The ACA promised better care through integration — but for many patients and physicians, it ushered in a new era of corporate control, moral injury, and skyrocketing costs.
I know hosiptals recieve more favorable reimbursement in the form of site-specific payments, but I was very surprised to see how that applied to my annual Medicare "wellness visit."
The EOB showed Medicare Part B approved the physician payment of $63.73. But because the physician is part of a hospital-based integrated delivery system, it showed Medicare Part A also approved payment of $132 for a "hospital outpatient clinic visit for asssessment and management of a patient (0510)." The physician practice is not located in a hospital outpatient clinic, it's a basic doctors' office located in a suburban strip mall. I guess the fact the hospital "system" pays their rent means the physicain gets to be reimbursed as if it was located in the hospital.
I love all these suggestions. Two more from my perspective: 1) take away non-profit health systems tax exempt status. Instead, have the tax incentive tied to actual charity care delivered, whether by a for profit or non profit hospital or physician group. 2) when we move to site neutral payments and prohibit facility fees, I would hope reimbursement would go up for physician practices, obviously down for health systems, and land around cost neutral. Excited to read your book!
Don't we have to start with the premise that health care should be paid for with our tax dollars, not with insurance dollars. Insurance companies must make profits to stay in business. Those profits add to the cost of our health care. It makes no sense to use an insurance model. The proposed Medicare For All Act of 2021, by Pramila Jayapal and Debbie Dingell, "would guarantee health care to everyone in America....with no copays, private insurance premiums, deductibles, or other cost-sharing." I just wish every essay that addresses the problems in our health care system would start with the statement that a single payer system is the most cost effective way to go. From that starting point, I'm sure there will be many questions, such as who might own hospitals (doctors?, private equity groups?), what redress, if any, is there if doctors or hospitals disagree with Medicare's Physicianl Fee Schedule or Prospective Payment System, etc., etc. The devil will always be in the details, but at the end of the day, an American citizen ought to be able to walk into a doctor's office or a hospital with nothing more than legal identification, and walk out with nothing more than a smile and a thank you for allowing us to help you. No bill. No worry that the doctor's visit will bankrupt the family.
Once upon a time, health insurers were nonprofits. We, as a society, decided we were ok with that changing. Maybe we need to decide differently now that the experiment has proven problematic.
Also, "an American citizen"? How about "a human in need"? When we visited the UK and needed care, we went to the village GP and walked out without a bill, unworried about bankruptcy. We are not UK citizens, but were certainly in need.
I love your "a human in need" thought. I apologize. I've been warped by the current government's vicious attack on all-things-immigrant. And we have to acknowledge that the current government, with all its people who hate non-whites, championed by Stephen Miller, was elected by a plurality of people who at the very least are comfortable with the premise that non-whites are less-than people, not really deserving of citizenship. I admit, I was avoiding a fight by throwing in "legal identification". Surely you can hear the exclamations, the gasps, the outrage if ever we were to suggest that any human being should be entitled to our health care. My god, who do you think we are, Jesus Christ?
Improved Medicare for all. It's the only approach that makes sense. In my county there are two big health systems, and one of them won't accept new patients with traditional Medicare. Only new patients enrolled in that system's preferred Medicare Advantage program. I'll go without healthcare insurance (like I did for 10 years when I was freelancing) before I will enroll in Medicare Advantage. What a total ripoff. Add to that all of the doctors, dentists, and nurses retiring young due to inexplicable health problems (COVID vax injuries, I suspect). The system is unsustainable and about to come tumbling down. First, do no harm my ass!
Agreed re Medicare Advantage. In a fully captured system (MFA), though, you are likely to have even less choice in your care. I would argue that what we need is MORE options, not fewer.
MFA groups everyone into one funding pool. The larger that pool, the less it costs any one person. That is why group health insurance was cheaper than individual health insurance (until the ACA). The insurers spread the risk around the largest possible group of individuals. MFA would include everyone in the U.S., the biggest and most efficient risk pool possible. As for choice, I agree, as long as I get to use the alternative health approaches that I trust. The entire COVID debacle destroyed my last ounce of trust in allopathic medicine. Take all vaccines and shove 'em, as far as I'm concerned.
I know hosiptals recieve more favorable reimbursement in the form of site-specific payments, but I was very surprised to see how that applied to my annual Medicare "wellness visit."
The EOB showed Medicare Part B approved the physician payment of $63.73. But because the physician is part of a hospital-based integrated delivery system, it showed Medicare Part A also approved payment of $132 for a "hospital outpatient clinic visit for asssessment and management of a patient (0510)." The physician practice is not located in a hospital outpatient clinic, it's a basic doctors' office located in a suburban strip mall. I guess the fact the hospital "system" pays their rent means the physicain gets to be reimbursed as if it was located in the hospital.
I love all these suggestions. Two more from my perspective: 1) take away non-profit health systems tax exempt status. Instead, have the tax incentive tied to actual charity care delivered, whether by a for profit or non profit hospital or physician group. 2) when we move to site neutral payments and prohibit facility fees, I would hope reimbursement would go up for physician practices, obviously down for health systems, and land around cost neutral. Excited to read your book!
Don't we have to start with the premise that health care should be paid for with our tax dollars, not with insurance dollars. Insurance companies must make profits to stay in business. Those profits add to the cost of our health care. It makes no sense to use an insurance model. The proposed Medicare For All Act of 2021, by Pramila Jayapal and Debbie Dingell, "would guarantee health care to everyone in America....with no copays, private insurance premiums, deductibles, or other cost-sharing." I just wish every essay that addresses the problems in our health care system would start with the statement that a single payer system is the most cost effective way to go. From that starting point, I'm sure there will be many questions, such as who might own hospitals (doctors?, private equity groups?), what redress, if any, is there if doctors or hospitals disagree with Medicare's Physicianl Fee Schedule or Prospective Payment System, etc., etc. The devil will always be in the details, but at the end of the day, an American citizen ought to be able to walk into a doctor's office or a hospital with nothing more than legal identification, and walk out with nothing more than a smile and a thank you for allowing us to help you. No bill. No worry that the doctor's visit will bankrupt the family.
Once upon a time, health insurers were nonprofits. We, as a society, decided we were ok with that changing. Maybe we need to decide differently now that the experiment has proven problematic.
Also, "an American citizen"? How about "a human in need"? When we visited the UK and needed care, we went to the village GP and walked out without a bill, unworried about bankruptcy. We are not UK citizens, but were certainly in need.
I love your "a human in need" thought. I apologize. I've been warped by the current government's vicious attack on all-things-immigrant. And we have to acknowledge that the current government, with all its people who hate non-whites, championed by Stephen Miller, was elected by a plurality of people who at the very least are comfortable with the premise that non-whites are less-than people, not really deserving of citizenship. I admit, I was avoiding a fight by throwing in "legal identification". Surely you can hear the exclamations, the gasps, the outrage if ever we were to suggest that any human being should be entitled to our health care. My god, who do you think we are, Jesus Christ?
Thank you….republicans will not compromise on universal, single payer nor expanded and improved Medicare 4 all.
Mostly republicans stand for corporate welfare.
It would be great for their constituents to help them see differently - patients and clinicians alike.
Improved Medicare for all. It's the only approach that makes sense. In my county there are two big health systems, and one of them won't accept new patients with traditional Medicare. Only new patients enrolled in that system's preferred Medicare Advantage program. I'll go without healthcare insurance (like I did for 10 years when I was freelancing) before I will enroll in Medicare Advantage. What a total ripoff. Add to that all of the doctors, dentists, and nurses retiring young due to inexplicable health problems (COVID vax injuries, I suspect). The system is unsustainable and about to come tumbling down. First, do no harm my ass!
Agreed re Medicare Advantage. In a fully captured system (MFA), though, you are likely to have even less choice in your care. I would argue that what we need is MORE options, not fewer.
MFA groups everyone into one funding pool. The larger that pool, the less it costs any one person. That is why group health insurance was cheaper than individual health insurance (until the ACA). The insurers spread the risk around the largest possible group of individuals. MFA would include everyone in the U.S., the biggest and most efficient risk pool possible. As for choice, I agree, as long as I get to use the alternative health approaches that I trust. The entire COVID debacle destroyed my last ounce of trust in allopathic medicine. Take all vaccines and shove 'em, as far as I'm concerned.