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UAH

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Yeah, I understand the argument. I'm just very skeptical due to my experience in government. Nothing the government does is done well. Not even the simplest of things.
No organization can afford to go it alone anymore. Corporations such as General Electric and General Motors, etc. have such large retiree medical obligations as to not be solvent in the future. The problem that any business that offers medical coverage today faces is all of the cost shifting that occurs from the uninsured receiving their primary care at emergency rooms. All levels of government as well are facing huge current and retired employee obligations that cannot be funded.
The only choice will be to pass all of that cost off to individuals or create a more efficient medical delivery system that will have far less duplication and price gouging that makes the US spend double per capita than the rest of the developed world.

I would also point out that Medicare does not administer the health care system. That is contracted out to the Blues, Aetna, Et al. who have the systems and expertise to negotiate pricing with providers and process claims.
 

TIDE-HSV

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What type "investments"? Also, since we've done away with insurance about four posts up. How do you address their ability to afford to pay for lawsuits filed against them? Without liability insurance they would have to be literally personally liable for any claims against them. Would these "investments" produce enough constant stream of income to cover that? Because at $150,000/year and doing no telling how many surgeries in any given year. There's no way they could save enough from that type income to cover legal cost of a claim filed against them. Would we have to now ask lawyers to lower their fees in the name of the greater good, so doctors can afford legal counsel?
I thought the issue was doing away with medical insurance, not liability insurance? Maybe I didn't read closely enough...
 

TIDE-HSV

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No doubt. But that's missing the point from earlier in the thread. Essentially any comparison between Medicare and private insurance shows that Medicare is able to "negotiate" lower prices and reduces the overall cost of healthcare for the same services performed by the same doctors. If people are interested in actually reducing overall expenditures rather than tossing the hot potato back and forth, this has proven an effective model. The CBO has a quick powerpoint with some basic price comparison data. This slide shows the variance in reimbursement from private insurers compared to Medicare.



Now, what would the consequences of a Medicare-for-all system be for medical professionals? No idea. If overall reimbursement is reduced, hospitals would presumably have to decide between juicy administration bonuses, buying that fancy new MRI machine, or keeping their physicians and staff happy. Personally, I find it hard to imagine a system where public insurance entirely supplants private insurance. More likely, both would exist concurrently, a la the German healthcare system. That said, German physicians get paid trash money, so many of them leave to practice in Switzerland or elsewhere.

But granting all that uncertainty, we do know that a large central negotiator like Medicare can reduce overall U.S. healthcare costs, which is what folks were asking about earlier in the thread. I forget which analysis showed that a Medicare-for-all plan would cut overall U.S. healthcare spending by hundreds of billions over ten years. And costs would drop even more if Medicare were finally permitted to negotiate prescription drug prices. The obvious catch, however, is that the burden of payment would shift largely from insurers and consumers to the federal government. Despite Medicare being far more efficient than private insurers (2% administrative costs vs. 17%, LINK), some are conditioned to reflexively fear this.
People, even those on Medicare, don't understand how it works and why it's so efficient. I wish I hadn't thrown away my most recent Medicare statement, so I could repeat the actual reimbursements. However, my "list price" for my heart bypass a few years ago was something like $120K.* The doc got paid well, but, it was something like $6K. When I had the first BCC surgery in October, the fee was reduced from $1.2K+ to something like $700, because it was the second surgery he'd performed that day. I was chatting with my Mohs surgeon while he did my surgery a week ago. He does eight patients in a ten hour day (without counting the drive back and forth from B'ham). He confirmed he only got paid the full fee for his first patient. He went further and told me that, if I'd needed additional cosmetic surgery, he would have not been compensated for that. He said "I would never think about leaving you with any disfigurement I could prevent." I will save my next Medicare statement and post the numbers. It's abundantly clear from this thread that many, if not most do not begin to understand how Medicare works...

*With my asset structure, had I not been either on Medicare or privately insured, they could have taken it out of my hide. If not, with the bypass, stents, colon resection and cancer surgery, I would have been driven into bankruptcy, like so many thousands in the US are every year. I do not understand why this is not understood as a national disgrace and is regarded as such by the rest of the civilized world...
 

92tide

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People, even those on Medicare, don't understand how it works and why it's so efficient. I wish I hadn't thrown away my most recent Medicare statement, so I could repeat the actual reimbursements. However, my "list price" for my heart bypass a few years ago was something like $120K.* The doc got paid well, but, it was something like $6K. When I had the first BCC surgery in October, the fee was reduced from $1.2K+ to something like $700, because it was the second surgery he'd performed that day. I was chatting with my Mohs surgeon while he did my surgery a week ago. He does eight patients in a ten hour day (without counting the drive back and forth from B'ham). He confirmed he only got paid the full fee for his first patient. He went further and told me that, if I'd needed additional cosmetic surgery, he would have not been compensated for that. He said "I would never think about leaving you with any disfigurement I could prevent." I will save my next Medicare statement and post the numbers. It's abundantly clear from this thread that many, if not most do not begin to understand how Medicare works...

*With my asset structure, had I not been either on Medicare or privately insured, they could have taken it out of my hide. If not, with the bypass, stents, colon resection and cancer surgery, I would have been driven into bankruptcy, like so many thousands in the US are every year. I do not understand why this is not understood as a national disgrace and is regarded as such by the rest of the civilized world...
we had a 4-5 year stretch that would have completely bankrupted us
 

NationalTitles18

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But the solution is basically government-run healthcare (at least in part), which many people (mostly Republicans) have been conditioned to fear. So to be frank, folks need to either embrace the solution or stop complaining.
I appreciate your enthusiasm and my opinion is that government has a role to play, but "embrace the solution or stop complaining"?

A little too arrogant and egotistical for my taste. People have different ideas that are just as valuable as yours. There are legitimate concerns with any system from complete free market all the way through universal government-run systems. It was legitimate concerns with differing forms of government that brought about our form of government, which though not perfect, is one of the better forms out there. It would be wise to listen to differing views so whatever system changes that occur are beneficial and safeguards are in place against the unintended consequences.
 

CharminTide

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I appreciate your enthusiasm and my opinion is that government has a role to play, but "embrace the solution or stop complaining"?

A little too arrogant and egotistical for my taste. People have different ideas that are just as valuable as yours. There are legitimate concerns with any system from complete free market all the way through universal government-run systems. It was legitimate concerns with differing forms of government that brought about our form of government, which though not perfect, is one of the better forms out there. It would be wise to listen to differing views so whatever system changes that occur are beneficial and safeguards are in place against the unintended consequences.
I'd love to hear alternative ideas, but I have never heard any other realistic method of controlling costs. All market-based attempts have failed outright. Folks who oppose a solution that involves the federal government tend to either invoke a solution that we've already tried and found lacking, or simply shrug and express an abstract reluctance without any alternative plan. I wasn't trying to be arrogant, only realistic -- we've been trying to find a way to reduce costs for decades while ignoring the one approach that has been proven successful both within our borders and abroad.
 

twofbyc

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All those who actually remember when there was no such thing as health insurance, raise your hand. [emoji113]
If you aren’t old enough to remember that, (or when a college education in some places was tuition free), and you’re still convinced Medicare for all isn’t a viable solution, then pure unadulterated capitalism has taken control of your brain and you can’t see anything outside of a profit/loss perspective.
If you are old enough to remember those days, not on Medicare yet (funny how no one on it has a single solitary bad thing to say about it but some of them don’t want everyone to have it) but still decry Medicare for all, the brainwashing is complete.
You’ve been processed. Congratulations.


Sent from my iPhone using Tapatalk
 

Bodhisattva

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People, even those on Medicare, don't understand how it works and why it's so efficient. I wish I hadn't thrown away my most recent Medicare statement, so I could repeat the actual reimbursements. However, my "list price" for my heart bypass a few years ago was something like $120K.* The doc got paid well, but, it was something like $6K. When I had the first BCC surgery in October, the fee was reduced from $1.2K+ to something like $700, because it was the second surgery he'd performed that day. I was chatting with my Mohs surgeon while he did my surgery a week ago. He does eight patients in a ten hour day (without counting the drive back and forth from B'ham). He confirmed he only got paid the full fee for his first patient. He went further and told me that, if I'd needed additional cosmetic surgery, he would have not been compensated for that. He said "I would never think about leaving you with any disfigurement I could prevent." I will save my next Medicare statement and post the numbers. It's abundantly clear from this thread that many, if not most do not begin to understand how Medicare works...

*With my asset structure, had I not been either on Medicare or privately insured, they could have taken it out of my hide. If not, with the bypass, stents, colon resection and cancer surgery, I would have been driven into bankruptcy, like so many thousands in the US are every year. I do not understand why this is not understood as a national disgrace and is regarded as such by the rest of the civilized world...
I've talked to probably a dozen doctors at office parties and medical conferences where I've tagged along with my wife. I couldn't discuss the subject in as much detail with them as I'd like due to the setting, but what you said pretty much fits with what they told me. What they couldn't tell me with certainty is how much of the bill is a real cost (versus additional padded cost to cover the subsidies on other procedures). And of that real cost happened to the cost that was not paid? Does the hospital eat the cost? Does the taxpayer foot the bill? I'm not sure that getting a doctor to work for dimes on the dollar is the best plan. God bless him if he is willing to do that though.
 

Bodhisattva

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Now, what would the consequences of a Medicare-for-all system be for medical professionals? No idea. If overall reimbursement is reduced, hospitals would presumably have to decide between juicy administration bonuses, buying that fancy new MRI machine, or keeping their physicians and staff happy. Personally, I find it hard to imagine a system where public insurance entirely supplants private insurance. More likely, both would exist concurrently, a la the German healthcare system. That said, German physicians get paid trash money, so many of them leave to practice in Switzerland or elsewhere.
Well, I would hope that quality medical staff would be retained. I don't really want to be worked on by Shaky the Surgeon and an anesthesia nurse with only an associates degree.
 

Its On A Slab

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I've talked to probably a dozen doctors at office parties and medical conferences where I've tagged along with my wife. I couldn't discuss the subject in as much detail with them as I'd like due to the setting, but what you said pretty much fits with what they told me. What they couldn't tell me with certainty is how much of the bill is a real cost (versus additional padded cost to cover the subsidies on other procedures). And of that real cost happened to the cost that was not paid? Does the hospital eat the cost? Does the taxpayer foot the bill? I'm not sure that getting a doctor to work for dimes on the dollar is the best plan. God bless him if he is willing to do that though.
During my Dad's convalescence, I had the good fortune to have to keep up with his bills. We would get these exorbitant bills, only to get the net several months later - a fraction of the original. I just paid off his final ambulance bills. The original was $1500 for a trip to the hospital. His part of it was $265.

My Dad was a pharma rep for most of his life. He always railed against what he called "socialized medicine". Yet, when my Mom was going down the tubes, he spoke highly of Medicare. I never really asked him, "Where'd you think all that money came from?"
 

TIDE-HSV

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I've talked to probably a dozen doctors at office parties and medical conferences where I've tagged along with my wife. I couldn't discuss the subject in as much detail with them as I'd like due to the setting, but what you said pretty much fits with what they told me. What they couldn't tell me with certainty is how much of the bill is a real cost (versus additional padded cost to cover the subsidies on other procedures). And of that real cost happened to the cost that was not paid? Does the hospital eat the cost? Does the taxpayer foot the bill? I'm not sure that getting a doctor to work for dimes on the dollar is the best plan. God bless him if he is willing to do that though.
The docs I know complain about it, but, OTOH, they're doing fine on what Medicare's paying them. Nobody has the bargaining power of Medicare. In the heart bypass procedure I had, I'm pretty sure that the the $120K price tag was just the hospital. I think the doc finally was cut down to a mere $1,000 per hour, which isn't bad...
 

Bamabuzzard

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I thought the issue was doing away with medical insurance, not liability insurance? Maybe I didn't read closely enough...



He used the generic term "insurance companies" but I'm certain he meant health insurance. However, this issue cannot be looked at in a vacuum nor can any potential solutions. Malpractice and general liability insurance costs are a part of the mark up on health costs as it is baked into the price of services rendered. But in our made up example of suggesting a surgeon needs to voluntarily accept a $150,000-$250,000 salary to operate on people. Let's say malpractice and general liability insurance still existed. The average cost of malpractice insurance in Louisiana for a general surgeon is approximately $20,000-$25,000 per year. My wife's cousin is a surgeon and just malpractice on himself is $24,000/year, that's not even counting the general liability policy they also have to take out on the practice. Which I have no idea what that yearly premium is. That's also not counting the worker's compensation policy the practice is required to have as well. Which again I have no idea what that figure is.

So referring back to the posters who are suggesting that it would be feasible for surgeons to work for $150-$250K/year. It's a solution constructed in a vacuum in my opinion.


Yes, if you qualified for the credits, the ACA was great. Problem is that most middle class folks don't qualify for the credits. My premiums doubled during the fist year of the ACA through my employer insurance program. The open market was even more expensive because I didn't qualify for the credits. So, from my point of view, the ACA sucks.

I do agree that support for Trump and the stripping of heath care by his base is odd because, their are probably plenty of them benefiting from the ACA credits.

I have no clue what would fix health care in this country. I like reading well thought out post from people offering ideas. When Obama was pushing the ACA, I was 100% against government run health care but, I think I'm now leaning more towards that because nothing else has worked. All I know is that the insurance companies need to go away because they are the ones ruining the system. The only reason hospitals charge tens of thousands of dollars for a multi-day stay is because of the insurance companies.
 

Bodhisattva

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During my Dad's convalescence, I had the good fortune to have to keep up with his bills. We would get these exorbitant bills, only to get the net several months later - a fraction of the original. I just paid off his final ambulance bills. The original was $1500 for a trip to the hospital. His part of it was $265.

My Dad was a pharma rep for most of his life. He always railed against what he called "socialized medicine". Yet, when my Mom was going down the tubes, he spoke highly of Medicare. I never really asked him, "Where'd you think all that money came from?"
I'd like to see how the $1500 was determined. Does it really cost that much per trip? If so, then someone is paying that bill. Real costs don't just disappear.

Not a medicare issue, but I have a neighbor who has sleep apnea. He periodically gets CPAP machine supplies (mask, tubing). His cost is $30. The bill sent to the insurer is $900. For a mass produced plastic mask and tubing. :confused:
 

Bodhisattva

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The docs I know complain about it, but, OTOH, they're doing fine on what Medicare's paying them. Nobody has the bargaining power of Medicare. In the heart bypass procedure I had, I'm pretty sure that the the $120K price tag was just the hospital. I think the doc finally was cut down to a mere $1,000 per hour, which isn't bad...
I'm hopeful this is working as well as advertised, because it looks like a medicare for all (at least as part of a two-tiered plan) is where we are heading. My concern is that quality suffers and costs are shifted/hidden rather than seriously reduced.
 

Bodhisattva

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He used the generic term "insurance companies" but I'm certain he meant health insurance. However, this issue cannot be looked at in a vacuum nor can any potential solutions. Malpractice and general liability insurance costs are a part of the mark up on health costs as it is baked into the price of services rendered. But in our made up example of suggesting a surgeon needs to voluntarily accept a $150,000-$250,000 salary to operate on people. Let's say malpractice and general liability insurance still existed. The average cost of malpractice insurance in Louisiana for a general surgeon is approximately $20,000-$25,000 per year. My wife's cousin is a surgeon and just malpractice on himself is $24,000/year, that's not even counting the general liability policy they also have to take out on the practice. Which I have no idea what that yearly premium is. That's also not counting the worker's compensation policy the practice is required to have as well. Which again I have no idea what that figure is.

So referring back to the posters who are suggesting that it would be feasible for surgeons to work for $150-$250K/year. It's a solution constructed in a vacuum in my opinion.
IIRC, malpractice insurance for professions like ob-gyns and anesthesiologists can run closer to $100k per year.
 

CharminTide

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I've talked to probably a dozen doctors at office parties and medical conferences where I've tagged along with my wife. I couldn't discuss the subject in as much detail with them as I'd like due to the setting, but what you said pretty much fits with what they told me. What they couldn't tell me with certainty is how much of the bill is a real cost (versus additional padded cost to cover the subsidies on other procedures). And of that real cost happened to the cost that was not paid? Does the hospital eat the cost? Does the taxpayer foot the bill? I'm not sure that getting a doctor to work for dimes on the dollar is the best plan. God bless him if he is willing to do that though.
Often, inflated payments from private insurance make up any difference. It used to be that some hospitals and practices tried to maintain a certain ratio of privately insured patients to Medicare patients, primarily to ensure they didn't have to eat the excess. This same buffer is used when an uninsured patient gets care and cannot pay their medical bills.
 

CharminTide

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IIRC, malpractice insurance for professions like ob-gyns and anesthesiologists can run closer to $100k per year.
I was curious and did a quick search. The median malpractice claim payment for an adult anesthesiologist was $90,000 in 1993, and $111,000 for a pediatric anesthesiologist. Corrected for inflation, that's almost $200,000 today.
 

Bodhisattva

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Often, inflated payments from private insurance make up any difference. It used to be that some hospitals and practices tried to maintain a certain ratio of privately insured patients to Medicare patients, primarily to ensure they didn't have to eat the excess. This same buffer is used when an uninsured patient gets care and cannot pay their medical bills.
But, isn't this instance more of a shift in cost rather than a reduction? It just seems like so much of this is a shell game.
 

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