Why is M4A necessary to reduce healthcare costs?

[dansolo]

In the bill, costs are controlled by mandating that all healthcare providers charge the Medicare rates. So why can't that part be passed separately? Everyone agrees that the costs have skyrocketed, but M4A advocates imply that this is the fault of the insurance companies. While they enable this practice because they can pass on the costs, ultimately the high costs are largely because there are little restrictions on what healthcare providers can charge. If everyone would be required to charge current Medicare rates, costs would be reduced dramatically, even in the existing system.

[cannabis_flower]

1. Except that..

If they were required to charge Medicare rate wouldn't they just decide to not approve the procedure?

[Ohiogal]

2. I am not on Medicare, yet

but I have read that in some cities, it's hard to find a doctor because many of them will not accept Medicare patients due to the "low reimbursement rates." Has anyone here encountered this?

Should there be a law that a doctor MUST accept a patient that has Medicare?

I personally know of some doctors in my area who will not accept Medicaid patients for that same reason.

[TreasonousBastard]

4. Tough to find a GP/Primary care doc who takes Medicare, but...

it's tough to find one anyway.

Medicare is so common around here that all the specialists take it. Medicaid has a bigger problem.

[DownriverDem]

7. Be careful what you with for

Without details, folks will not support it. It just sounds like a slogan to many of us.

[beachbumbob]

3. need to understand what is behind the cost on american healthcare to be able to control it

I hear no one talking about the issues that drive it. All I hear is we need to reduce it. So how do that if you don;t understand the forces.


So, for instance, look at other countries that have good healthcare at lower cost and understand why:

1. How much does it cost to become a doctor in Canada, England, Germany? vs how much it cost in America?

2. Healthcare services that are provided are regulated in all these countries so why isn't that discussed for America? In England , you don;t have hospital clusters siting across each other all providing same services as that creates duplication of services and the need to run "more test", do more MRIs and CT scans and etc which all run up the cost in America.

3, Public clinics dominate in other countries. In america its ER rooms that MUST provide the services in most cases for medicaid, Why is that? Why is it not discussed revamping some basic rules? Be easy enough with just saying IF you claim to be "non-for-profit" provider then you must operate so many satellite public clinics, staffing so many doctors and seeing so many patients at the set cost of "XX.XX" fee.



The answer is not screaming M4A or any variation in that, the answers is understanding some of the root causes and addressing those.

[TreasonousBastard]

5. All too true. M4A will not reduce the costs of care, just what care will be paid...

And that would mean a major reorganization of care. How it would be reorganized is anyone's guess.

[DownriverDem]

6. Seniors

What about those already on Medicare? No one talks about them.

[Demsrule86]

18. Oh the GOP will talk about them alright...and they will rise up and vote us down.

[wasupaloopa]

8. The cost of providing medical services is not covered by Medicare reimbursement. A clinic needs

patients with regular insurance coverage to cover what Medicare doesn't pay along with state and local tax revenue such as sales tax and vehicle license fees.

I was a controller of a medical clinic and also worked for a county health care department I know costs and reimbursement issues.

The cost of care include the salary of doctor or nurse or both. The medication and medical supplies used and rent, utilities and office costs such as accounting, billing inventory control.

Unless you find a way to reduce health care salaries in every department you can't charge Medicare rates.

People on DU are naive when it comes to costs and reimbursement. You can't just dictate that people take less pay or that businesses shut their doors and suppliers cut their cost so you can get by with paying less for their services.

M4A is not rational because individuals demand health care as a right and demand that providers and what it takes to provide health care be there for them for less income.

Stop this insane demanding that everyone in the health care field bow to your simplistic ideas!

[Hoyt]

12. Lots of truth in that. I have worked with doctors in rural areas where almost all their income is

from patients with Medicare and Medicaid. They were doing OK, but they didn't have a big house, have a vacation home, their office wasn't that nice (no aquariums, etc.), and their staff made a lot less than the fancy, high paid docs in bigger cities. Don't think most docs and staff are ready for that, although they should see the writing on the wall.

Point is, I don't get too upset that doctors might make less. But their nurses, techs, etc., aren't going to be happy when their pay gets cut. Registered Nurses in UK and Canada typically make $15K - $20K less than their American RNs.

Patients aren't going to be happy either when the doc sees them for even less time than now, use more PAs/NPs, you get to see whatever doc is working that way in a group, etc.

On the other hand, we need to get prepared for all that because everyone does deserve coverage. But, these candidates aren't being honest about what is coming.

At least with a Public Option, patients and providers get to get use to what is coming. Mandatory MFA will have providers and patients blaming the government for the change.

[wasupaloopa]

15. At our clinic I did cost studies just so we could cover our costs. I found that a doctor could not

spend more than 15 min with a patient or we lose money. We had to contract with one supplier to get the lowest cost for medical supplies. Nurses could only work when the doctor was in. Doctors could only earn 50% of the revenue they generated. Doctors also had to work 40 hours. We could only pay minimum wage to non medical staff employees. We had to make zero mistakes during the billing cycle. A re-billing caused us to lose money on the procedure.

We were a rural clinic. Most patients were Medicare, Medicaid or indigent. Some had regular insurance and subsidized those who didn't. Without insurance companies we could not stay open. We barely broke even. I spent most of my days fending off creditors and hoping I could meet the payroll.

At the county clinic were I worked patients were on Medicaid or Medicare or indigent. We could not refuse to treat anyone but those who could afford to go to a private doctor. Medicaid paid 50% of costs. The indigent paid zero. Medicare had their fee schedule that did not cover costs. We relied on sales tax, vehicle license fees, grants and 2 to 8% general fund contributions which came from property tax. We could not operated at a deficit.

So when I see a DUer demanding M4A I could pull my hair out.

[mopinko]

9. the short answer is-

this is not a socialist country. the govt has no power to tell private businesses what to charge.

but as others have said- w/o private ins payments, the doc who take medicare would be losing money. you dont take one of the most important professions in the country and squash it.

single payer will have to be much more generous than medicare.

[wasupaloopa]

11. A rare moment of truth here thank you.

"It's my right to health care and I demand that you treat me and take whatever I want to pay for it."

"It's my right to health care so all you rich people pay for it!"

"It's my right to health care and I don't want insurance companies to exist so your insurance co. stock is worthless, your owners and employees can go pound sand."

"It's my right to health care so the government has to provide it to me!"

"It's my right to health care and I want free health care because other countries do it."

[Demsrule86]

17. +1000

Others who vote in 20 will see it exactly as you see it...and we will lose.

[dansolo]

13. That is why Bernie's plan will cost a lot more than they are claiming

All of the cost savings are based on the assumption that reimbursements will be based on the current Medicare rates. If that is not sustainable, then the costs will go up. Neither Sanders nor Warren mention this little detail.

[Hoyt]

10. Between Medicare, Medicaid and private insurance, there are actually restrictions on what docs get

paid for a given service.

Docs can charge a million dollars for an office visit, but Medicaid is going to pay them about $50, Medicare about $75, private insurance $100. The rest they'll have to write-off as if they never charged it. There are similar limits on hospitals and other facilities too.

Point is, there actually are restrictions on what healthcare providers get paid for a given service.

Doctors can still make a decent living at $75, but they'll make less and won't like it and will cut the pay of their nurses and techs. They'll also put more lab and diagnostic equipment in their office to make a few extra bucks. They'll also fear that rates will be cut to $50 to make things work.

[BlueMississippi]

14. Most procedures and visits cost far more than the medicare allows

Hospitals and doctors will have to raise rates for everyone or go bankrupt.

The only way one can function under all medicare rates is with volume -- which means there will be one or two clinics serving an entire county and one hospital between 2 or 3 counties so there are no empty beds. Good luck if you have an emergency like a heart attack.

[Demsrule86]

16. If you have to explain, you have already lost...you will not convince people to give up their

workplace insurance and accept MFA...first of all and there is no way to pass it...Secondly, we will lose the election in 20 if we run on it..so it is a bad bad idea. I was disappointed the EW didn't walk it back at the debates.