Obama Returns to End-of-Life Plan That Caused Stir

[DawnInTexas]

If you’re in England, and you have stage 3 or 4 Breast Cancer-the Government sends you home with pain relief to wait for the inevitable. I met these women in a group at Yahoo! It was hard on me-their emotional roller coaster-they were so brave-eventually they died.

That is the point Cancer treatment becomes most aggressive here in the USA.

I do not believe I would have received the quality of care, nor the speed of treatment I did, if the Government had their hand in my Cancer Treatments.

God Bless you.
+Peace Be With You.
Love, Dawn

 

[Ridgerunner]

No, what you have said is fundamentally flawed. You essentially repeated what I said but claimed without reason that it is the government’s fault. Medicare does not cause health care providers to act as a geographic monopoly. Health care providers can charge “bogus rates” because they are local monopoly. It is the nature of their business, just like utilities typically have geographic monopolies on their particular service (e.g. it doesn’t make sense to argue for competition for tap water.) The only way the government is at fault for this is that they have not engaged in price fixing, mandating that all health care providers charge specific rates for specific services.

In order to actually mandate lower rates, governments typically implement a single payer system, which causes the health care market to become a monopsony in which the government can dictate the terms of health care services.

It seems to me that you are saying this:
“Health care providers charge very high rates to the uninsured (or people with insurance they don’t except), and it is the government’s fault. It is the governments fault because they negotiate rates that cause health care providers to operate at a loss, a loss that they recoup by charging higher rates to the uninsured”

The problem with that statement is this: the majority of the uninsured are uninsured because they cannot afford insurance. The health care providers are not going to recoup any losses by charging someone who lives paycheck to paycheck $12,000 per MRI for example. Quite simply, that person doesn’t have that much money to give them.

Moreover, if everyone has health insurance, the health care providers will not have any customers left to charge “bogus rates.”

No. Government does, by and large, determine healthcare rates, and it does encourage monopolies in the healthcare arena. Medicare rates are determined by the cost of the '(name removed by moderator)uts". All sorts of things are included in the “(name removed by moderator)uts”, including highly-paid management of the very monopoly entities you dislike, duplication of efforts, gold plating, overbuilding and the cost of dealing with Medicare itself, which is expensive. All rates negotiated by insurers are determined by reference to Medicare rates. Some may negotiate less and some may negotiate more. But the inability of people to buy insurance nationwide is not conducive to negotiating good rates across the board.

Theoretically, providers lose money on every Medicare covered thing they do. But it’s not actually true. Most medical providers do NOT lose money on Medicare rates. I never said they do. Quite the contrary. I will say, however, that Medicare rate “fairness” is pretty spotty. For example, general surgeon “reimbursement” rates are low relative to what they do, whereas neurosurgeon rates are high relative to what they do most of the time. That very fact tends to cause concentration in the medical field.

Nobody has established that the majority of uninsureds don’t have it because they can’t afford it. Many are uninsured by choice. Many are between employers who would provide it. Many are illegal immigrants. Even this administration has varied the numbers, as has the GAO. That tells me nobody really knows.

 

[TheTrueCentrist]

No. Government does, by and large, determine healthcare rates, and it does encourage monopolies in the healthcare arena. Medicare rates are determined by the cost of the '(name removed by moderator)uts". All sorts of things are included in the “(name removed by moderator)uts”, including highly-paid management of the very monopoly entities you dislike, duplication of efforts, gold plating, overbuilding and the cost of dealing with Medicare itself, which is expensive. All rates negotiated by insurers are determined by reference to Medicare rates. Some may negotiate less and some may negotiate more. But the inability of people to buy insurance nationwide is not conducive to negotiating good rates across the board.

Theoretically, providers lose money on every Medicare covered thing they do. But it’s not actually true. Most medical providers do NOT lose money on Medicare rates. I never said they do. Quite the contrary. I will say, however, that Medicare rate “fairness” is pretty spotty. For example, general surgeon “reimbursement” rates are low relative to what they do, whereas neurosurgeon rates are high relative to what they do most of the time. That very fact tends to cause concentration in the medical field.

Nobody has established that the majority of uninsureds don’t have it because they can’t afford it. Many are uninsured by choice. Many are between employers who would provide it. Many are illegal immigrants. Even this administration has varied the numbers, as has the GAO. That tells me nobody really knows.

I agree that disparities in pay (e.g. between neurosurgeons and general surgeons) can and does skew the distribution of practitioners. That, however, is a separate issue.

If health care providers are not trying to recoup losses from Medicare, then how exactly do medicare rates determine the rates for everyone else? You say that “Some [insurers] may negotiate less and some may negotiate more [than medicare].” That is correct; that Medicare is the reference is of no consequence. The Celsius temperature scale is based on the freezing and boiling points of water, but that doesn’t mean that water determines the freezing and boiling points of everything else. It would be trivial to define a new scale that referenced something else in either case.

Why people are uninsured isn’t hugely important, what is relevant is that many people are simply unable to pay the very high “bogus” medical costs. Nearly 2/3rds of personal bankruptcies are caused by medical bills.

 

[Ridgerunner]

I agree that disparities in pay (e.g. between neurosurgeons and general surgeons) can and does skew the distribution of practitioners. That, however, is a separate issue.

If health care providers are not trying to recoup losses from Medicare, then how exactly do medicare rates determine the rates for everyone else? You say that “Some [insurers] may negotiate less and some may negotiate more [than medicare].” That is correct; that Medicare is the reference is of no consequence. The Celsius temperature scale is based on the freezing and boiling points of water, but that doesn’t mean that water determines the freezing and boiling points of everything else. It would be trivial to define a new scale that referenced something else in either case.

Why people are uninsured isn’t hugely important, what is relevant is that many people are simply unable to pay the very high “bogus” medical costs. Nearly 2/3rds of personal bankruptcies are caused by medical bills.

First point. Medicare rates are the foundation stone for all rate negotiations. Most insurers end up with lower rates than Medicare rate. I know, I used to negotiate them, and I never failed to get a discount from Medicare rate, and the providers were happy to get it. Virtually always those were negotiations with mega-providers. When you can end up paying more than Medicare rate is when the covered person is, necessarily out of network because of geographical location, uber-specialty or something like that. You can’t very well negotiate rates for one person unless, like the Amish, you pay immediately and in cash.

The reason why the starting point is Medicare rate is simplicity. An insurer and the provider do not have to negotiate every treatment, test and procedure separately. It would take forever to do that. Since everybody knows “reasonable and necessary” is bogus, there’s no point even talking about discounts from that. The “real” rate actually is Medicare rate. Insurers can plug those into the computer, apply a broad discount and perhaps a few specialized discounts, and then everybody knows what the rate is for any given thing. I’ll admit the big providers sometimes fail to apply the discounts, but they always back off if the adjuster got it right. It’s hard, even for big providers, to apply different discounts to different insurers. So they generally just take the adjuster’s word for it. I have seen that a number of times.

On an individual basis, however, Medicare rate can be chintzy, depending on what the provider is offering by way of services. That’s one of the reasons why medical providers are so big nowadays. Another, of course, is that “capturing” physicians on the “low end” as referral sources for the “high end” providers makes the arrangement more lucrative for all, or at least more secure. If you maximize the services of the expensive physicians, everybody benefits. Now and then, you will see a group of high-end physicians go form their own group. But they only do that if they think they’ll still get sufficient patients to keep them busy. A lot of that depends on relationships with insurers.

The reason why “reasonable and necessary” is bogus is because Medicare is, itself, is a theoretically discounted rate. But in actual practice, it isn’t. Everybody knows that, including the government.

 

[seekerz]

Nobody has established that the majority of uninsureds don’t have it because they can’t afford it. Many are uninsured by choice. Many are between employers who would provide it. Many are illegal immigrants. Even this administration has varied the numbers, as has the GAO. That tells me nobody really knows.

And the employees of companies which don’t provide it? And the under-insured? Nobody really knows?.. I think medical practices have a pretty good idea. What I am convinced of, is the injustice of a system where the least able to pay (the uninsured) are faced with the largest bills for indentical services. That just needs to be fixed.

 

[seekerz]

First point. Medicare rates are the foundation stone for all rate negotiations. Most insurers end up with lower rates than Medicare rate. I know, I used to negotiate them, and I never failed to get a discount from Medicare rate, and the providers were happy to get it. Virtually always those were negotiations with mega-providers. When you can end up paying more than Medicare rate is when the covered person is, necessarily out of network because of geographical location, uber-specialty or something like that. You can’t very well negotiate rates for one person unless, like the Amish, you pay immediately and in cash.

Not sure where you live, but that has not been my experience (or I am misunderstanding your post) - virtually every insurer (including Medicaid) pays more than Medicare. The smaller the insurance company, the higher the reimbursement rate but of them all, Medicare rates tend to be the lowest. People paying out of pocket tend to pay most of all unless they can negotiate a discount.

 

[Ridgerunner]

And the employees of companies which don’t provide it? And the under-insured? Nobody really knows?.. I think medical practices have a pretty good idea. What I am convinced of, is the injustice of a system where the least able to pay (the uninsured) are faced with the largest bills for indentical services. That just needs to be fixed.

Of course it’s unjust. It’s one of those governmental lies that turns everyone else into a liar as well. The primary lie is that Medicare is truly discounted. The secondary lie, flowing from the first, is that “reasonable and necessary” charges really are reasonable and necessary.

 

[Ridgerunner]

Not sure where you live, but that has not been my experience (or I am misunderstanding your post) - virtually every insurer (including Medicaid) pays more than Medicare. The smaller the insurance company, the higher the reimbursement rate but of them all, Medicare rates tend to be the lowest. People paying out of pocket tend to pay most of all unless they can negotiate a discount.

Southern Missouri. I won’t say that no insurers pay more than Medicare, and never said that. Some insurer with no significant volume in a given area is going to have difficulty negotiating with providers in that area. If you have volume, you can get deep discounts for the asking. The only question is “how deep”? And they’re glad to get it.

The “patient flow” is more important, on the whole, than is the price of a service. That could be affected by a lot of things, but the insurer deals and organization are extremely important to efficient patient flow.

But I won’t say it’s true everywhere either. Just everywhere I have negotiated services and rates. About two years ago I talked to my successor in that job and he is still getting big discounts from Medicare rate, particularly in low-population areas.

This area actually is part of an economic zone that includes northwest Arkansas. Medical providers and facilities in both places are excellent. Other than the relatively low cost of living here, I can’t explain why Medicare rate would be lower than major area insurers would pay somewhere else. Well, I will say that the big provider groups here are pretty well capitalized, and that matters.

Medicaid does not pay more than Medicare on a per-service basis. It pays less, and providers are reluctant to take on too many of them. It’s possible that the average Medicaid patient costs more than the average Medicare patient on an annual basis because Medicaid is very overutilized. Probably the worst Medicaid abuse is constant resort to ER treatment for minor things. It’s free, so why wait for the doctor’s office to open? Another Medicaid abuse comes from the fact that a lot of Medicaid patients are subject to the authority of governmental entities, and the latter massively encourage overutilization in order to cover their own backsides from charges of neglect.

 

[seekerz]

Southern Missouri. I won’t say that no insurers pay more than Medicare, and never said that. Some insurer with no significant volume in a given area is going to have difficulty negotiating with providers in that area. If you have volume, you can get deep discounts for the asking. The only question is “how deep”? And they’re glad to get it.

The “patient flow” is more important, on the whole, than is the price of a service. That could be affected by a lot of things, but the insurer deals and organization are extremely important to efficient patient flow.

But I won’t say it’s true everywhere either. Just everywhere I have negotiated services and rates. About two years ago I talked to my successor in that job and he is still getting big discounts from Medicare rate, particularly in low-population areas.

This area actually is part of an economic zone that includes northwest Arkansas. Medical providers and facilities in both places are excellent. Other than the relatively low cost of living here, I can’t explain why Medicare rate would be lower than major area insurers would pay somewhere else. Well, I will say that the big provider groups here are pretty well capitalized, and that matters.

Medicaid does not pay more than Medicare on a per-service basis. It pays less, and providers are reluctant to take on too many of them. It’s possible that the average Medicaid patient costs more than the average Medicare patient on an annual basis because Medicaid is very overutilized. Probably the worst Medicaid abuse is constant resort to ER treatment for minor things. It’s free, so why wait for the doctor’s office to open? Another Medicaid abuse comes from the fact that a lot of Medicaid patients are subject to the authority of governmental entities, and the latter massively encourage overutilization in order to cover their own backsides from charges of neglect.

Then I guess these things can’t be generalized. I’m in Texas and nobody pays less than Medicare does.

 

[Suudy]

Then I guess these things can’t be generalized. I’m in Texas and nobody pays less than Medicare does.

I’ll say this. When I worked at a large medical device company (pacemakers) our training discussed the reimbursement procedures. Since most of the patients were older (most pacemakers go into seniors) most of the reimbursement was from Medicare. They showed a slide during the training showing the reimbursement rates from many locations across the country. All the numbers were as a percentage of the standard Medicare rate.

Interestingly, the middle of the country was the least expensive. I think I remember seeing Arkansas being the cheapest, with reimbursement for ICD implants running at 60% of the Medicare rate. And they were the highest in Seattle (I remember, because that’s where I’m from) at 250%. Now, it appears that Medicare sets the standard rate for a procedure, then adjusts from that standard depending upon where the service is provided. The point of this slide is that it helps the company set the price point for their products, and also some doctors encourage their patients to go to the cheaper areas (if they can afford the travel) to save on the out of pocket costs.

Now, it seems that both you and Ridge are correct. If Ridge is speaking to the national standard Medicare rate, then some places are paying less and some places are paying more. And if you are speaking to the local Medicare rate, then yes, everyone pays that rate.

 

[Ridgerunner]

I’ll say this. When I worked at a large medical device company (pacemakers) our training discussed the reimbursement procedures. Since most of the patients were older (most pacemakers go into seniors) most of the reimbursement was from Medicare. They showed a slide during the training showing the reimbursement rates from many locations across the country. All the numbers were as a percentage of the standard Medicare rate.

Interestingly, the middle of the country was the least expensive. I think I remember seeing Arkansas being the cheapest, with reimbursement for ICD implants running at 60% of the Medicare rate. And they were the highest in Seattle (I remember, because that’s where I’m from) at 250%. Now, it appears that Medicare sets the standard rate for a procedure, then adjusts from that standard depending upon where the service is provided. The point of this slide is that it helps the company set the price point for their products, and also some doctors encourage their patients to go to the cheaper areas (if they can afford the travel) to save on the out of pocket costs.

Now, it seems that both you and Ridge are correct. If Ridge is speaking to the national standard Medicare rate, then some places are paying less and some places are paying more. And if you are speaking to the local Medicare rate, then yes, everyone pays that rate.

Insurers in this area (if they have volume) pay less than local Medicare rate. At least they did when I negotiated the insurer rates, and they did the last time I talked to anybody who negotiated them, which was maybe two years ago. I’ll add that the discounts also vary depending on the provider. If you are dealing with a provider in a smallish town that has, say, an MRI that stands idle most of the time, or has an underutilized specialist on staff, they’ll cut to a fraction of local Medicare rate for you. Another example is where a big provider has “outreach” facilities and circulates their newer subspecialist recruits through those facilities. Volume and full utilization of facilities and staff mean a lot, and if you bring a lot of insureds to an underutilized situation, the providers will give you the moon, just to get the volume.

 

[Ridgerunner]

Then I guess these things can’t be generalized. I’m in Texas and nobody pays less than Medicare does.

I’m sure things can’t be generalized nationwide, but I think I know a guy who negotiates in Texas. I’ll try to hunt him up and find out. However, it would be my general belief that it would vary from place to place in Texas just like it varies from place to place in Mo. and Ark, which it does.