I asked this question about Medicare for all before and never got a real answer

[dsc]

so I am trying again.

First some back round. I live in NC and am a teacher which makes me a state employee in terms of benefits. There are 720,000 of us on this plan in a state of about 10 million. So we aren't everyone but we aren't chopped liver either. Our treasurer, who is the administrator of our health plan, decided he wanted to change how hospitals would be reimbursed. So he said, we will give hospitals 183% of the Medicare rate, no takers. He upped it to 200% and waited to the deadline and even past the deadline. 5 hospitals, not chains but hospitals signed on. In a state with thousands of hospitals, 5 relatively small hospitals signed on. 0 in our largest city, 0 in our largest county. 0 in our second largest city, 0 in our second largest county. No trauma centers. He eventually had to fold.

Now here is my question. If hospitals in our 9th largest state were willing to lose access to 720,000 people when being offered 2x the Medicare rate, what do you think will happen when they are being forced to take the Medicare rate for everyone? Clearly the hospitals are being paid much higher currently and feel they can't live on the reduction. How will hospitals keep quality with a huge decrease of income? I think this is a valid question and is a big reason those who are well insured are worried. The amount being spent on their health care will decline (every advocate of M4A says this explicitly) so how will quality stay high? How will hospitals stay open?

[samnsara]

1. hubbys a commisioner for our small, rural hospital. i will try to get him to answer this if he can..

[SWBTATTReg]

2. Good questions. I think people are asking these very same questions that ...

Last edited Wed Feb 12, 2020, 01:42 PM - Edit history (1)

you are. Patients that are on Medicare now are having issues finding doctors that will take them on as patients, even now. I hear this from my friends sometimes when we chat about doctors, etc.

I do question the 'in a state with thousands of hospitals', perhaps a little bit exaggerated? Maybe you are also included doctor's offices, clinics, urgent care facilities, etc.? If you are correct in the number of hospitals, then I am amazed, I didn't know that they are so many around (if true in NC, then probably true in MO where I am at). Take care.

[unc70]

4. NC has 125-150 hospitals depending on what you include

The higher number includes certain long term care and specialty facilities. There are five Level 1 trauma centers. The number of hospital beds per population is well below the national average. Most of the smaller hospitals are now affiliated with one of the large hospitals systems (Duke, UNC, etc.).

[dsc]

6. sorry my bad on that

[moose65]

5. I just looked it up...

There are 126 hospitals in NC. We have 100 counties, and there's no hospital in 17 of them. Perhaps dsc was referring to clinics, outpatient facilities, doctor's offices, etc.

I too am employed by the state of NC in the community college system. In the state health insurance plan, we really don't have a choice - we have to choose from an 80-20 plan or a 70-30 plan, administered by Blue Cross of NC (a for-profit entity). I wish we had more choices of plans to choose from. My partner is with the US Postal Service, and during their Open Enrollment period, we looked through lots of options. I wish we had more to choose from!

I pay $50 per month for the 80-20 plan, and the state pays the rest (it's over $500). So it's approximately $600 per month that goes to this for-profit company. I never really thought much about it, but last year I had to have gallbladder surgery - the first time I'd been in the hospital since birth. The insurance covered everything, but I still had to meet the $1200 deductible and pay the 20% that insurance didn't cover. My out-of-pocket maximum is just short of $5,000, and I hit that in January of last year! I am still paying off that bill. Luckily I have a good job and was able to get an interest-free credit card to pay that bill, but there are lots of people in NC and around the country who would have a hard time paying that $5000 bill.

The way that the insurance plan negotiates with hospitals is insane, too. When I got my explanation of benefits after my surgery, the total bill was like $54,000. There was an immediate "discount" because the hospital had an agreement with the state health plan, which reduced the bill by half right off the bat. In the end, the insurance paid about $20,000 and I paid the rest. And my surgery was routine, with no complications. I shudder to think what major surgery would have cost.

During my 5 days in the hospital (I had pancreatitis, too, that had to be treated), no one ever mentioned how much anything cost, nor did I ask. All I cared about at that time was getting those pain meds! I never had to deal with the insurance directly - it was all handled by the hospital, which is how it should be. I've read many horror stories about insurance companies denying treatment or about "surprise bills" but thankfully that never happened to me. It shouldn't happen to anyone! There has to be a better way.

[dsc]

7. my bad there I messed up on the number

but I do want to say one thing about our health plan, we self fund which means we are paying only a small percent to manage the plan to blue cross.

[SWBTATTReg]

8. It shouldn't happen to anyone! There has to be a better way. WISE WORDS!!

Thank you and the other posters for the hospital information. I remember too, when I was sick last Sept., I too, didn't ask, w/ finding out how much everything cost. I just was hoping that it wouldn't break the bank (mine), and that I had enough on hand to handle it (the deductible part and out of pocket maximum). I did, Thank god. The one thing I didn't like about the whole process? Not truly knowing still what I would have to end up paying. I was nervous for months until I got the final bills afterwards.

Thanks so much.

[moose65]

12. Same here

I had no idea how much it would cost. That’s the one thing common to all health care - if you’re sick or dying or unconscious in the hospital, you don’t give a shit about the cost. You can’t go out and shop around when you’re in pain. Health care isn’t just another “product,” as many Republicans say. It does not respond to changes in demand like other products do. You don’t have the option of not purchasing it at all, as you do for other products. And if you’re dying there’s no limit to what you’d try to pay to keep yourself alive.

[Blue_true]

15. Based upon my city, I extrapolated up to 600 for 10 million people.

But I also feel that my city actually has an abundance of hospitals and Doctors and serve surrounding counties in addition to my county.

But you looked up the number, which sounds right for a state with a handful of big cities.

[Blue_true]

14. I live in a city of 65,000. We have three hospitals.

If that is extrapolated to 10 million, that works out to around 450-600 hospitals, which sound more rational than thousands.

[doc03]

3. In this area we lost two of our three area hospitals this year because of

what you describe. Now if we have an emergency we have one local hospital. What is going to happen if we
have an industrial accident or one of those mass murders? If you have a major auto accident now they almost always
have to life flight you to either Pittsburgh (60 miles away) or Columbus (120 miles away).

[SWBTATTReg]

10. Yes, we have the same thing happening in MO. There a little chain of hospitals that serve ...

outlying areas or rural areas of the state (in MO where I'm at), and quite a few of the hospitals of the chain are closing, for, get this, not enough patients. Tongue in cheek, perhaps coronavirus is perhaps a good thing, for these struggling hospitals?

Employees of Pinnacle Regional Hospital in Boonville, Mo., got less than one day's notice before the hospital closed. Pinnacle Regional closed Jan. 15 at 7 p.m., about seven hours after officials first announced the hospital was shutting down. In a statement posted to the hospital's Facebook page, officials cited the need for costly repairs as the reason for the closure. ... ... ... Hospital officials initially said they were working with the state to rectify the situation, but they ultimately decided to close the facility instead of making the repairs. rest of article continues.

Fulton (Mo.) Medical Center, the only hospital in its county, is set to close Sept. 22, which has caused the local ambulance district to make changes to ensure patients receive the care they need, according to KBIA.

The hospital's 158 employees were notified of the closure plans in July. At that time, Fulton Medical Center's owner, Leawood, Kan.-based NueHealth, told Becker's Hospital Review the 37-bed hospital was closing due to low patient volumes, a plant in need of extensive repairs and denial for a certificate of need by the state for an expansion project. ... ... ... rest of aricle continues.

After Fulton Medical Center shuts down, local residents will be taken to hospitals in Jefferson City or Columbia, Mo., which are each about 25 miles away. To ensure the safety of local residents once the hospital closes, Fulton Mayor LeRoy Benton said the Callaway County Ambulance District is doubling shifts from 12 hours to 24, according to the report.
....................................

This was one of the reasons why I chose to remain living in the St. Louis area...with all of the hospitals around still, if I have had an health issue (of which I have several), it is possible that they (the ambulance) wouldn't have made it in time. Scary. I suspect that this is going to be an issue all across the country, in that people will have to make a choice about where they live at, access to medical care, in case of something serious. I never thought that this would be an issue that I had to consider but there it is.

[uponit7771]

9. "quality stay high" ... it is? This is the answer to your question the premise that

... US has high quality healthcare, we don't ... we have expensive healthcare.

You're right, we need to lower the amount of money we're giving hospital groups, doctors and pharmacy.

It will be growing pains

[ismnotwasm]

11. Medicare underfunds hospitals

This is a multi-layered complex problem, and why, while I definitely want universal healthcare, the Medicare system needs to be reworked. My hospital already takes more than it’s share of the underserved and indigent population,(there is extra funding for this) and has among the top third sickest peoples in the country.

You know what management tell us the most expensive part of healthcare is? Healthcare workers, in my case Registered Nurses. I work in an unionized state hospital with good management. While they fight us on wage increases, they don’t deny them completely. They watch things like incremental overtime (you stay for 15 extra minutes to get charting done etc) Washington state just passed a mandatory break law, so we have to take breaks, and we best get paid for them if we don’t. But pressure is there and we go through periods of being chronically understaffed. Do you want your nurse to be overwhelmed and overworked and overtired? No you all don’t.

So, no. Hospitals won’t.

We recently had a patient who was “kicked out” of a county hospital after a long stay because “they aren’t a charity hospital” it’s a longer story, but that’s a good summary.

Drug pricing and pharmaceutical companies are the first step. Proving enough primary care clinics is the next. Nursing leaders want to empower NPs to fill the provider gap that is happening in a lot of areas. Patient education is an absolute must. Yes, college costs play a factor in the provider shortage, but healthcare is messed up enough that less people are choosing that path in a time we need more, PCPs aren’t making tons of money. So depending where you live matters.

So housing costs/shelter matter. Food costs matter. Childcare matters. Environmental factors When you get into the hierarchy of needs, the basic have to be covered for healthcare to be as effective as possible.

M4A, as I’ve read through the plans aren’t addressing enough of the factors. They do not take into account what Medicare currently is, or isn’t. One of the things it isn’t is a Scandinavian type system of payment.

I can type this crap out with data and links and anecdotal experience and I find people still want to hear about a slogan.

Everyone needs to have a healthcare discussion. What have we done to stay healthy today? I haven’t done shit except to sit in my hottub. So later today, I’ll take my dog for a walk. (My hottub is refurbished and a friend did the electrical work for free). I *do* have health insurance so I’ll think about what preventative measures I can take. I’m healthy, no issues.

Now my spouse is chronically ill.

And here’s an ethical question

Hes On disability. He is very expensive medically wise. Partly because of drug costs. They blow my mind. I keep a healthcare spending account for him. It’s available through my work as a benefit.

What is his worth as a human being?

How about the junkies who are non compliant with procedures that keep them alive, and show up
To ERs over and over again.

Or, and this one is HARD, because as much as I hate multiple sclerosis, I hate cancer worse

The costs of stem cell transplant or chemo for cancer, when it all goes wrong and the cost burden is astronomical?

Or life long care for traumatic brain injuries? With a trach? On dialysis?

And their family wants everything done and the weeks turn into months?


How do we place costs on people? An arm costs this much, a leg that much

That’s actually a thing by the way.

So all this rambling means is in we are in more trouble then slogan politics will fix.

FWIW, I value all life equally, as part of my human family, which means if some POS like Rush Limbaugh was my patient I still would give him excellent care.

[MH1]

13. Yes, primary care physicians also get screwed by current Medicare.

In this country we don't know how to pay teachers decently. We frequently don't maintain infrastructure like roads and bridges the way we should.

It is HARD to become a doctor. Why the hell shouldn't they make a decent paycheck once they go through all that, and after many years maybe have their student loans in sight of being paid off? Yet many don't make a good living at all, let alone matching the stereotype of "rich doctor".

I want universal health care but I think we are several steps away from it. It's not a magic "snap your fingers and you have it". The most annoying thing about this primary season (okay only one of the most annoying things, sigh) is the people acting like not supporting a certain candidate means you don't support giving people decent health care.

(I do support an M4A candidate now but that's not the main reason. I think Liz is smart enough to take the steps we can, even if the end goal is for now out of reach.)

[Blue_true]

16. The "Rich Doctor" analogy is big among some here.

My PCP drives a truck and wears the same scruffed-up shoes. He is not living the high life as best I can tell. From his "fee", he has to pay a nurse, a receptionist and a checkout clerk, pay to keep the lights on and for Internet to communicate with hospitals and drug stores.

I just don't see how people can go through life and still buy into the fantasy about healthcare that one candidate in particular is pushing.