Would it be workable for Medicare to “underwrite” (I’m not sure the right term) everybody’s insurance — to pay everybody’s bill up to the amount it currently sets — leave everything else in place; leaving private plans to pick up the difference? You still have your own insurance from your employer; it just pays a lot less than before.
Taxes instead of premiums would take up a lot of the load.
Keeping in mind that Medicare reimbursement rates are too low to keep our medical system going if that is all the system were paid. J
“Medicare reimbursement rates are too low to keep our medical system”
Where do you get this drivel from today? Both myself and Maggie Mahar have gone through this time and time again. There is much waste in Medicare and how healthcare is provide. Former head of Medicare Don Berwick estimated 1/3 of Medicare expenditures is wasted.
Run,
Basically I thinking of protecting doctors’ incomes. Their pretax income after expenses account for only 10% of health costs. I figure they have to go to school pretty much all their lives — it takes over their lives — and when you consider what they do I don’t think they get paid too much. I know doctors in other countries get paid less than ours but I think they are being cheated. Far as I know a neurosurgeon in Germany might get paid less than a Lufthansa pilot.
If you read KevinMD everyday you will get an idea of what doctors put up with here. http://www.kevinmd.com/blog/
PCP has some of the lowest salaries. Specialists do not. Most specialists are already in the upper 5% of household incomes with many in the 1% or $500,000.
Actually at a couple of the hearings recently I heard the Idea of reinsurance brought up the federal government would pay the expenses of folks on the individual market above some amount (maybe 100k) so that really sick folks would not drive up the premiums for everyone.
“Different formularies and reporting requirements complicate the practice of medicine to Kafkaesque levels. The helplessness induced by this nightmarish bureaucracy is a major contributor to physician burnout. I want to give just one example by outlining how to prescribe a glucometer.
“I first go to the billing section of the patient’s EHR to identify the insurer. Patients on Medicaid in Hawaii must enroll with one of the following: HMSA, AlohaCare, Ohana (WellCare), United Healthcare and Kaiser. I then go to The Prescribing Guide to identify which brand of glucometer (Freestyle, OneTouch, AccuChek) I can prescribe. Each insurer contracts with a specific manufacturer, and the preferred brand can change every six months. If you enter the wrong brand, the pharmacy will tell you to obtain prior authorization.
“Next, I have to identify the ICD-10 diabetes code of the highest complexity. Does she have nephropathy, neuropathy, ophthalmopathy? I search for the creatinine/GFR. What did the optometrist say? Am I going to prescribe insulin? Insulin justifies asking for more test strips. All of this – the number of measurements per day, the ICD-10 code, and whether or not the patient is on insulin has to be on the prescription.”
If you meant medicare there are no income limits, rather the part B and Part D premiums increase if income is above 85k single and 170k married filing jointly up to 80%+ of the full cost of part B, Part A is what is paid for by the medicare tax and for those not having 10 years of credits costs about 480/month.
You answered my question. For individuals you could come close to the same means testing for the individual insurance also. This is an income limitation before you have to pay more for Medicare.
““I first go to the billing section of the patient’s EHR to identify the insurer. Patients on Medicaid in Hawaii must enroll with one of the following: HMSA, AlohaCare, Ohana (WellCare), United Healthcare and Kaiser. I then go to The Prescribing Guide to identify which brand of glucometer (Freestyle, OneTouch, AccuChek) I can prescribe. Each insurer contracts with a specific manufacturer, and the preferred brand can change every six months. If you enter the wrong brand, the pharmacy will tell you to obtain prior authorization.
“Next, I have to identify the ICD-10 diabetes code of the highest complexity. Does she have nephropathy, neuropathy, ophthalmopathy? I search for the creatinine/GFR. What did the optometrist say? Am I going to prescribe insulin? Insulin justifies asking for more test strips. All of this – the number of measurements per day, the ICD-10 code, and whether or not the patient is on insulin has to be on the prescription.”
Let’s see if I can count the clicks and time this “Kafkaesque” process takes.
One click gets me the insurer.
Two clicks gets the allowed glucometer. (and if it does change every six months, the next time you click it will give you the right one)
Figure maybe six clicks for the ICD-10 codes. I have actually watched this being done, but not by a doctor. Also means the doctor gets paid.
Meanwhile, I did more work than this in almost every single financial application I ever processed.
Now, let’s take ti to the next level.
Almost everything in here is not done by the doctor, it is done by an assistant. “I am going to put this person on a glucometer.”
My comment:
Uber isn’t a high-tech business — it is a send unorganized/unprotected-by-regulations labor on a race-to-the-bottom business (a.k.a., “the sharing economy”, a.k.a., reducing labor’s market power to zero). In case you hadn’t heard Uber is a virtual Ponzi scheme which is burning through billions of new investor dollars to stay afloat via subsidizing rides to 40% of costs. Only a matter of time before it runs out of money (suckers) unless it is successful at putting cabs out of business — in which case prices will go way up (drivers poor incomes?).
How would you like a world in which Uber survives — how would you like a world with no legitimate cab companies, with only ride share companies? That’s what Uber’s success can only mean.
Would it be workable for Medicare to “underwrite” (I’m not sure the right term) everybody’s insurance — to pay everybody’s bill up to the amount it currently sets — leave everything else in place; leaving private plans to pick up the difference? You still have your own insurance from your employer; it just pays a lot less than before.
Taxes instead of premiums would take up a lot of the load.
Keeping in mind that Medicare reimbursement rates are too low to keep our medical system going if that is all the system were paid. J
“Medicare reimbursement rates are too low to keep our medical system”
Where do you get this drivel from today? Both myself and Maggie Mahar have gone through this time and time again. There is much waste in Medicare and how healthcare is provide. Former head of Medicare Don Berwick estimated 1/3 of Medicare expenditures is wasted.
Run,
Basically I thinking of protecting doctors’ incomes. Their pretax income after expenses account for only 10% of health costs. I figure they have to go to school pretty much all their lives — it takes over their lives — and when you consider what they do I don’t think they get paid too much. I know doctors in other countries get paid less than ours but I think they are being cheated. Far as I know a neurosurgeon in Germany might get paid less than a Lufthansa pilot.
If you read KevinMD everyday you will get an idea of what doctors put up with here.
http://www.kevinmd.com/blog/
Denis:
PCP has some of the lowest salaries. Specialists do not. Most specialists are already in the upper 5% of household incomes with many in the 1% or $500,000.
Actually at a couple of the hearings recently I heard the Idea of reinsurance brought up the federal government would pay the expenses of folks on the individual market above some amount (maybe 100k) so that really sick folks would not drive up the premiums for everyone.
Lyle:
Do you know what Medicare has in income limits?
Not exactly where we came into this movie but just read this:
Here’s how a glucometer turned this doctor against Medicaid for all
Seiji Yamada, MD, MPH | Policy | September 22, 2017
http://www.kevinmd.com/blog/2017/09/heres-glucometer-turned-doctor-medicaid.html
“Different formularies and reporting requirements complicate the practice of medicine to Kafkaesque levels. The helplessness induced by this nightmarish bureaucracy is a major contributor to physician burnout. I want to give just one example by outlining how to prescribe a glucometer.
“I first go to the billing section of the patient’s EHR to identify the insurer. Patients on Medicaid in Hawaii must enroll with one of the following: HMSA, AlohaCare, Ohana (WellCare), United Healthcare and Kaiser. I then go to The Prescribing Guide to identify which brand of glucometer (Freestyle, OneTouch, AccuChek) I can prescribe. Each insurer contracts with a specific manufacturer, and the preferred brand can change every six months. If you enter the wrong brand, the pharmacy will tell you to obtain prior authorization.
“Next, I have to identify the ICD-10 diabetes code of the highest complexity. Does she have nephropathy, neuropathy, ophthalmopathy? I search for the creatinine/GFR. What did the optometrist say? Am I going to prescribe insulin? Insulin justifies asking for more test strips. All of this – the number of measurements per day, the ICD-10 code, and whether or not the patient is on insulin has to be on the prescription.”
If you meant medicare there are no income limits, rather the part B and Part D premiums increase if income is above 85k single and 170k married filing jointly up to 80%+ of the full cost of part B, Part A is what is paid for by the medicare tax and for those not having 10 years of credits costs about 480/month.
Lyle
You answered my question. For individuals you could come close to the same means testing for the individual insurance also. This is an income limitation before you have to pay more for Medicare.
““I first go to the billing section of the patient’s EHR to identify the insurer. Patients on Medicaid in Hawaii must enroll with one of the following: HMSA, AlohaCare, Ohana (WellCare), United Healthcare and Kaiser. I then go to The Prescribing Guide to identify which brand of glucometer (Freestyle, OneTouch, AccuChek) I can prescribe. Each insurer contracts with a specific manufacturer, and the preferred brand can change every six months. If you enter the wrong brand, the pharmacy will tell you to obtain prior authorization.
“Next, I have to identify the ICD-10 diabetes code of the highest complexity. Does she have nephropathy, neuropathy, ophthalmopathy? I search for the creatinine/GFR. What did the optometrist say? Am I going to prescribe insulin? Insulin justifies asking for more test strips. All of this – the number of measurements per day, the ICD-10 code, and whether or not the patient is on insulin has to be on the prescription.”
Let’s see if I can count the clicks and time this “Kafkaesque” process takes.
One click gets me the insurer.
Two clicks gets the allowed glucometer. (and if it does change every six months, the next time you click it will give you the right one)
Figure maybe six clicks for the ICD-10 codes. I have actually watched this being done, but not by a doctor. Also means the doctor gets paid.
Meanwhile, I did more work than this in almost every single financial application I ever processed.
Now, let’s take ti to the next level.
Almost everything in here is not done by the doctor, it is done by an assistant. “I am going to put this person on a glucometer.”
Done.
EM:
I agree. To make it easier, the Gov has the ability to standardize the process even more.
The usually clear headed Tyler Cowen wrote a piece in Bloomberg seeing London’s junking of Uber as discouraging other “high-tech” investors — supposedly a post-Brexit step back.
https://www.bloomberg.com/view/articles/2017-09-22/london-s-uber-ban-is-a-big-brexit-mistake
My comment:
Uber isn’t a high-tech business — it is a send unorganized/unprotected-by-regulations labor on a race-to-the-bottom business (a.k.a., “the sharing economy”, a.k.a., reducing labor’s market power to zero). In case you hadn’t heard Uber is a virtual Ponzi scheme which is burning through billions of new investor dollars to stay afloat via subsidizing rides to 40% of costs. Only a matter of time before it runs out of money (suckers) unless it is successful at putting cabs out of business — in which case prices will go way up (drivers poor incomes?).
How would you like a world in which Uber survives — how would you like a world with no legitimate cab companies, with only ride share companies? That’s what Uber’s success can only mean.
Ah, “Brexit’ the Rothschild new scam from 2016.