Joe Biden: “How Are We to Pay for Single Payer Healthcare Alias Medicare for All?”
Joe knows the answer to this question and he is baiting the other candidates. Joe has a history of supporting big business interests as witnessed by his aggressive support of the banking industry with bankruptcy laws favoring banking against the needs of citizens and with a special intended harshness when it comes to student loans. Joe has sponsored or cosponsored every bankruptcy bill since 1997. With his question and his healthcare bill, I believe Joe is courting the healthcare industry and the healthcare insurance industry’s support. Other candidates need to call Joe out on this.
Before moving to Medicare4All or a form of it, we need to attack the costs of healthcare which are rising at a clip greater than inflation.
Much of the payment for improved healthcare will come from negotiating with pharmaceutical companies, reducing the increasing cost of hospital inpatient and outpatient care, rolling back unnecessary pricing increases, reducing costs to 120% of Medicare costs today, etc. There are enough cost targets to attack which should provide a wealth of lower costs and funding for expansion. Healthcare Cost Drivers Pharma, Doctors, and Hospitals
Kocher and Berwick gave an outstanding recital of how we will get from Medicare and Commercial Insurance to just Single Payer Medicare4All. “While Considering Medicare For All: Policies For Making Health Care In The United States Better.” It is unlikely, Congress will move on Medicare4All in the beginning. It will take time. Today’s Medicare is not free from issues.
As the Director of Medicare and Medicaid and upon departing the position, Donald Berwick made this observation of today’s Medicare:
“20 to 30 percent of health spending is ‘waste’ that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by Medicare and Medicaid.
He listed five reasons for what he described as the ‘extremely high level of waste.’ They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.
Much is done that does not help patients at all and many physicians know it.”
Within the PPACA, the issues with ACOs must be fixed. The initial PPACA ACO strategy has given hospitals the ability to exploit the market through consolidation, eliminating or minimizing competition in regions, leading to increased pricing, and enabling the employment of specialist doctors, making them “must haves” in insurance networks. As planned, the ACOs should have generated administrative cost synergy and quality benefits instead of enabling ACOs to consolidate and control prices.
Single payer does not use ACOs. In single payer, the government will pay hospitals, healthcare professionals, pharmaceutical and healthcare supply companies. The government will also set the budgets for hospitals and healthcare. Single Payer in Vermont was going to fail and failed due to cost because it used 3 ACOs to manage its plan. Bernie Sanders is also using ACOs in his plan. “Why the Bernie Sanders Bill Is Not Single Payer” The only fear I have of this type of arrangement is the influence of the healthcare industry on those determining pricing and accepting costs. The healthcare industry is attempting to establish a methodology using value brought to the patient clinically and in quality of life with resulting benefits to the health-care system and society also. It is an argument on the issue of the morality of higher prices. Single Payer will have to contend with this as much of the pricing argument is not justified.
The plan should be to gradually move from insurance administered healthcare (what Kocher and Berwick propose) to a single payer system similar to what Sanders proposes but minus ACOs. As I explained, there are enough cost targets to pay for much of the implementation to be derived from reducing costs in the present healthcare system.
Run75441 (Bill H)
Part of the difficulty here is that the candidates are campaigning and, in the process, make proposals. To try to make them as you’ve articulated (the plan) is tricky. If one proposes single payer, that’s what people hear, not single payer eventually and in the immediate future something else like permissive medicare participation. The honest proposal would be permissive medicare and “we’ll see what, if anything, comes next”. Regardless of Joe’s business connections, that’s really what he’s proposing, isn’t it? I don’t like Joe for a lot of reasons but his healthcare proposal seems to be essentially what you are advocating and I agree with it.
WE do things for different reasons at times. Joe wants to win. Joe has a history of being in the pocket of business . . . banks. Joe advocates for those businesses. Joe is making a pitch at the healthcare industry. I think Kocher and Berwick are correct. I do not think Joe gives a damn what citizens need the same as he did not care for Millennials or students.
Just yesterday in fact
I don’t disagree. We may be stuck with him. We in the Society of Drowning Men (see the New Geezers-reddit), will vote for a ham sandwich against Trump if need be.
I read one doctor’s opinion that health insurance companies should be made nonprofit (done in some European companies I believe) — which would eliminate the squads of people trying to deny and those fighting denials.
How about if we enrolled everyone in a plan that would pay 10% of whatever Medicare pays — sort of reverse supplemental — and gradually increase to Medicare levels over 10 years — or to new, somewhat higher level given Medicare pays a little light; keeping in mind that doctors pretax only amounts to 10% of health costs.
Never mind regulating drug prices — how about just scrapping the entire drug patent law, period? I love business people; they build the world and take chances; don’t even know how they do it — but leaving them in charge of scientific research, depending on market motives results in obscurities like paying pharma companies 200-300 billion dollars over their 20 year patent runs NOT to wipe out Hepatitis C. At the end of 20 years, and another 400,000 dead we will have more ill patients than we started with.
Sitting in traffic this morning on 93 elevated, I was thinking about the medical loss ratio. Many health insurance companies are public companies, and they have the typical corporate obsession with increasing profits.
You can increase profit by increasing efficiency, or by just increasing revenues.
A lot of “regular” companies like to “increase efficiency” (cost geography optimization of administrative tasks, streamlining of manufacturing or consolidation of sites, etc.) or go into austerity on a fairly regular basis (cutting R&D, travel bans, hiring freezes, temp labor cramdowns).
The options to a company that is basically all administration are fewer. At some point a certain amount of paper needs to be pushed and a certain number of calls need to be fielded, and a fair number of lawyers are needed on staff to figure out if some other insurance company can be made to pay the bills your customers racked up, and of course, the CEO needs to have 20% annual pay increases and stock option windfalls, which means you have got to have those profit increases to keep the share price up).
Efficiency is hard. If you won’t go that route, you need to increase profits by geographic expansion, market penetration, or just by letting medical costs increase relative to administrative costs. For every 80 cents more that you pay to doctors, you can take 20 cents more in profits as long as you can hold administrative costs flat. You instantly create the appearance of efficiency, and increase profitability.
Private equity firms are buying up specialty doctors’ practices at an alarming rate because surprise medical bills allow them to extract high payments for medical care from patients and/or insurance companies. It’s private equity whose interests are opposed to those of insurance companies.
Private Equity Tries to Protect Another Profit Center — Sep 9, 2019
https://prospect.org › article › private-equity-tries-protect-another-profit-center
Air Ambulances Woo Rural Consumers With Memberships That May Leave Them Hanging
Posted on September 16, 2019 by Lambert Strether
Lambert here: Wouldn’t you just know it, but AirMedCare is owned by private equity, whose talented analysts have figured out yet another way to screw desperate rural communities who have lost their hospitals, and collect on the mother of all out-of-network billing scams. Ditto the medical evacuation business generally. This story reinforces Eileen Applebaum and Rosemary Batt’s work here. Needless to say, don’t fall for the brightly-colored brochures.
Sarah Jane Tribble, Kaiser Health News. Originally published at Kaiser Health News
[CUT-AND-PASTE — I think this was the one I went back looking for this morning]
Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’ — September 13, 2019
By Reed Abelson, Julie Creswell and Margot Sanger-Katz
Two doctor-staffing companies are pushing back against legislation that could hit their bottom lines. Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’
In 2014 the total cost of US Healthcare was $3.8 Trillion and it is escalating every year with no constraints. At that time (2014) over ten years the cost would be $38 trillion with out increases that have been going up annually at 5.6%+.
The Koch Brothers sponsored a study in 2018 at Mercatus Center at George Mason University that estimated the cost of Medicare for All / Single Payer / Universal care over 10 years at $32 Trillion. America as a nation is well past time to be looking at establishing a NEW model and stop the extortion of our elderly and most vulnerable.
VOTE BLUE and end the LIES… and INSANITY!
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“The increase represents a sharp uptick from 2017 spending, which the U.S. Centers for Medicare and Medicaid Services (CMS) now estimates to have been a 4.6 percent climb to nearly $3.5 trillion. It had previously forecast a 2017 rise of 5.4 percent.
CMS projected that healthcare spending will on average rise 5.5 percent annually from 2017 to 2026 and will comprise 19.7 percent of the U.S. economy in 2026, up from 17.9 percent in 2016. By 2026, health spending is projected to reach $5.7 trillion.”