This is some of the best stuff I've ever read on this forum. Just the first paragraph has so much great stuff to unpack. It lost a little momentum after this, but I'm going to save this part. So that I can read it whenever I need a little pick-me-up.
Just for Clarity and those that might wonder if I have slipped a gear, I do not want a National Health Care system. I loath the reality that we are there! We have a National Health Care System today, right now and it sucks. It was brought to us a piece at a time, a step forward to the goal, one step, then another, until we are here! With a barely functional system, never designed, but guided to the enclosure, like sheep by the progressives, little by little generation after generation. Not one conservative leader every took us back one step. Amazing! Never back, although a few spoke of the dangers, no meaningful regression was every attempted until this week. Trump tried to push the Congress for one step back! I applaud his try, but people become accustom to the benefits at hand. They have no fear of what the can not see, and do not long for what is not in memory. Their Representative are electable and not much more. They can not help the people see nor do they remember themselves, the better way. So we can not go back, for many reasons. I could tell you the way it worked when it was damn near ideal. It left room for people strive for more, but it was not bad for even the those that lagged. I am not speaking of the science of health care, that is far better today and I expect more tomorrow. I am speak of how we pay for what we had, the system we had. But I think I will save you the time, as it is pointless. The path to that place is not visible to the pathfinders, and no one can hear those that remember. So we must go forward, what we have is crap, I can remember very good, this is crap. I think I will even save you from reading the steps we took, from Good to Crap. Because that is too much like finding the lost trail. To make a long long story short, I now think you all need to push for a National Health Care System. You have a Republican President that I think would sign the law if it could be sent before him. You have a Republican Congress that just humiliated themselves and they need some success and I think there are enough of them that just may see what I see. There is no other way. Then you have a bunch of Democrats in the Congress that have been for this for as long as they can remember. You need to chide them for celebration of a hollow victory, it was they, that took the last step that brought you this crap. You need to forget about whether the Democrats own this or the Republicans. Neither one does, you do! You need to kick ass now, the nearest Representative’s derrière will do just fine. You need to push them all hard for a proper Health Care System and it might as well be the Cadillac plan you seek. One that works for you where ever you go, doing what you do.
Not good at all. It was a major contributor to the down fall of the our health care system. Primarily because it only reimburses the providers, hospitals at a partial level. Leave the remainder to be cost shift to those that can pay, like those that have insurance. This is really bad for a major section of the our system, the self insured employers. Year ago, before the cost shifting became a thing, they were providing us insurance at a average cost of 52% of what it cost you from an insurance company, Of course cost shift screwed this up badly. Then the providers are encouraged by the system to run you through all the crap that Medicare will reimburse them for performing. Provide a code, get paid. I call it mining the patient. I like the VA since it saves me from this stuff, they don't get paid for codes. But that has fault too.
So Medicare would be a lot better if it fully reimbursed health care providers, for everyone enrolled in the system?
Not sure what you suggest here, but either way, no it is still poor. When people paid their provider directly, that is without the intermediary, Medicare or and Insurance company, the providers did not need a several people on staff to understand codes and do the billing Cost shifting still occurred but the freeloader was rare. The standard rate of course needed to compensate for the freeloader but like I say it was rare and the rates were low. Medicare became the first government run systematic partial freeloader. Followed about ten years later by Medicaid. Then the insurance companies joined in with the "in network provider" system squeezing the provider from another direction. This then left those that pay their own bills and the self insured employers to be targets still standing, taking the brunt of the cost shifting. Ah ha! a new market for the insurance companies, the self insured employers. Not to sell them insurance but to save them money by managing their plans to provide their employees coverage. Thereby saving them money by shielding them from cost shifting by the providers. This had another undesirable effect, taking the consumer out of the loop except as being a patient. He no longer paid the bills or even knowing the amount. In the mean time, more and more people without insurance or an employee health care become the reality for several reason (another story). So the need to cost shift become ever greater for the providers. Laws like the EMTALA act were passed which require the providers to treat those that have no means of paying. Pushing the cost the providers must charge even higher, really sticking it to those that do not have a intermediary with agreement with the provider. So now the provider have quite a staff to manage this chaos, which doesn't help actual costs at all, trying to find ways to increase revenue. Crap what a deal, providers have to worry about revenue instead of Healthcare! Non profit hospitals slowly learn, charge the maxim for every service or procedure regardless of the actual cost. Break every thing down to the most number of codes that will be be remebused by Medicare, Medicaid, or the Insurance company. Make sure every procedure a patient is eligible to receive is use and billed. I could expand the hell out of this section participially from personal experience, but you can thank me later for saving you this tale. Healthcare is now out of reach for everyone that is without a intermediary (the cash customer) that has any means, like a home, but is not rich. Homestead law in most states protected most people from losing the home, but inflation of the 70s and 80s wiped that out. In Oregon the law protects 40K of home value and that covered the bulk of homes prior to inflation, but today it is close to meaningless. Hospital can and will get a judgement to collect their cost shift bloated bills from the non payers that have means. The 40k left will probably be blown before you can recover your senses. In 2009 I think, a group in Oregon attempted to get this old Homestead protection updated via initiative. But the liberal state administration fought it at every turn and it failed to get the signatures in on time. So if you ask, should Medicare fully reimburse providers? My answer would be, fuck no! The total system needs to be redesigned to encourage healthcare efficiently. If you ask, should everyone be enrolled in Medicare? My answer would be, fuck no! The total system needs to be... I see several liked your question, they can ask some too.
Seriously produce greatly improved longevity and the quality of life, at a fraction of the cost, and please a 100 percent.
I think the cost of a medical degree should be zero and would like a competitive quota system test based, temperament based, skill based to be filled by candidates from high school who earn the scholarships and increase the amount of medical school graduates by a large amount...then lower the pay scale...no more quarter million dollar college debt to pay for by over charging patients...more competitions...more neighborhood privately owned clinics capable of dealing with most needs. Doctors, teachers, should get equal pay then and benefits...also raise the bar for syllabus material in public school...take the time to have a quality ciriculum and hold administrators accountable for maintaining good education practices...no more mailing it in.
Seems like there are some other places that get closer to that than we do. Maybe we should copy their homework, since we can't seem to figure out the answer ourselves. barfo
It's not as though the basic idea of just expanding Medicare to cover everyone is all that complex. It's that you can't sell the idea to the Tea Partiers because of their notions that government entitlement programs are borne of the devil, or to all of the labor, public employee and teacher's unions that have spent the past fifty years pushing Cadillac health insurance for their members and aren't about to take some stripped down Chevy.
Nothing wrong with cadillac health care. Instead of complaining about about their coverage we should talk about improving ours.
I'm all for Cadillac's for everyone. Hell, since the imports are so much better, let's all get Mercedes or Volvos. Somebody has to pay for it though. Don't know about you, but I'm about tapped out on healthcare.
There exist currently insurance plans that supplement Medicare - I assume those would still exist even if Medicare covered everyone. Single payer does not prevent anyone from paying additional money for additional service/coverage. But I do see the point that it would be hard to get agreement that government employees should get a better plan than the rest of the citizens (even though that's the current situation, on average). Then again part of the tradeoff is that government employees are often paid less than their private sector equivalents. barfo
