One of the reasons Medicare is unsustainable is because a lot of provider lose money on Medicare payments (they make it back on private insurance and people who pay rack rates with cash).(This comes from my insider knowlege of the industry, not a specefic source I can cite) And we’d still need private insurance because a lot of people don’t tolerate the lousy benefits so they buy Medigap policies. I’m not saying Medicare for all is a bad thing (and I’d still have a job because Medicare outsources claims processing to private insurance companies). Just that to make the system sustainable we’d have to increase the payouts, and to make it patitable without supplemental insurance we’d have to increase benefits. Both of those are going to cost a lot more than just getting out a caculcator and multiplying it’s cost per person by the number of people to expand it too.
I find that kind of hard to believe, Md (not that I’m doubting you, just that my second-hand experience is different). I know more than a few MD’s that make 100% of their income from Medicare and Medicaid patients. Some of them certainly do have supplemental coverage, but from what I’ve seen it’s a minority. None of these doctor’s are making specialist salaries, obviously, but they’re certainly not hurting either.
It’s sort of a truism that if you want to bend the cost curve you either have to: reduce consumption/demand, find efficiencies, or pay providers less. Nothing else will reduce overall medical spending (Medicare or otherwise).
I don’t doubt that some can (especially private practice doctors that have a much lower overhead than say a hospital), but there are a some that couldn’t (and supplemental insurance wouldn’t help because it just pays the 20% coinsurance that the patient would pay, it doesn’t increase the overall payout) Some of it probably depends on the expenses a given doctor has relative to the area. Since Medicare payments are based on the overall cost of a specific area, and all providers of a type in that area are paid the same, I general practitioner operating out of a cheap office of a back street in an expensive area would do better than one in a shiny new expensive office in a cheap area with all the new toys with an in-house lab and xray equipment to pay off.
Ah, yes, these are all private practice primary-care docs operating out of nursing homes and the like. Thanks for the clarification.
I didn’t say pull the plug on granny. (But yeah, it’s more efficient.)
Did anyone think a pap smear for a dying 80 year old was necessary? Come on. And a lot of elderly know they’re going to die before they do. Most of that end of life care isn’t care at all. It’s milking a cash cow.
Well, there’s the answer; we just take a public poll before every medical procedure. All in favor of another MRI, raise your hands: sorry grandma, the consensus is that lump is probably nothing.
Glad you don’t mind that endless waste that is Medicare - the waste that COULD be insuring more low income families.
There are already people that have a “Do not resuscitate” order for certain conditions, and there are people who decline cancer treatment or treatment for other fatal conditions. These decisions are made by the individual, and they do it because they do not want to suffer through chemo and radiation, and be hooked up to machines and end their lives in agony in a hospital.
I think many people would be willing to review the recommended tests to determine what the test is, what it may tell us, what indicates that the test needs to be done now, etc.
I know people are not animals, but here is a comparison. I had an old cat with a few problems, but the main thing was some kind of blood disease. My vet suggested a test that would tell us if it was leukemia or another type of blood disease. I asked him what would we do based on the different outcomes of the test. Well, the cat was pretty sick, and clearly had weeks if not days left. Given the condition of the cat, the treatment would have been the same regardless of the outcome of the test. Declining to pay for that test did not hasten my cats death by one second or reduce the quality of his care.
If people in advanced states of decline are given this kind of information before they go and do an inconvenient procedure that does not improve outcomes, some will choose to save every one the trouble and reduce the cost of care. Nobody should be refused care, but there is no reason to force things on people that may not improve their outcome.
Outcome based statistics for various treatments could be used to determine when to treat, and when to comfort.
I know this would require a social shift from the mentality that living long is more important than quality of life, and the need of the hospital to give everyone the full Monty when they come in for an infected hang nail.
Yeah, I know I’m a liberal Pollyanna, but you gotta have nice place to aim at when you want to improve things in the near term. Part the question on my mind is “where should a Good Liberal American ™ start the negotiations with a Trustworthy Conservative ™?” Kind of a wish list, but with a few things the GLA would be willing to negotiate away. I’m telling you, it is a fun place in my imaginary political world. It is mostly based on “The West Wing”. I love me some president Bartlett.
Thanks every body for your input! It has been very informative.
nm