M4A vs Public Option

[ZiprHead]

There is also a huge amount of fraud and abuse in Medicare. When I started working in home health back in the late 70s, every single bill we sent was reviewed and approved or denied by M'care. That stopped a long time ago due to the overwhelming number of people who received home health. We would need to hire an army of Medicare reviewers to check every bill. Private insurance companies are usually stricter about reviewing bills and making sure that the charge was warranted. I've seen Medicare abused by companies I've worked for and by providers who gave me care. For example, I had a tele visit with my NP earlier this year. The group billed M'care over 200 dollars, although M'care paid about 100. The worst abuse I've read about lately, is providers charging for an extensive visit when a person has a COVID test. Patients usually don't even spend time with the provider when they get a COVID test, but some providers are billing for a 400 dollar visit, in addition to the test. M'care pays about half of that. By receiving less money, the provider or agency is able to write off the rest as a tax loss. It's crazy. Providers don't work for M'care. They just provide care and bill M'care, but in my experience, the majority of them, including so called non profits, have a tendency to over bill.

That (bolded) is not fraud. That's typical medical insurance billing. The provider bills their standard rate. When the provider agrees to accept medicare it agrees to the medicare reimbursement. The bill would also include the portion you are required to pay, if any (deductible and/or copay). The provider gets the same information as you, then bills you for what medicare tells them they can bill you. The same as commercial insurance plans. I worked for well over ten years in insurance reimbursement for a major hospital system, sometimes working directly with Medicare personnel themselves during audits.

BTW, here's a list of major fraud and abuse enforcement cases that have been settled.

Here's another list

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

My apologies. But it sure read like you were using that as an example of fraud.

 

[southernhybrid]

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

My apologies. But it sure read like you were using that as an example of fraud.

I admit that my post was a bit confusing. What I meant was that 200 dollars for a 10 minute phone call is crazy. But, I didn't mean to say it was fraud. I was typing really fast because I had to do something else. Sorry.

I don't want to give up my plan which is provided by private insurance. Advantage plans are subsidized by the federal government. Why not have insurance plans for everyone that are subsidized by the federal government, but an improvement over Obama care? That's what a lot of countries do that have UHC. I tend to think that is probably a better way to go, and it would be more popular. Plus, I seriously doubt there would ever be enough support from the Congress for a plan like Bernie's. I need to go, but I will check back tomorrow to read your links and clarify anything else that I've said that might be confusing.

 

[Loren Pechtel]

Private health insurance has three huge financial disadvantages:
(1) Insurers are motivated to deny care whenever they can, regardless of medical advice or risk/benefit assessments.

And the same pressures exist in a government system--it's about looking good at budget time rather than looking good to shareholders, but the same forces are at work. The difference is there's generally no way to hold the government accountable for denied care.

 

[Loren Pechtel]

There is also a huge amount of fraud and abuse in Medicare. When I started working in home health back in the late 70s, every single bill we sent was reviewed and approved or denied by M'care. That stopped a long time ago due to the overwhelming number of people who received home health. We would need to hire an army of Medicare reviewers to check every bill. Private insurance companies are usually stricter about reviewing bills and making sure that the charge was warranted. I've seen Medicare abused by companies I've worked for and by providers who gave me care. For example, I had a tele visit with my NP earlier this year. The group billed M'care over 200 dollars, although M'care paid about 100. The worst abuse I've read about lately, is providers charging for an extensive visit when a person has a COVID test. Patients usually don't even spend time with the provider when they get a COVID test, but some providers are billing for a 400 dollar visit, in addition to the test. M'care pays about half of that. By receiving less money, the provider or agency is able to write off the rest as a tax loss. It's crazy. Providers don't work for M'care. They just provide care and bill M'care, but in my experience, the majority of them, including so called non profits, have a tendency to over bill.

While I agree about the abuse (which is why the medicare advantage plans provide more at the same cost--they're more careful about abuse) you've got one glaring error: writing off the rest as a tax loss. That's not how it works.

Either they are recording the $400 as income at the time and then taking a $200 loss against it, producing $200 income as a result, or they are recording $200 income when they get paid. They are not getting $200 in income and $200 in losses for a net of $0.

 

[Loren Pechtel]

The problem that I have with M4A, is that people are under the false impression that it's all free. Bernie Sanders means well, but when he said that M4A would be free and that it would cover dental, vision, drugs, long term care etc. he never explained how the country would be able to afford such coverage. I've read numerous articles explaining the over all cost and none of them seemed to find a reasonable way to pay for all of those things. We already have M'caid for those who are poor and have never paid into Medicare for at least 10 years, the minimum number of years to qualify. I've had many patients on M'caid when I was still working. While it was sometimes difficult to find a provider who accepted M'caid, all of my patients were able to get the care they needed. They were just limited to the smaller number of providers who accept that payment.

Sorry, but Bernie's plan is still cheaper than what we pay now. The Koch brothers funded a study to prove M4A would be more expensive. Too bad for them the study proved just the opposite.

'Medicare-for-All' program could cost $32 trillion but may also save $2 trillion

The PDF of the study.

Still has the same problem it had when it came out--assuming the costs don't go up. Unfortunately, they will because it would end a lot of cost shifting that is currently subsidizing medicare coverage.

 

[Loren Pechtel]

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

No. It's not about a tax break. It's about ensuring they don't leave money on the table. Any doctor's office is going to set it's price at least as high as the highest insurance reimbursement anyone might pay them, and they want it considerably higher because of liability cases--they might not get paid for years in those but they're not going to get any interest and they might not even get paid if the person loses their case or doesn't collect enough to cover all the costs.

 

[T.G.G. Moogly]

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

My apologies. But it sure read like you were using that as an example of fraud.

I admit that my post was a bit confusing. What I meant was that 200 dollars for a 10 minute phone call is crazy. But, I didn't mean to say it was fraud. I was typing really fast because I had to do something else. Sorry.

I don't want to give up my plan which is provided by private insurance. Advantage plans are subsidized by the federal government. Why not have insurance plans for everyone that are subsidized by the federal government, but an improvement over Obama care? That's what a lot of countries do that have UHC. I tend to think that is probably a better way to go, and it would be more popular. Plus, I seriously doubt there would ever be enough support from the Congress for a plan like Bernie's. I need to go, but I will check back tomorrow to read your links and clarify anything else that I've said that might be confusing.

We regularly receive invitations from our medicare advantage provider. My wife recently accepted one of those checkups that amounted to a conversation over the phone. She was on the phone for a very short time and her EOB showed a 240 dollar charge, although we payed nothing. To me that's shady. It just means the provider is looking for a way to make claims, which is why I always decline their random invitations for care.

The medicare premium for hospitalization is deducted from my SS monthly. I then buy an advantage plan which is very inexpensive. And there are advantage plans which have zero premium payments. So how does that work exactly? Is the SSA giving a certain amount of money to my advantage provider, essentially giving them the equivalent of a supplement? Is that how these advantage plans are working?

 

[southernhybrid]

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

No. It's not about a tax break. It's about ensuring they don't leave money on the table. Any doctor's office is going to set it's price at least as high as the highest insurance reimbursement anyone might pay them, and they want it considerably higher because of liability cases--they might not get paid for years in those but they're not going to get any interest and they might not even get paid if the person loses their case or doesn't collect enough to cover all the costs.

If you are correct, my brother in law, who is a dentist has been cheating on his taxes for decades. I suspect that he does cheat on his taxes, knowing some of the things that he has claimed as business expenses over the years. I don't know why he has shared so much information with my husband.

When I worked in home health, I was given the impression from management that supplies were billed at exorbitant amounts in order to take a tax right off. That was a long time ago, but why would an agency charge 150 dollars for a simple urinary catheter, when they only received about 15 dollars from Medicare for that device? It never made any sense. No insurance company is going to pay 150 dollars for a urinary catheter, plus almost all home health care is provided through Medicare or M'caid. Home health agencies rarely ever get sued. Regardless of the reason, those charges were insane. Why does the so called non profit Emory Healthcare charge for an extended visit of 400 dollars when someone gets a COVID test, despite the fact that no time was spent with a provider, other than to obtain the specimen? An extended visit is supposed to take at least 45 minutes, not 5 minutes. The lab test is also billed. There are so many things that make no sense in the way that our health care providers bill. What about labs? Why would a lab charge more than twice the reimbursement rate for a simple test? It's hard for me to believe that this is all due to fear of liability or as you said, not leaving any money on the table. If it's not about writing things off as a tax loss, it makes no sense as to why some of these tests, procedures etc. are billed at exorbitant amounts. Maybe a good start would be to have all tests, procedures, medical visits, etc. billed and paid at the same rate. Worse yet, why are those without any insurance billed at much higher rates than those who do have insurance? Regardless of what is decided, we need drastic changes in the way that the country provides and bills for healthcare.

I don't live in a state where there are that many lawsuits and there is a two year limit here on being able to sue medical providers and agencies. I think that's fair in most cases. We expect too much from medical providers. People need to take more responsibility for their own health and not depend too much on medical providers. But, I'm off topic, so I'll leave it at that.

 

[southernhybrid]

I admit that my post was a bit confusing. What I meant was that 200 dollars for a 10 minute phone call is crazy. But, I didn't mean to say it was fraud. I was typing really fast because I had to do something else. Sorry.

I don't want to give up my plan which is provided by private insurance. Advantage plans are subsidized by the federal government. Why not have insurance plans for everyone that are subsidized by the federal government, but an improvement over Obama care? That's what a lot of countries do that have UHC. I tend to think that is probably a better way to go, and it would be more popular. Plus, I seriously doubt there would ever be enough support from the Congress for a plan like Bernie's. I need to go, but I will check back tomorrow to read your links and clarify anything else that I've said that might be confusing.

We regularly receive invitations from our medicare advantage provider. My wife recently accepted one of those checkups that amounted to a conversation over the phone. She was on the phone for a very short time and her EOB showed a 240 dollar charge, although we payed nothing. To me that's shady. It just means the provider is looking for a way to make claims, which is why I always decline their random invitations for care.

The medicare premium for hospitalization is deducted from my SS monthly. I then buy an advantage plan which is very inexpensive. And there are advantage plans which have zero premium payments. So how does that work exactly? Is the SSA giving a certain amount of money to my advantage provider, essentially giving them the equivalent of a supplement? Is that how these advantage plans are working?

The federal government subsidizes Advantage Plans. I think I mentioned that in a former post. Advantage Plans have gotten much better over the years. When they first came out, I think they were all HMO's, but now PPOs are becoming more common. I had patients who had to drop their Advantage Plans once they started having serious medical problems because a lot of providers wouldn't take them on as patients. That is changing now. Hopefully, things will get better as more people choose them. The last time I read about them, over one third of Medicare recipients were choosing them instead of Traditional Medicare.

Medicare care part A is free. That's the part that covers hospitalization with some deductibles. It's B that has premiums. If you're poor, part B is free. Most people will pay 148.50 next year for Part B, but if your income is over a certain amount, the part B premium is higher. I'm not in that income range so I don't remember exactly what the premium is for those over a certain income level. Most Advantage Plans are free, but some have premiums. It's a bit confusing and can be overwhelming for some people. I have an agent. I haven't needed her to help me choose a plan, but last year, Cigna got my pain mixed up and she advocated for me with both Cigna and Medicare and helped me get things straightened out. It doesn't hurt to have an agent help with choosing a Medicare Plan, considering the many choices and complexity of them.

 

[Worldtraveller]

The problem that most people have with M4A is that they envision it being implemented more or less as Medicare is now, just for everyone. That would maybe work, but it would better to overhaul the system to a true UHC, IMO.

Because Medicare sprang up in the already existing market that was ruled by employer/private insurance, it doesn't really work like it could. The big difference is that costs at the provider level aren't really controlled in a meaningful way. It's capitalism...charge as much as the market will bear.

The classic examples of picking some medical procedure in another country with UHC compared to the US. You could usually afford to fly to that other country, get a 2 week vacation, and still get your issue (broken arm, major surgery, etc) taken care of. A broken arm doesn't need to cost $6k like it does in the US. We need to get out of that mindset before any meaningful change can happen.

Costs need to be regulated (and we can use other countries for good guidelines) and eliminate so much of the current waste in the system. Something like 2/3 of medical expenses go to paperwork largely due to the non-standardized billing from all the private insurers.

 

[southernhybrid]

The problem that I have with M4A, is that people are under the false impression that it's all free. Bernie Sanders means well, but when he said that M4A would be free and that it would cover dental, vision, drugs, long term care etc. he never explained how the country would be able to afford such coverage. I've read numerous articles explaining the over all cost and none of them seemed to find a reasonable way to pay for all of those things. We already have M'caid for those who are poor and have never paid into Medicare for at least 10 years, the minimum number of years to qualify. I've had many patients on M'caid when I was still working. While it was sometimes difficult to find a provider who accepted M'caid, all of my patients were able to get the care they needed. They were just limited to the smaller number of providers who accept that payment.

Sorry, but Bernie's plan is still cheaper than what we pay now. The Koch brothers funded a study to prove M4A would be more expensive. Too bad for them the study proved just the opposite.

'Medicare-for-All' program could cost $32 trillion but may also save $2 trillion

The PDF of the study.

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

Maybe there's a way to do it very slowly over time, by perhaps extending M'care to 60 year olds at first. But, I don't see any way to rapidly go from where we are now to a single payer system. I prefer options. Maybe if we had Medicare with the private insurance options that we have now, it could gradually cover everyone. But, it's not going to be simple and people need to understand that it's not just the uber wealthy who will be paying more taxes. Tax rates at all levels would have to be increased.

Maybe a public option would work, if the rate was lower than most private health insurance rates. I just know that we need drastic changes and it won't be easy to accomplish. I tend to think that Bernie's plan is extremely unrealistic. He wants it all to be free, but he doesn't mention how much more taxes people will have to pay.

I think it might be better to have premiums based on income. Older adults tend to have much lower incomes than younger or middle aged adults, despite what some people think. Sure, there are a small percentage of older adults who have a huge amount of assets, but the last time I read a report about the assets of older adults, most had less than 60K in their savings and plenty had no savings. In the past, insurance companies refused to insure older adults, which is the primary reason why M'care was initiatiated.

I don't have all the answers, but I do know it's complicated to change how things are done in a country the size of he US. Maybe we should look at the system that Germany has. It's a fairly large country that has UHC but it's not single payer. To be honest, I don't understand the enthusiasm over single payer. Americans tend to like choices. It would be difficult to convince most Americans that single payer is the best way to accomplish medical care, especially when tax rates would need to be raised significantly. I guess time will tell which way the country will head when it comes to trying to provide UHC. I just hope that the new administration will get enough cooperation to make some progress.

In the meantime, people could try and work at establishing healthier lifestyles. That in itself would help reduce the price of healthcare, as many chronic diseases are due to eating habits, smoking, lack of exercise etc. Perhaps the government needs to spend more money in helping people establish healthier living. That would be a good place to start lowering the cost of healthcare. Just a thought, not meant to shame anyone.

 

[Worldtraveller]

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

Most people wouldn't, but that's because most people are brainwashed morons.

Until I broke into the $90k+ range of income, my taxes every year (and I paid a lot because I was an independent contractor) were significantly lower than my health insurance premiums. That didn't change when I was a regular employee. Somewhere around $100k, depending on too many factors to list, most peoples' current health insurance premiums are significantly more than they pay in taxes, so they are already doubled.

It's just that we've 40 years of idiotic GOP claiming that taxes are the most evil thing evar!! And idiots that listen to them without being good at even basic arithmetic. So yeah, go ahead and double my taxes! Also, eliminate the SS cap. I will net (after taxes) more income/year and so will most other people.

The cost of M4A is less than the current tax+health insurance for probably 80% or more of the US population.

 

[ZiprHead]

The problem that I have with M4A, is that people are under the false impression that it's all free. Bernie Sanders means well, but when he said that M4A would be free and that it would cover dental, vision, drugs, long term care etc. he never explained how the country would be able to afford such coverage. I've read numerous articles explaining the over all cost and none of them seemed to find a reasonable way to pay for all of those things. We already have M'caid for those who are poor and have never paid into Medicare for at least 10 years, the minimum number of years to qualify. I've had many patients on M'caid when I was still working. While it was sometimes difficult to find a provider who accepted M'caid, all of my patients were able to get the care they needed. They were just limited to the smaller number of providers who accept that payment.

Sorry, but Bernie's plan is still cheaper than what we pay now. The Koch brothers funded a study to prove M4A would be more expensive. Too bad for them the study proved just the opposite.

'Medicare-for-All' program could cost $32 trillion but may also save $2 trillion

The PDF of the study.

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

My brother in law pays over $600/mo for his employer provided health care with huge deductibles, and he's single. He could quadruple his Medicare taxes and still pay less.

That it would raise taxes is the exact argument the righties are using against M4A.

 

[Elixir]

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

Most people wouldn't, but that's because most people are brainwashed morons.

Until I broke into the $90k+ range of income, my taxes every year (and I paid a lot because I was an independent contractor) were significantly lower than my health insurance premiums. That didn't change when I was a regular employee. Somewhere around $100k, depending on too many factors to list, most peoples' current health insurance premiums are significantly more than they pay in taxes, so they are already doubled.

It's just that we've 40 years of idiotic GOP claiming that taxes are the most evil thing evar!! And idiots that listen to them without being good at even basic arithmetic. So yeah, go ahead and double my taxes! Also, eliminate the SS cap. I will net (after taxes) more income/year and so will most other people.

The cost of M4A is less than the current tax+health insurance for probably 80% or more of the US population.

Huh? You got off easy! Years ago when I was extracting 35-40k salary from my startup, the cost for my wife and myself to get private (blue cross/blue shield) "catastrophic only" (10k deductible, no prescription) coverage was over 8k and climbing every year.
Now I'm more than a decade older (therefore higher risk) and am paying Medicare premiums on the order of $3500/yr plus about 2k/yr for a "Part N" that reduces our deductible to zero. It's going to go way down from there in a few years because I'm still in the six-figure bracket, and premiums are based on two-year trailing income.

I don't care how you slice it, inserting a middleman who extracts massive profits and accrues vast administrative expenses, does NOT produce cheaper or better health care. That so many people are brainwashed into thinking otherwise in the face of global (and national) evidence to the contrary, speaks directly to the stupidity and vulnerability to propaganda that put Trump, McConnell and the rest of the kleptocrat community in charge of our government.

 

[T.G.G. Moogly]

In the meantime, people could try and work at establishing healthier lifestyles. That in itself would help reduce the price of healthcare, as many chronic diseases are due to eating habits, smoking, lack of exercise etc.

Not surprisingly that is the most effective way to drastically lower and even eliminate one's medical bills. But not gonna happen anytime soon.

 

[Metaphor]

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

For me, it's difficult to believe that the overall cost to consumers of healthcare would be higher under single payer.

It is certain that taxes will have to increase, but surely the median tax increase due to single payer would be more than compensated for by the decrease in premiums that individual consumers (or employers on their behalf) would pay?

 

[Treedbear]

The articles said that if taxes were doubled it still wouldn't be enough to cover M4A. Do you really think that most Americans would be happy to pay twice their current rate of taxes in order to have M4A? I'm highly skeptical of that. Your link also said that was the reason why states like California weren't able to accomplish single payer. The large increase in taxes wasn't considered feasible. If I remember correctly, even Vermont, Bernie's state, wasn't able to come up with an affordable single payer plan without raises taxes substantially. I don't know.

For me, it's difficult to believe that the overall cost to consumers of healthcare would be higher under single payer.

It is certain that taxes will have to increase, but surely the median tax increase due to single payer would be more than compensated for by the decrease in premiums that individual consumers (or employers on their behalf) would pay?

I was googling around and found that all health insurance plans paid out a total of $1.2T in a recent year. And total federal tax revenue is about $3.5T per year. So if the reported cost for M4A is $3.2T per year then you have an increased cost of $2.0T, or 57%. And that doesn't factor in the profits and overhead going to the insurance companies.

 

[Loren Pechtel]

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

No. It's not about a tax break. It's about ensuring they don't leave money on the table. Any doctor's office is going to set it's price at least as high as the highest insurance reimbursement anyone might pay them, and they want it considerably higher because of liability cases--they might not get paid for years in those but they're not going to get any interest and they might not even get paid if the person loses their case or doesn't collect enough to cover all the costs.

If you are correct, my brother in law, who is a dentist has been cheating on his taxes for decades. I suspect that he does cheat on his taxes, knowing some of the things that he has claimed as business expenses over the years. I don't know why he has shared so much information with my husband.

When I worked in home health, I was given the impression from management that supplies were billed at exorbitant amounts in order to take a tax right off. That was a long time ago, but why would an agency charge 150 dollars for a simple urinary catheter, when they only received about 15 dollars from Medicare for that device? It never made any sense. No insurance company is going to pay 150 dollars for a urinary catheter, plus almost all home health care is provided through Medicare or M'caid. Home health agencies rarely ever get sued. Regardless of the reason, those charges were insane. Why does the so called non profit Emory Healthcare charge for an extended visit of 400 dollars when someone gets a COVID test, despite the fact that no time was spent with a provider, other than to obtain the specimen? An extended visit is supposed to take at least 45 minutes, not 5 minutes. The lab test is also billed. There are so many things that make no sense in the way that our health care providers bill. What about labs? Why would a lab charge more than twice the reimbursement rate for a simple test? It's hard for me to believe that this is all due to fear of liability or as you said, not leaving any money on the table. If it's not about writing things off as a tax loss, it makes no sense as to why some of these tests, procedures etc. are billed at exorbitant amounts. Maybe a good start would be to have all tests, procedures, medical visits, etc. billed and paid at the same rate. Worse yet, why are those without any insurance billed at much higher rates than those who do have insurance? Regardless of what is decided, we need drastic changes in the way that the country provides and bills for healthcare.

I don't live in a state where there are that many lawsuits and there is a two year limit here on being able to sue medical providers and agencies. I think that's fair in most cases. We expect too much from medical providers. People need to take more responsibility for their own health and not depend too much on medical providers. But, I'm off topic, so I'll leave it at that.

You misunderstand--by "liability" I wasn't talking about them being sued, but about when they are getting care because of a lawsuit--say, the person who ended up badly disabled by an auto accident.

The thing is there is no downside to setting the charge very high. Usually it's moot, occasionally it means a bunch of money for them.

As for the brother-in-law, if they're doing accrual accounting it's completely legitimate--it's just the write-off is of the amount they charged but didn't get. Your income is what you actually collect, whether you do cash accounting which records what you actually get, or accrual which records what you charge and writes off what you didn't collect. The final answer is the same either way, although it can make a difference in what year income shows up in. I know of no reason for a small company to do accrual accounting but I'm not an accountant.

 

[Loren Pechtel]

The federal government subsidizes Advantage Plans. I think I mentioned that in a former post. Advantage Plans have gotten much better over the years. When they first came out, I think they were all HMO's, but now PPOs are becoming more common. I had patients who had to drop their Advantage Plans once they started having serious medical problems because a lot of providers wouldn't take them on as patients. That is changing now. Hopefully, things will get better as more people choose them. The last time I read about them, over one third of Medicare recipients were choosing them instead of Traditional Medicare.

Medicare care part A is free. That's the part that covers hospitalization with some deductibles. It's B that has premiums. If you're poor, part B is free. Most people will pay 148.50 next year for Part B, but if your income is over a certain amount, the part B premium is higher. I'm not in that income range so I don't remember exactly what the premium is for those over a certain income level. Most Advantage Plans are free, but some have premiums. It's a bit confusing and can be overwhelming for some people. I have an agent. I haven't needed her to help me choose a plan, but last year, Cigna got my pain mixed up and she advocated for me with both Cigna and Medicare and helped me get things straightened out. It doesn't hurt to have an agent help with choosing a Medicare Plan, considering the many choices and complexity of them.

My understanding is that if your health is reasonably good the medicare advantage plans are your best bet, but when things go downhill they can be a problem. With HMOs the approval process can interfere with getting prompt care.

 

[Loren Pechtel]

The problem that most people have with M4A is that they envision it being implemented more or less as Medicare is now, just for everyone. That would maybe work, but it would better to overhaul the system to a true UHC, IMO.

Because Medicare sprang up in the already existing market that was ruled by employer/private insurance, it doesn't really work like it could. The big difference is that costs at the provider level aren't really controlled in a meaningful way. It's capitalism...charge as much as the market will bear.

The classic examples of picking some medical procedure in another country with UHC compared to the US. You could usually afford to fly to that other country, get a 2 week vacation, and still get your issue (broken arm, major surgery, etc) taken care of. A broken arm doesn't need to cost $6k like it does in the US. We need to get out of that mindset before any meaningful change can happen.

Costs need to be regulated (and we can use other countries for good guidelines) and eliminate so much of the current waste in the system. Something like 2/3 of medical expenses go to paperwork largely due to the non-standardized billing from all the private insurers.

Something to keep in mind with medical tourism--while the care might appear to be western-level their ability to deal with something going wrong is almost certainly nowhere near western level.