Why Trump will be reelected

Delvo said:
The individual mandate was just one of several ways Trump (anti-Constitutionally) sabotaged ACA. (A President doesn't get to just decide not to enforce or follow a properly passed & signed law, but a Dictator does.) But it was the biggest and most important one. Without that part, its costs are mostly unfunded. It's like having Medicare For All in place, and not repealing it, but also getting rid of the tax that came with it. They've successfully forced several million people who had health insurance out of it. Winning!
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You are off here. The individual mandate was eliminated as part of the Tax Cuts and Jobs Act of 2017; not by EO. Also, the marketplace and subsidies are still in place, so anyone who wants an "ACA" plan can still get one. No one has been forced out of health insurance; but people who had to have one before may have opted not to, now that they won't get penalized.
 
Segnosaur said:
From what I understand, not all doctors/hospitals accept medicare. And supposedly the costs reimbursed by medicare can actually be less than the cost of treatment.

From: https://www.cnn.com/2019/03/18/politics/medicare-for-all-doctors-hospitals/index.html
Medicare payments only covered 87% of costs... "Hospitals are already paid far less than the cost of caring for Medicare patients, and more patients with Medicare would strain hospitals even more, and could threaten hospitals' survival," wrote Rick Pollack, chief executive of the association.

(Note that the figures come from a group called the American Hospital Association, which is a private group, but the figures seem to fit in with other numbers I've seen.)

So, if Medicare-for-all is expanded:
- Doctors who previously rejected Medicare patients will have to change their practices. How do you do that?
- Some medical facilities may end up losing money (and end up going out of business) if the reimbursement by Medicare is not enough to cover the costs. What happens then?

Now, there are some claims about how it will ultimately save doctors/hospitals money by making things more efficient. I remain skeptical (since often medicare payments are late, which may cause a cashflow problem with medical facilities.)
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I don't see how (theoretically) having only one payor will make things more efficient; we would still have to bill for services and wait 2 weeks (at least) for payment. Medicare would still have all the rules in place for "clean claims," documentation requirements, getting approval for certain services, etc etc. We would still have to fight with Medicare through appeals of denials, rejected claims, etc. The administrative burden would not be eased at all. I seriously doubt a rise in Medicare rates would happen in an environment where it now has to cover everybody in the nation.

Right now, there are very few doctors who could make it if all they took was Medicare. I mean, maybe they could if they increased volume and cut costs a bit. But that comes with tradeoffs: less time with patients, primarily. The rates are simply too low. We need to have a payor mix that includes cash patients and commercial insurance.
 
xjx388 said:
From what I understand, not all doctors/hospitals accept medicare. And supposedly the costs reimbursed by medicare can actually be less than the cost of treatment.
...
So, if Medicare-for-all is expanded:
- Doctors who previously rejected Medicare patients will have to change their practices. How do you do that?
- Some medical facilities may end up losing money (and end up going out of business) if the reimbursement by Medicare is not enough to cover the costs.

Now, there are some claims about how it will ultimately save doctors/hospitals money by making things more efficient. I remain skeptical (since often medicare payments are late, which may cause a cashflow problem with medical facilities.)
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I don't see how (theoretically) having only one payor will make things more efficient; we would still have to bill for services and wait 2 weeks (at least) for payment. Medicare would still have all the rules in place for "clean claims," documentation requirements, getting approval for certain services, etc etc. We would still have to fight with Medicare through appeals of denials, rejected claims, etc. The administrative burden would not be eased at all. I seriously doubt a rise in Medicare rates would happen in an environment where it now has to cover everybody in the nation.
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I think one of the problems with the current system is that doctors/hospitals may have to deal with multiple insurance companies, and that there is often negotiations that happen over fees. (e.g. hospital says "We charge X", insurance says "We'll give Y"). Having a single point of payment and set fee schedules would simplify things, although I don't think it will give anywhere near the savings people think it will.
 
Segnosaur said:
I think one of the problems with the current system is that doctors/hospitals may have to deal with multiple insurance companies, and that there is often negotiations that happen over fees. (e.g. hospital says "We charge X", insurance says "We'll give Y"). Having a single point of payment and set fee schedules would simplify things, although I don't think it will give anywhere near the savings people think it will.
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From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule and get different amounts back. All of that is pretty much processed electronically and it's actually very efficient now, other than how long they take to pay us. Some payers, like BCBS, often pay us within 2-3 days. Other, smaller payers can take a month. Medicare is a standard two weeks.

So it wouldn't really mean much for us at all to only have one payer to deal with. The problem is that Medicare is a bear to deal with on everything else.
 
xjx388 said:
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule and get different amounts back. All of that is pretty much processed electronically and it's actually very efficient now, other than how long they take to pay us. Some payers, like BCBS, often pay us within 2-3 days. Other, smaller payers can take a month. Medicare is a standard two weeks.

So it wouldn't really mean much for us at all to only have one payer to deal with. The problem is that Medicare is a bear to deal with on everything else.
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The clearinghouse sounds like a parasitic middleman.
 
Sideroxylon said:
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them.
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The clearinghouse sounds like a parasitic middleman.
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They are performing a function that would have to be done regardless of whether it is a public or private system.

Somewhere someone has to push some paper around... to ensure ensure the doctor or hospital gets paid, to make sure there is no fraud going on, etc.

Whether that is done by an independent company or by some government minions, you will always have this necessary overhead.
 
xjx388 said:
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule...
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You may only have one fee schedule, but an insurance company will have to deal with multiple doctors/hospitals, which may charge different amounts.
and get different amounts back.
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How exactly does that work? If you charge $100 for a procedure, do you know ahead of time how much you'll get back from the insurance company? Are some companies cheaper than others? If an insurance company offers very little back, do you go after the patient for the difference?

Note: I'm not saying that its a bad system, and some of the claims of "massive savings" by going to Medicare are probably wrong. I am just acknowledging that there may be some inefficiencies in the billing process.
 
Cabbage said:
Actually, I've seen more demonization of Bernie and his supporters than the other way around.
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"Bernie Bro" started out at a term for the most loyal and fanatical members of Sanders' base.

But then it turned into Sanders' base.

Now it appears some posters have started calling out supposed Bernie Bros in this subforum.

Amazing.
 
Venom said:
"Bernie Bro" started out at a term for the most loyal and fanatical members of Sanders' base.

But then it turned into Sanders' base.

Now it appears some posters have started calling out supposed Bernie Bros in this subforum.

Amazing.
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Because the Berniebros went on a Jihad aganst any Democrate who did not support Bernie or dared to question anything Bernie said or did.
 
dudalb said:
Because the Berniebros went on a Jihad aganst any Democrate who did not support Bernie or dared to question anything Bernie said or did.
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Could you provide examples of this behavior? I think your description is somewhat hyperbolic, I'm curious if you can demonstrate otherwise.
 
Sideroxylon said:
The clearinghouse sounds like a parasitic middleman.
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Maybe? Not from my perspective, but the issues seem complex. Their job is to interface with all the insurance companies, Medicare and Medicaid. That way, we (and our billing system)don’t have to worry about configuring claim formats to be compatible with each insurance company. And they don’t have to worry about matching up with our system.

Granted, if everyone just agreed on one transaction standard and one response standard, that would be great; but, that isn’t the reality we live in. In the end, the clearinghouses have made everything work together transparently and efficiently.
 
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