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Hospitals Stand to Lose Billions Under ‘Medicare for All’

SouthernDemocrat said:
Well the flip side of this is that providers have been screwing Americans for decades now. Hospitals billing 400 dollars for a 20 dollar metabolic panel. Plastic surgeons billing 20k for a handful of facial stitches. Neurologists billing 5k for less than 5 minutes of their time to glance at a CT scan. Oncologists slowing down the rate of chemo infusions simply to increase billing. An entire coding industry cropping up in the last 20 years whose soul purpose is to increase billing all the way up to the legal line of fraud.

Look, I am not for Medicare for All. Let's not pretend though that providers are not part of the problem though.

There is a reason why no country on earth wants our healthcare system.

Also, most other countries have far better rural health systems than we do. Having to travel to a metro for healthcare is a bigger problem here than it is in most of our peer countries. This is because in half of all of our healthcare markets, one health system has a monopoly and they have eliminated rural healthcare centers as they are not as profitable.
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We should do what we should have done all along. Both sides should work together to fix the problem. Democrats crammed through Obamacare and arrogantly thought that they would remain in power to fix any glitches that came up. They were wrong. Now Republicans want to cram through their own plan (yeah, I know, they don't actually have a plan) without any Democratic support and then expect Democrats to fix any glitches that come up. If we have a truly bipartisan plan then when glitches come up then they will actually get fixed. The problem is both sides are saying that it is either their way or the highway and the American people are caught in the middle.

What we should have done in the first place is come up with a solution for those who have no insurance or bad insurance and leave everyone else the hell alone. Just like Obama said, "If you like your insurance you can keep your insurance. If you like your doctor you can keep your doctor". We shouldn't be screwing with the millions who are happy with their employer based insurance.
 
Greenbeard said:
Looks like this time around we're getting to the level of seriousness where trade-offs and winners-and-losers will get explored. Which is good! But it underscore the risks that primary candidates run in hitching their wagons to a very speculative idea without fully exploring those trade-offs.

Hospitals Stand to Lose Billions Under ‘Medicare for All’



The Stuart Altman quote is the crux of it:



This would be uncharted territory.
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It's not uncharted in Canada and elsewhere. Whether hospitals can adjust is not the question. Of course they will. The question is how much longer we're going to allow private insurance profiteers to be the unnecessary middlemen between Americans and their healthcare.

Once we remove profits for a few as the primary goal of the health industry we can focus more on actual health and the model will shift more towards prevention and lifestyle changes. Then, instead of the constant projections of 18% yearly increases and average people losing their homes because they got sick, costs will stabilize and even go down.
 
The takeaway for me with Medicare-for-all is: the quality of healthcare will go down. You won't be able to keep your doctor.

The only way for costs not to skyrocket under Medicare-for-all is if services are curtailed...and they will be since there will be no competition among providers.

We'll have crappy healthcare insurance for all...Like Canada.
 
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JustHanging said:
Yep, and you didn't look at the links I provided, did you? OECD, 2017:

Canada: 14 categories of healthcare above average, USA: 7 categories of healthcare above average. (Note: I did not count expenditure above average in this, which applied to both countries)



You didn't bother reading, that either did you? Christ, you know, if you actually spent a few seconds listening, instead of mindlessly parroting talking points, over and over and over and ov..... you might actually learn something, and quit repeating all this nonsense.

To repeat, I said it's higher in some areas, lower in others. For example, Trump has imposed tariffs on the American people, Trudeau hasn't done this to Canadians. Alberta pays zero percent provincial sales tax. It's different in each province, much like it is in the USA in regards to States. I just picked the closest state to us, WA, and here's what I found. According to this website:

The Washington (WA) state sales tax rate is currently 6.5%. Depending on local municipalities, the total tax rate can be as high as 10.4%

We have much better social programs than in the USA, any minor difference in taxes is well worth it, particularly when you consider we are getting better healthcare than Americans, thrown in for "free" as it were.
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Speaking of not reading.....do you happen to know WHY Washington has a varied total tax rate? Bet you had to look this up, (I did)

As far as your links, you realize that what you linked has NOTHING TO DO WITH THE QUALITY OF CARE right? Health Status, Risk Factors, that's what it measures, they are literally measuring for quality 30 day AMI mortality rate, and colon cancer survival rates as indicators of quality. Essentially how many people survive a heart attack, and colon cancer.....really good way to measure quality eh?
 
sjmay said:
Speaking of not reading.....do you happen to know WHY Washington has a varied total tax rate?
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Yep.

As far as your links, you realize that what you linked has NOTHING TO DO WITH THE QUALITY OF CARE right?
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Actually, it did. You didn't bother reading. You are just parroting the right wing talking points you've been told to parrot, and not providing any reputable sources to support your arguments. I already know all the right wing talking points, other people have parroted them before you, trust me. So when you can provide reputable sources to support your assertions, I'll be happy to continue the discussion.
 
Rogue Valley said:
We can't simply keep accepting ballooning doctor, hospital, procedure, and drug costs.

This trajectory has to change or someday in our lifetimes, routine healthcare will only be available to the wealthy.
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That’s definitely the area that’s driving the costs up. Everyone likes to focus on the insurance companies but it’s the providers and drug companies that are driving up the costs way beyond the rate of inflation.
 
JustHanging said:
Yep.



Actually, it did. You didn't bother reading. You are just parroting the right wing talking points you've been told to parrot, and not providing any reputable sources to support your arguments. I already know all the right wing talking points, other people have parroted them before you, trust me. So when you can provide reputable sources to support your assertions, I'll be happy to continue the discussion.
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Reputable sources?

How about first hand knowledge, working in two different ERs, on two different coasts, and observing the ERs from 3-4 different hospitals in the GTA, now granted, observing only won't tell you much, but when you hear people talk, and you see people schedule procedures in FOREIGN countries, because they can get them done FASTER, you tend to learn a bit.

I know, you have your fancy studies, good job, your studies that you quoted again, had nothing to do with Quality, and you can't even see it....

No idea what the right wing talking points are to be honest with you, and while yes, there are absolutely parts of the US system that has to be improved, quality isn't one of them.
 
Northern Light said:
That's not true. You're only looking at one piece of the picture and not the whole picture. Let me explain...

A major reason hospitals charge more for care is because uninsured patients can't pay their bills, yet the hospital is required to treat them. Cost burden then gets transferred to patients who *can* pay, and they end up paying more. Administrative overhead becomes greater because you then need departments who can manage these differences and negotiate payouts from insurance companies at higher rates, which are all based on different rules depending on the insurance company.
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Under a single payer system, all the cost falls on the taxpayer.

With the government as the sole payer, payouts become standardized, and everyone can pay.
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That is not true, not everyone pays, far from it. 40% of citizens in this country pay no federal taxes. Under a single payer the taxpayer has the full responsibility to cover all the cost of healthcare.

Cost burden then gets redistributed, everyone is charged the same amount and everyone pays the same amount. In other words service prices drop because there is no unequal cost burden. Extraneous departments and administration then get cut.
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I take it that you don't know that no medical group, Doctor, Hospital etc cannot survive under the Medicare system of their payment schedule. Thus for a single payer system you would have to greatly increase payments to all so that they can recoup all their expenses and make a profit equal to the years of training and cost to provide such services.

Now let's consider what you just said, if the hospital responds by cutting services. They still have an obligation to handle urgent care, no matter if the person can pay or not. If they cut services, then quality drops, and patients get substandard care. Substandard care means more repeat visits that they can't pay for, which increases the debt burden that gets transferred to cost of service -- which is what is happening already right now.
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I repeat, with the pay schedule that Medicare has now, there will be no medical care for anyone. No one can survive on what Medicare pays. Further with a single payer all the medical providers get their payments no matter what from Medicare.

The future of our healthcare really only has two choices:
1) Remove the legal obligation of hospitals to treat all urgent care patients and leave people to die. Yeah, we're not doing that.
2) Create a universal payer for everyone regardless of their income level. In other words, the government.

Right now, hospitals are basically trying to get reimbursed for their losses through the private sector. This raises costs astronomically. In turn, price of services goes up, and then patients who can't pay get slapped with an even bigger bill that they can't pay. The cycle then repeats over and over.
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Your having a hard time to understand that 40% of Americans do not pay federal taxes. The price for a single payer system will skyrocket as no one can live on what Medicare pays now. When you add up all these new costs, taxes are going to skyrocket.

This could all be remedied with single payer universal health care. People are already getting de facto free care, but because they can't pay the care is:
1) Substandard because the hospital knows they can't pay so they get minimal care, so they keep coming back
2) Too expensive, they can't pay even if they wanted to
3) Putting individuals into huge household debt that is a burden to our economy'
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Providing minimal care does not equal they keep coming back. Hell because a nurse does not come by as often as they used to does not mean they keep coming back.
Too expensive, they can't pay. Then who is going to pay. Yep the taxpayer, all your doing is moving the deck chairs.
Putting people into huge household debt. If they can't pay, then they can't pay, but someone else will pay for them, the taxpayer.

Hospitals should not be for-profit institutions. In all the UHC countries, hospitals make enough to pay their staff + a bit extra for expansion programs, and the rest of their expansion funding comes from wealthy donors.
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Of course to a socialist, you want government to control everything. Problem is to pay for all this stuff there has to someone to tax. And who would that be? Your whole post was all about people that can't pay etc but you never mention who is going to pay for it.
 
Lovebug said:
That is something that bugs me. The rich have, once again, more choices than the rest. They can pay their own way or select from A, B or C, while everyone else is herded into the same door.
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You shouldn't let it bug you. It's just the way of the world.

So why not make this truly MFA? If it is good, it should be good for ALL indeed, no exceptions. Pelosi, Sanders, Warren, the Hollywood elite, Gates and the rest of us, go through the same gate, get the same care.
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I find this immoral.

It's sadly true that we can't save every person from every disease but for those with the means to get obscure or even untested treatments I can't see it as acceptable to deny them the basic right to seek that salvation.
 
cabse5 said:
The takeaway for me with Medicare-for-all is: the quality of healthcare will go down. You won't be able to keep your doctor.
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Highly unlikely that your quality of healthcare will go down. It's already poor. Most likely, unless the USA is an Idiocracy, you pay much less, maybe 1/2 what you do now, but get better outcomes.

That's based on what other Western nations have done.

The only way for costs not to skyrocket under Medicare-for-all is if services are curtailed...and they will be since there will be no competition among providers.
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Wrong again. I'm Canadian, what services can't I get?

We'll have crappy healthcare insurance for all...Like Canada.
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Wow, I'm always amazed at how gullible Americans are. Christ, not only does your healthcare suck, but you public education system is terrible as well, great for producing parrots, terrible for producing critical thinkers. Kind of explains how a common flimflam man like Trump can convince so many Americans that he actually cares about them.

I linked OECD reports for our two healthcare systems in post #172. In those reports:

Canada: 14 categories of healthcare above average, USA: 7 categories of healthcare above average. (Note: I did not count expenditure above average in this, which applied to both countries)
 
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Moderate Right said:
We should do what we should have done all along. Both sides should work together to fix the problem. Democrats crammed through Obamacare and arrogantly thought that they would remain in power to fix any glitches that came up. They were wrong. Now Republicans want to cram through their own plan (yeah, I know, they don't actually have a plan) without any Democratic support and then expect Democrats to fix any glitches that come up. If we have a truly bipartisan plan then when glitches come up then they will actually get fixed. The problem is both sides are saying that it is either their way or the highway and the American people are caught in the middle.

What we should have done in the first place is come up with a solution for those who have no insurance or bad insurance and leave everyone else the hell alone. Just like Obama said, "If you like your insurance you can keep your insurance. If you like your doctor you can keep your doctor". We shouldn't be screwing with the millions who are happy with their employer based insurance.
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A solution can't leave everyone else alone. Why do you think insurance premiums have gone up significantly every year for 20 years now? It's because the insurers cannot control costs sufficiently with the providers. Literally half our healthcare markets in this country are a monopoly today. A monopoly where one health system controls the entire healthcare market for the area. In those markets insurers have to pay whatever the providers want, or simply not offer coverage in the market. The costs are just passed on to the rest of us in the form of higher premiums.

The point is a solution to control costs and cost growth in healthcare will have to be pretty radical. No one can be left untouched. The problem is that everyone on both sides lies to American voters about our healthcare system.

If they are Republicans they make ridiculous claims about how HSA compatible plans will control costs. That's absurd because only 7% of healthcare spend is on primary care.

If they are Democrats they make ridiculous claims about prescription drugs. Drugs are expensive, but they are only 10% of healthcare spend. You can give away every prescription drug, and healthcare would still be absurdly expensive.

The Democrats solution, Medicare for All. We obviously cannot afford it as it would be by far the most expensive socialized healthcare plan on earth.

The Republicans solution, privatize everything. All that does is a big cost shift. Moreover, they don't recognize that healthcare is a market failure. If I show up to a car dealership and we cannot agree on a price, I just walk away. If I show up at a hospital and I need heart surgery, its pay them whatever they ask me to pay them, or die.

Voters don't want any changes, but they want to bitch about the state the system is in.

At this point, I think the whole system will have to collapse in on itself before anything of substance is done.
 
JustHanging said:
Highly unlikely that your quality of healthcare will go down. It's already poor. Most likely, unless the USA is an Idiocracy, you pay much less, maybe 1/2 what you do now, but get better outcomes.

That's based on what other Western nations have done.



Wrong again. I'm Canadian, what services can't I get?



Wow, I'm always amazed at how gullible Americans are. Christ, not only does your healthcare suck, but you public education system is terrible as well, great for producing parrots, terrible for producing critical thinkers. Kind of explains how a common flimflam man like Trump can convince so many Americans that he actually cares about them.

I linked OECD reports for our two healthcare systems in post #172. In those reports:

Canada: 14 categories of healthcare above average, USA: 7 categories of healthcare above average. (Note: I did not count expenditure above average in this, which applied to both countries)
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Canada's healthcare is already poor, you conjecture? Which services can't you get in Canada? Any medical procedure that isn't deemed necessary due to a critical need.

In Canada, I haven't seen a turn away of healthcare for someone with a critical need for care. What I have seen In Canada are delays or rejections of care if the crisis is not deemed critical. I don't have the YouTube of the lady who had Canadian healthcare and had feet pain due to an emergent diabetes situation. Her discomfort was not treated because her situation was not critical. Her foot pain relief was considered elective medicine. Finally, the Canadian had both feet removed because the medical situation had progressed to a critical stage.
 
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SouthernDemocrat said:
A solution can't leave everyone else alone. Why do you think insurance premiums have gone up significantly every year for 20 years now? It's because the insurers cannot control costs sufficiently with the providers. Literally half our healthcare markets in this country are a monopoly today. A monopoly where one health system controls the entire healthcare market for the area. In those markets insurers have to pay whatever the providers want, or simply not offer coverage in the market. The costs are just passed on to the rest of us in the form of higher premiums.

The point is a solution to control costs and cost growth in healthcare will have to be pretty radical. No one can be left untouched. The problem is that everyone on both sides lies to American voters about our healthcare system.

If they are Republicans they make ridiculous claims about how HSA compatible plans will control costs. That's absurd because only 7% of healthcare spend is on primary care.

If they are Democrats they make ridiculous claims about prescription drugs. Drugs are expensive, but they are only 10% of healthcare spend. You can give away every prescription drug, and healthcare would still be absurdly expensive.

The Democrats solution, Medicare for All. We obviously cannot afford it as it would be by far the most expensive socialized healthcare plan on earth.

The Republicans solution, privatize everything. All that does is a big cost shift. Moreover, they don't recognize that healthcare is a market failure. If I show up to a car dealership and we cannot agree on a price, I just walk away. If I show up at a hospital and I need heart surgery, its pay them whatever they ask me to pay them, or die.

Voters don't want any changes, but they want to bitch about the state the system is in.

At this point, I think the whole system will have to collapse in on itself before anything of substance is done.
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Most people are actually happy with their employer based health insurance. Screwing them over for the sake of less than 30% of the population is insanely stupid. Don't screw 70% of Americans for the sake of the other 30%. Just help the 30%

Majority of Americans Satisfied with Their Employer’s Health Plan, New Survey Shows - AHIP
 
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Republicans only want wealthy people to have health care. Their solution is to just let sick people die
 
Thingfish said:
Yup, talk is cheap...on both sides of the isle.
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Talk may be cheap, but if you remember correctly, the Dems actually put their political capital where their mouth was in 2009 and 2010. So, sir, in this particular case, putting the Dems and Reps in the same bucket is cheap, as thus far, the Republicans have done nothing but talk (there never has a been a legitimate replace in the "repeal and replace"), while the Democrats risked (and many lost) their seats to actually produce something.
 
Moderate Right said:
Most people are actually happy with their employer based health insurance. Screwing them over for the sake of less than 20% of the population is insanely stupid.
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I agree and one could argue over the rising costs of gov't. I've already proposed that the gov't set up a Medicaid for those who can't get healthcare and the employer-based health insurance kept in place. Too bad employer-based healthcare won't ever return due to ACA.
 
Moderate Right said:
Most people are actually happy with their employer based health insurance. Screwing them over for the sake of less than 30% of the population is insanely stupid. Don't screw 70% of Americans for the sake of the other 30%. Just help the 30%

Majority of Americans Satisfied with Their Employer’s Health Plan, New Survey Shows - AHIP
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That is fine for people that have employers....but America is about entrepreneurship. A system that tethers employees to an employer so they can have healthcare (or because they have a pre-exisiting condition) is actually contrary to the best interests of the American economy. One of the best things about the PPACA was it was a giant step in favor of individuals taking responsibility for their healthcare and unbundling from something that we had to get from an employer.
 
Moderate Right said:
Most people are actually happy with their employer based health insurance. Screwing them over for the sake of less than 30% of the population is insanely stupid. Don't screw 70% of Americans for the sake of the other 30%. Just help the 30%

Majority of Americans Satisfied with Their Employer’s Health Plan, New Survey Shows - AHIP
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I understand that many people are happy with their employer based plans. However, their employers are often in an untenable situation because every year, offering those plans becomes more and more expensive. Employers are paying on average 70% of the 14,800 dollars year to provide coverage for employees and their dependents.

Cost of Employer Health Coverage to Rise in 2019

So sure, everyone likes what they have. I like what I have, but that doesn't mean it is sustainable.
 
cabse5 said:
I agree and one could argue over the rising costs of gov't. I've already proposed that the gov't set up a Medicaid for those who can't get healthcare and the employer-based health insurance kept in place. Too bad employer-based healthcare won't ever return due to ACA.
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No one cares about their insurance. They like their doctors.

Insurance companies are not likeable. I don't know a single person who says hey man Aetna is great.
 
Greenbeard said:
Looks like this time around we're getting to the level of seriousness where trade-offs and winners-and-losers will get explored. Which is good! But it underscore the risks that primary candidates run in hitching their wagons to a very speculative idea without fully exploring those trade-offs.

Hospitals Stand to Lose Billions Under ‘Medicare for All’

The Stuart Altman quote is the crux of it:
This would be uncharted territory.
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Smart kids go to college to prepare themselves for high paying jobs. If the government takes over the healthcare industry then fewer kids will go into the medical field, likely causing shortages which will add a serious strain on the system which will already be strained with the increasing number of patients that will flood the system when care is free for all.
 
marke said:
Smart kids go to college to prepare themselves for high paying jobs. If the government takes over the healthcare industry then fewer kids will go into the medical field, likely causing shortages which will add a serious strain on the system which will already be strained with the increasing number of patients that will flood the system when care is free for all.
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I'm curious. Explain to me how Medicare for all is the government taking over healthcare.
 
Obscurity said:
I'm curious. Explain to me how Medicare for all is the government taking over healthcare.
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The government mandates are similar to what Obama told the nuns: 'You can opt out of contraceptive coverage for religious reasons if I say you can and I say you can't.'
 
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