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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Lane3 who wrote (6843)	6/1/2009 8:02:47 AM
From: skinowski	Respond to of 42652

The preliminary guestimate, though, is that I'm not costing BCBS much at all and my doctors aren't being enriched much at all. And yet, the costs are great. Found this interesting PDF from Kaiser -- Total health care cost per Medicare beneficiary in 2005 was just about 14.5 thousand dollars - and growing. 1/2 of it came from Medicare, 17% directly out of pocket, and most of the balance from Medicaid, Medigap and other third parties. kff.org Obviously, there must be an enormous amount of waste and inefficiency. This problem will not get solved by extending membership to more people. Like Chrysler and GM, the system will probably have to go bankrupt before we'll be ready to talk about meaningful changes.

To: Lane3 who wrote (6843)	6/1/2009 8:12:36 AM
From: i-node	Read Replies (3) \| Respond to of 42652

I do, well, sort of. I have both. Medicare pays first. I've only been on Medicare for a year so I don't have enough data yet to go back and work through the detail, but I have noticed that BCBS wasn't adding very much to the pot. I was surprised at that. When I have a firmer figure, I'll post it. The preliminary guestimate, though, is that I'm not costing BCBS much at all and my doctors aren't being enriched much at all. You have BCBS supplemental, I assume, which is a different thing. (A supplemental, by design, just picks up the part of the Medicare allowable amount that the patient would normally pay themselves, usually 20%). Here, BCBS pays 38% higher than Medicare for a typical OV code. That, for many (perhaps most) physicians, is the difference between breaking even and turning a profit. State Medicaid is worse, paying only HALF what BCBS pays. The point is that no provider can be profitable on fees allowed by government payers. Now, nobody has said that government coverage extended to more patients will reimburse less, but to generate "savings", that is a necessary ingredient. Most physicians currently accept Medicare because those patients (a) contribute to fixed cost overhead and (b) it is difficult to grow a practice if you refuse all patients over 65. Many, many physicians who build up large Medicare practices later realize they are paying a huge price for it. Financially, today, it makes little sense for a physician to accept Medicare patients if they have an alternative. As you ramp up the number of patients under these programs, physicians are going to opt out of them unless you do something about the fees. Now, I don't know how much of it waste as skin. mentioned, I'm sure there's a lot. But that waste comes from a variety of places and you can't just wave your hand and get rid of it. Tort reform would probably do as much as anything.