Why is the focus almost exclusively on the insurance companies?

[dansolo]

For Medicare for All to have any possibility of being passed and properly paid for, costs have to be dramatically reduced. But all of the debate seems to suggest it that it is insurance company profits that is the reason why things cost so much. However, that is only one small piece of the puzzle. It is the healthcare providers who charge a rediculous amount of money that really deserve more of the blame. What I hate is that all of the focus is on who will pay for it, and not how can costs be reduced. Just declaring that the government will arbitrarily cap the amount that providers can charge is not enough.

If you want to know why people "like" their private insurance, I can give you my own personal experience. Last year I had a hernia surgery that required an overnight stay. When I got the bill, it was over $54,000. On top of that, the anesthesiologist was out-of-network, and they charged me $3500. My insurance company reduced the hospital charge down to under $9000, and negotiated the other bill down to about a third of the charge, even though they were out-of network. I reached my deductable, so that reduced what I had to pay even more. Do you think I was going to blame the insurance company for saving me over $50000? No, my anger was the the hospital who can charge these rediculous amounts, and` to the anesthesiologists who game the system to increase their profits. This the part of the discussion we should be having, but seems to be completely ignored.

[Sherman A1]

1. I agree

I liken it to the stereotype of buying a used car.

The Provider Prices the thing outrageously, then when questioned (in this case by the insurance company) about a better deal, the price suddenly drops dramatically. It is just a friggin' game.

The underlying problem is the for profit nature of our healthcare from both the provider perspective and the insurance. Providers need to see as many patients as possible and churn the numbers, insurance companies have to likewise make a profit to survive. The whole system is upside down when it should be about providing good results to patients. This is discussed in Andrew Yang's M4A policy proposal.

"With a shift to a Medicare for All system, costs can also be controlled directly by setting prices provided for medical services. The best approach is highlighted by the top-ranked Cleveland Clinic. There, doctors are paid a flat salary instead of by a price-for-service model. This shift has led to a hospital where costs are visible and under control. Redundant tests are at a minimum, and physician turnover is much lower than at comparable hospitals.

Doctors also report being more involved with their patients. Since they’re salaried, there’s no need to churn through patient after patient. Instead, they can spend the proper amount of time to ensure that each patient receives their undivided attention and empathy.

Outside of a shift to a Medicare for All system, we can look to the Southcentral Foundation for another important shift necessary in the way we treat patients: holistic approaches. At this treatment center for native Alaskans, mental and physical problems are both investigated, and, unsurprisingly, the two are often linked. By referring patients to psychologists during routine physicals, doctors are able to treat, for example, both the symptoms of obesity and the underlying mental health issue that often is related to the issue. The referral also leads people with issues they may otherwise try to bury – sexual abuse, addictions, or domestic violence issues – to bring them up with a doctor so that they can be addressed.

By providing holistic healthcare to all our citizens, we’ll drastically increase the average quality of life, extend life expectancy, and treat issues that often go untreated. We’ll also be able to bring costs under control and outcomes up, as most other industrialized nations have.

Finally, being tied to an employer so that you don’t lose your healthcare prevents economic mobility. It’s important that people feel free to seek out new opportunities, and our current employer-provided healthcare system prevents that." https://www.yang2020.com/policies/medicare-for-all/

[redqueen]

9. Thanks for including Andrew's plan in this discussion!

[PhoenixDem]

2. ...

The fees/prices charged include the cost of malpractice insurance and regulatory burden.

Anesthesiologists are one of the most frequently sued specialty and that anesthesiologist monitored you every second during surgery so that you stayed pain-free and ALIVE.

Do you want to provide cut-rate care with substandard personnel only to have the label MFA?

Do you want to do malpractice reform, cap the jury awards to say $100K and lose the trial lawyer constituency?

[oldsoftie]

6. The anesthesiologist rarely is in the room for the entire procedure.

When I had my surgery, he told me "I'll be in and out; I have 4 surgeries going at one time". His staff IS in the room the entire time, but they arent anesthesiologists.

[PhoenixDem]

8. His "staff" involves highly trained nurse anesthetists

who don't come cheaply. They get paid about $120K a year plus FICA, Medicare, benefits, Workers Comp and malpractice make the cost of a nurse anesthetist about $180K a year.

The question still remains, "Do you want cut rate staff and less regulated hospitals so that one can have a dream of MFA?" Because with price cuts, many hospitals, primarily in the rural area will go out of business.

[oldsoftie]

10. No. But rural hospitals are already going out of business. Not sure how to fix that.

I imagine too many people drive to the bigger cities. But that may be simplifying things.

[SLClarke]

3. True cost of care

Medicare admin costs are about 3-5% - in total. Insurance company costs are $20-25% (knowing that the insurance companies do not count certain costs they incur, which takes that 25% way up).
Hospitals do charge a lot, and the charges vary, but consider this, they also, by law, have to take in people who cannot pay. The last time I searched for those costs, at Regions Hospital, in Saint Paul, the hospital had to cover anywhere from 16-20% of not-able-to-pay ER visits and hospital stays. They have to cover those costs somehow, so they up the charges for payers.
Imagine this - no co-pay, no bill for care, no deductible, no having to change your doctor because you change your job, no out-of-network super charges, no worries about what comes next in the mail, and no having-to-deal-with denials, and no having to worry about whether you are facing losing your home because of medical bills.

[dansolo]

7. M4A admin costs will be more than 3-5%

This is one of the fallacies of M4A administrative costs. Medicare offloads a lot of administrative costs to the insurance companies. If Medicare was extended to cover every possible service for every single person, the administrative costs will go up.

[gab13by13]

4. I'm having a procedure done in January at UPMC, Pittsburgh.

The lady who handles the insurance told me she will ok the insurance payment. I told her that I bet she spends a lot of time on the phone arguing if they will cover my procedure. She said, you have Medicare as your primary insurance, I basically have zero problems with Medicare, she said, I do spend a lot of time fighting with private insurance companies. Her words not mine.

People like their doctors, like their hospitals. like their nurses. People don't like their insurance companies unless they have Cadillac plans.

[oldsoftie]

5. Covered people pay for those who get procedures and do not pay.

Its like the cost of shoplifting being passed on to other shoppers. Except on steroids.
But i do agree on the doctors.
I had an ER visit for a kidney stone & the ER doctor bill, billed separately, was 1400.00. How is it possible for ONE doctor to charge that much for coming into the room 3 times and saying "give him pain meds & get a CT"? The HOSPITAL can say "well, you have to pay for all the equipment and staff we have on hand".
The doctor is a contracted worker, hence the separate billing. He has NO excuse for that kind of bill