"Who's gonna pay for Medicare for all?" is either stupid or disingenuous

Everyone gonna mail in their premium?

 

No, I am NOT saying that there is no bureaucracy in private health (triple negative). There is plenty. But private companies are much more flexible and do pay much more. At least 3 months down the road when you finally get paid, it will be worth the trouble. And if you make enough of a fuss with a private company you can bypass needless protocol.

As for itemized bills, are you kidding?? Every aspect of an encounter can be itemized. If you were to say to someone, "you're fat you should probably exercise or something" you then write in your assessment and plan that you spoke to the patient at length about exercise and home health and you bill for that. I know people that practice not according to their assessment of best practices, but their consult and treatment follows insurance billing protocols to make the most money. So if you are ever in the US and your doctor ever stops your consult to talk about how you sit in the chair or smoking or something, he is just stacking up little itemized points so that he can charge your insurance company $900 so that he will hopefully receive a check for $200 in several months. This is much more desirable than the $30 you would get from treating a medicare patient.

 

The cost of care is directly affected by insurance in some ways. They drive the price of care up indirectly.

As for the $15 Tylenol, that happens because insurance companies will generally only pay a percentage of the listed fee schedule. In reality that is probably a $5 Tylenol, which is still way too expensive, but it will look even more expensive when you see what your insurance is being billed. When they tell you they are paying in full, they actually mean that you can not be held responsible for the remainder of the bill and they generally pay a fraction. This happens when you are in network as a provider with some types of insurance. Some insurance will actually pay in full, but most do not.

 

My prescriptions also come from outside the US. One item would be $5 per pill here; is $0.35 imported.

I'm for legislation not to control the costs, but to control the situation that fuels the costs.
Personally, I think our legal intensity- our propensity to sue anybody with money is a huge issue. About half the ads on TV are either a drug company spending half the commercials quoting side effect warnings (which indemnify them from lawsuits) or lawyers telling you that if you took some pill and developed bad gas later, you are entitled to free money.

The nation of Japan has 7 lawyers per 100,000 population.
England is law-suit happy, they have 83 per 100,000. Number two in the world.
America- well, we have 287. Tort law is

Medical litigation is an industry here, a money-mine..... with insurance and deep pockets being the natural resource, and lawyers being the miners. They get 35-60% of whatever they win. They create class-actions suits where millions in legal fees are awarded, but the "victims" are lucky to get $5. That is not justice, that's milking a captive cash cow. Liability/malpractice insurance costs are huge- and every doctor, hospital and medical facility have to have it. Many nurses do as well, but it's usually not a requirement.

One aspect of this environment is doctors practicing defensive medicine, taking step they take only to guard against potential lawsuits. That alone is estimated to cost $45.6 billion per year- all winding up in insurance premiums. Forbes Financial estimates that reasonable TORT law reform would drop medical costs 27%. TORT is the non-criminal pursuit of money for alleged damages. One aspect for instance is that when a doctor or hospital is sued, even if they suit is thrown out or goes in their favor, they spend huge money in defense of the suit. Many suits are a form of extortion- and if a settlement can be made that is cheaper than defense costs, it often is. There are some countries where the legal costs of both side of a case are paid by the loser, which goes far to discourage frivolous claims. This is not the case in America. That one change would dramatically improve the process of damage litigation.

 

And that is true- most claims are negotiated or arbitrarily reduced. The resulting effect is to over-charge sufficiently so that after the adjustment you still come out with a good number. That entire process is also a trouble-maker, keeping the water muddy and the perception of the system as corrupt boiling. Of course, the hospital CAN bill you and pursue you for the balance your insurance did not pay. Sometime they do, sometimes they do not. What if they all just sat down and agreed to be reasonable in the first place, instead of making the whole process an ongoing adversary war? Why don't they?

Too many lawyers on board, and lawyers thrive on adversary, not cooperative situations.

 

You do not seem to comprehend the difference between the government taking an individuals money through taxation and that same individual spending his own money as he sees fit.

 

Here are a few things worth reading.

https://www.politifact.com/truth-o-...ing-administrative-costs-private-insurance-a/

https://www.vox.com/policy-and-poli...e-for-all-costs-bernie-sanders-mercatus-study

 

So how about this: Let's allow business and individuals to buy into Medicare at some rate higher than the cost? We could start with the 55 to 65 age group then the younger people would get a reduced rate as well.

 

Forbes is likely incorrect. Several studies have consistently shown that tort reform alone does not lower costs or the practice of defensive medicine. As far as bad policies go, defensive medicine isn't the worst. It does allow the occasional early find of cancer or other serious condition. It is extremely wasteful though. I have seen figures as high as 1 in 4 health care dollars being spent on defensive medicine. That seems dubious though. They are likely including medicare fraud in this figure.
Don't get me wrong, I am all for tort reform, but it does not seem to actually help drive down the cost of medicine. There is something called the Patients' Compensation System that would actually address the tort reform, malpractice insurance issues, and overall cost of healthcare. A few states are considering the idea and we can see if it works in the real world. In this system the patient seeks redress from a panel of doctors and the physician in question is not directly sued. I have seen it compared to a workers compensation like system for physicians. I am not doing the idea any justice, but it seems like a really good idea, you should check it out.

 

The part in bold exactly. It is a ridiculous process. You end up doing all sorts of weird math to figure out what to charge to break even a statistically significant amount of the time. If you charge too little the insurance companies that are trying to stick it to you percentage wise will pay you $12 so you end up charging ridiculous things on paper. A lot of people do what is known as a "cash discount" which is really just charging you the actual price because you don't have insurance.
I am not saying that the system we have now is great. It isn't. I am just concerned about what the proposed alternative here would actually look like. We need to fix our system no doubt. I just think we should be very cautious about how we move forward in doing that. There are a lot of overlapping factors and interests that have to be considered.

 

As long as people are voluntarily joining and shouldering the financial burden themselves, I can't imagine anyone would have a problem with this. I say that, but I can imagine it. Someone will hate it. But it seems like a fair compromise if I am understanding you correctly.

 

easiest way is to make all medical personnel, including all those exclusive surgeons, state/federal employees with 'normal' salaries, until then, 'socialized medicine' won't work

 

No, it's not off-topic. You can't have a bunch of illegals coming in and using all of these services that you want taxpayers to pay for without it bumping the price to ridiculous amounts, or reducing the quality to a bucket of leeches and witch doctors.

You can call it a rant all you like, but the fact is that you can't have everything. And no, you can't have medicare for all. You had your chance with obamacare and you blew it.

 

Santa

Short of that tax the fatties food.

 

I love the micromanaging you've got going on here. Massage the pay roll tax rates, reduce this for the rich, increase that for the poor...

I guess if you can get another democratic majority in both houses and win the white house, you might have a chance at pulling this one off with no more success than democrats have at anything, but you can always dream.

 

Relatively simple formula at work here.

Cost of loss to be covered directly controls the cost of insurance- the two are inextricably connected.
Anything that lowers or increases the cost of medical care, lowers or increases the cost of insuring it.
Continuous fighting over payments and logic add expense to both the medical profession and the insurance companies. And as a result- add to the cost of insurance premiums.

Doctors often hire billing experts to figure out how to use the insurance rules to maximize their net payment. For example, I read one article describing how an appendectomy can be divided and billed as two procedures instead of one- as a laporotomy (opening the abdominal cavity) and an appendectomy (removal of the appendix).

Doctors hate insurance companies. Not only do they have to fight to collect, but their payments are usually months behind, creating financial problems for the providers.
Insurance companies hate doctors- thinking they always cheat, and always trying to beat them down on price.
My doctor for example will not take patients insured by Humana. Out of curiosity, I asked him way. He's been my doctor for over 40 years, and never has he spent so much time or been so passionate about something talking to me as the tirade he spent ripping on the insurance industry. I hit a sore spot for sure just by asking.

Years ago, auto insurers used to do everything they could to whittle down claims, and the claimants had to fight to get a fair shake. Often, both were making lawyers wealthy. Eventually, that insurance industry discovered the value in fair claims practice- good reputation, high customer retention and satisfaction, and much lower legal costs. That is why today, getting your car fixed takes about 80% less BS to deal with than it would have been 50 years ago. That perception has not reached the medical insurance business.

 

Funny how the flock is willing to pay higher prices due to tariffs, but not for healthcare.

 

What has gone up in price due to tariffs?

 

I am for it.

 

Indeed Canada and Scandinavia are much much more humane then USA.

In USA 27 million people have no medical insurance.

Tens of millions of people are poor. About a million are homeless.

 

"make all medical personnel"? Are we into slavery now?

 

So you're happy to shop with your family for your vegetables side-by-side with diseased, contagious non-citizens at your local grocery store?

 

gotta love lefties...

It's like a constant battle of strawmen.

 

As long as I can continue not having insurance and paying my medical bills out of pocket when they arise (or going in to debt when I can't afford them), then do it however you want.

 

The OP explained that you're not taking into account that he's gonna make you pay into "medicare for all" and to hell with you and your paying out of pocket stuff. He wants to force you to pay into his scheme, and if you don't, he's gonna put you in prison.

That's how the left rolls. They're into slavery. Force medical workers to work for the government, taxes, force this, force that....

They're really showing their hand in this thread. They don't care about anything except how much you can afford to pay for their geritol. You got a dollar? Then I'm gonna take just a few pennies! It's okay, because you know you'll miss me when I'm gone!

No, we won't miss you! Begone evil lefties!!!! You are not necessary!