Snorkelson
Footballguy
Right. They didn’t need healthcare for all, because everyone got healthcare because the prices were affordable. And if you couldn’t pay your bill you just gave them a chicken or something.
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Trump care, Trump just lied straight into your face (1 Viewer)
- Thread starter bosoxs45
- Start date
The Commish
Footballguy
I think it's important to remember how we got to where we're at. Matttyl's comments are appropriate and knowledgeable. The others refusing to discuss the current situation and only want to focus on history? Well, I cut them a break given they have no choice. Their "side" isn't giving them much to work with so it's best to just sit back and watch the show as they flale about like a flag in the wind. And I did post the M4A thing here forgetting there was a whole thread for it. So that was my bad. No shot of that happening under GOP watch. Way too many donor bucks coming in there.
matttyl
Footballguy
Well, he wasn't my buddy, he was my client. I'm curious as to these reasons someone wsn't covered before their back injury. Again, the point of insurance is to have it in place before the unknown occurs.
As to my "buddy" (client), you say that perhaps he'll find himself in a different situation later - what do you mean by that? That another health related mater could come up? Well, that's why he had insurance in place - my point above.
matttyl
Footballguy
Charge more than the allowable Medicare/Medicaid rates. That was my point above. Just because everyone would have Medicare doesn't mean that doctors and hospitals would have to accept it - they could still charge whatever they want and "balance bill" you. The numbers I just found are a few years old (and were only getting worse at the time), but of all Primary Care docs (who as a general rule accept far more insurance types than specialist docs) in a 2015 study done by KFF, only 72% of them were accepting new patients with Medicare (and less than half of them [who aren't pediatricians] accept new patients with Medicaid). Those numbers are what they are in today's world where they can supplement that "lost income" by making up for it with patients who have private insurance where they get paid more for the same thing. So if everyone all of a sudden had Medicare, they'd either start not accepting new patients with it (as 28% of them were doing in 2015), or require Medicaid to pay them more than the current amount.What would their choice be? Isn't that the "fear" the GOP has, that if the government can set the prices it will somehow blow the whole thing up? FWIW....I think it's a bit unrealistic to see an immediate cut of 40%, but I can see that being a target that's phased in. I can't help but wonder, after my wife's recent gall bladder surgery, that they wouldn't be able to save that in administrative costs alone. I sat there watching dollar bill burned up by the minute in inefficiencies of their processes.
And yes, I know all about the inefficiencies in our health care system - my 3 year old spent 22 nights in hospitals last year. Thank God, he's perfectly fine now. But I dealt with the inefficiencies in the process which likely in the end saved his eyesight, and possibly even more.
Gachi
Footballguy
Maybe it’s an extreme case, but according to Michael Moore’s doc “Sicko” a pre-existing condition could mean anything from being slightly overweight to having had a yeast infection or eczema.
So the issue is that “pre-existing conditions” is (or was) completely arbitrary according to insurance companies. Under the ACA, insurance companies have to offer you something no matter your condition. They can not deny you coverage, which has lead to “death spirals” apparently.
As someone who hasn’t had medical coverage in years because I can’t afford it, I’m in the camp of price transparency and eliminating administrative costs. I detest libertarians, but I do agree with their belief on healthcare: “if people paid full price for it, the prices will drop.”
So the issue is that “pre-existing conditions” is (or was) completely arbitrary according to insurance companies. Under the ACA, insurance companies have to offer you something no matter your condition. They can not deny you coverage, which has lead to “death spirals” apparently.
As someone who hasn’t had medical coverage in years because I can’t afford it, I’m in the camp of price transparency and eliminating administrative costs. I detest libertarians, but I do agree with their belief on healthcare: “if people paid full price for it, the prices will drop.”
Jackstraw
Footballguy
https://www.cnn.com/2019/04/02/politics/trump-health-care-2020-election/index.html?utm_term=link&utm_medium=social&utm_content=2019-04-02T07%3A05%3A02&utm_source=twCNN
Trump says vote on GOP's health care proposal won't come until after 2020 election
By Kyle Feldscher, CNN
Updated 8:12 AM ET, Tue April 2, 2019
(CNN)President Donald Trump said late Monday night that Republicans are working on a new health care plan but won't introduce it until after the 2020 election.
"Everybody agrees that ObamaCare doesn't work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance," Trump said on Twitter. There is no evidence that there is another health care reform proposal coming from the GOP.
"The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win back the House. It will be truly great HealthCare that will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!"
AND THE MAGAS WILL EAT THAT STUFF UP I TOTALLY HAVE A HOT GIRLFRIEND BUT SHE LIVES IN CANADA YOU WOULDN"T KNOW HER.
He's gonna run on lower premiums, lower deductibles, lower costs, pre existing conditions and universal coverage you'll get so sick of winning!!!! Crafty.
What a joke.
Trump says vote on GOP's health care proposal won't come until after 2020 election
By Kyle Feldscher, CNN
Updated 8:12 AM ET, Tue April 2, 2019
(CNN)President Donald Trump said late Monday night that Republicans are working on a new health care plan but won't introduce it until after the 2020 election.
"Everybody agrees that ObamaCare doesn't work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance," Trump said on Twitter. There is no evidence that there is another health care reform proposal coming from the GOP.
"The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win back the House. It will be truly great HealthCare that will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!"
AND THE MAGAS WILL EAT THAT STUFF UP I TOTALLY HAVE A HOT GIRLFRIEND BUT SHE LIVES IN CANADA YOU WOULDN"T KNOW HER.
He's gonna run on lower premiums, lower deductibles, lower costs, pre existing conditions and universal coverage you'll get so sick of winning!!!! Crafty.
What a joke.
The Commish
Footballguy
So break the law? I'm not being flippant so I hope it doesn't come across that way, but if M4A was implemented into law as above (for illustrative purposes only) setting those prices would be part of the deal and written into the law. Going this route makes it easy to invision many hospitals shutting down shop if they refuse the revenue source that would be supplying well over 50% of their revenue, no? It's either that or they attempt to make a run at being the hospital for the elite and not dealing with insurance at all.
I think this goes back to the cost predicament you and I have talked about (and agree on, I think) time and time again. These hospitals are going to go through a huge transition in this scenario. They won't be able to keep status quo.
The Commish
Footballguy
Sadly, that's probably the smartest thing he's done politically since he got into office. It is a 100% losing argument. However, if I am the Dems, I still pound on this bringing it up time and time again. He opened that door and there's no reason not to keep it open.
matttyl
Footballguy
That's the best way to phrase it. And no, Moore's doc wasn't an extreme case at all.
Anything and everything could have been a "pre-exisiting condition", so when I see stats that "170m people have a pre-exisiting condition", I'd think to myself it's more than that - everyone has one. Myself included. Back in the pre-ACA days, if you were trying to get an individual health policy, you'd take a paper application and in it were medical questions (I still have old ones here in my office). They'd ask your height and weight, if you smoke, how much you drink, if you partake in illegal drug use. Then they'd ask some "yes/no" type questions for a lifetime with stuff like heart attacks, strokes, cancer, diabetes, MS, hepatitis, and so on. Then maybe a "in the past 5 or 10 years" yes/no questions with stuff like arthritis, asthma, hernia, implants, STDs, hypertension, and so forth. They'd also ask about any hospitalizations you've had in the past so many years. Any yes answers - there was a place to put details. The underwriter would take that information and make an offer of coverage.
My main carrier at the time (and still), who has a color in their name (you know the one) had a bunch of policies available (different deductible or out of pocket amounts) and would give you your choice of any of them at one of four health levels - conveniently named 1, 2, 3, and 4. A "level 1" would be the best health rating, and come with the lowest premium. A level 2 would be someone who's generally healthy, but maybe uses tobacco occasionally, or could lose a few pounds, or who's on a generic medication or two - and generally had a premium 10-25% higher depending on age. A level 3 was someone with a slightly more extensive health history - like me at the time I applied. See above where I listed "implants"? Well in college I broke my wrist, and in setting it back the doc needed to use a plate and 5 screws - so I had an "implant", AKA "internal fixation device" which automatically put me at a level 3 for either 5 or 7 years post surgery with no complications (I reapplied after the time frame expired, and I was upgraded to a level 1). A level 3 typically came with a premium that was 30-50% higher than a level 1, depending again on age.
Now for level 4. If you were coming from other "credible coverage" (like an employer group plan) and were thus "HIPAA qualified", but had an extensive health history and would otherwise be declined you were offered a policy that was 2-3x as expensive as a level 1 (maybe more, depending on age). So it was your health history that deemed what "level" you were offered with a policy. If you weren't coming from other HIPAA qualified coverage, you could be denied. So if you already had coverage, and were losing it, you couldn't be denied new coverage (but it could be prohibitively expensive)
Now for the tricky part - a pre-exisiting condition limitation. No matter what health level you were given, if you weren't coming from a qualified health plan before this new policy you were applying for (had at least a 63 day break in coverage from your prior coverage) you were given a pre-ex limitation - meaning the policy wouldn't cover anything you had (or were treated for) just prior to this new policy going into effect for a period of time, typically 12 months. You were given credit against that limitation for every month you had coverage prior - so if you had a policy for only 6 months prior to this new policy, the new pre-ex on the plan you apply for would only be 6 months. So if you were taking a blood pressure medication, for instance, and had this pre-ex limitation, the new policy wouldn't cover it if you didn't have qualifying coverage prior to this policy (even though you may have already been rated for it via underwriting described above). This prevented people from simply buying coverage when they needed it (well, this and underwriting), and why it was always important to have continuous coverage.
Was hoping this post wouldn't be a long one, seems like I failed. Anyway, I think that anything involving a new "Trump Care" alternative to the ACA will most likely have something similar. You simply can't have guaranteed issue (everyone can get a policy), community rating (everyone pays the same rate), and the elimination of a pre-ex limitation (everyone gets coverage for everything from day 1 with no waiting periods) all work together without a "death spiral" (prices going up and the number of insured going down) or something close to it occurring due to adverse selection.
matttyl
Footballguy
It wouldn't be breaking the law. The law would simply be that everyone (or close to) would have Medicare, and here's what Medicare pays for procedure X. Providers can still charge whatever they want to - which could be the Medicare approved charge, or it could be something much higher. I don't think the government has to authority to force the providers to charge only certain amounts.
timschochet
Footballguy
It will be the central issue of the debates between Trump and the Democratic candidate.
Godsbrother
Footballguy
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The Commish
Footballguy
We see this all the time with price gouging laws in state/local situations like hotels after a disaster etc. I haven't looked into it, and I could be wrong, but I don't think it's out of the ordinary to put caps on pricing by governments.
matttyl
Footballguy
I did, this past year. Very much so. If I had an ACA individual plan, I'd be hundreds of thousands in debt right now. Due to the plan I had for my kid (private health insurance through my wife's employer), we were out a few grand from my HSA and everything else was paid for - likely saving my son's vision.
matttyl
Footballguy
Sounds like extenuating circumstances there, and likely only for a limited period of time. It would be like the government forcing an auto manufacturer to sell cars for $20k when they want to sell them for $30k. The government would just be saying (if we went medicare for all) "here's what we'll pay" - just like in today's world it would be up to the provider to either accept Medicare reimbursement rates, or not.
Sheriff Bart
Footballguy
The Commish
Footballguy
Perhaps. I think there is a significant amount of gray area between "charge whatever you want" that we have today and "you're only allowed to charge X amount".
matttyl
Footballguy
They can only do that if they don't accept the type of coverage you have (just making sure we're on the same page). If they do accept your coverage, then they have to follow the "you're only allowed to charge X amount." That's why I try to steer people into the largest network available to them (PPO vs HMO), I don't want to be the one telling them they can't go to Johns Hopkins or wherever should the need arise.
Going Medicare for all would just mean everyone shifts to that, but the providers would still be able to either be in network or not.
That's good news about your son. How is he doing now?
I haven't really kept up with the Obamacare thread, so I don't know if you've posted your thoughts on this already, but what changes would you like to see to the system that would make it work more effectively for everyone? I suspect we don't see eye-to-eye politically, but it sounds like you work in the industry and have an insider's perspective on a lot of this stuff, whereas I try mightily to understand how it all works but still find it highly inscrutable. Also, while I would love to get to a point where a) everyone is covered and b) we de-link coverage from employment, I'm also very nervous about how disruptive a transition period could be, and what unintended consequences might crop up.
siffoin
Footballguy
How do you know this as 100% fact. It's possible (dare I say probable) that M4A or Universal HC would be similar in many ways to the current Medicare, but different in many ways as well. If there is no law in place for M4A, how is it possible to know EXACTLY how providers or networks will care for patients, what they are paid, the impact of private insurance etc?
Skoo
Footballguy
January 11th, 2017:
President-elect Trump on Wednesday said a "repeal-and-replace" plan for Obamacare would be submitted as soon as the Senate approves his nominee, Rep. Tom Price, R-Ga., for secretary of the U.S. Health and Human Services Department.
"It will be essentially simultaneously," Trump said. "The same day or the same week ... could be the same hour."
President-elect Trump on Wednesday said a "repeal-and-replace" plan for Obamacare would be submitted as soon as the Senate approves his nominee, Rep. Tom Price, R-Ga., for secretary of the U.S. Health and Human Services Department.
"It will be essentially simultaneously," Trump said. "The same day or the same week ... could be the same hour."
matttyl
Footballguy
Sorry, I'm not following what you're asking here. You bolded my last statement and then ask if this is fact. Why wouldn't it be? It's what's in place today. Currently we have what, 325m Americans. Of them about 30m have traditional Medicare (over 65), 17m have Medicare Advantage (Medicare and private insurance mix), and about 9m have Medicare and are under 65 (end stage renal disease, or eligible for Medicare for another reason while being under age 65). That's only about 17% of the total population, and only 12% have "traditional medicare". Medicare typically pays less than private insurance to providers - which is why many don't take it, or won't take new patients that have it. Those that do accept it do so knowing they'll make less from them, but will make up for it with more profitable patients that have private insurance. If everyone all of a sudden had Medicare and not private insurance, it would still be up to the provider to either be in network and accept that lower payment scale, or be out of network and still be able to charge what they want.
TobiasFunke
Footballguy
Pelosi said we have to pass Obamacare so people can find out what's in it and it totally made sense in context (she was referring to how many of the benefits would become clear once it was the law), but she still gets killed for this constantly to the point that everyone here knows who said that line and what it was about.
Trump basically just said "I have an Obamacare replacement, but you have to reelect me to see what's in it," and this will go completely unchallenged by the media and the public.
We've lowered the bar to previously unseen depths in our collective effort to normalize an incompetent monstrous buffoon and his enablers.
Skoo
Footballguy
Is there any precedence for this?
"We will have an amazing plan but it won't be released for two years and that's only if we win back the house!"
It's almost, almost as if this guy has no clue what he's doing. Almost.
Amused to Death
Footballguy
Why the rush? The GOP has only had what, 9 years to come up with a plan? What's another year and a half? Whatever it is, I'm sure it will be wonderful - and cheap.
Skoo
Footballguy
Mitch McConnell: Obamacare is the worst piece of legislation in the last 50 years!
Also Mitch McConnell: What? No, I never said we had a better plan.
TobiasFunke
Footballguy
There is no precedent for any of this. Nobody has ever dared to think so little of the American people and gotten away with it. Even P.T. Barnum would be shaking his head in amazement.
Skoo
Footballguy
I for one am shocked that the world's greatest deal maker can only get something passed if he controls both houses of Congress.
Oh, right. He can't even do that.
matttyl
Footballguy
He's doing great. It's a long story, but about 2 weeks ago we had our 3 month follow up with another MRI/MRA/MRV scan and all looks good. His final diagnosis was "Pseudotumor" (aka idiopathic intracranial hypertension - means his body either created too much spinal fluid, or didn't absorb it back fast enough causing his intracranial pressure to rise), which if you look up is already extremely rare - but when it does happen it's generally with "women of childbearing age who are generally overweight." We ended up having to go to Children's National Hospital in DC and spend 11 nights there as no one in the country had every seen this diagnosis in a male child of that age, so they didn't believe it. The fix was simple enough, even though it was technically brain surgery - a shunt was installed in his head (like a pressure relief valve), and it drains to his abdominal cavity.
Anyway, I specifically mentioned Children's National in DC because that's outside the state of Virginia (where I live), and thus would have been out of network if we had the only individual plan available to us where we live (which is an in state only HMO). I'd have been paying cash, to the tune of hundreds of thousands of dollars (possibly 7 figures), which even though I'm a FBG, I don't have sitting around. Because he was covered on my wife's employer plan with a nationwide PPO, they were in network, and we just hit our max OOP and the policy covered the rest, in full. We never received a single "balance bill", thank God.
I have a lot of thoughts on what to change if we stay in a non-single payer system. I never thought a system which is guaranteed issue (no one can be declined), community rated (everyone pays the same regardless of health), and has no pre-ex limitations (no waiting periods for services, everything is fully covered from day 1) would work unless each and every single person was in the pool - which was never going to happen. You can't just allow people to sign up for coverage when they need it, and then drop it when they don't - everyone has to be in the deal from the start, and stay there. Even then it might not work. So I think we need to adjust the later two (community rating and pre-ex limits). Even bigger than that, and what should be obvious to everyone - the biggest issue here is the cost of care. Most people don't realize it, but for every dollar you spend in health insurance premiums, generally only about 3-5 cents ends up as profit to the carrier, sometimes less. I understand that we're talking about 3-5 cents of a whole lot of dollars, but the vast bulk of that dollar is going to pay for healthcare. Generally around 87 cents or so (the rest to stuff like overhead, taxes, a small commission to an agent or broker like me
. If people realized what stuff costs, which there generally is no way to determine, they'd be shocked. I mean, I get that my son spent 11 nights in a Children's hospital in a private room, but should each of those nights been over ten grand (likely more)? Should each of the MRIs or MRVs or MRAs he got (those are all different, by the way) be around $3k? If we're able to do something about the cost of care itself, then the cost of insuring that care will come down, and more people will be able to afford it. I've got other thoughts as well, including how dumb Americans are in general, but this post is already long enough.
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TobiasFunke
Footballguy
Obviously when you're there your thoughts are elsewhere, but if you ever have to return for a stay for any reason at all, the complex is within walking distance of Casa Funke. Recommendations, rides, a home-cooked meal, a place to crash- whatever you and yours need.
matttyl
Footballguy
Also, for everyone saying we need to cut the employment-health coverage link - if we did so without an immediate replacement (and not the current individual market), the uninsured rate would skyrocket. Said another way - there are lots of people who only have coverage today because their employer has them set up on it. If you suddenly cut that off, even if you give the employees the money that the employer was spending on it, many of them will never go through the process of getting themselves alternate coverage. They'll just pocket the money and go uninsured.
I mean I'm setting up a new group this week, where the employer is going to offer a gold tier plan with only a $1k deductible and pay 75% of the premiums for the employees (all of which can afford the other 25% from the incomes I see on the census). A few of them still don't want it, even though it would only be like $100 a month for that plan. If they won't jump it when paying only 25% of the premium, they sure won't jump in when they'd have to pay 100% of it.
I mean I'm setting up a new group this week, where the employer is going to offer a gold tier plan with only a $1k deductible and pay 75% of the premiums for the employees (all of which can afford the other 25% from the incomes I see on the census). A few of them still don't want it, even though it would only be like $100 a month for that plan. If they won't jump it when paying only 25% of the premium, they sure won't jump in when they'd have to pay 100% of it.
matttyl
Footballguy
Very much appreciate that offer. We'll be back every 6 months or so for checkups.TobiasFunke said:
So you'll like this story - after about a week there, it was a Saturday with great weather. I'd been sleeping in a recliner for about a week at this point, looked like poop, felt even worse. My wife kicked me out (her mother was there, and my son was fine watching TV) for a few hours to take a walk and do a few things - one of which was to get my haircut. I walked west to Georgia Ave and walked into the first barbershop I could find. "You lost son?" I got a fade....
I highly recommend you visit Spruill's if you ever get the opportunity. They know me there.
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TobiasFunke
Footballguy
This is actually an ongoing problem for me. The guys at the shops are nice as can be, but they clearly don't know what the hell to do with a middle-aged white man and his receding hairline. I've resorted to just getting haircuts every time we visit my parents or in-laws.
matttyl
Footballguy
Stop in Spruill's and get the old guy in the back on the left. He'll set you up nice. I actually learned a lot about barber shop etiquette that I simply didn't know. A great experience. But I couldn't find anywhere down that way to buy airplane bottle of liquor that I could sneak in.
This is actually an ongoing problem for me. The guys at the shops are nice as can be, but they clearly don't know what the hell to do with a middle-aged white man and his receding hairline. I've resorted to just getting haircuts every time we visit my parents or in-laws.
ETA - oh, but I did see one of the greatest signs I've ever seen right there in a bar beside Howard U. You could get a shot of whiskey, a beer and a hot dog for $5. I spent a good hour or two there....
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Joe Mammy
Footballguy
To even further screw up the chances of the Republicans coming up with a healthcare plan Trump appointed Senator Rick Scott of FL to spearhead their new "plan". As a lifetime Floridian I cringe every time I hear Red Tide Rick's name. We suffered through many years of his governorship.
Sabertooth
Footballguy
Trump never lies.
BobbyLayne
Footballguy
There’s no plan? I’m shocked.Jackstraw said:
The Commish
Footballguy
I think....I think.....everyone here who's provided the separation of insurance from employment as a net benefit is provided it with this understanding. Again, it goes to the "true cost" that most people aren't aware of or don't think of in terms of their insurance plans. We live a decent life. I married into a bit of credit card debt, we aren't house poor, can afford many things that a lot of people can't, but I couldn't afford my existing crap plan if I had to pay the whole thing myself every month...no way.
The Commish
Footballguy
siffoin
Footballguy
I guess I must be confused. It just seems to me that we can't know exactly how M4A would be structured until they begin to actually work out the details of M4A. My thought is that M4A would be similar to current Medicare, but not exactly.matttyl said:
In addition, if "EVERYONE" had M4A and that was the only option out there. Then Hospitals and Drs would either provide heath care services or they would be out of business as there would be no other option.
My point is we can't exactly say what it's going to be like until we see all of the details. And though you have magnitudes of understanding and experience far beyond me - because you work as an insurance provider it's possible your opinion is slanted - in the same way that if they decided to do a Traders Tax for financial transactions, I would be in here telling everyone how such a law would completely send the US to the economic dark ages. With that said, I do appreciate your opinion.
matttyl
Footballguy
They started putting it on line DD (I think) of W-2s a few years back. Really just so people would know how much their employer is paying for their health benefits. Blew a lot of people away here.
matttyl
Footballguy
But again, that's not necessarily the case. They could still provide health care services and charge whatever they wanted to. I don't think a M4A law would force them to participate. They can say "we'll charge 40% more than medicare pays" or something - so they'll take what Medicare pays and bill the individual the 40% extra balance (by the way, I think that's the most likely course of any M4A plan). Now this likely would cause fewer people to go to them for care, but in general doctors aren't hurting for business these days - the local primary care doc facility in my town generally has a few week wait time for new appointments.
Anyway, this all goes back to the study someone posted a page or two ago that assumed that all providers would be paid at Medicare rates and it showed the savings it would provide. The study itself realized that wouldn't likely be the case - providers would either require a higher reimbursement scale, or wouldn't participate and do their own deal (that's their other option).
Providers aren't just going to accept a ~30% pay cut without fighting back somehow.
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The Commish
Footballguy
Tau837
Footballguy
Not necessarily. Two obvious alternatives that exist today might still apply:
- Providers could no longer file insurance on behalf of the patient. That means they would bill the patient whatever they choose, and the patient could submit that for reimbursement via M4A. M4A would reimburse the payment in accordance with Medicare provider payouts. If the provider billed the patient more than that, the patient is out of pocket for the delta. My wife is disabled. We moved from VA to CA in 2014 and lived there until moving back last year. We encountered many healthcare providers in CA that fit this model, i.e., accepted/filed no insurance for patients. We spent a lot more money out of pocket for healthcare from those providers.
- Providers could charge concierge fees to be a member of the practice, but otherwise adhere to the M4A payment schedule. My wife's primary doctor here in VA has a concierge practice. We pay $1200 per year so she can see him. There is no reimbursement at all for that fee. When she visits him, he files insurance normally for those visits. I assume he would do so under M4A, although the concierge fee might go up to make up for his delta in provider payments.
Tau837
Footballguy
In fairness, there is an argument that private insurance companies drive the bulk of administrative cost for healthcare providers, since the private companies have a profit incentive and thus require more prior authorizations, impose more restrictions, delay payments, etc. I have read that many providers like dealing with Medicare much more, because they pay consistently and with the least hassle. So the argument goes that eliminating all private insurance via M4A would eliminate a huge source of administrative cost, which would at least partially offset the decline in provider payments.
I suspect that M4A advocates overestimate the cost savings, but I do think those cost savings are non-zero. As usual, the truth probably lies somewhere in the middle.
siffoin
Footballguy
Yikes. Admittedly I don't understand all of this.
So if I go in for a Quad By Pass and the cost is $100k. Medicare covers $60k. I'm on the hook for the other $40k? As the average household savings is less than $40k for people under 65 - Seems nearly every person is eventually going to go bankrupt under this scenario.
Tau837
Footballguy
Well, if the new law allowed for this scenario to occur, then inevitably private insurance would fill the gap, and we could be back to some of the same old issues of the past, e.g., can you get that private insurance if you have pre-existing conditions, how much is out of pocket/deductible, etc.
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