Obamacare and hospitals

SC_RNDude · Nov 16, 2014

He was -- Dick Cheney and the other smart people in the administration engineered the deception.

Interesting. I guess we can't count you among the "it's Bush's fault" crowd.

By the way, awhile back in this thread I asked you how medicare would become more financially robust and sustainable if everyone was covered by it. I've been giving it a lot of thought as I await your answer, but I have nothing. Care to elaborate on your statement?

MunoRN, RN · Nov 16, 2014

Interesting. I guess we can't count you among the "it's Bush's fault" crowd.
By the way, awhile back in this thread I asked you how medicare would become more financially robust and sustainable if everyone was covered by it. I've been giving it a lot of thought as I await your answer, but I have nothing. Care to elaborate on your statement?

I don't understand why you think it wouldn't be more sustainable to pay less for the same service.

Both medicare and private insurers perform the same basic function; they pool revenue and pay bills, which costs us a percentage of that revenue for them performing the service. The percentage we lose when medicare provides that service is far less than the percentage we lose to private insurers.

As an example, let's say you run a business and you use two different accountants to handle your bills. One charges 5% of the total funds they are handling and one charges 14%. Would just using the accountant that charges 5% make the business more or less financially sustainable?

SC_RNDude · Nov 16, 2014

I don't understand why you think it wouldn't be more sustainable to pay less for the same service.
Both medicare and private insurers perform the same basic function; they pool revenue and pay bills, which costs us a percentage of that revenue for them performing the service. The percentage we lose when medicare provides that service is far less than the percentage we lose to private insurers.
As an example, let's say you run a business and you use two different accountants to handle your bills. One charges 5% of the total funds they are handling and one charges 14%. Would just using the accountant that charges 5% make the business more or less financially sustainable?

If we are all already paying into medicare already, but only a small portion of us are using it, how is it going to be more "financially robust" and sustainable if all of us are now using it?

And, your implication that Medicare is better efficient then private insurance companies is debatable, at best.

Myth vs. Fact: Administrative Costs in Medicare & Private Health Plans | AHIP Coverage

Not_A_Hat_Person, RN · Nov 17, 2014

According to Snopes.com, Gruber's remarks were extracted from a longer video by a Philadelphia investment advisor, who passed it along to American Commitment, a group led by a former vice president of Americans for Prosperity. It's definitely not a neutral source.

MunoRN, RN · Nov 17, 2014

If we are all already paying into medicare already, but only a small portion of us are using it, how is it going to be more "financially robust" and sustainable if all of us are now using it?

Actually nearly everyone will use medicare at some point. Of the total amount we pay for healthcare, $2.8 trillion, about $572 billion of that is what we pay to medicare to cover us all in our later years. If we all use medicare from the start, then we'd have the 2.2 trillion we are no longer giving to private insurers available to pay for the additional care medicare would now be covering. In other words, the same amount would go to the actual service providers, except we'd save a significant portion on the additional overhead costs we'd no longer be paying private insurers.

And, your implication that Medicare is better efficient then private insurance companies is debatable, at best.

Myth vs. Fact: Administrative Costs in Medicare & Private Health Plans | AHIP Coverage

I make it a rule not to discount information based solely on the source, but it's worth noting the context of AHIP, which is the lobbying group for the for-profit health insurance industry. Their job is to convince us we need the for-profit health insurance industry regardless of the available evidence, and they do work hard to earn the $150 million they get annually from the insurance industry.

The title of the article "myth vs fact: administrative costs in medicare & private health plans" sort of implies they are going to prove false the fairly well established fact that medicare overhead costs are less than that of private insurers for the same services, although they never actually do that. They set up a strawman to disprove; that medicare overhead is about 3% while private insurers is about 17%, which they are correct isn't true, as the articles they refer to point out it's closer to 5% vs 14%. So while the 3%/17% numbers aren't accurate, medicare still runs far lower overhead for comparable services.

Probably the best example is medicare advantage. These are private companies who provide the exact same services medicare provides, for which we've been paying them about 12% more. One of the big criticisms of the ACA is that it not friendly to medicare advantage, when really all it does is require medicare advantage plans to do what they've supposed to have been doing from the beginning; providing the same (or better) service than what medicare provides at the same (or cheaper) price.

I get the aversion to change, which is why the proposal that gets thrown around more than single payer is a public option. Where people can chose which they would prefer, just let people chose which one they want to use.

SC_RNDude · Nov 18, 2014

According to Snopes.com, Gruber's remarks were extracted from a longer video by a Philadelphia investment advisor, who passed it along to American Commitment, a group led by a former vice president of Americans for Prosperity. It's definitely not a neutral source.

Lol...so, the source isn't neutral. Does that me he didn't make those remarks???

SC_RNDude · Nov 18, 2014

Actually nearly everyone will use medicare at some point. Of the total amount we pay for healthcare, $2.8 trillion, about $572 billion of that is what we pay to medicare to cover us all in our later years. If we all use medicare from the start, then we'd have the 2.2 trillion we are no longer giving to private insurers available to pay for the additional care medicare would now be covering. In other words, the same amount would go to the actual service providers, except we'd save a significant portion on the additional overhead costs we'd no longer be paying private insurers.
Myth vs. Fact: Administrative Costs in Medicare & Private Health Plans | AHIP Coverage

I make it a rule not to discount information based solely on the source, but it's worth noting the context of AHIP, which is the lobbying group for the for-profit health insurance industry. Their job is to convince us we need the for-profit health insurance industry regardless of the available evidence, and they do work hard to earn the $150 million they get annually from the insurance industry.

The title of the article "myth vs fact: administrative costs in medicare & private health plans" sort of implies they are going to prove false the fairly well established fact that medicare overhead costs are less than that of private insurers for the same services, although they never actually do that. They set up a strawman to disprove; that medicare overhead is about 3% while private insurers is about 17%, which they are correct isn't true, as the articles they refer to point out it's closer to 5% vs 14%. So while the 3%/17% numbers aren't accurate, medicare still runs far lower overhead for comparable services.

Probably the best example is medicare advantage. These are private companies who provide the exact same services medicare provides, for which we've been paying them about 12% more. One of the big criticisms of the ACA is that it not friendly to medicare advantage, when really all it does is require medicare advantage plans to do what they've supposed to have been doing from the beginning; providing the same (or better) service than what medicare provides at the same (or cheaper) price.

I get the aversion to change, which is why the proposal that gets thrown around more than single payer is a public option. Where people can chose which they would prefer, just let people chose which one they want to use.

You seem to be missing some important points when comparing administration costs.

The bottom line is, you and others for some reason believe the government can control costs and run an industry more efficiently then the private sector. The same government that borrows over 40 cents of every dollar it spends, and has shown no motivation or ability to control costs or run efficiently when it comes to anything.

As for your point about Medicare Advantage, it appears the Federal Gov't can't even handle "outsourcing" efficiently:

Medicare Advantage Isn't Reducing Health Care Costs | The Fiscal Times

elkpark · Nov 18, 2014

You seem to be missing some important points when comparing administration costs.
The bottom line is, you and others for some reason believe the government can control costs and run an industry more efficiently then the private sector. The same government that borrows over 40 cents of every dollar it spends, and has shown no motivation or ability to control costs or run efficiently when it comes to anything.
As for your point about Medicare Advantage, it appears the Federal Gov't can't even handle "outsourcing" efficiently:
Medicare Advantage Isn't Reducing Health Care Costs | The Fiscal Times

You seem to be missing some points, as well. Medicare IS currently operating more cost-effectively than private, for-profit insurance companies.

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

http://www.pnhp.org/news/2013/february/setting-the-record-straight-on-medicare%E2%80%99s-overhead-costs

http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/?_r=0

http://www.reuters.com/article/2012/08/15/us-column-miller-medicare-idUSBRE87E15N20120815

http://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/

(Just for fun, I included the Forbes article, which makes the point that, okay, yes, Medicare has significantly lower administrative costs than private insurance, but that's okay because higher administrative costs are good. :))

As for "outsourcing" Medicare not being cost-effective, no, Medicare Advantage plans never have been cost-effective. They were invented by the Republicans in Congress as a "pilot program" to demonstrate that privatizing Medicare would be a great thing that would make everything better for everyone. Since they couldn't sell the public or the congressional Democrats on just outright privatizing Medicare, they came up with the idea of the "Medicare Advantage" programs. Private insurance companies would sign up seniors and be given the money that traditional Medicare allotted for providing their healthcare, the private companies would surely do a better and more cost-effective job of providing the care, the free market would flourish, all would be right with the world, and the program would be so popular that, in a few years, the Republicans would be able to convince everyone that traditional Medicare should be abolished entirely. The only problem was, after they came up with the plan, it turned out none of the private-for-profit insurance companies wanted to participate, because they figured they couldn't make big enough profits from providing health insurance to seniors. So, then, the Republicans came up with the idea of offering the ~12% bonus payments on top of the Medicare funds the insurance companies would already be getting -- to guarantee the insurance companies profits (so much for the "free market" ...) and to, essentially, bribe them to participate in the program. And so it has continued since then. I remember clearly -- I was around at the time, watching all the reporting about this.

Oh, also, another problem was that the majority of Medicare recipients have preferred to stay with traditional Medicare, and don't want to sign up for Medicare Advantage programs, despite the huge amount of advertising (more money down the tubes!) by private insurance companies for their Medicare Advantage products. Medicare Advantage Enrollees as a Percent of Total Medicare Population | The Henry J. Kaiser Family Foundation

So, all this time, the American taxpayers have been paying private insurance companies above and beyond what it would cost traditional Medicare to provide seniors with healthcare, to bribe them to cover seniors, guarantee them profits in doing so, and to perpetuate this Republican fantasy that private-for-profit services are always, by definition, better than public services.

Yeah, you're right, that's not very efficient.

toomuchbaloney · Nov 18, 2014

How did our Congress fund the additional "bonus" payment to the private insurers for the Medicare Advantage Program?

SC_RNDude · Nov 19, 2014

So, all this time, the American taxpayers have been paying private insurance companies above and beyond what it would cost traditional Medicare to provide seniors with healthcare, to bribe them to cover seniors, guarantee them profits in doing so, and to perpetuate this Republican fantasy that private-for-profit services are always, by definition, better than public services.
Yeah, you're right, that's not very efficient.

Yes, that is my point. Why would we trust those evil republicans, and even the god-sent democrats, to run a cost-effective, efficient, and non-corrupt Medicare for all?

As for most of everything else you posted, well, it's obvious that you are one of the folks I mentioned that believe the federal government can run health insurance better efficient and cost effective then what private health insurance companies do. You have posted opinion pieces to back it up, just like I had a opinion piece to go with what I believe.

However, I also have common sense and history on my side.

SC_RNDude · Nov 19, 2014

How did our Congress fund the additional "bonus" payment to the private insurers for the Medicare Advantage Program?

Just like they fund everything else they don't have money for. On the back of the taxpayers.

toomuchbaloney · Nov 19, 2014

Just like they fund everything else they don't have money for. On the back of the taxpayers.

When that program was conceived and the bill written and then passed into law there must have been a plan to cover that additional expense of the incentive bonuses. The fiscal conservatives in Congress must have required that be addressed, right? That is sort of their hallmark comment..."how are you going to pay for ___"?