Medicare for All

[docsherm]

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

And no, I will not be affected at all. There will always have to be someone to administer any program. My concern is the quality of that program. I can see the difference between the different kines of businesses that we administer. We even run an indigent care charity program that cost the people that qualify absolutely nothing...... it is coverage but they really do get what that pay for.

[Averageman]

Follow the money, if there isn't money involved, follow the political power involved.
"They" are giving pregnancy tests to ten year old's who illegally crossed the border. Think about that for a hot minute, think about who the small percentage of positive tests might give an advantage to, think about why a ten year old gets pregnant?
We're screwed.

[GH41]

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.



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?



...

The wait and see approach must be common. Wife crashed her bike and broke her wrist. It was bad enough to require plates/screws. Her Sawbones did put it in a light cast and gave her some pain meds but it took 7 days for our insurance company to approve the surgery. We paid our deductible up front and 6 months later we are still getting bills for stuff the insurance didn't cover. We are 5K out of pocket so far. We are lucky in that her policy is 100% paid for by her employer and her deductible is only $2,500.

[sundance435]

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?

What a ridiculously absurd statement. Right, the only people who can't afford health insurance are those without jobs and/or made bad life decisions. I'm sure you go to church every Sunday, too.

Also, I never said ACA was THE solution. In fact, I said it was the least bad solution between doing nothing and single-payer. Let's just shit-can it, though, because Obama, and let insurance premiums and healthcare spending spiral upward to infinity. Cross-state policies? Sure, that's a minor fix, but not the panacea some claim it to be.

[grnamin]

Those who are for MFA would rather have the illusion of medical coverage rather than the reality of very little or nothing.

[Adrenaline_6]

Let's just shit-can it, though, because Obama, and let insurance premiums and healthcare spending spiral upward to infinity.

Let insurance premiums skyrocket? What rock have you been under dude?

[26 Inf]

Let insurance premiums skyrocket? What rock have you been under dude?

Going to get worse unless we do something.

The study confirmed that the U.S. has substantially higher spending, worse population health outcomes, and worse access to care than other wealthy countries. For example, in 2016, the U.S. spent 17.8 percent of its gross domestic product on health care, while other countries ranged from 9.6 percent (Australia) to 12.4 percent (Switzerland). Life expectancy in the U.S. was the lowest of all 11 countries in the study, at 78.8 years; the range for other countries was 80.7 to 83.9 years. The proportion of the U.S. population with health insurance was 90 percent, lower than all the other countries, which ranged from 99 to 100 percent coverage.

But commonly held beliefs for these differences appear at odds with the evidence, the study found.

Belief: The U.S. uses more health care services than peer countries, thus leading to higher costs.
Evidence: The U.S. has lower rates of physician visits and days spent in the hospital than other nations.

Belief: The U.S. has too many specialists and not enough primary care physicians.
Evidence: The primary care versus specialist mix in the U.S. is roughly the same as that of the average of other countries.

Belief: The U.S. provides too much inpatient hospital care.
Evidence: Only 19 percent of total health care spending in the U.S. is spent on inpatient services — among the lowest proportion of similar countries.

Belief: The U.S. spends too little on social services and this may contribute to higher health care costs among certain populations.
Evidence: The U.S. does spend a bit less on social services than other countries, but it is not an outlier.

Belief: The quality of health care is much lower in the U.S. than in other countries.
Evidence: Overall, quality of care in the U.S. isn’t markedly different from that of other countries, and in fact excels in many areas. For example, the U.S. appears to have the best outcomes for those who have heart attacks or strokes, but is below average for avoidable hospitalizations for patients with diabetes and asthma.

What does explain higher spending in the U.S. is administrative complexity and high prices across a wide range of health care services. For example, the findings showed that:

• Administrative costs of care — activities related to planning, regulating, and managing health systems and services — accounted for 8 percent of total health care costs, compared with a range of 1 to 3 percent for other countries.

• Per capita spending for pharmaceuticals was $1,443 in the U.S., compared with a range of $466 to $939 in other nations. For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next-highest price.

• The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607 to $154,126.

https://news.harvard.edu/gazette/sto...alth-outcomes/

Lets visit this one for a moment: • The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607 to $154,126.

I think this is pretty much misleading. In my community we have essentially two places for care, one a non-profit, medicare/medicaid focused clinic, the other a doctor owned clinic. So my doctor gets a salary and a cut of the profits. Not sure how widespread this practice is.

I also find it curious that we accept statements such as '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.' without challenge. Why? Is it a law?

Nobody, wants physicians to be underpaid for their dedication and knowledge, but from my perspective things could be made better for all with a little less profit motive on the part of hospitals and clinics.

[Adrenaline_6]

Going to get worse unless we do something.

Understood, but I have a hard time swallowing the fact that a government run system will be more efficient, cheaper, and a better overall consumer experience. Name one instance in the US that this is the case...at the federal or state level.

[Dr. Bullseye]

The goal of Socialism is Communism. Great example here.

[sundance435]

Let insurance premiums skyrocket? What rock have you been under dude?

For non-ACA plans, premium increases are down to below pre-ACA levels. The exchange is a disaster because of insurance companies leaving the market after subsequent repeal of certain ACA provisions. Again, neither the ACA or the status quo ante tackled the structural problems of our insurance/healthcare system, but ACA at least attempted to - generally by applying Medicare-like oversight.

Going to get worse unless we do something.

Exactly. I'm no fan of the ACA, but to ignore it completely and go back to the status quo is at least just as irresponsible. If anything, the ACA tried to tackle, in both banal and novel ways, some of the structural problems that others have alluded to - terrible patient outcomes, exorbitant costs, unnecessary care, etc., short of going full-on single-payer.

Understood, but I have a hard time swallowing the fact that a government run system will be more efficient, cheaper, and a better overall consumer experience. Name one instance in the US that this is the case...at the federal or state level.

You're right, government control should never be considered the best option. However, Government or not, in the real world, you can have 2 of those 3, but not all 3. We currently don't even have 1 of the 3 with ACA-lite and were arguably worse off prior to the ACA, so what's your solution beyond repealing the ACA (because that ain't gonna do it)?