Category Archives: Hospitals

Provider Reimbursements under Medicare for All

Yesterday, Healthcare Dive.com posted an article outlining the various proposals for a public health insurance program.

While it did not cover new ground, there was one part that made me curious as to why it was a big deal. It had to do with provider reimbursements under Medicare and Medicaid being lower, and if a single payer system was enacted, providers would see less in reimbursements.

Here is what Healthcare Dive said:

“Providers are already taking up arms against any expanded public health plan. Since Medicare and Medicaid tend to pay less than private payers, more government reimbursement would mean less money in hospitals’ coffers.”

Really?

Excuse me if I sound a little confused, but if you expand the number of persons covered for health insurance, even though you are being paid less under such a plan, won’t you still make more money than if the number of persons covered was smaller?

So for example, if x number of Americans are covered by Medicare and Medicaid, and the providers are reimbursed at a high amount without a single payer plan, wouldn’t covering all 300+ million Americans under single payer, mean that providers would make just about the same, or maybe even more than before single payer?

If providers were paid $1,000 for each of 200 covered individuals in the current system, totaling $20,000 for example, then by raising the number of covered under Medicare for All to let’s say, 3000, providers would be paid $800 for each covered person, then they would make $2.4 million. And for arguments sake, if there were fifty providers, then without MFA they each would make $400 each, but with MFA, they would make $48,000 each. Not bad.

So why are providers up in arms? Could it be that they are engaged in a financial version of adverse selection by wanting to only take private insurance reimbursements, and not single payer?

Or maybe that is part of the problem with our health care system? Pure, unadulterated greed.

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that they are deciding that they have the right to tell the rest of us that we must continue to experience this broken, complex and complicated system just so that they can make money. And that they have a right to prevent us from getting lower cost health care that provides better outcomes and does not leave millions under-insured or uninsured.

However, not all these individuals are doing this because of their jobs. Some are doing so because they are wedded to an economic and political ideology based on the free market as the answer to every social issue, including health care. They argue that if we only had a true free market, competitive health care system, the costs would come down.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, the free market companies have jacked up the prices simply because they can, and because lobbyists for the pharmaceutical industry have forced Congress to pass a law forbidding the government from negotiating prices, as other nation’s governments do.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.

1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Readers of this blog will recall that I wrote four earlier posts about the closing of rural hospitals, so the article from Healthcare Dive.com comes as no surprise.

Previous posts ( https://wp.me/p2QJfz-GeL, https://wp.me/p2QJfz-IZ3, https://wp.me/p2QJfz-N0u, and https://wp.me/p2QJfz-QSn) go into greater detail about the seriousness of the issue.

But once again, we have to remind the readers that until we enact Single Payer health care, more Americans will lose access to medical care at rural hospitals.

Here is the article:

More than 60% of those facilities are “highly essential” to the heath and economic well-being of their communities, according to a new report.

Source: 1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Hospital Mergers Improve Health? Evidence Shows the Opposite – The New York Times

Yesterday’s post, Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive, suggested that moving towards an improved and expanded Medicare for All system would force hospitals to close, so the article below in today’s New York Times would seem to argue that the urge to merge does not improve health.

So on the one hand, if we adopt a democratic socialist approach to health care, hospitals may close; yet, if we allow them to follow capitalist economic laws regarding economies of scale, they don’t offer better care.

Perhaps, then it is better to try the democratic socialist approach, because the economies of scale approach has not worked, and let’s see if hospitals do close, or they see an increase in patients due to more people being covered.

Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

Sound the alarm bells, the health care industry is trying to prevent Americans from having the same kind of health care other Western industrialized countries give their citizens — universal health care; in this case, an improved and expanded Medicare-for-All.

Instead, they want to perpetuate the current system which by all accounts, is failing to provide quality health care at affordable costs, with better outcomes.

And the tactic they are using is fear-mongering of the worse kind, saying that if we move towards a Medicare-for-All system, the people who like their employer-based health care, or the hospitals, insurance companies, pharmaceutical companies, etc., will lose what they have, hospitals will close, and companies go bankrupt; in other words, they will lose huge profits the current broken system generates for them.

As the following article from Healthcare Dive reports, the hospital lobby is opposing this movement towards a more equitable system of health care in this country all for the purpose of protecting their bottom lines.

Don’t let them scare you. Universal health care is a right, not a privilege. We are the only Western industrial nation without such a system. People before profits. Health care for all, not for the few.

Here is the article:

As more Democratic presidential hopefuls embrace the idea, health systems and providers have picked up lobbying efforts arguing it would shutter hospitals.

Source: Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

One Implant, Two Prices. It Depends On Who’s Paying. | Kaiser Health News

Here is another example of our broken health care system and the way in which health care has become a cash cow for hospitals, physicians, medical device manufacturers, which includes implant manufacturers, and pharmaceutical companies.

The following article from Kaiser Health News is eerily familiar to a piece I wrote a while back about a man who needed a hip replacement, and went to Belgium to get it, and discovered that the hip they gave him was made near his home in the US, but was considerably cheaper in Belgium than in the US, even though it was the same hip he would have gotten if he had the surgery locally.

That the same implant should come with two different costs, either because it is implanted in the US, or in a foreign country, or in the case below, because of the type of surgeries performed, is illogical and a symptom of a dysfunctional, profit-driven health care system that is out of control.

Here is the article link:

Breast implants — used for both cancer and cosmetic surgeries — give a glimpse into how hospitals mark up prices of medical devices to increase their bottom lines.

Source: One Implant, Two Prices. It Depends On Who’s Paying. | Kaiser Health News

Establishment looks to crush liberals on Medicare for All – POLITICO

FYI to all Progressives and Medicare for All supporters:

The coalition that fought Obamacare repeal has fragmented as the party tries to follow through on campaign promises.

Source: Establishment looks to crush liberals on Medicare for All – POLITICO