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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Tue July 31, 2018 6:04 pm 
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Bi_3 wrote:
elliseamos wrote:
Bi_3 wrote:
elliseamos wrote:
Bi_3 wrote:
elliseamos wrote:
Bi_3 wrote:

Quote:
The Mercatus study takes issue with a key cost-saving feature of the plan — that hospitals and doctors will accept payment based on lower Medicare rates for all their patients.
This seems like the whole crux of the plan. What does the the study do for these cost estimates?


It’s cagey about it, but:

“M4A would markedly increase the demand for healthcare services while simultaneously cutting payments to providers by more than 40 percent, reducing payments to levels that are lower on average than providers’ current costs of providing care. It cannot be known how much providers will react to these losses by reducing the availabil- ity of existing health services, the quality of such services, or both.”

There is an assumption in most of single payer plans that the market would adjust to Medicare/Medicaid rates by elimination of the insurance middleman, but they are short on details of how.
does anything attempt to explain that such a system would mean that all patient services would be paid, therefore overall costs would have to come down bc there wouldn't be any deferred cost placed on insured patients (which is what currently creates the pricing mystery)? Likewise, is there any mention that by having everyone insured at younger ages, the cost of care at advanced age should be reduced bc people would be healthier? Every doctor I get the chance to speak with (which is many bc it's my wife's field) always emphasizes the value of preventative care.


I think this assumption is part of what the study is disputing, but I did not read the whole thing and am by no means an expert on this topic.

It only mentions this:

"For example, in 2014, hospitals were reimbursed just 89% of their costs of treating Medicare patients and 90% of their costs of treating Medicaid patients -- losses that were offset by hospitals collecting private insurance reimbursement rates equaling 144% of their costs."

It then jumps to say that if every patient was only covered at medicare rates then all hospitals would run negative, but the author ignores the gap that currently exists for unpaid patient services. So my question still remains, which this study didn't/couldn't answer, but what would such a plan do for hospitals overall if (1) all services were paid in full & on time; and (2) if more and more patients were getting preventative care/scans/tests, as oppose to emergent care (which is much more expensive)?

And like McP pointed out, the study finds that overall M4A would reduce costs from what they're expected to be without a change to the system.


Reducing an estimated $10B from an estimated $3,200B is not significant enough to be a point in this debate and the external costs to the economic structure of the country might not even be estimable.


But your quote above misses an important point from this and nearly every study on the topic, that Medicare rates are too low to be profitable for most hospitals and doctors. So even if they were being paid 100% of the time, they would still be losing money on most interactions:

Image


Now take those numbers and magnify across the entire population...

I think that still avoids the point. If the prices aren't inflated due to non-payers (those without any coverage that get treatment) and over-payers (those with insurance that pays a higher rate to attempt to mitigate the prior group's unpaid bills), then M4A is the only price no matter where you go and it's 100% covered.


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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Tue July 31, 2018 6:12 pm 
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4/5 wrote:
elliseamos wrote:
4/5 wrote:
elliseamos wrote:
(2) if more and more patients were getting preventative care/scans/tests, as oppose to emergent care (which is much more expensive)?

That sounds good, but I'd be concerned that increased tests and screening would lead to more false positives and more treatment for conditions that wouldn't have affected the person's quality of life had they not been discovered. I imagine that this in turn could lead to more not less treatment.

This is true, but earlier treatment will (in most instances) be less costly than an individual's system failure later on down the line. As I've been told, the two biggest drivers of absurd costs within the current US system of medicine is unnecessary emergency care and caring for the elderly.

Of course I agree that earlier treatment is usually less costly. On an individual level that's certainly true but I wonder if it still holds for society as a whole if you greatly increase the preventative/testing/screening, etc. across the board. I'm just thinking out loud, I don't have any data I'm referring to. It would seem to me that at some point that so much could be spent on the upfront preventative stuff on healthy people that it could outweigh the decreases in emergency care. I have no idea where that threshold would be, but it seems like it should likely exist at some point.
I get it, and it's a good question, but the sense I get from friends is that improving things upstream (younger ages more regularly and detecting problems earlier) saves significant money.


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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Tue July 31, 2018 6:56 pm 
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elliseamos wrote:
Bi_3 wrote:
elliseamos wrote:
Bi_3 wrote:

I think this assumption is part of what the study is disputing, but I did not read the whole thing and am by no means an expert on this topic.

It only mentions this:

"For example, in 2014, hospitals were reimbursed just 89% of their costs of treating Medicare patients and 90% of their costs of treating Medicaid patients -- losses that were offset by hospitals collecting private insurance reimbursement rates equaling 144% of their costs."

It then jumps to say that if every patient was only covered at medicare rates then all hospitals would run negative, but the author ignores the gap that currently exists for unpaid patient services. So my question still remains, which this study didn't/couldn't answer, but what would such a plan do for hospitals overall if (1) all services were paid in full & on time; and (2) if more and more patients were getting preventative care/scans/tests, as oppose to emergent care (which is much more expensive)?

And like McP pointed out, the study finds that overall M4A would reduce costs from what they're expected to be without a change to the system.


Reducing an estimated $10B from an estimated $3,200B is not significant enough to be a point in this debate and the external costs to the economic structure of the country might not even be estimable.


But your quote above misses an important point from this and nearly every study on the topic, that Medicare rates are too low to be profitable for most hospitals and doctors. So even if they were being paid 100% of the time, they would still be losing money on most interactions:

Image


Now take those numbers and magnify across the entire population...

I think that still avoids the point. If the prices aren't inflated due to non-payers (those without any coverage that get treatment) and over-payers (those with insurance that pays a higher rate to attempt to mitigate the prior group's unpaid bills), then M4A is the only price no matter where you go and it's 100% covered.



*snipped out the middle

I think we are talking about two different things and both could be right. You are correct in that hospitals would not need to vary the prices if all patient services were reimbursed at a fixed rate and that in itself may reduce overall costs through reductions in administrative needs. My point was (and what is covered in that HBR link above) is that it doesn't matter what percentage of the patients provide reimbursement if the dollar amount of the reimbursement is below cost of providing the service, which is currently the case for both Medicare and Medicaid. If 100% of the customers are paying you 90% of what it costs you to make something, you will go bankrupt quickly (vs. charging some custs 110+% to compensate).


I'm also not sold that preventative care will reduce costs in the long term. It will certainly defer costs and improve quality of life (QoL is a different question), but the longer people live after they stop working, the more expensive their care is relative to their contributions thus placing a greater burden on the support system.

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I really hope we get this figured out soon


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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Tue July 31, 2018 7:12 pm 
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Bi_3 wrote:
I think we are talking about two different things and both could be right. You are correct in that hospitals would not need to vary the prices if all patient services were reimbursed at a fixed rate and that in itself may reduce overall costs through reductions in administrative needs. My point was (and what is covered in that HBR link above) is that it doesn't matter what percentage of the patients provide reimbursement if the dollar amount of the reimbursement is below cost of providing the service, which is currently the case for both Medicare and Medicaid. If 100% of the customers are paying you 90% of what it costs you to make something, you will go bankrupt quickly (vs. charging some custs 110+% to compensate).
As far as I know/understand things (which could be wrong), the idea that "reimbursement will be below [the] cost of providing the service" is not a real concern. The price will be what it is and that price will be paid.

Bi_3 wrote:
I'm also not sold that preventative care will reduce costs in the long term. It will certainly defer costs and improve quality of life (QoL is a different question), but the longer people live after they stop working, the more expensive their care is relative to their contributions thus placing a greater burden on the support system.
Again, this is not something I'm well versed in as the majority of my opinion/position is based on conversations with doctors during dinners/cookouts, but the impression I get is what I've been saying "reducing the unnecessary emergency room patients" and "treating ailments earlier" will reduce costs for providers.


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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Wed August 01, 2018 12:04 am 
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Quote:
Even using Blahous’s numbers — which may be off by roughly $15 trillion according to Himmelstein and Woolhandler’s estimates — the conclusion is plain: “Medicare for All” would cover more people, increase the quality of coverage, and cost less than is currently being spent on health care. “Blahous admits that covering the uninsured and upgrading coverage for most others could be achieved at virtually no additional cost through a single payer reform,”


https://theintercept.com/2018/07/30/med ... are-wages/


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 Post subject: Re: Healthcare Thread (really "Sickcare" in America)
PostPosted: Mon August 27, 2018 5:44 pm 
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