Single Payer Health Care Financing – Part 2
PNHP Single Payer Healthcare Financing Series, Kip Sullivan JD
Kip Sullivan is known for his commentary on commercial healthcare and healthcare insurance. He is one of the few who can honestly depict what the issues are today and where we are going with healthcare in the US.
In this segment Kip discusses the overuse of healthcare claim of being caused by Fee for Service healthcare. This was supposedly reduced by HMOs and a method of payment called capitation (payment per patient per year). The use of capitation as the method of payment, will limit choice of provider and also micromanage doctors with utilization of review. This combination is the basis for Managed Care which now should be offering some natural products as Exhale Well – delta 9 edibles.
There is no supporting evidence which can be offered up that Fee for Service has led to the overuse of healthcare and resulting costs to the US. Both Kip and I have presented information it is the pricing of healthcare which is the cause. When compared with other countries, US pricing and the total cost of US healthcare.
Value Base Payment is the offshoot of HMO and is commonly known as the ACO.
This is approximately one hour long and packed with detail and statistics. Kip tracks the history of going from HMOs in the seventies, to ACOS with the advent of the PPACA more commonly known as Obamacare, and finally to DCEs in 2019 by the Trump administration.
Some Take Aways
DCEs are meant to begin the privatization of Medicare to Medicare Advantage. It was set to start in 2021 and has been pushed back to 2022 (from what I have read) due to the pandemic.
A key part of this presentation is Kip’s commentary. Managed Healthcare, better known as HMOs, ACOs, Advantage plans are no better than Fee for Service (FFS) Traditional Medicare in preventing Overuse and are worse for the under usage of healthcare.
Here again is a YouTube presentation.
Great stuff, thanks for posting this! I remember hearing about HMOs in the late ’70s/early ’80s. The propaganda sounded convincing, and I think we were even enrolled in BCBS HMO for a short while. Of course, we were young and healthy, exactly the demographic they sought to subsidize their business model.
At the time, I was building my career and didn’t have the bandwidth to think critically about the claims of HMOs. Thanks to the intertubes, I don’t have to do my own research, I can benefit from the research and critical thinking of others.
i suspect that the entire ‘health care’ system, isnt a system but cluge at best. in the US we get worse care, and pay the most. i get why Congress doesnt want to fix it, since that would put them on the hook to fix problems. that most of them have no care to fix. today’s ‘health care system’, has the best of high prices, monopolies, and reduced care. Congress seems to think that individuals can pay for and get reasonable care, and they dont think the government can. but that just a talking point, cause if the government can’t pay for it, how can individuals even try to? and considering it seems that the cost of any procedures, etc, isnt known to any body, but the billing offices, and considering how little non medical people know about care, just how do they ever make any rational choices on what care they need? and how does a market which is supposed to be buyers (informed….see above) decide what to get or what is a reasonable price for it? or that it will actually work/
i think i agree with what you are saying here, so please don’t overreact if you think i am disagreeing with you.
fwiw, local hospital charged me 4 thousand dollars to put ten stitches in my thumb.
of course there were all the x-rays and iv antibiotics, and the “private contractor” doctors roaming the halls looking for business..who said “the x-ray showed the bone is crushed and will need a hand surgeon” i said no thanks to the last, and the thumb healed without incident. i tried to tell Medicare about this. they were not interested.
they did reduce the charge two thousand dollars, leaving me only about 200 dollar co-payment.
i hope this makes clear one reason why medicare is not cutting costs. the beauty of Medicare is that it allows you to pay for medical care (insurance) while you are young and healthy and have an income so you don’t have to pay a lot more for insurance when you are old and need health care and may not have an income.
Medicare Part B eliminates at least part of this advantage…and most young people cannot see the advantage of paying “more” when they “don’t need it.”
meanwhile Medicare is paid for only partly by worker taxes. the Medicare tax falls heavily on “higher income” general tax payers. they don’t want to pay for your health care. you wouldn’t either if you were in their shoes.
i think the answer to all of this is “single payer” or at least “public option”, and “worker paid” by which i mean paid the same way Social Security is.. a flat tax up to a cap…that represents the expected cost of the medical care spread out over a lifetime and over the general population. “the rich” would pay more…as they pay more for Social Security… but only as much more as it makes sense for them as insurance..including for them insurance against the possibility of becoming poor and not making enough for a flat tax to fully pay for their expected cost of medical care proper.
this will not of itself control costs unless some kind of agency is created to manage the program independent of direct control by congress. that agency would need to be watched carefully by its “customers” or at least it’s most vigilant customers… so the kind of neglect and abuse that has crept into Medicare will not destroy it’s cost control measures.
if cutting the existing insurance companies out of the business is politically impossible, I would require them to bid for contracts to manage the bookkeeping and cost controls…contracts with the government..the agency i have proposed.
I don’t know how this would work out in detail, and I don’t know how it conflicts with what is being proposed by others. but the hate i get from people who don’t seem to understand what i am saying…and hear “worker paid” as somehow the individual worker pays full, unregulated, costs exactly as he would pay in an entirely “free market”… makes me despair.
if “you” (not dw) can’t understand what i am getting at, and can’t tolerate what you think is criticism, there is no chance you will get anyone with any power to pay serious attention to your proposal. or maybe they will, if they can see a way to game it.
as of this point I DON’T KNOW WHAT YOUR PROPOSAL IS. this is based on the responses i got to my response to what i think was an earlier version of it a few years ago, and to my response to Part One of this series. I wrote that I did not have an hour or more to sit though a TV presentation that covered ground I was already familiar with and could read in a few minutes. I was told by AB management essentially to go to Hell.
sorry if I hurt anyone’s feelings. that was not my purpose.
As for Hell, it’s fine with me. at least there is less pointless anger there.