The Glade 4.0

Since I am the new 'kid' on the block, let me preface this by letting you all know that I have been working in health care for over 20 years, and am very familiar with both the medical and financial aspects of health care.

First question: Does Medicare ration health care?

Yes.

Medicare rations health care both directly and indirectly.

Direct rationing occurs via a two pronged approach: denial of payment for medically necessary procedures, and making it impossible for a person on Medicare to purchase wanted/needed care outside the Medicare system.

Two examples of direct rationing are cataract surgery and knee replacements. Once one cataract has been removed, it is very difficult to get the other one done (because the person now has good vision albeit only in one eye.) Medicare does not permit both knees to be replaced at the same time. A patient must get one, and then wait a year to get the other one done. (FYI many people need both knees replaced at the same time and this rule actually costs more in the long run with two hospitalizations and two post operative rehabilitation courses.)

So what happens if a person on Medicare wants to have that second cataract removed so they can see better to drive. Well it is almost impossible to find a physician who will do that. Why not you ask? Certainly a well off person can just pay cash? Well you see, physicians must either participate or not participate in Medicare. If the doctor participates, then they can not be paid directly by any people on Medicare for any listed medical services.

Two examples of indirect rationing are lowering reimbursement for medicine used within an office to below cost for the medication and lowering payments for doctor visits. The first example is easy to understand. If Medicare pays the doctor $100 for a medicine that costs $120 to buy, the doctor can not afford to do that. Medicare wins two ways with this. First they can say that they do allow it to be given and blame the 'rich' doctor for not providing it. Second since no one can afford to provide it, Medicare does not have to pay even their allowed portion. Brilliant really if you think of it.

The second example is more insidious and requires an explanation of medical billing and an explanation of overhead costs. The doctor sees you, diagnoses what is wrong and prescribes treatment. The bill is for $100. Medicare 'allows' $40 dollars of which they pay 80%. This takes 4 to 6 weeks to happen, if nothing goes wrong, which it does about 40% of the time. Does the doctor pocket that $40? No. That money goes into an account which pays the rent, utilities, medical staff, office staff, liability insurance, supplies etc. These costs are overhead. Only if there is money left over does the doctor get anything. So for the doctor to keep his doors open, he must see more patients to pay those bills.

The federal government controls doctor's payments. Through Medicare, they state what a doctor can be paid for each service they provide. All the insurance companies then pay physicians a percentage of that 'Medicare rate'.

There is a law out there called the balanced budget act which states that medical costs can not increase and if they do, then payments must be slashed. Every year for the past 15 years there has been an announcement that Medicare payments to doctors are going to be cut anywhere from 5 to 21.5%. These cuts were prevented however no increases have occurred so with inflation, doctors take home pay dropped dramatically. This is worse for the ‘thinking’ specialties in medicine (family practice, pediatrics, internal medicine, etc.) What has this done? Well I personally know 11 physicians who closed their offices (not retired). Less than 30% of Internists will accept a new patient on Medicare, because their overhead costs are higher than what they are paid. This is rationing of care if a person can not get care because it is not available.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

Wow. Thanks for laying it out...but..but that just sounds so sad!

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

your post ignores certain realities of the Health Insurance industry, Squirrel Girl, and paints a somewhat misleading picture. Medicare covers procedures in specific ways, it's true. No, people don't get to have everything they want right away, and no, doctors don't get to charge whatever they want, either.

But the same thing is true for private insurance companies. They ration care in exactly the same way, often more restrictively, and sometimes with lethal results. People who failed to report a case of *acne* are dropped from coverage because they have cancer, and they die for lack of treatement. That isn't an imaginary story. Private insurance companies use Reasonable and Customary costs and force either doctors or patients to make up the difference. Your example is in *no* way exclusive to Medicare - it's standard practice for the private health insurance industry as well.

The difference between Medicare and a private insurance company is that a private insurance company has about 10 times the amount of cost (profit, overhead, etc) that medicare has. Medicare is more efficient, and it has the kind of bargaining clout that can keep exorbitant doctor's fees reasonable.

So, from my perspective, I have two choices. I can go with a private insurance company. They can drop my coverage at any time. They can deny payment for claims after I have paid premiums on a technicality. They will ration my care, they will decide which doctors I can see, when I can see them, and for what. They will control what drugs I can get. My premiums will pay for their profit margin, their exorbitant CEO salaries and severance deals, and their losses in the stock market. My premiums will continue to inflate because of a lack of competition and poor regulation.

Or, I can chose a medicare-like program, where I will not be paying premiums to cover a profit margin, exorbitant CEO compensation, losses in the stock market, etc. I will be paying into a non profit program backed by the federal government. I will be paying into a system that I have some actual say in, and a system that is not motivated by profit margin over my health care. This system will run more efficiently than any private health insurance company. I will be able to see any doctor I want to see. I have more freedom under the government plan than I would under a private insurance company, and I am less likely to get **** over.

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It feels like all the people who want limited government really just want government limited to Republicans.
---The Daily Show

Looking people in the eyes who have lost their ability to work in their calling and those frightened and looking for care is worse.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

Thats exactly what I was picturing in my head when I was reading your post.

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

You can't possibly tell me you are blaming medicare for that, can you? Without medicare, they likely would have no treatment at all. And with a private plan, it could even be worse.

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It feels like all the people who want limited government really just want government limited to Republicans.
---The Daily Show

Montegue:

You should probably apologize to Squirrel Girl, seeing as you just told a Certified Rehabilitation Specialist and practicing physician who can count 2 former Presidents as clients that she doesn't know how her own practice works or the costs associated with maintaining Medicare/Medicaid compliance.

Indeed, you completely ignore the fact that private insurance companies won't pay anymore than Medicare/Medicaid for given procedure. They use the existing "public option" to set their allowance ceilings and further restrict the options available to customers who seek private insurance. But, that's ok ...

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Or, perhaps she should apologize to the board for not giving the whole story. Her attack on medicare was dishonest in that she framed it to appear as if medicare was somehow some sort of monster (the implication being that private insurance was not) and I was giving her the benefit of the doubt that she was not doing so intentionally.

While I'm sure she has an excellent resume, that doesn't make her more right. Private insurance plans do everything she blames Medicare for, and more. She seemed to be implying that the issue was with medicare specifically. If she wasn't meaning to imply that, then that's fantastic. If she's a doctor, and I have no reason to doubt that she is, then she knows darn well that the vast majority of private insurance companies operate on a Usual and Customary fee schedule. She knows that they insurance companies pick doctors for people, because she has probably been a part of a PPO. And if she hasn't been, she doubtless knows what that entails. Insurance companies get groups of doctors to agree to their fee schedules. They send their insured to those doctors specifically (going out of network is too costly for most people). When your insurance changes, they can force you to go to another doctor.

She must know all of this.

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It feels like all the people who want limited government really just want government limited to Republicans.
---The Daily Show

Wow, it took her what? One, two posts before you called her a liar? Is that a record?

Thank you for proving me right.

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"It is true that democracy undermines freedom when voters believe they can live off of others' productivity, when they modify the commandment: 'Thou shalt not steal, except by majority vote.' The politics of plunder is no doubt destructive of both morality and the division of labor."

Oh, so the new threshold for calling someone a liar is saying their post is misleading?

Little sensitive today?

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It feels like all the people who want limited government really just want government limited to Republicans.
---The Daily Show

Montegue:

She did give the full story. We're talking about how the current public option already rations care and leads to rationing in the broader industry. We're talking about how it's already putting private physicians out of business because they cannot maintain their practices with all the red-tape. Now you're simply trying to poison the well and create a false analogy and straw-man.

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Monte,

My note specifically addressed your statement that Medicare did not ration care. The facts stated prove that Medicare does indeed ration care both directly and indirectly. What you just said is a complete non-sequitur.

"Or, perhaps she should apologize to the board for not giving the whole story. Her attack on medicare was dishonest in that she framed it to appear as if medicare was somehow some sort of monster (the implication being that private insurance was not)"

There was no statement at all about private insurance except to note that they pay as a percentage of Medicare rates.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

And yet, that's not really the whole story. Because it implies that the private market is somehow better. And it isn't. The private market is just as bad as Medicare when it comes to controlling doctor's fees, eliminating patient choice, and leaving private health providers holding the bag when they treat someone who winds up having the rug pulled out from under them by their insurance company.

You seem to want to place the blame on medicare too, and that's not the whole picture. In fact, Medicare pays more regularly than many insurance companies. Medicare is more efficient, that's for sure.

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It feels like all the people who want limited government really just want government limited to Republicans.
---The Daily Show

Lol. What a piece of work.

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"It is true that democracy undermines freedom when voters believe they can live off of others' productivity, when they modify the commandment: 'Thou shalt not steal, except by majority vote.' The politics of plunder is no doubt destructive of both morality and the division of labor."

Answer mine first. I've only asked it three times.

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"...but there exists also in the human heart a depraved taste for equality, which impels the weak to attempt to lower the powerful to their own level and reduces men to prefer equality in slavery to inequality with freedom." - De Tocqueville

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"It's real, grew up in trife life, the times of white lines
The hype vice, murderous nighttimes and knife fights invite crimes" - Nasir Jones

Monte,

This is a very out of date concept. Yes some of this wording still exists, however very few insurance companies really use this to pay physicians. What is used is a flat percentage of Medicare rates, 85 to 125% being the most common.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

Monte doesn’t even admit that when existing disincentives to actualize demand are removed that demand will increase and the only way to prevent this is to introduce new disincentives such as restrictions.

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"...but there exists also in the human heart a depraved taste for equality, which impels the weak to attempt to lower the powerful to their own level and reduces men to prefer equality in slavery to inequality with freedom." - De Tocqueville

Double post.

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"...but there exists also in the human heart a depraved taste for equality, which impels the weak to attempt to lower the powerful to their own level and reduces men to prefer equality in slavery to inequality with freedom." - De Tocqueville

You complete piece of ****. May every blade you hold chip and shatter!

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Darksiege
Traveller, Calé, Whisperer
Lead me not into temptation; for I know a shortcut

You're new here, so I'm just going to inform you that logic and reason is the inappropriate tactic. Generally fallacy and cynicism is the best approach with this poster.

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“The duty of a patriot is to protect his country from its government.” - Thomas Paine

I was begining to think I was trying to talk to an irrational eel...... and that can never end well.

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Memento Vivere

I have local knowledge.
That sandbar was not there yesterday!

And also, I hope Khross feels some remorse at exposing you to this, even if you are a ringer.

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My fondness for Squirrel Girl is based almost entirely on the fact she's smarter than me. Of course, she's also a wonderful, delightful, and generally charming human being with a subtly wry sense of humor.

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How can you tell when someone is smarter than you? Anyone who is probably smarter than me seems to have the same intelligence as me, from my perspective. (I am trying to explain here, not be arrogant)