It will become a necessity.
"The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open... The social budget is limited.”-- Donald Berwick, Director of Medicare and Medicaid.
I agree with him.
While the linked article is obviously biased towards a non-governmental healthcare paradigm, rationing will become a necessity. It clearly is occurring in the UK and in Canada. (Google: NICE healthcare UK) There is only so much wealth that can be confiscated and redistributed in any insurance scheme. Including the private healthcare paradigm. Rationing needs to occur.
I work in the healthcare profession, and while I personally would not want to be party to any government scheme, I see the utter waste that occurs every day in the public/private sector. Why is a 91 year old great-grandmother who has smoked and drank herself into abysmal health getting a heart valve? While that is just one example, my day is full of examples of the waste of resources that occur on an epic scale.
So why is it so horrible to have the private sector to tell granny, "No pacemaker for you", but it is OK for some nameless federal bureaucrat to do that very thing?
It seems like every day I read about some Medicare and Medicaid fraud, and that each year the govt loses about $75B. I'm constantly reading about these various gangs affiliated with providers and lawyers, and it seems they tend to concentrate in Florida, New York, NJ, Texas and California. Nevertheless, I don't hear or read about private insurance fraud. I'm sure there is some level of fraud, but my guess is that it is substantially less than Medicare and Medicaid.
If so, do the private insurance companies, i.e. Aetna, Cigna, etc have better technology, processes in place to detect fraud before it occurs? Isn't there a need to integrate the public and private systems in order to identify and control fraud?
My mother has Medicare. It seems everything is approved, nothing is questioned, and Medicare pays out first, then attempts to insure there was no fraud. Now consider how much people pay into the system over their lifetime, and in no way will it cover what they will use in Medicare. It's just a flawed business model.
Last comment, you need to get the consumer involved in the process. Name me any other product or service where the consumer has absolutely no knowledge or control.
-- Modified on 11/16/2011 4:32:22 PM
According to the AMA's statistics, Medicare and Medicaid deny more claims (source: 2008 Health Insurance Report Card) as a percentage and in real numbers than the top private insurers combined. So I do not feel confident at all that our Federal government can tell accurate time, let alone run a nationalized health insurance system. This on top of their fraud problem.
So Medicare/Medicaid is both stingy and wasteful.
Private insurers are very careful with their dollars, IMHO. They deny less, most likely because it is less likely someone is trying to defraud them. A beautiful example of Capitalistic checks and balances.
My concern is that SOMEONE is going to have to be the gatekeeper. In the Utopian ideal, stakeholders would have universal coverage at a low cost with great care. Unfortunately, you can only have any two. I work for a company that offers world class medical care, and all things considered, it is relatively inexpensive for the level of care and professionalism they offer. Unfortunately, it isn't inexpensive for those without insurance. IF we are going to be offering universal coverage with the same level of costs for coverage, I fear that we will become a half-assed outfit.
What is going to happen when the single payer system decides that doctors, nurses and technicians are now going to be making 1/3 of their wages? (This would happen out of necessity if Medicare was the national paradigm)
Currently, there is no gatekeeper. Which is why costs associated with medical care is so high. Everybody and their cousin wants EVERYTHING DONE to prolong the life of Gramps and Granny. We throw VAST amounts of cash at hopeless procedures because we fear being sued.
I would rather have a physician or other care provider be that person. An honest assessment needs to be made, and NOT by some half-wit bureaucrat in DC. Rationing is coming. Its just a matter of who you want to do it. And when the Federal governemnt says, "These are non-covered services because this is not deemed a ‘medical necessity’ by the payer."... there is no suing the Federal government for denial of service.
One big difference is that the government tries to expand its ase of patients. They do not want to question people who may be "needy." Also, with private insurance you can't just submit a claim.
It is like food stamps. Say you need them and you get them first, questions verified later, if at all. Say you lost them, and the mandate is to replace them as soon as possible. The office that distributes the most is rewarded for "filling the need."
The big problem with govt medical programs is that a doctor can find a "new patient," who doesn't exist. Or else, the same patient can be drafted by six doctors. Likewise, who the hell will look at it twice if the doctor bills for a urine test because he thinks he sees something that requires it.
If so, do the private insurance companies, i.e. Aetna, Cigna, etc have better technology, processes in place to detect fraud before it occurs? Isn't there a need to integrate the public and private systems in order to identify and control fraud?
My mother has Medicare. It seems everything is approved, nothing is questioned, and Medicare pays out first, then attempts to insure there was no fraud. Now consider how much people pay into the system over their lifetime, and in no way will it cover what they will use in Medicare. It's just a flawed business model.
Last comment, you need to get the consumer involved in the process. Name me any other product or service where the consumer has absolutely no knowledge or control.
-- Modified on 11/16/2011 4:32:22 PM
Private insurance won't touch those who can get medical treatment under Medicare and Medicaid. Just try to get private insurance if you are 65 and retired. You will no doubt be turned down for having a pre-existing condition, if taken seriously at all. You can pay top dollar for a Medicare supplemental plan, and fight with the insurance company to pay what Medicare will not.
In answer to the question about fraud, few self-respecting healthcare providers take Medicare payment because they don't want the hassle of filing out all the paperwork, along with such measly reimbursement. So, who do you have left?
I get it that less providers take Medicare due to lower reimbursements or paperwork BS, but it does not answer the question on why Medicare and Medicaid have so much fraud year in and year out. It's to the tune of $75B a year. You read the papers where some roving band of Albanians (lol) in Florida rip of Medicare to the tune of $$$$. So my question is do private insurers have fraud problems to the same extent as Medicare, or less because they have better technology, better processes, or they are just better at being assholes. I don't know the answer, but I would sure like to know.
I don't understand your 65 and retired and can't get private insurance. First, you turn 65 you get Medicare. That covers Part A hospitalization. You also get Part B (office visits) to a point, hence the use of Medicare supplements that you purchase in the open market. Private insurers love this market because it's profitable, and their exposure is limited as they are secondary insurer.
Now if you retire from work prior to 65, then yes, trying to find private insurance in the open market is difficult especially if you have existing health problems.
-- Modified on 11/17/2011 9:14:54 AM
He was talking about differences between Medicare/Medicaid vs private insurance. My point was, that you are basically comparing apples to oranges because private insurance won't touch those who medicare and medicaid covers. Let's put it this way. If you are 63, without a job, and have had no insurance for a year, how easy would it be for you to get health insurance. Given that you've no doubt had received some sort of treatment for medical condition, you would be denied coverage, and given your age, the insurance company would charge you an extremely high premium, which you would find difficult to to pay. In other words you would be a poor bet for the insurance company regarding them making any money off you, so they will find any way they can to deny you coverage.
Regarding, corruption. I can't be specific, but given you're dealing with a government bureaucracy, it's par for the course. It's no different than with any government agency or branch of the military. I can tell you horror stories for times I was in the military service.
starting in 1620 at Plymouth Rock. Money has determined who got care and who didn't. I'm not for Obomacare but rationing health care is a dog that won't hunt.
