Medicare fix

[daenku32]

I'm having hard time seeing formulation for fixing the Medicare, outside of the ones proposed by the administration. Most other ideas about fixing Medicare just appear to be refutations of "Obamacare", and I don't see any ideas to fixing it. Even the Tea Partiers don't want it cut, which I suppose is explained by their overwhelming use of the program.

 

[casebro]

As a receiver, I don't see anything about it that needs fixing.

Whats is the perceived problem?

 

[TragicMonkey]

As a receiver, I don't see anything about it that needs fixing.

Whats is the perceived problem?

It doesn't pay out enough. Frequently it doesn't cover the cost of the procedures, much less allow the provider to make a profit. That's why it's a struggle in many places to find a provider willing to accept new patients who will be on Medicare. Other providers simply have to accept what Medicare pays out, and either absorb the loss or pass it along to the patients.

While it would be nice to simply ignore the need for a profit and treat everybody at cost (or below), the fact is that even doctors and nurses need to eat. A practice that doesn't break even goes under, and then it's more patients scrambling to find a new doctor that will accept new patients on Medicare, knowing they're not going to break even on them...

 

[leftysergeant]

It's really very simple. Remove the cap on income taxed for Social Security, and pay the care givers a decent amount for services rendered.

 

[casebro]

As a receiver, I don't see anything about it that needs fixing.

Whats is the perceived problem?

Let me add that I am in a huge HMO (Kaiser) and that I have had no problems. YMMV, but I'm thinking that economies of scale spread the revenues well enough to break even. The HMO is getting twice as much from Medicare as I was paying them before SSI kicked in.

 

[TragicMonkey]

Let me add that I am in a huge HMO (Kaiser) and that I have had no problems. YMMV, but I'm thinking that economies of scale spread the revenues well enough to break even. The HMO is getting twice as much from Medicare as I was paying them before SSI kicked in.

So you're not in regular Medicare, but a "Managed Medicare" plan from a commercial insurance? Oh, lord. Those are even worse for paying providers.

 

[casebro]

So you're not in regular Medicare, but a "Managed Medicare" plan from a commercial insurance? Oh, lord. Those are even worse for paying providers.

So far as huge HMOs go, the providers are on salary. They are employees of the HMO, work 9-5, don't run the business. They don't get paid as much either.

But for all the gripes from providers about how they don't get paid enough, I hardly ever hear of a doctor getting his Mercedes repo'd.
Sounds like greed to me. I know a anesthesiologist making $600k, who mentioned that the hospital expected him to do lots of freebies. But he was still making $600k. He was not complaining, bragging more like. Funny, he thought the $600k was sick, but felt the prices were driven upwards by MEDICARE! He never asked to raise the rates, but Medicare being the biggest provider, set the rates. Well, that was one specialty, ten years ago.

Oh, they bitch about the freebies they have to give, and the student loans, and the alimony too. But you just don't see them picking up aluminum cans in the park either. Go drive through a hospital parking structure and look in to the "Doctors Only" parking section. Count the Ford Fiestas, vs the BMWs and Mercedes, and tell me how bad off doctors have it. I remember on complaining that it cost him $600 for the routine maintenance on his Mercedes. Poor guy, too bad Medicare doesn't pay on time.

 

[ponderingturtle]

It doesn't pay out enough. Frequently it doesn't cover the cost of the procedures, much less allow the provider to make a profit. That's why it's a struggle in many places to find a provider willing to accept new patients who will be on Medicare. Other providers simply have to accept what Medicare pays out, and either absorb the loss or pass it along to the patients.

While it would be nice to simply ignore the need for a profit and treat everybody at cost (or below), the fact is that even doctors and nurses need to eat. A practice that doesn't break even goes under, and then it's more patients scrambling to find a new doctor that will accept new patients on Medicare, knowing they're not going to break even on them...

Which is interesting because as a percentage of GDP medicare and medicaid cost as much as any other nations health care systems. So how do all of them manage to run at a loss?

 

[ponderingturtle]

So you're not in regular Medicare, but a "Managed Medicare" plan from a commercial insurance? Oh, lord. Those are even worse for paying providers.

And have 3 times the overhead that taxpayers have to pay.

 

[WildCat]

So far as huge HMOs go, the providers are on salary. They are employees of the HMO, work 9-5, don't run the business. They don't get paid as much either.

But for all the gripes from providers about how they don't get paid enough, I hardly ever hear of a doctor getting his Mercedes repo'd.
Sounds like greed to me. I know a anesthesiologist making $600k, who mentioned that the hospital expected him to do lots of freebies. But he was still making $600k. He was not complaining, bragging more like. Funny, he thought the $600k was sick, but felt the prices were driven upwards by MEDICARE! He never asked to raise the rates, but Medicare being the biggest provider, set the rates. Well, that was one specialty, ten years ago.

How does someone on salary "do lots of freebies"?

 

[Thunder]

It's really very simple. Remove the cap on income taxed for Social Security, .

totally.

 

[casebro]

How does someone on salary "do lots of freebies"?

Did I say that?

New paragraph, new idea, right? Or doesn't it work like that in your English?

Paragraph one: salaried employees of HMOs. HMOs only work on their own enrollees, no chance of being required to do freebies.

Paragraph three: Independent providers, who make as much as $600k, in spite of doing work for which they receive no recompense.

 

[WildCat]

Did I say that?

New paragraph, new idea, right? Or doesn't it work like that in your English?

It could have been more clear.

Paragraph one: salaried employees of HMOs. HMOs only work on their own enrollees, no chance of being required to do freebies.

Paragraph three: Independent providers, who make as much as $600k, in spite of doing work for which they receive no recompense.

Which is what the health insurance bill should have done, encourage HMOs and other cost-cutting types of medical care. Anesthesiologists shouldn't be making $600K a year, not on the taxpayer dime anyway. PPO plans should be luxury taxed out of existence.

 

[ARubberChickenWithAPulley]

Which is interesting because as a percentage of GDP medicare and medicaid cost as much as any other nations health care systems. So how do all of them manage to run at a loss?

They don't run at a loss (well, some do, and eventually they fold), they charge cash-paying and commercial insured patients more. For example, there has been a recent study in the news about difference in payment rates from insurers to hospitals. They vary a lot, but one thing that is consistent is that they are all higher than Medicare:

Looking across eight health care markets—Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin—average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco, according to the study.

Large hospitals have a lot of negotiating power, even against the largest commercial insurers, and they use it just as insurers do in the same situation. So one could convincingly argue that commercial insurance, in effect, subsidizes Medicare via hospitals (which is discussed in more detail in the above article).

Of course, if you're a small independent provider, you probably get hosed in either case.

 

[TragicMonkey]

So far as huge HMOs go, the providers are on salary. They are employees of the HMO, work 9-5, don't run the business. They don't get paid as much either.

Ah. I forgot that Kaiser was like that. They're not around here so I don't have any dealings with them.

But for all the gripes from providers about how they don't get paid enough, I hardly ever hear of a doctor getting his Mercedes repo'd.
Sounds like greed to me. I know a anesthesiologist making $600k, who mentioned that the hospital expected him to do lots of freebies. But he was still making $600k. He was not complaining, bragging more like. Funny, he thought the $600k was sick, but felt the prices were driven upwards by MEDICARE! He never asked to raise the rates, but Medicare being the biggest provider, set the rates. Well, that was one specialty, ten years ago.

Oh, they bitch about the freebies they have to give, and the student loans, and the alimony too. But you just don't see them picking up aluminum cans in the park either. Go drive through a hospital parking structure and look in to the "Doctors Only" parking section. Count the Ford Fiestas, vs the BMWs and Mercedes, and tell me how bad off doctors have it. I remember on complaining that it cost him $600 for the routine maintenance on his Mercedes. Poor guy, too bad Medicare doesn't pay on time.

Sigh. Because most practices tend to be owned by the doctors themselves, and they get paid off the top. When less money comes in, they are the last to get a reduction in their pay. It's the smaller fry who get the pay cuts, and the layoffs. Front desk staff, medical assistants, office people patients don't know exist. My own workplace is very doctor-oriented, they still get their extremely large salaries (and bonuses!) even in very bad years when other employees are getting laid off, or nobody else gets a raise. Which isn't economically sound of the business (the lowest paid doctor here makes in two weeks slightly more than they pay me in a year), but our doctors own the business and they want their money. Human, and understandable, but it doesn't make us love them.

But yeah, nobody remembers that for every doctor there are several other staff (at my workplace it's about 15 staff to each doctor), and that none of them get paid like the doctors do. Just as everybody knows Streisand's rolling in money, but do you think her maid is rich, too? Her gardeners?

 

[ponderingturtle]

They don't run at a loss (well, some do, and eventually they fold), they charge cash-paying and commercial insured patients more. For example, there has been a recent study in the news about difference in payment rates from insurers to hospitals. They vary a lot, but one thing that is consistent is that they are all higher than Medicare:

How do hospitals in say britian charge cash paying and commercial insured patients more? Remember any other nation can cover everyone for what we pay per capita for our socialized medical care that does not cover everyone.

So there has to be a way to provide care for even less than the rates medicare pays.

 

[ARubberChickenWithAPulley]

So there has to be a way to provide care for even less than the rates medicare pays.

Whether we can ever get to "less than the rates medicare pays," I don't know, but a commonly cited reason for the high cost in the U.S. is that our prices are higher. Drug companies charge higher prices in the U.S. than other countries, ditto medical device manufacturers, and thus so do hospitals and doctors. Add in that nobody has any idea what any given hospital and/or insurer charges for a particular procedure, and you have a cost mess. Here are a couple of interesting articles on that topic:

U.S. Medical Prices Highest In the World
To Cut Healthcare Costs, Let's Start With the Secret Prices
An End to the ‘Medical Arms Race’ in Massachusetts

That's the problem with Medicare: if Medicare just sets the payments it will charge providers, but nobody addresses the providers' costs (drug prices, medical device prices, labor costs, etc.), then providers will lose money.

 

[casebro]

Something doesn't seem to balance out here. Some Doctors claim they are going to go out of business, while others are making 25 times what their wage slaves get. That is a range of $0 to $500,000.

Perhaps some kind of price fixing is needed here? Or just a few thousand doses of truth serum?

 

[ponderingturtle]

Something doesn't seem to balance out here. Some Doctors claim they are going to go out of business, while others are making 25 times what their wage slaves get. That is a range of $0 to $500,000.

Perhaps some kind of price fixing is needed here? Or just a few thousand doses of truth serum?

See it all depends on what kind of doctor they are. GP's make about $150,000 a year on average. Specialists regardless of type make about $400,000 a year again as a national average.

Of course any legislation to cut doctors paychecks would be fought tooth and nail by the AMA with advertisements and lobbying. That is the kind of thing that no politician has the guts to face.

 

[WildCat]

How do hospitals in say britian charge cash paying and commercial insured patients more? Remember any other nation can cover everyone for what we pay per capita for our socialized medical care that does not cover everyone.

So there has to be a way to provide care for even less than the rates medicare pays.

Doctors in the UK make salary, while doctors here most often get paid per procedure. And we have more specialists, who demand even more money per procedure. And when you get paid per procedure, a shocking thing happens: you get more procedures, often unnecessary ones. And the real fun begins when doctors have an ownership interest in, say, the MRI clinic across the street. Think they recommend more MRIs than other doctors in the same specialty?

The whole US system is rife with conflicts of interest, CYA, too many specialists, too few GPs, and for-profit hospitals selling procedures like a car dealership sells rust proofing and premium audio packages.

I must have heard half a dozen hospital ads on the radio today, and that's just in the hour I spent driving to and from work. Do hospitals really need to drum up business like that? Are there people sitting at home with lung cancer and thinking "boy, I wish there was somewhere I could go that would treat this cancer I have".

It's ridiculous.