Medicare for All

[sundance435]

Does everyone recognize that Medicare for all is not the equivalent of a completely government run healthcare system, which would be more like VA medical care for all? I’m not in favor of Medicare for all or any government run healthcare system. But it’s important to understand that Medicare is health insurance. Patients go to private, non-government physicians and use their Medicare as one would use any other commercial insurance. Long wait times, poor quality of care, etc would be the result of a healthcare system. Again, I’m not in favor of Medicare for all.

No, I don't think they do. Few buzzwords strike up abortion-level sentiments as "M4A". Medicare and Medicaid DO control supplier-side costs - if you want to sign up for government-run health insurance, go for it. I think that can only drive positive competition among private health plans. I think that Obamacare was the least bad choice between cosmetic tweaks of the existing system and doing nothing. It went as far as you can without single-payer or M4A and now 7 years on, things are relatively normal. What I struggle with is the huge Constitutional overreach of the expansion of the commerce clause to hold the penalty as Constitutional and the nonsensical interpretation of what is a penalty vs. a tax.

RE: Other countries. As I understand it, private insurance is still alive and well in the U.K. and Canada more so as supplementary insurance, which helps with "skipping the queue" on stuff the state doesn't deem a priority (plus, if it really is only $400 Canadian cash for an MRI, there have been times I would gladly pay that rather than deal with my insurance company on the backend). I've never heard of an infant cancer patient being denied care on a timely basis (at least not systematically), but I have read reports of what we in the U.S. would consider unreasonable wait times for "borderline" cases. What I mean is, cases where the medical condition actually impacts a person's life/productivity being untreated for seemingly long periods, which I doubt factors into the value proposition, if any, from the state's perspective. Even if someone didn't receive timely care for a serious issue in Canada/the U.K., etc., that still happens here - it's a straw-man argument to use it against other healthcare systems.

The Republicans trying to repeal Obamacare with no viable alternative was the biggest political clown-fest of the last 4 years. I don't have an alternative and I don't support single-payer as it's being used now, but repealing Obamacare without a feasible alternative that seeks to tackle some of the structural problems in our healthcare system is highly irresponsible. Obamacare should be studied for the effects, positive and negative, it had on those structural problems.

[The_War_Wagon]

The Republicans trying to repeal Obamacare with no viable alternative

I reject the notion, that ANY "alternative" was necessary - especially a gummint one.

INTERSTATE health insurance policy sales (REAL competition), is the MOST feasible solution, that truly lowers cost - AND - keeps the gummint OUT of health CARE. Der Kommissar ObamassarKare is - and remains - a complete failure.

[docsherm]

No, I don't think they do. Few buzzwords strike up abortion-level sentiments as "M4A". Medicare and Medicaid DO control supplier-side costs - if you want to sign up for government-run health insurance, go for it. I think that can only drive positive competition among private health plans. I think that Obamacare was the least bad choice between cosmetic tweaks of the existing system and doing nothing. It went as far as you can without single-payer or M4A and now 7 years on, things are relatively normal. What I struggle with is the huge Constitutional overreach of the expansion of the commerce clause to hold the penalty as Constitutional and the nonsensical interpretation of what is a penalty vs. a tax.

RE: Other countries. As I understand it, private insurance is still alive and well in the U.K. and Canada more so as supplementary insurance, which helps with "skipping the queue" on stuff the state doesn't deem a priority (plus, if it really is only $400 Canadian cash for an MRI, there have been times I would gladly pay that rather than deal with my insurance company on the backend). I've never heard of an infant cancer patient being denied care on a timely basis (at least not systematically), but I have read reports of what we in the U.S. would consider unreasonable wait times for "borderline" cases. What I mean is, cases where the medical condition actually impacts a person's life/productivity being untreated for seemingly long periods, which I doubt factors into the value proposition, if any, from the state's perspective. Even if someone didn't receive timely care for a serious issue in Canada/the U.K., etc., that still happens here - it's a straw-man argument to use it against other healthcare systems.

The Republicans trying to repeal Obamacare with no viable alternative was the biggest political clown-fest of the last 4 years. I don't have an alternative and I don't support single-payer as it's being used now, but repealing Obamacare without a feasible alternative that seeks to tackle some of the structural problems in our healthcare system is highly irresponsible. Obamacare should be studied for the effects, positive and negative, it had on those structural problems.

So after reading your post I can tell you really don't know anything about the current condition of the ACA. Many carriers are switching completely to Off Exchange products. That means they don't have to deal with the government other than getting their plans approved. No subsidies, no crazy 90 day retroactive terminations, no mid month rate changes, no file errors for membership, and they don't have to deal with the Risk Ajustment. The ACA is a trainwreck full of lepers.


Yes it happens here all of the time. Look at the VA.... And with other questionable insurance.... I am speaking of Medicare and Medicaid....... the wait times are high because it is often hard to contract with many specialist providers because they don't want to deal with that CMS rules.

Yes private insurance is alive and well in many of those countries and will continue to be for the rich. Nothing like having to pay for 2 insurance policies and you will never use one.

There is an alternative to Obama care already in place. It is called get a job and pay for your insurance. Why should the entire US population pay for those that made bad life decisions?

[FromMyColdDeadHand]

The only way any entity can keep medical costs down is to ration care. That’s already being done on a fairly broad scale in the US by all of the insurance companies, and certainly by Medicare/Medicaid and the VA, but in a single payer system...yeah...death panels or something equivalent are inevitable. Health care rationing is the only way to keep costs down while maintaining quality.

If/when “Medicare for All” becomes reality, be aware that in your declining years your “doctor” is going to actually be a nurse. There won’t be enough doctors.

Not saying that insurance companies have cost containment protocols, but I think describing it as rationing at a 'fairly broad scale' is to put it, a fairly broad statement.

I don't think so. I suspect that lawyers and the tort system are relatively small components.

Definitely in direct costs, but the impact on how medicine is practiced is hard to discern. There isn't enough money to fix the system, but it isn't inconsequential.

[FlyingHunter]

The "Medicare for all" concept is very similar to "gun control for all".

Neither has anything much to do with care or guns...it's all about control.

[Hmac]

Not saying that insurance companies have cost containment protocols, but I think describing it as rationing at a 'fairly broad scale' is to put it, a fairly broad statement.



Definitely in direct costs, but the impact on how medicine is practiced is hard to discern. There isn't enough money to fix the system, but it isn't inconsequential.

"Cost containment protocols" . What a bullshit euphemism. It's rationing. Insurance companies deny care to patients in need Every. Single. Day. And I deal with it directly Every. Single. Day.

As to the tort system... the indirect costs, Defensive Medicine, play a role, but a relatively minor one.

[TomMcC]

I think it's pretty clear that nobody is going to get all the healthcare he wants. Except maybe the fairly rich folks. It seems to me the question is how much govt we want involved in what healthcare we can afford.

[FromMyColdDeadHand]

"Cost containment protocols" . What a bullshit euphemism. It's rationing. Insurance companies deny care to patients in need Every. Single. Day. And I deal with it directly Every. Single. Day.

As to the tort system... the indirect costs, Defensive Medicine, play a role, but a relatively minor one.

Wife is a doc, and a specialist. The only thing she ever says is an issue is transporting patients to a different facility for non-medical reasons is what isn’t paid for.

Is it specific surgeries or techniques that you won’t get reimbursed for?

[26 Inf]

never mind - From My, post was not directed at you.

[Hmac]

Wife is a doc, and a specialist. The only thing she ever says is an issue is transporting patients to a different facility for non-medical reasons is what isn’t paid for.

Is it specific surgeries or techniques that you won’t get reimbursed for?

Yes. Various operations, particularly the advanced MIS operations and revisions that I do, routinely require pre-authorization and are routinely denied. That in turn leads to time-consuming wrestling with appeals to the insurance company while the patient is in limbo, and often suffering to some degree. At least a couple of times a week, I have to take time out of my day to talk on the phone with some Family Practitioner insurance company medical director that hasn't practiced medicine in years since he/she took that 9-5 desk job and review for him/her the current literature (because I actually read the current literature) that supports an obvious assertion as to why that particular patient needs that particular operation.

Furthermore, they aren't stopping at denying pre-authorization for surgical procedures. A couple of days ago, I got this email, cut and pasted here, from our Radiology director.

All:

New Prior Authorization guidelines took affect January 1, 2019.
The stricter guidelines and increased denial rates requires us to modify our practices.
High Tech imaging orders (CT, MRI, PET and some injections/procedures with the radiologist) will follow the process below.

The Prior Authorization department needs a minimum of 5-7 days before radiology can schedule outpatient exams.
Prior Auth. can no longer be completed retrospectively. As a result we can’t initiate exams without a completed Prior Authorization.
Ordering an outpatient exam as “ASAP” or “STAT” does not exempt it from the routine Prior Authorization process and the standard wait time. These orders will go in the queue with all the other outpatient orders.
Patients with true emergencies need to be referred to the ED for same day care.
In some rare cases the Prior Authorization team may be able to expedite the process. The provider/nurse should call Prior Auth. at 4132 or 2627 to get this process started.

Thank you for your understanding and patience.

So...you come into my office with significant lower abdominal pain increasing over three days. I suspect diverticulitis but need a CT scan to confirm that diagnosis and determine whether or not it has perforated and an abscess has formed that needs to drained (which, by the way, will require another pre-authorization). Or, whether or not I need to take you to the operating room within the next few hours. Sorry...you'll have to wait 5-7 days for pre-authorization from your insurance company (not including the weekend) OR I can send you over to the ER. You'll sit over there for awhile in the waiting room. They'll evaluate you, repeat the labs I already drew in the office, then order the CT scan, and then call me for an ER consult. They'll charge you a bunch of money for the ER visit, you'll have to cough up another co-pay, AND you'll have to cover that rather breathtaking component of your insurance deductible. And by the way, I'll have to charge you for an ER consultation in addition to the office visit I just charged you for earlier that day while you were in my office. Think about what that costs...not just the extra ER visit but the fact that we actually have a "Pre-Authorization Department". Several people, all getting a salary and benefits, whose sole job it is to help a patient wade through and stand in line while the health care rationing process plays itself out.

Additionally, what if it's not a "true emergency" that warrants a trip to the ER? What if you're just in pain, but your labs and vitals are stable? Not life-threatening, just painful? I don't know exactly what's going on in your body...how do I treat you? Do I give you pain medication to try to keep you comfortable while we wait for the CT scan to be approved? No, I can't do that....we have an "opioid crisis" here in the US, so I can't give you pain medication. So....sorry. Good luck with all that...I'll see you back in 5-7 days (not including weekends) after we have the CT scan. If, or when, you get worse and it becomes a true emergency, then you can hit the ER and we can begin the process that I tried to start 5-7 days ago.

This is just a rather routine example of the "cost containment protocols" that insurance companies are increasingly implementing. It's not just a nuisance, it's time-consuming, prevents me from providing good patient care, and detracts from my ability to be productive. The solution? I don't have time to wade through the pre-authorization process so we just hire a bunch of people to do all that nuisance work. Yes, it's expensive but it actually saves us money if it keeps the doctors productive and providing patient care. But seriously...think about the cost of hiring all those administrative people. Who do you think, in the end, is paying for that?



...