors that don't take any insurance. That is what I meant. I can even settle for a lower income person get a 6-7 care (out of ten),(instead of a one-two that some get now here) while a upper middle class person who pays more premiums get an eight care.
The super rich will always be at ten. They have the money not matter what country they live in.
The super rich will always be at ten. They have the money not matter what country they live in.
6
Speaking of "just plain wrong," Sean, you are just plain wrong. All three of those countries use "mixed," systems, in which the wealthiest can indeed buy added coverages.
2