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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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@GailL1 wrote:

@JANMB 

 

So what, we might save a bit in Administrative cost - a tiny drop in the bucket, so to speak.

Instead of Medicare paying private contracted insurers to process (meaning paper shuffling)  their claims, why does Medicare not do it themselves if they can do it so well?

 

PolitiFact 09.20.2017 - Comparing administrative costs for private insurance and Medicare 

 

Administrative costs are the expenses incurred by medical insurers that are not strictly medical, such as marketing, customer service, billing, claims review, quality assurance, information technology and profits.

 

Is the gap between private and public health insurance providers’ administrative costs really that high? Most experts agreed the numbers looked about right. But because of key differences between Medicare and private insurance, the trade-off isn’t as simple as Sanders suggests.

 

To measure the administrative costs for Medicare, we turned to the 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds -- the document prepared by Medicare’s fiscal overseers.

 

The trustees’ summary listed total Medicare expenditures of $678.7 billion for 2016, of which $9.2 billion was characterized as "administrative expenses." That works out to 1.4 percent, which is even lower than what Sanders stated.

 

That covers salaries and expenses, patient outreach, and fraud and abuse control by the Health and Human Services, Justice Department and FBI, among other things.

 

But because much of Medicare piggybacks off Social Security, other administrative costs such as enrollment, payment and keeping track of patients are left to the Social Security system. That’s one of multiple reasons using the current administrative costs for Medicare wouldn’t translate as cleanly if the entire population were to be covered. (Medicare serves those over age 65 currently; Sanders would like to see all Americans covered by a similar program.)

 

. . . . unlike Medicare, private insurers take on more responsibility than simply paying claims or occasionally going after fraud. Before a claim is even filed, they check its appropriateness, assess whether it is medically necessary, and whether it can be done in a cheaper way (outpatient versus inpatient care, for example).

 

Medicare has been trying in fits and starts to look a little more closely at how it pays claims but generally speaking, it is passive in processing claims," Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.

 

In addition, private insurers create provider networks, which is where they determine which doctors will offer which services under each plan and negotiate reimbursement rates. They also review which drugs will be most effective and affordable.

 

"Not all carriers are doing this effectively, well or thoughtfully, but when they do, it lowers the overall system costs," Corlette said.

 

But a lot of administrative costs go to marketing, because private health insurers have to compete for clients. That’s something Medicare doesn’t have to deal with, and which wouldn’t be a problem with a similar universal health plan.

 

That also explains why there’s more leeway in the individual market costs, as it’s more expensive to target a new individual customer than groups.

 

I think it would help Medicare beneficiaries tremedously, if government did a bit more educating on the plan and its offshoots.


Once again nice long article. Here are some comments on it. You do realize that medicare claims are paid by Insurance Cos. because they can do it cheaper What you say about what Insurance Cos. do when they pay claims I would say dream on. Have you ever seen what goes into paying a claim. If not do not take much stock in what you read. One thing the carrier does is to see if it can avoid paying the claim and that includes a lot of nit picking. Once past that they are basically the same. Medicare pays over 95% out in losses out of every dollar it takes in. Insurance Carriers before the ACA were about 60%. That is a 35% difference. The goal for profit on every policy when I was working was 18% from all sources. Provider networks were created to save Insurance Carriers money period. They do that, but many times do not serve the insured. I told you a little of the problem my Insurance created for me through their drive to save money, and it cost them (Medicare) more. I have had that type of thing happen 2 times this year alone. I have fought Insurance Carriers on how they were handling my claims many times, and knowing where they are coming from won just about every time, but the average person does not have that background, and that includes the readers of articles. I told in here how Carriers do not want to pay for preventive shots for things like Malaria, but will pay to treat you if you get it which cost them much more. Group Insurance is always cheaper than Indv. because the costs are less. Group was created for ease of handling, and cost savings. I hope no one ever follows what you are talking about because if they do it will cost them money, and it is why people who give advice on Insurance have to be licensed. As I have said in here there was a poster who gave me advice on my Drug coverage. If I had followed it I would have had an increased cost of over $1,000 per year. People should learn the system then let the experts create the best system, and that can happen as there are people who could do it. Right now Trump is the problem so solve that problem.

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 2 of 31

@GailL1 wrote:

@JANMB wrote:

 

 

There are many things our Govt does very well.   One is the Social Security Administration  who never misses a paycheck.....in existence since the last century.  

 

Another handles medicare for seniors very well.    It's the for profit---healthcare  that is  killing people and costs for healthcare keep rising in the USA. There are some institutions and companies  that should never be for profit-only.  

Not-for-profit healthcare organizations typically promote a culture that’s service-driven rather than business-driven.        As service-driven entities, not-for-profit healthcare organizations tend to be more aggressive negotiators when approaching expenses such as managed care contracts.  


 



  


Come around 2034, if we don't fix the finances in the Social Security System, you may still get a check but it might be 22% or more lower.  Government can't even fix what is wrong with a system which they completely oversee.

 

Medicare isn't in great shape either - Part B cost continue to rise.  Part B Premiums for most everybody are going to $ 144.60. (Premiums only represent 25% of the cost - the government pays the other 75% out of the General Fund).  Part B Deductible is going to $ 198.  About 7% of beneficiaries will pay extra premiums from income-related adjustment amounts (IRMAA).  Traditional Medicare keeps paying for services and medications which either aren't approved for their illness or other countries have found them to be USELESS.  Our government can't even stop this - we continue to let those beneficiaries in traditional Medicare self-refer to specialist as much as they want even when the treatment can be handled in less costly manners.

 

As long as we keep subsidizing healthcare, keep covering it up in one way or another, people just think things are fine - until they aren't.  Just like you, thinking that Medicare does not have problems - Last I looked, beneficiaries are gripping about the cost of their Medigap plans going up.

Last I looked, beneficiaries are gripping about not being able to afford their meds even when the government is covering the majority of the cost under Part D. 

 

Now these are government programs - and we can't even fix what is wrong with them. 

 

Escalating Healthcare cost affects all of us, in whatever marketplace or program.

 

Today, there is little difference in for-profit and not-for-profit when just looking at them from the outside.  The only place where this makes a difference is how they file their tax return.

If you need a product that is limited supply - the one that gives them the best deal is gonna be the one that walks away with the bigger prize.

KHN 11/08/2019 - Bruising Labor Battles Put Kaiser Permanente’s Reputation On The Line 

Kaiser Permanente's CEO Bernard Tyson was* the HIGHEST paid NON-profit executive int the nation in 2017.  Kaiser Permanente also bid up to 295 Million dollars to become the Golden State Warriors’ official health care provider.  The deal gave the health system naming rights for the shopping and restaurant complex surrounding the team’s new arena in San Francisco, which it has dubbed “Thrive City.”      read more at the link ~

 

Now even the Unions want more from this non-profit's bounty for employees.  Not for patients, not for beneficiaries -

 

Even PUBLIC hospital have to make money to survive because taxpayers cannot fund the whole thing.  Public Hospitals cannot survive off of the money that Medicare, Medicaid pays them; they give away charity care - well, maybe they could survive somewhat but care would be at the very lowest level.  Healthcare moves forward with new and better treatments, hopefully science-based - They have to move forward to become good at something so that private payers do not go somewhere else to spend their healthcare dollars - sef-pay or insurance.  The one in my area has expertise in Strokes and Burns.  They advertise their expertise, they pay docs in these area of expertise a lot to maintain their status.  They do this so that they can cost shift from those who privately pay to the ones that are getting care under a program that does not cover the full cost.

 

* A few days after this article was published - Kaiser Permanente CEO Bernard Tyson died unexpectedly in his sleep early Nov. 10. After learning of Tyson’s death, the National Union of Healthcare Workers voted to postpone its five-day strike of mental health workers, which had been scheduled to begin Nov. 11. A new strike date has not been set.

 

 


Nice long answer from reading but it means little to the subject. Fiirst step is to get rid of Trump. The SS system will do fine over the long haul. The type of article you quote has been written for years now, and never has come true, and never will unless Trump remains in office. They will fix SS as they always do. One way apply the tax to all income including investment might be a good start. The same applies to Medicare. As I have said learn the entire health care  system which means less reading of articles that apply to only one small part. You want to solve the problem well the first step is to end the trump mess, and then in 4 years we will be ready to solve the problem. This is just a total waste of time between now and then because the writers of these articles have not a clue what they are talking about with Trump calling the shots, and anyone who uses them to do any thing to either system is just joining Trump in wrecking them.

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 3 of 31

@easyed598 wrote:



Janb wrote-Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter.      (  THAT"S PROFIT OFF   YOUR PERSONAL HEALTHCARE and PREMIUMS    )  that’s up more about 29 percent from the same quarter a year ago       HOW IS THIS HELPING YOU if you aren't one of the CEO's or investors   ????   ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------No one I know goes to Europe to get cheap health care. There are people who come here ,however to get excellent health care. Why should health care be free? Like any other service you get you have to pay.for what you get.  Plumbers and electricians don`t work for free and expect a profit for work performed  and the company who hires them expect a profit. It is called Capitalism.

 


Hate to burst you bubble on this. There are people going to Mexico everyday for health care and to get their medicines. There are vans that will take you, and bring you back they even will help you get the right Dr. or Dentist, or drug store. There is one from my city doing that. If you go to Asia you will find hospitals created just for people from other countries, and a lot are from the US. I have a friend who has had just about all of his major health problems treated in Pennag. He had a heart operation and his heart Dr.is tied in with the Mayo Clinic. He even teaches there. One Blue Cross has a deal where you go out of country for surgery, and they pay your air fare, plus hotel on the beach charges. I have dined in the hospital for out of country people in Payatta.  As I have said all need to learn the full health care system, then when they speak about the system they know what they are talking about.

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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I think it would help Medicare beneficiaries tremedously, if government did a bit more educating on the plan and its offshoots.-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------When did ever Government do any educating when launching new programs?  Look how Obamacare was launched  which promised lower premiums and choice of Doctors and health facilities. None of it was true and actually was a lot more expensive. 10 years later politicians are promising pie in the sky Health Care at a cheaper price.

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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@afisher 

 

If you have a rural area where the vast majority of people are already on Medicare, regular Medicaid and you sign up a bunch more of them into expanded Medicaid, and with only have a few of the neighboring population having any sort of private health plans - the hospital is not gonna survive anyway or care will be at the very, very minimum.

 

For many rural hospitals to survive, there has to be a population that can make it survive and hopefully thrive.

 

It is not just about the hospital - it is about paying the providers that are needed to make the hospital work. 

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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Message 6 of 31

@JANMB 

 

So what, we might save a bit in Administrative cost - a tiny drop in the bucket, so to speak.

Instead of Medicare paying private contracted insurers to process (meaning paper shuffling)  their claims, why does Medicare not do it themselves if they can do it so well?

 

PolitiFact 09.20.2017 - Comparing administrative costs for private insurance and Medicare 

 

Administrative costs are the expenses incurred by medical insurers that are not strictly medical, such as marketing, customer service, billing, claims review, quality assurance, information technology and profits.

 

Is the gap between private and public health insurance providers’ administrative costs really that high? Most experts agreed the numbers looked about right. But because of key differences between Medicare and private insurance, the trade-off isn’t as simple as Sanders suggests.

 

To measure the administrative costs for Medicare, we turned to the 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds -- the document prepared by Medicare’s fiscal overseers.

 

The trustees’ summary listed total Medicare expenditures of $678.7 billion for 2016, of which $9.2 billion was characterized as "administrative expenses." That works out to 1.4 percent, which is even lower than what Sanders stated.

 

That covers salaries and expenses, patient outreach, and fraud and abuse control by the Health and Human Services, Justice Department and FBI, among other things.

 

But because much of Medicare piggybacks off Social Security, other administrative costs such as enrollment, payment and keeping track of patients are left to the Social Security system. That’s one of multiple reasons using the current administrative costs for Medicare wouldn’t translate as cleanly if the entire population were to be covered. (Medicare serves those over age 65 currently; Sanders would like to see all Americans covered by a similar program.)

 

. . . . unlike Medicare, private insurers take on more responsibility than simply paying claims or occasionally going after fraud. Before a claim is even filed, they check its appropriateness, assess whether it is medically necessary, and whether it can be done in a cheaper way (outpatient versus inpatient care, for example).

 

Medicare has been trying in fits and starts to look a little more closely at how it pays claims but generally speaking, it is passive in processing claims," Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.

 

In addition, private insurers create provider networks, which is where they determine which doctors will offer which services under each plan and negotiate reimbursement rates. They also review which drugs will be most effective and affordable.

 

"Not all carriers are doing this effectively, well or thoughtfully, but when they do, it lowers the overall system costs," Corlette said.

 

But a lot of administrative costs go to marketing, because private health insurers have to compete for clients. That’s something Medicare doesn’t have to deal with, and which wouldn’t be a problem with a similar universal health plan.

 

That also explains why there’s more leeway in the individual market costs, as it’s more expensive to target a new individual customer than groups.

 

I think it would help Medicare beneficiaries tremedously, if government did a bit more educating on the plan and its offshoots.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 7 of 31

@JANMB wrote:

 

 

There are many things our Govt does very well.   One is the Social Security Administration  who never misses a paycheck.....in existence since the last century.  

 

Another handles medicare for seniors very well.    It's the for profit---healthcare  that is  killing people and costs for healthcare keep rising in the USA. There are some institutions and companies  that should never be for profit-only.  

Not-for-profit healthcare organizations typically promote a culture that’s service-driven rather than business-driven.        As service-driven entities, not-for-profit healthcare organizations tend to be more aggressive negotiators when approaching expenses such as managed care contracts.  


 



  


Come around 2034, if we don't fix the finances in the Social Security System, you may still get a check but it might be 22% or more lower.  Government can't even fix what is wrong with a system which they completely oversee.

 

Medicare isn't in great shape either - Part B cost continue to rise.  Part B Premiums for most everybody are going to $ 144.60. (Premiums only represent 25% of the cost - the government pays the other 75% out of the General Fund).  Part B Deductible is going to $ 198.  About 7% of beneficiaries will pay extra premiums from income-related adjustment amounts (IRMAA).  Traditional Medicare keeps paying for services and medications which either aren't approved for their illness or other countries have found them to be USELESS.  Our government can't even stop this - we continue to let those beneficiaries in traditional Medicare self-refer to specialist as much as they want even when the treatment can be handled in less costly manners.

 

As long as we keep subsidizing healthcare, keep covering it up in one way or another, people just think things are fine - until they aren't.  Just like you, thinking that Medicare does not have problems - Last I looked, beneficiaries are gripping about the cost of their Medigap plans going up.

Last I looked, beneficiaries are gripping about not being able to afford their meds even when the government is covering the majority of the cost under Part D. 

 

Now these are government programs - and we can't even fix what is wrong with them. 

 

Escalating Healthcare cost affects all of us, in whatever marketplace or program.

 

Today, there is little difference in for-profit and not-for-profit when just looking at them from the outside.  The only place where this makes a difference is how they file their tax return.

If you need a product that is limited supply - the one that gives them the best deal is gonna be the one that walks away with the bigger prize.

KHN 11/08/2019 - Bruising Labor Battles Put Kaiser Permanente’s Reputation On The Line 

Kaiser Permanente's CEO Bernard Tyson was* the HIGHEST paid NON-profit executive int the nation in 2017.  Kaiser Permanente also bid up to 295 Million dollars to become the Golden State Warriors’ official health care provider.  The deal gave the health system naming rights for the shopping and restaurant complex surrounding the team’s new arena in San Francisco, which it has dubbed “Thrive City.”      read more at the link ~

 

Now even the Unions want more from this non-profit's bounty for employees.  Not for patients, not for beneficiaries -

 

Even PUBLIC hospital have to make money to survive because taxpayers cannot fund the whole thing.  Public Hospitals cannot survive off of the money that Medicare, Medicaid pays them; they give away charity care - well, maybe they could survive somewhat but care would be at the very lowest level.  Healthcare moves forward with new and better treatments, hopefully science-based - They have to move forward to become good at something so that private payers do not go somewhere else to spend their healthcare dollars - sef-pay or insurance.  The one in my area has expertise in Strokes and Burns.  They advertise their expertise, they pay docs in these area of expertise a lot to maintain their status.  They do this so that they can cost shift from those who privately pay to the ones that are getting care under a program that does not cover the full cost.

 

* A few days after this article was published - Kaiser Permanente CEO Bernard Tyson died unexpectedly in his sleep early Nov. 10. After learning of Tyson’s death, the National Union of Healthcare Workers voted to postpone its five-day strike of mental health workers, which had been scheduled to begin Nov. 11. A new strike date has not been set.

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 8 of 31



Janb wrote-Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter.      (  THAT"S PROFIT OFF   YOUR PERSONAL HEALTHCARE and PREMIUMS    )  that’s up more about 29 percent from the same quarter a year ago       HOW IS THIS HELPING YOU if you aren't one of the CEO's or investors   ????   ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------No one I know goes to Europe to get cheap health care. There are people who come here ,however to get excellent health care. Why should health care be free? Like any other service you get you have to pay.for what you get.  Plumbers and electricians don`t work for free and expect a profit for work performed  and the company who hires them expect a profit. It is called Capitalism.

 

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 9 of 31

MDs reject ACA, Medicaid and even Medicare because they think it CUTS THEIR INCOME by not giving them as much as they want for their services. Poor dears, the family practice docs (bottom of the financial heap and the hardest working) ONLY average $200,800/year and ONLY got a 9% tax CUT from the tRump Taxscam of 2017. The REALITY is all those Government Programs JACK UP their income because they get SOMETHING from patients who otherwise would have NOTHING TO GIVE. Of course Republican MDs believe Market Forces should govern so those who cannot pay cannot play... or eat or drink or dance - BECAUSE THEY ARE DEAD.

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Re: Doctors, hospitals take up arms against Democrats' health care change Proposals

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Message 10 of 31

But as I am writing this post, if you allow either of those people (Sanders, Warren) to become the Democratic Candidates, you will for sure lose the 2020 elections.

 

+++++++++++++++++++++++++++++++

 

You think so?....

 

 

m4a nurses endorse bernie.jpg

 

Major Nurses’ Union Backs Bernie Sanders and His Push for ‘Medicare for All’


The National Nurses United (NNU) boasts over 150,000 members nationwide and has been a driving force in the grassroots push to build support for Medicare for All across the United States.


“We know what we have done and what it takes to bring about fundamental change, and it’s massive organizing and a mass movement,” said Jean Ross, a co-president of the union. “Of all the candidates, Bernie is the one who understands that.”


The union plans to formally endorse Mr. Sanders on Friday at a news conference in Oakland, California.


https://www.nationalnursesunited.org/press/national-nurses-united-endorse-bernie-sanders

 

 

bernie nurses values.jpg

 

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