Yep, yesirree, and you got it.
Now for the big dollar question:
Will a single payer system fund that sort of last six months for everyone, or will it not?
Hear, hear.
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To be fair, that’s not Medicare: that’s the DOJ reacting (over-reacting?) to specific cases of abuse. CMS (the government agency that oversees Medicare) is almost always the first payer to adopt new technologies, then the private insurers fall in line.
Bundled payment is aimed directly against feature-creep in those particular areas. Artificial knee prices were increasing faster than COL/inflation due to a rapid cadence of new feature introduction with very little evidence to support increased value. Likewise with drug-eluting stents for heart disease. Factor in the hospital markup for medical devices, often ~100% (!) and any price increase from the manufacturer gets doubled. While not as bad as the Epi-pen, the cumulative effect was pretty bad.
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I agree with you, which is why I have an advanced medical directive. But they often don’t go far enough, in my opinion. I think we need far more discussions about “right to die” than we have at present.
After a elderly relative suffered a burst aneurysm, she went into a coma. The neurologists assured everyone that “she might recover, sometime, but with significant disability.” Fortunately her directive was found, but the hospital ethics officer had to get involved (fabulous fellow he was) in order to force the hospital to let her go. And we still had problems with doctors who wanted to “save” her, even after she was in hospice. She did not regain consciousness before dying.
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If CMS’ coverage rules had kept up with the state of the art in cardiac care rather than being frozen in 2003-5, the DOJ would have concentrated on truly medically unnecessary surgeries (of which there certainly are some) because there would have been no legitimate lifesaving cases which fell afoul of CMS’ rulemaking.
This sort of thing is why I facepalm every time I hear that “Medicare for all” will reduce administrative costs. The people who say that have no idea how much hospitals, clinics, and doctors have to spend on lawyers, consultants, and in house staff to keep from getting prosecuted for violations of some arcane Medicare regulation that’s written as vaguely as possible.
Absolutely no idea.
Actually, when conservatives tout the unpopularity of Obamacare, they include liberals who think the law doesn’t go far enough.
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Gotta keep it under patent!!!
ETA: And if that’s not bad enough, you never get long term data on any one design, because by the time enough long term data is collected, the implant has been replaced by a newer design.
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I didn’t think I just meant conservatives here. I’m well aware that the criticism cuts across the political aisle, for good reason. My point was that premiums were spiking well before the ACA was enacted.
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New policy: For a new doctor who becomes a GP in an underserved community and sets their rates at a designated standard, the govenrment pays for 1/10 of their student loan each year they live and work in the underserved community. After 10 years, their student loan is paid off.
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GP’s aren’t the problem. Much of what GP’s are now doing can be done by midlevel practitioners.
It’s when you want to tell that pediatric oncologist, or that neurosurgeon, that she needs to make $200K a year instead of $800K, that there may be a little difficulty.
Here is one of the main reasons doctors in the USA make a lot more money:
tl:dr version -
Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs. Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors.
But the AMA’s estimates of the time involved in many procedures are exaggerated,
sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals. If the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting. This volume of work does not mean these doctors are doing anything wrong. They are just getting paid at the rates set by the government, under the guidance of the AMA.
And this is, again, Medicare we are talking about. The same Medicare which is run so efficiently and should be “for all”…
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Britain will soon be throwing out a load of foreign doctors, apparently.
I imagine quite a few would work in the US for $200K.
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Well, if I tell you they won’t be unexpected, will they ? 
Doctor compensation in the US varies wildly. Family practice doctors are underpaid and struggling. Some specialties are way overpaid. So we don’t need to change the pay for all doctors; just the overpaid ones. And we do it through the medicare pay scales, which already set the insurance compensation for all doctors in the US anyway. And we also ensure that doctors have to follow those scales, as per California’s new AB72.
Some (expected) consequences:
- more Family practitioners. A key problem in US healthcare as noted in tons of studies is that we don’t have enough family care practitioners, and this hurts our preventative care. Part of the reason we don’t have the FPs is because doctors go into urology or whatever to get more money. Even out the pay scales, get more doctors back into FP, and we get more preventative care.
- Less boutique care. Those private clinics where you can be treated like a mogul and you have to pay extra out of pocket? They don’t have that shit in Europe and we don’t need it here either.
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The headline just isn’t taking into account the health of the coprorate persons who made these decisions. The corporations who profit from private health care in the US, make more money here than they make anywhere else. So those “people” are healthier than they ever were, from an acounting perspective.
If you look at things from the correct perspective, everything is fine, you can ignore a few whiners…
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still ignoring the main cost driver: cancer. And focusing on pure edge cases (450 lb knee replacements? Why are you even talking about that?)
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'cos that’s the low hanging fruit. It’s relatively easy to restrict care to patients with bad lifestyle choices, because fat people are, you know, icky. They don’t parkour, or rock climb, or even do pilates, for heaven’s sake!!
The harder choices will come later.
As a medical device industry insider, I must admit that it feels like an out-of-body experience to be defending CMS. 
I would argue the downward trend in ICD/CRT-D implantations in the US was due primarily to the recall frenzy from 2005 to 2009, followed by the lack of landmark primary prevention trials after SCD-HFT. The decline started in 2007, 4 years before the DOJ investigation started. Right now, it’s at about half what it was in 2006, when there was about 30-35% utilization rate of ICDs/CRT-Ds in patients who had direct indications for the therapy. Which equates to hundreds of thousands of people at risk for sudden cardiac death who remain unprotected. If we’re making a list of those who are to blame for that, CMS is pretty far down the list. Maybe not on the first page.
I won’t claim that CMS is quick, but they aren’t exactly slow. Additionally, they have a number of pathways for hospitals and physicians to get reimbursed for new procedures and technologies prior to the final reimbursement ruling specifically for that therapy or diagnosis (look at how they nurtured remote monitoring technology through the years it took to get explicit reimbursement). The long pole in the tent for the final ruling is the collection of compelling medical economic studies to validate the cost-effectiveness and set an appropriate reimbursement rate. That’s not something CMS controls.
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I immediately read this in my head like the first line of The Offspring’s “Come Out and Play.” Thank you!
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I blame ACA because it not only kept the insurance companies in control, it mandated that we all purchase coverage from them. I immediately lost the good policy I had for years and the best I could do was less coverage for more money.
I live part-time in Japan, have no health insurance there, and pay less than a fourth as much for any procedures I need.
To top it all off, I work in health care in the USA. Insurers have reduced what they will pay me by over 30% while increasing what I have to pay them.
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Uh, you’re welcome. Not familiar but looked up the lyrics. “Gotta keep em separated” sort of works too!
