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Precisely. The same procedure X or drug Y costs many multiples in the US what it does elsewhere. We have to do what is necessary to bring those costs in line. If and when we've done that, then our options open up as to how to make quality health care available and affordable to everyone.
What are the thoughts about the various versions of the Democratic initiatives allowing seniors (50+) to buy-into Medicare before 65? Sounds like these debates may pick-up steam in 2019. Would be curious to see the cost, but potential bridge to earlier retirement and/or a viable safety net for those who find themselves unemployed/unemployable.
Even when they 'explain' it to us we won't understand. I swear, the authors of Obamacare must be psychotic in order to write that nonsense - and you would have to be neurotic to read it.
They'll get it wrong and it won't change much, although there will be convincing sounding people on both sides.
I'm a Republican and would have been just as happy with single payer.
While I didn't read this entire thread, to me (as an economic conservative) the idea of younger seniors buying into Medicare seems fairly good (meaning that it will probably fly with the Republicans too, as my economic thinking always ends up being aligned with Republican, although I am not actively aiming for that as a non-partisan). I think the idea is good because more people paying into an insurance pool, particularly people who tend to be less sick than people over 65, will bring more money into the insurance pool, and therefore decrease an individual premium (or at least keep it from rising), and will certainly help in keeping Medicare solvent.
While I didn't read this entire thread, to me (as an economic conservative) the idea of younger seniors buying into Medicare seems fairly good (meaning that it will probably fly with the Republicans too, as my economic thinking always ends up being aligned with Republican, although I am not actively aiming for that as a non-partisan). I think the idea is good because more people paying into an insurance pool, particularly people who tend to be less sick than people over 65, will bring more money into the insurance pool, and therefore decrease an individual premium (or at least keep it from rising), and will certainly help in keeping Medicare solvent.
Those aspects make sense and I'd add another: fewer uncollectible debt write-offs by hospitals as more people have coverage. BUT:
1. You've now agreed to let people into Medicare after paying payroll taxes for up to 15 years less than people currently eligible. Will they pay an equivalent lump sum to buy in? If not, where will the money come from? Medicare is already subsidized by taxpayers who are still working and by IRMAA surcharges.
2. One of the reasons Medicare works (with subsidies) is that reimbursement rates are about 40% of those of private insurers. Many docs will take you if you were with them for years and then go on Medicare but will not accept new Medicare patients and that's why. We can fantasize about doctors rolling in money and driving BMWs (and some are) but many have massive student loan debt and need every dime they get. Will thus disrupt the supply of doctors for Medicare patients?
3. Would we really want to charge the 50-year olds and the 70-year olds the same "blended" rate? Unless you give the younger, healthier group a break on their premiums, you may get only the ones with expensive medical issues signing up. The ACA has struggled with this. One of the Trump administration's proposals for improving the ACA, which made me shiver in my boots when I had ACA, was to reduce the amount of cross-subsidization by making premiums lower for younger people and higher for older ones. As an actuary it made perfect sense to me. As someone already paying $900/month in premiums, it was terrifying. We can't turn the 50-55 year olds into a major profit center to help pay for the 70-year olds or we'll get only the very sick 50-55 year olds signing up.
Sorry, I don't buy it. My ex-wife is a veterinarian. They go to school for 8 years, costs just as much as human med school, they work long hours too, but they make under six figures in most markets (BLS says median veterinary pay is 91k/yr, median primary care physician, the lowest paid among physicians is 198k). WAY less than MDs and the market is full of vets. People do what they want to do. There isn't a MD working full time that can't pay their student loans and live a reasonable lifestyle.
Quote:
Originally Posted by athena53
We can fantasize about doctors rolling in money and driving BMWs (and some are) but many have massive student loan debt and need every dime they get. Will thus disrupt the supply of doctors for Medicare patients?
Doctors make a very good living, but they are not getting rich. No 200 foot yachts and private G5 jets.
X-Ray technicians make a nice living, but they are not getting rich.
Physical Therapists make a nice living, but they are not getting rich.
Occupational Therapists make a nice living, but they are not getting rich.
Respiratory Therapists make a nice living, but they are not getting rich.
Registered Nurses earn a decent amount, but they are not getting rich.
Nurse Practitioners make a nice living, but they are not getting rich.
Hospital administrators make a lot of money, but they don't own 200 foot yachts and private jets.
The conclusion when you look at the data is we have a long-term decline in labor productivity in the healthcare industry. Productivity is defined by the value of the total health care goods & services consumed in America divided by the total labor hours in the USA required to produce those health care goods and services.
This long-term decline in labor productivity is especially troubling because of the advanced technology that has been thrown at the problem. Here's one way to look at it: in the 1960s, health insurance cost a typical employee about 6 days wages per year. Nowadays, health insurance costs a typical employee about 60 days wages per year. That's 10x. This is true even when we realize that we patients can schedule appointments using smartphone apps, the physicians can send prescriptions to pharmacies over secure networks with the click of a button, Nurses receive automatic notices when they are about to administer two drugs that have interactions, doctors answer follow-up questions with secure networks, etc.
The root cause of the long-term decline in labor productivity isn't that doctors, nurses, X-Ray techs, therapists etc are lazy or spending their days on Facebook or C-D or Instagram.
No, the root cause is bureaucratic overhead -- physicians groups employ armies of paper pushers who do nothing but bill insurance companies, re-bill insurance companies when prior bills are rejected, re-re-code bills in creative ways in an attempt to maximize the reimbursement from insurance companies, work out payment plans for patients, etc. Insurance companies employ small armies of paper pushers who review insurance claims, knocking reimbursements down, and who look for insurance fraud, etc.
The same subject matter experts who hold seminars on Monday teaching billing employees at hospitals and physicians groups how to maximize reimbursement hold different seminars on Wednesday teaching insurance companies how to minimize reimbursements.
Healthcare costs too damn much because there are far too many people employed in healthcare, most all of whom do not deliver healthcare at all. They push paper. Long term healthcare labor productivity has declined because there are far too many labor hours expended by people who are not healthcare professionals - they are paper pushing professionals.
The solution is to find a way to fire 3/4 of these people who don't add value to healthcare actually delivered - they just push paper.
What to do with the future unemployed bureaucrats and mandarins is separate issue.
While I didn't read this entire thread, to me (as an economic conservative) the idea of younger seniors buying into Medicare seems fairly good.
A famous economist once said, "Nothing is either good or bad save the alternatives make it look that way."
The question is - buy into Medicare at what price? What should the upfront, one-time buy-in be? 65 minus your age, multiplied by $25,000? So a 60 year old would buy-in at a rate of (65-60)*$25,000=$125,000 one time payment? Plus monthly premiums of what - say, $2,000?
I would argue the root cause is advancement of treatment and diagnostic technology and the cost associated. The first human MRI was not until 1977, now millions are performed every year.
Furthermore we have limited ability to outsource/offshore medical care which is where many other product areas (electronics, computers, etc) get their increased productivity.
Quote:
Originally Posted by RationalExpectations
Doctors make a very good living, but they are not getting rich. No 200 foot yachts and private G5 jets.
X-Ray technicians make a nice living, but they are not getting rich.
Physical Therapists make a nice living, but they are not getting rich.
Occupational Therapists make a nice living, but they are not getting rich.
Respiratory Therapists make a nice living, but they are not getting rich.
Registered Nurses earn a decent amount, but they are not getting rich.
Nurse Practitioners make a nice living, but they are not getting rich.
Hospital administrators make a lot of money, but they don't own 200 foot yachts and private jets.
Those aspects make sense and I'd add another: fewer uncollectible debt write-offs by hospitals as more people have coverage. BUT:
1. You've now agreed to let people into Medicare after paying payroll taxes for up to 15 years less than people currently eligible. Will they pay an equivalent lump sum to buy in? If not, where will the money come from? Medicare is already subsidized by taxpayers who are still working and by IRMAA surcharges.
2. One of the reasons Medicare works (with subsidies) is that reimbursement rates are about 40% of those of private insurers. Many docs will take you if you were with them for years and then go on Medicare but will not accept new Medicare patients and that's why. We can fantasize about doctors rolling in money and driving BMWs (and some are) but many have massive student loan debt and need every dime they get. Will thus disrupt the supply of doctors for Medicare patients?
3. Would we really want to charge the 50-year olds and the 70-year olds the same "blended" rate? Unless you give the younger, healthier group a break on their premiums, you may get only the ones with expensive medical issues signing up. The ACA has struggled with this. One of the Trump administration's proposals for improving the ACA, which made me shiver in my boots when I had ACA, was to reduce the amount of cross-subsidization by making premiums lower for younger people and higher for older ones. As an actuary it made perfect sense to me. As someone already paying $900/month in premiums, it was terrifying. We can't turn the 50-55 year olds into a major profit center to help pay for the 70-year olds or we'll get only the very sick 50-55 year olds signing up.
1. The fact that younger people do not use healthcare as much as the older ones would compensate for the fact that younger people contributed 15 years less in Medicare taxes. Plus, many (likely most) of the 50-64 year olds would probably continue to work anyway (at least part time, or on temporary contracts) and contribute Medicare taxes.
2. I am in medicine, am not rolling in money, and accept Medicare :-). The fact that you can collect 100% of Medicare bills (as you pointed out in the first sentence) without hassle is quite alright with many doctors, particularly if they practice in low-income areas. With many more people contributing to Medicare insurance pool, Medicare could even possibly afford to increase doctors' reimbursement.
3. Medicare rates for 70 yr olds are typically lower than private insurance rates for 55 yr olds, so I don't think only the very sick 55 yr olds would sign up - the price would be attractive to all 55 yr olds.
When I was uninsured and paying all my medical expenses out of pocket, every single one of my individual providers (GP, oncologist, surgeons, anesthesiologists, radiologist's office for MRIs, MUGA scans and PET/CT scans) agreed to charge me the same as their Medicare rate was, provided I paid in full at the time of service. Which I did (thank goodness for credit cards.)
The only two exceptions were the hospital itself and the blood testing labs (Quest and LabCorp.)
The hospital did take off 10% from their standard full-price rate (which legally they are not required to do) and also offered me a monthly repayment plan (which they are required to do in my state.) But it was not anywhere near the Medicare levels. However, I was grateful for any break I could get.
It did depend on the hospital though. The hospital where I had my cancer surgery offered the deal above. However, when I had to go to a different hospital's emergency room twice, they refused to give me any price break whatsoever on the bill which was several thousand each time. (FYI, just as an aside, the hospital that refused any sort of price negotiation is one run by the local Catholic diocese. So much for "Christian charity" in that case. The one that offered a price break was a secular hospital.)
Quest and LabCorp would not agree to any adjustment for self-pay patients. If you didn't have insurance you paid full price. A typical fee for a simple CBC/diff plus CMP was about $160 in 2010 and I needed those on a monthly basis. No discount, no negotiation. I'm assuming that's because they are a chain/franchise operation and individual locations have no say in the pricing. Or they're just a bunch of Grinches, LOL
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