Health Care Discussion

[ChicosBailBonds]

Single payer wasn't passed.  Nor was it ever introduced.

It's the pipe dream that you guys want, and some are arguing that when O'B Care flops wildly, as it likely will, it's the next step.

[ChicosBailBonds]

With so much talk about controlling costs, how can we when some hospitals charge $30,000 more than another for the same operation.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/?hpid=z1

I'd also want to know if it is truly the "same operation".  Why does Marquette charge more than UW-M for the "same" bachelor's degree in Education?   

[warriorchick]

I did read the article, and yes these are submitted prices, and yes they talk that they get negotiated down...but if different hospitals have different negotiating start points for prices, obviously, you are incentivitized to start at the highest point possible, giving yourself the best chance to have the highest amount paid by Medicare.

Shouldn't a CATscan cost (roughly 10-15%) the same thing across the country?

I agree.  And if the government is negotiating from the top down as opposed to the bottom up, that's another reason they shouldn't be running healthcare.

[muwarrior69]

I am guessing these are list prices and are meaningless.  If you ever read an EOB from your healthcare provider, you would know that the negotiated prices are 40%-80% lower.  Sometimes it's more than that.  jsglow recently received a bill on which the original charge was $880. Our insurance company's negotiated rate was $90.

And if your insurance company allows you to receive treatment at a hospital that charges that much more and then pays the bill, you are being insured by a very poorly run company.

Notice that the article is comparing bills for the same procedure that were submitted to Medicare. It didn't say Medicare paid the entire amount.  And if your provider doesn't accept Medicare assignment and you don't have supplemental insurance, shame on you for not shopping around.

Seniors can opt out of Medicare. If they do, they loose their social security...so not really an option. If your provider does not accept Medicare your supplemental will not cover it as well as they only pay the 20% that Medicare "allows" and does not pay. No Medicare no supplemental. Medicare reimbursements are terribly low which is why our doctor charges us 3K a year. Do we really want to go to single payer system where the government will dictate what a Doctor will be paid? You think there is a Doctor shortage now? Just wait!

[mu_hilltopper]

Like I said above a family whose income is 40K will pay no more than 2% of their income about 800 dollars a year. My wife and I are paying 7200 a year. So who is subsidizing who...it's folks like my wife and I.

No, sorry, it is not.  

While you may find examples of 40 year olds paying less than 70 year olds, this is not the case for all 40 and 70 year olds.   In macro terms, the characteristics are quite clear.  20-30-40-50 year olds are just far healthier and in far less need of health care services than 65+ year olds.  

I suppose you could also generalize and say "the healthy subsidize the sick."   By and large, youth are healthy, the older you get, the more health care you demand.  This illuminates the fact that the younger, healthier populations subsidize the older, less healthy.

[muwarrior69]

No, sorry, it is not.  

While you may find examples of 40 year olds paying less than 70 year olds, this is not the case for all 40 and 70 year olds.   In macro terms, the characteristics are quite clear.  20-30-40-50 year olds are just far healthier and in far less need of health care services than 65+ year olds.  

I suppose you could also generalize and say "the healthy subsidize the sick."   By and large, youth are healthy, the older you get, the more health care you demand.  This illuminates the fact that the younger, healthier populations subsidize the older, less healthy.

Your missing the point. The ACA is based on income levels for those not on Medicare. If the ACA is to be fair they should cap premiums for all based on income. Why should a senior pay 5-10% of their fixed  income for premiums with no subsidies while working families earning 40K be capped at 2%. Families who earn up to 92K a year will get a subsidy while no one on Medicare will.

[dwaderoy2004]

I agree.  And if the government is negotiating from the top down as opposed to the bottom up, that's another reason they shouldn't be running healthcare.

I don't believe that's how Medicare works.  They have set prices for procedures, so it doesn't matter what a provider may list as the cost to them.  Medicare does not negotiate with individual providers, they just set a price that they deem to cover the entire cost of the procedure, including equipment, hospital time, salaries and overhead.  

Now, the higher list prices may affect what a provider receives from private insurance, as they do negotiate with individual providers.

[mu03eng]

I am guessing these are list prices and are meaningless.  If you ever read an EOB from your healthcare provider, you would know that the negotiated prices are 40%-80% lower.  Sometimes it's more than that.  jsglow recently received a bill on which the original charge was $880. Our insurance company's negotiated rate was $90.

And if your insurance company allows you to receive treatment at a hospital that charges that much more and then pays the bill, you are being insured by a very poorly run company.

Notice that the article is comparing bills for the same procedure that were submitted to Medicare. It didn't say Medicare paid the entire amount.  And if your provider doesn't accept Medicare assignment and you don't have supplemental insurance, shame on you for not shopping around.

Where my wife works, the best example is reusable ice packs.  They have to bill any time someone uses an ice pack.  The billed rate is $90 per "unit" or time segment used.  Some insurances have negotiated a $25 rate, some $50, some $90, etc.  In case you missed it, this is a REUSABLE ice pack and at the cheapest the insurance is paying more than the cost of the ice pack in the first place for one use.

And for those advocating for Medicare, it may be a federal program but it is administrated by the states.  Before the expansion of Medicare, Illinois is behind in medicare reimbursment payments to the tune of $1.7 billion

http://www.sj-r.com/carousel/x1545203621/Deadbeat-Illinois-Medicaid-expansion-could-lead-to-more-payment-delays?zc_p=0

Is that the new model, we'll pay when we feel like it and the provider has to operate in a cash flow nightmare for 6-9 months?  I had an Illinois ER manager come into our managerial accounting class as part of MU's MBA program and he talked about all the Lean/Six Sigma, cost accounting, and process flow activities to improve patient efficiency.  On average they reduced patient wait/treatment times by 2 hours, and reduced cost by 40%.  All that savings went into merely covering the cost of 6 months of medicare cash short falls.

[ChicosBailBonds]

TRAIN. WRECK.

http://thehill.com/blogs/healthwatch/health-reform-implementation/294501-baucus-warns-of-huge-train-wreck-in-obamacare-implementation

[BME to MD]

And for those advocating for Medicare, it may be a federal program but it is administrated by the states.  Before the expansion of Medicare, Illinois is behind in medicare reimbursment payments to the tune of $1.7 billion

You are incorrect.  Medicare and Medicaid are not the same.  Medicare is administered by the federal government through the Social Security Administration.  Medicaid is administered by the states.

If you don't know the differences between Medicare and Medicaid I am not sure you are in a strong position to lecture those that may or may not be advocating for an expansion of Medicare.

[mu03eng]

You are incorrect.  Medicare and Medicaid are not the same.  Medicare is administered by the federal government through the Social Security Administration.  Medicaid is administered by the states.

If you don't know the differences between Medicare and Medicaid I am not sure you are in a strong position to lecture those that may or may not be advocating for an expansion of Medicare.

I apologize, I will endeavor to not interchange the names of the two programs again.  I know the difference between the two, the point remains, Medicaid is targeted at low income families, primarily those that are likely to not have their own insurance.  And medicaid can't control cost anymore than medicare can.

[Hards Alumni]

It's the pipe dream that you guys want, and some are arguing that when O'B Care flops wildly, as it likely will, it's the next step.

So just to review:

Single payer is a pipe dream.

You know that I belong to a group.

You know that is what I and this group want is single payer.

You think that single payer is the next logical step after a presumed government mandated health care flop.

I want to live in your world.

[BME to MD]

Your missing the point. The ACA is based on income levels for those not on Medicare. If the ACA is to be fair they should cap premiums for all based on income. Why should a senior pay 5-10% of their fixed  income for premiums with no subsidies while working families earning 40K be capped at 2%. Families who earn up to 92K a year will get a subsidy while no one on Medicare will.

I think you are missing Hilltopper's point.  Are you upset that young people can get very cheap life insurance?  Are you upset that middle aged people with safe driving records pay much lower car insurance premiums?

Also, by taking the total 2011 Medicare expenditures ($1,000,000,000,000.00) and total beneficiaries (48 million) I just calculated the average expenditure per Medicare patient to be ~$21,000.  

Keep in mind that total national healthcare expenditures in 2011 was $2.7 trillion for 311 million people.  Therefore seniors representing 15.4% of the total population absorbed 37% of our national healthcare expenditures.

Per AARP the average out-of-pocket cost per Medicare beneficiary was ~$4,550.  

[reinko]

I think you are missing Hilltopper's point.  Are you upset that young people can get very cheap life insurance?  Are you upset that middle aged people with safe driving records pay much lower car insurance premiums?

Also, by taking the total 2011 Medicare expenditures ($1,000,000,000,000.00) and total beneficiaries (48 million) I just calculated the average expenditure per Medicare patient to be ~$21,000.  

Keep in mind that total national healthcare expenditures in 2011 was $2.7 trillion for 311 million people.  Therefore seniors representing 15.4% of the total population absorbed 37% of our national healthcare expenditures.

Per AARP the average out-of-pocket cost per Medicare beneficiary was ~$4,550.  

You are incorrect.  We are talking about health insurance, not life insurance, they are not the same.

If you don't know the differences between health insurance and life insurance I am not sure you are in a strong position to lecture those that may or may not be advocating for an expansion of health insurance.

[BME to MD]

I apologize, I will endeavor to not interchange the names of the two programs again.  I know the difference between the two, the point remains, Medicaid is targeted at low income families, primarily those that are likely to not have their own insurance.  And medicaid can't control cost anymore than medicare can.

Medicare is certainly better than Medicaid given that its recommendations essentially guide healthcare reimbursement and its rules on things like early readmission or hospital acquired pneumonia rates are working to decrease these costly outcomes.

However, the only hope for true cost control is rationing.  I highly recommend Daniel Callahan's visionary book "Setting Limits: Medical Goals in an Aging Society."

[mu03eng]

You are incorrect.  We are talking about health insurance, not life insurance, they are not the same.

If you don't know the differences between health insurance and life insurance I am not sure you are in a strong position to lecture those that may or may not be advocating for an expansion of health insurance.

+1 fastest hoisting by one's own petard in internet history  

[BME to MD]

You are incorrect.  We are talking about health insurance, not life insurance, they are not the same.

If you don't know the differences between health insurance and life insurance I am not sure you are in a strong position to lecture those that may or may not be advocating for an expansion of health insurance.

Not trying to interrupt the focus of the Superbar mudfight.  Just trying to illustrate to muwarrior69 that healthcare insurance like all other types of insurance (life and car included) is based on risk estimation.

Back to the eternal battle of freedom vs communism!

[muwarrior69]

I think you are missing Hilltopper's point.  Are you upset that young people can get very cheap life insurance?  Are you upset that middle aged people with safe driving records pay much lower car insurance premiums?
Also, by taking the total 2011 Medicare expenditures ($1,000,000,000,000.00) and total beneficiaries (48 million) I just calculated the average expenditure per Medicare patient to be ~$21,000.  

Keep in mind that total national healthcare expenditures in 2011 was $2.7 trillion for 311 million people.  Therefore seniors representing 15.4% of the total population absorbed 37% of our national healthcare expenditures.

Per AARP the average out-of-pocket cost per Medicare beneficiary was ~$4,550.  

I am upset that folks regardless of age (i.e. less than 65) that earn up to 92k a year will get a subsidy while those of us forced on Medicare have to pay full freight after paying into Medicare all those years do not receive a subsidy. I am also upset that Doctors and other health care providers are not being reimbursed by Medicare so that they can stay in practice. Medicare is not the end all and be all that many who want a single payer system think it is.

[Hards Alumni]

+1 fastest hoisting by one's own petard in internet history  

Unsure if you understand reinko's sense of humor.

[BME to MD]

I am upset that folks regardless of age (i.e. less than 65) that earn up to 92k a year will get a subsidy while those of us forced on Medicare have to pay full freight after paying into Medicare all those years do not receive a subsidy. I am also upset that Doctors and other health care providers are not being reimbursed by Medicare so that they can stay in practice. Medicare is not the end all and be all that many who want a single payer system think it is.

We are all paying full freight to keep Medicare and Social Security going*.  In fact we are paying an extra 0.9% in Medicare taxes on all income over 200k single filer or 250k married jointly.  Average per capita income is ~40k which would equate to a Medicare tax rate of $580 per year.  Given that the average Medicare beneficiary paid in the equivalent of $580 and is now benefiting to the tune of 21k per year after 4.5k per year out of pocket that seems like a very generous subsidy.

The argument about providers is very true but unfortunately the only possibilities to change that behavior are to control private insurance payments to a degree most Americans would consider it a government takeover, increase Medicare reimbursement rates also impossible given the focus is on decreasing government spending, or to further strengthen rules about which types of providers must see Medicare patients which is also highly unlikely.


*There is a real possibility (with ever increasing likelihood) that my generation will never benefit from either of these programs also.

[muwarrior69]

We are all paying full freight to keep Medicare and Social Security going*.  In fact we are paying an extra 0.9% in Medicare taxes on all income over 200k single filer or 250k married jointly.  Average per capita income is ~40k which would equate to a Medicare tax rate of $580 per year.  Given that the average Medicare beneficiary paid in the equivalent of $580 and is now benefiting to the tune of 21k per year after 4.5k per year out of pocket that seems like a very generous subsidy.

The argument about providers is very true but unfortunately the only possibilities to change that behavior are to control private insurance payments to a degree most Americans would consider it a government takeover, increase Medicare reimbursement rates also impossible given the focus is on decreasing government spending, or to further strengthen rules about which types of providers must see Medicare patients which is also highly unlikely.


*There is a real possibility (with ever increasing likelihood) that my generation will never benefit from either of these programs also.

Something we do agree on. I really worry for my daughter and granddaughter.

Now back to the Al to talk basketball.

[ChicosBailBonds]

So just to review:

Single payer is a pipe dream.  Of the left, yes

You know that I belong to a group.  Yes, you have admitted to being in said aisle.

You know that is what I and this group want is single payer.  You, I don't know...the group...yes and there videos, and speeches, and articles, and policy positions by the truckloads to back it up.

You think that single payer is the next logical step after a presumed government mandated health care flop.  No, that's not what I said.  I said SOME argue that is the next step.

I want to live in your world.  No thanks, I'd prefer you keep your hands in your own world and stop messing around with mine.

[ChicosBailBonds]

Something we do agree on. I really worry for my daughter and granddaughter.

Don't worry, they'll just keep printing money......money money money....what could POSSIBLY go wrong?

[mu03eng]

Unsure if you understand reinko's sense of humor.

Unsure if you understand mine

[Canned Goods n Ammo]

(Rant warning)

We are smart people. We all took logic class. We should be able to have a discussion without trying to corner the "other side" and devolve into political posturing. That's not using logic, that's using rhetoric.

I don't know if the US has always been this politically polarized, or if I'm just old enough now to realize it. Either way, it drives me nuts, and I honestly think it's a big problem in this country.

(end of rant).