In addition to the fine point that Humbabella made, I took your suggestion and asked some actual providers. Here’s feedback from two doc’s I just spoke to (friends both, one in private practice, one at a teaching hospital). Both noted that the Medicare billing rules are neither more nor less complex than those of the myriad of other third-party payers that they must deal with. What they want is one set of rules to work with. This is one of the “cost curve bending” issues that you raise in your first post (but misdiagnosed) - medical providers of all stripes spend silly amounts of time/$$$ trying to find their way through dozens of disparate billing systems. Those dollars are one of the many reasons our system is saturated with costs that don’t actually go into actual care. Give the providers single-payer and costs go down.
As for “jail time” - that’s silliness. In the words of HCFA (the Health Care Financing Administration, previously the Centers for Medicare & Medicaid Services or CMS) Administrator Nancy-Ann Min DeParle, doctors “will not be punished for honest mistakes and we [HCFA] will not make referrals to the Office of the Inspector General for occasional errors.” You make it sound like a mis-code can send a doc to jail and that’s simply not the case.
$180k for 6 months = about $1000/day. You don’t need to come with theoreticals on that, it happens regularly and it’s way more than $1000/day – that’s a bargain. And as far as I know there is no limit to the amount of money that Medicare will spend to keep someone alive or save their live. 56% of payments made to hospitals nationwide is by Medicare/Medicaid. We already have the socialized single payer system everyone wants to not have for everyone paying over half the payments to hospitals!
fine-idUSKCN0SO1XT20151030[quote=“lamaranagram, post:25, topic:72904”]
And as far as I know there is no limit to the amount of money that Medicare will spend to keep someone alive or save their live.
[/quote]
Not your fault for not knowing this, it’s still in the “inside baseball” category:
Medicare’s coverage guidelines (dating from 2005) are not current with the best practices in cardiology.
I know of several cases in which doctors have implanted defibrillators for which neither the hospital nor the doctor bills Medicare, because - it’s the only way to save the patient’s life, and because if they bill Medicare, they can face civil or criminal charges.
Now you might think that’s a good thing, because doctors and hospitals are all swimming in dough just like Scrooge McDuck, right?? But extend that sort of policy far enough, and providers will start retiring early and closing their doors.
That’s press release bullshit. A hospital I work with got run through the wringer by the OIG for a billing error that affected less than seventy patients out of over 4,000 with the same procedure.
I think part of the problem there, though, is that Medicare in the US is targeted at the poorest people, people who wield very little political power and get very little interest from journalists. Right now there are a lot of Americans who would probably perceive complaints about the quality of Medicare with disdain because it is a welfare system to begin with - people who are getting handouts complaining about their handouts. Politicians face few repercussions from letting the system languish.
You are absolutely right that there will still be limits on what will be done. Some treatments are just too expensive relative to their outcome. What I find weird is that people seem to think this will be different than it is now. Private insurers make the exact same kind of decisions about what to cover and what not to cover. When the government does it they are balancing the value of spending on a treatment vs. the value of spending the money elsewhere to help the public. When private insurers do it they are balancing spending money on treatment against personal profit. It boggles my mind that people think that latter somehow produces better or more reasonable outcomes than the former.
What I think is liable to happen under any USA single payer system is not “people are going to die because expensive treatments are disallowed”. And really, I think that some doctors will retire early and many small hospitals will close, but we can probably take that in stride.
What I think is going to happen is extensive pressure on the political system to cover everything, regardless of cost. We are really good in the USA at saying “If it saves Just One Life it’s worth it”, and when a weeping child or smiling grandma is the face of that one life, our political class finds it impossible to say no.
The question is what’s going to happen to the forecasted economics of the system when it meets the behaviors of the American public, and the latter starts winning some battles.
Edit:
Perhaps you are confusing Medicare with Medicaid? The average Medicare recipient is not in poverty by any measure I’m aware of.
Yeah, but Canada shares that culture with America. That’s why sometimes stories of people not being able to get experimental treatments that might save or extend their lives (or might do nothing) make the national news. Costs of providing medicine grow quite a bit faster than the economy does and we need to start improving the way we do medicine. I could make a long list of problems that current exist with the way my province provides health care and how much we pay for it.
But with all that we’re spending $4400 per capita on healthcare to the US’s $8700. Medicare + Medicaid covers less than 16% of Americans, so that’s over $54,000 per person covered. I keep looking at these numbers and swearing I must be doing something wrong, but that really seems to be the public price of care in the US. If Canada is currently delivering health care for less than one twelfth of the price per person - with at least equivalent outcomes - how could a change to our system possibly be predicted to increase costs?
I am! I think my essential point - that people see these as handout services and know they are expected to have private insurance - is still valid. It’s still only 49 million americans who have Medicare coverage, so if it’s means tested the majority will be in the bottom quintile. It’s like that other piece recently:
The people with political power aren’t necessarily pushing for improvements to a system that they don’t see as affecting them. How else could we square the “Even if it saves one life” rhetoric with billing rules that don’t allow lives to be saved? Your political class actually has a very easy time throwing lives away, as long as they are the right lives (no claim of superiority there, though, it’s not like Canada’s politicians are better on this front).
I’m not sure where you are trying to go with this number. The per capita number for the USA seems to be $8-9K from multiple sources, I don’t see how you can just gross that up to $54K.
Be that as it may, the cost in the USA is at least 80% higher than that in the great white north. No doubt some of that is due to insurance transaction costs. But a good deal of it comes from:
(1) Drug costs. I think it’s high time that the US consumer stopped footing the drug R&D bill for the entire rest of the planet, and I’m entirely in favor of having Medicare negotiate drug prices and allowing US patients and hospitals to buy drugs from reliable overseas sources. It’s not my fault that Obama and the congressional Democrats got rolled by the pharma industry in 2010.
(2) Technological competition. Every major hospital has gotta have the newest everything, including the most recent poster child for cost without benefit, robotic assisted surgery. I don’t see this changing under a single payer plan, because every hospital will still be aggressively competing for patients. Only a revision of our archaic antitrust laws to permit cooperative operation of high-tech facilities will do any good here.
(3) The tort law system. And it’s not the cost of settlements, or insurance, that I’m talking about here. It’s the overuse of tests and hospital stays to cover the doctor’s ass when (if) sued. The fact that what the doctor did was in line with the best standards of practice does not compensate, in the jury’s eyes, for the fact that the patient was not cured, and therefore is owed a bunch of money.
(4) The American health care consumer is generally of the opinion that he or she is entitled to all the health care services desired, and available at exactly the time desired to consume them. Medicare and Medicaid patients are no exception to this. Tell Americans that they might have to wait four weeks for an MRI, or four months for a hip replacement, and they’ll be on the phone to their congressman’s office in four seconds or less. This won’t change, and the economics of any single payer plan in the US will have to accomodate it.
Personally, I don’t think Hillary or Sanders is an asshole. But her policy positions (going by her record, not her campaign promises, which we’ve seen mean little to any politician) are essentially conservative, and she’s a machine politician. Sanders is non-trivially to the left of me on economic issues, but that would be a nice change after a lifetime of candidates and electees who are decidedly to the right of me on almost everything.
I’d love to see a woman leading the so-called free world, but Clinton isn’t who I want in charge. That said, she’s infinitely better than anyone on the Republican field.
Sanders in the primaries. Democrat in the general election. Easy peasy.
It’s $54k for each person currently benefiting from medicare/medicaid. In the interim I’ve thought of a few reasons why that number might not be meaningful, but it is the amount per person on medicare/medicaid. Again, $8-$9 is not per person that receives funding, it is per person in the country, when you only actually pay for the care of the sixth of the people, that means you are paying a lot more for each of those people. What does the government cover for those who are not on medicare/medicaid? There must be some funding for public hospitals (otherwise they wouldn’t be “public”). What else?
I agree with some of your reasons for the inflated costs. I disagree that technological competition would continue under single-payer - how can you reconcile the idea that services will be rationed with the idea that there will be fierce competition for patients? Tort law is a huge problem is the US for sure.
As for the American attitude towards healthcare, you are talking about the attitude of some Americans. Another part of America just doesn’t go to the doctor because it is too expensive until they end up in the emergency room. And maybe the American psyche just can’t accept a system where people are equal because it necessarily means less for the people on top, I don’t know.
There’s a nice piece about Hillary on The Onion right now. Go read it and decide if this is as cozy a relationship as the BB article makes it out to be.
And what’s with all the technical healthcare cost discussion in the comments for an article about The Onion?
The Onion.
Onions make you cry, burn your eyes.
Burn.
Feel the Bern.
Bernie Sanders wants to take all your money.
Money.
Spend your money on a single payer system.
System.
System of a down.
Chop Suey.
Chop.
Cut.
Cut off your nose to spite your face.
Face.
Face facts, your healthcare system sucks and you should do something about it, perhaps by voting for Bernie.
Bernie.
Burn.
Onions burn your eyes,
The Onion.
