Expanding Medicare will mean more patients being seen at reimbursement rates that don’t cover the cost of their care.
You seem to be assuming that reimbursement rates would necessarily stay the same across the board while the program expanded. Do you think the program budget wouldn’t change? Why?
You also seem to be ignoring that the states that are having these problems are, according to your own article, seeing them in part because those states rejected attempts to expand the medicaid spending in those states.
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There’s also the fact that the efficiencies of single-payer system billing and purchasing standards result in other savings that can make the difference between closing and staying open for a small hospital.
Concepts like cost efficiencies and economies of scale are sometimes difficult for Randian tycoons to grasp.
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Well - your search methodology is flawed, at the least.
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It’s also going to help redefine the Democratic Party agenda as being for something instead of just against Trump et al. Although in contrast, just being against someone worked out fairly well for the Republicans the last few years insofar as winning elections.
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1 - I’m not aware of any first world, single payer government system which does not fund itself through large and regressive taxes (income and VAT) pushing down well into middle class income levels. Bernie’s plan would be a first to use a wealth tax as far as I know.
2 - It will be interesting to see how the Wall Street, Silicon Valley, entertainment industry mega-rich who have supported Democrats over the last couple of decades react to this. If they like it, it’s because they have already figured out ways to shelter their wealth as well as their income.
Medicare reimbursement rates have consistently dropped, for all areas of care, under both D and R administrations, for the last three decades. I see no reason to assume any changes in that regard unless so many hospitals close and so many doctors retire that the voters rebel.
You are right, insurers can use only the civil courts as a remedy. If the feds had to operate under the same constraint, I would not have made my original post and in fact my biggest objection to “Medicare for all” would evaporate.
You are also correct that both Medicare and the commercial insurance market aggressively micromanage physicians in order to meet cost targets. (but only one can bully them with threats of criminal charges)
So you’re two for two. Good on ya.
Let me ask you about the case you cited.
“Dr. Cecilia Ibrahim treated patients with lower back pain using an experimental procedure not covered by the insurance company, yet she “knowingly and deliberately” submitted paperwork saying she had performed a covered procedure”
If you were on the jury, knowing what’s in the article, would you be inclined to find for Blue Cross, or for Dr. Ibrahim?
You have to start laying the groundwork sometime and now is as good a time as any.
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Same finding as the Medicare case, no additional facts.
“Medically unnecessary” in this context can mean implanting a stent when the patient’s artery is 68% blocked, when Medicare has decided it can only afford to pay for stents at 70% and up.
To me. a good doctor is one who does things that contribute to the patient’s health, and one whose patients have a record of good outcomes. Nothing in my citation or yours describes anything to the contrary.
If I saw some patients who were actually harmed as a result of seeing Dr. Patil, you’d have an apology from me.
The state medical licensing board specifically says he didn’t perform
necessary test, patient histories or keep records and
performed unnecessary procedures. So not only is he not a good Dr - he is
no longer a Dr.
*“There can be no legitimate justification for the careless, casual,
systemic over utilization of invasive and interventional treatments in this
case…these complications arose from illegitimate procedures that were
not necessary…it is doubtful that remedial education is the solution to
this pattern of gross overutilization…never once did the patient have a
physical exam to determine whether there actually existed any objective
evidence of ischemia” *
In a mentally ill patient.
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Because it’s the same problem the republicans had - instead of concentrating on other legislation, you are wasting time and political capital pushing an agenda that you know will inherently fail, to please and energize your constituency. So okay, you highlight enough egregious behavior to put some more guys on your side back in some drivers’ seats, and the other side raises hackles with the same behavior. But at no point is anyone at the top seemingly concerned with the Catch-22: neither side has any real chance, or true impetus to actually find a plan that will solve the healthcare problem. Why give up such a valuable bullhorn when everyone listens each time you pull the trigger and start screaming?
Ah, so it is just an assumption that a fundamental change in the population making use of it would not cause any changes in reimbursement.
You do still seem to be ignoring the rejection of medicaid expansion, and the impact it seems to have had on the problem you’re using as a justification.
Criminal fraud charges can be brought in cases of fraudulent claims with private insurers as well. Two examples I found with a (very) brief look:
http://www.nbc12.com/story/16317406/four-get-prison-in-aflac-insurance-fraud-case
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You’re starting from a position that single payer healthcare is extreme and unworkable, in a world where it is the norm and more effective. I think that says something about the efficacy of pushing extreme policies/ideas (such as healthcare/everything must be privatized) for decades in the United States. It’s not fast, but neither is anything else (supposed to be) in politics.
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If the plaintiff could demonstrate that she knowingly and deliberately submitted paperwork saying she had performed a covered procedure which was not in fact covered, then it’s not a question of inclination, no matter what I think of for-profit insurers. She attempted to deliberately defraud them, and under the law a juror must find for the plaintiff if that’s proven.
If Blue Cross was that sure, by the way, they also could have “bullied” her by pressing criminal fraud charges (nothing preventing that). However, they were focused on making sure their shareholders didn’t lose money rather than taking a dodgy physician out of circulation.
Yes, those dastardly educated bleeding heart liberal UHNWIs who made their money the “wrong” ways. As opposed to the good type of conservative mega-rich individuals, Real Muricans™ like the Kochs and Waltons who are too busy having beers with ordinary folks to stash their wealth overseas.
[This is BoingBoing, not a MAGA rally – your appeals to Know-Nothing populism about wealthy “Hollywood types” and “intellectuals” are wasted here. And if you don’t think that those “good” conservative mega-rich people don’t hedge their bets by donating regularly to both parties, you’re very naive.]
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Back on topic, y’all might want to read this:
or this:
or this from a year or two ago:
Let’s not forget the history…
Trump has repeatedly praised single-payer systems in Canada, Australia, and Scotland. He has promised “Universal” health care at a cost lower than Obamacare. His attempts to get the Republican party to “solve” the health care problem for him (and take the blame for failure) haven’t worked out so far.
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Wouldn’t rural hospitals reopen if single-payer or medicare-for-all goes through?
It seems to me that if [nearly] everyone had medical coverage, every populated area would be able to support health care facilities.
Aside from greed, is there really any reason why rural areas can’t have community health care facilities under single-payer?
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Did you even read the attachment all the way through? The patient-by-patient review not only documents multiple unnecessary invasive procedures, but that many of those interventions were poorly performed, which required additional invasive procedures to correct. Patient A: harmed. Patient B: harmed. Patient C: Dr. Patil placed a stent in an unobstructed, 10-year-old graft! HARM. Patient D: just the lack of diagnosis. Patient E: appropriate diagnosis & treatment.
Here’s the thing. There is a metric crap-ton of clinical data on cardiac interventional procedures. Standards are set based on scientific evidence, and there is the mandate by professional societies that physicians use an evidence-based approach to diagnosis and treatment. The guidelines ALREADY provide a lot of wiggle-room for judgement of medical necessity. 70% stenosis isn’t the threshold for emergency intervention. It’s the lower threshold established by consensus of experts based on studies of many tens of thousands of patients’ data, to allow clinicians freedom to practice medicine. Even if the stenosis was 68%, that’s not in the shades of gray. It’s well outside.
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Yes, the alt-right does like the Trump voter. And Donald Trump loves to lie about everything to get votes. That’s pretty much common knowledge.
Even hard-nosed conservative pundits called for the GOP to back single-payer systems since 2007 when the ACA was being discussed in congress. Just like Clinton “opposed” single payer by calling it a better solution that will never, ever pass congress. But people don’t really care about what they can’t meme.
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