What happens under Medicare For All if providers aren't required to accept it?

[Recursion]

This, still, is the biggest of the many big holes in the Sanders plan: he does not address if providers will be required to accept it. They aren't required to accept Medicare now, many do not, and it can be very difficult to find a doctor that accepts Medicare.

Will physicians and hospitals be legally required to accept Medicare For All, without any balance billing? If not, how will you make sure there are enough providers that will actually see people? If so, how do the providers make up the lost income (Medicare reimburses less for most procedures than private insurance).

Will it be illegal for a doctor or hospital to accept cash payment or private insurance for a treatment covered by Medicare For All? (It is in Canada.)

If you can't answer that question, how can you possibly say you support this plan?

[JaneyVee]

1. Here's how other countries do it:

Longer wait times and only 1/10th of our population. We would need lots of more doctors, which would be great, but would we get more doctors knowing their pay would probably take a hit?

[ForgoTheConsequence]

13. Some people have to wait months for charity care.

Don't talk to me about "longer wait times" people in this country die waiting for doctors. Sorry you might be slightly inconvenienced, Janey.

[JaneyVee]

15. I wont be inconvenienced, I live in NYC...

Thousands and thousands of doctors and nurses here. And I like my employer based union healthcare. I pay virtually nothing now (except high taxes).

[ForgoTheConsequence]

16. Good for you.

Unfortunately not everyone has the same privledges as you and if we're going to join the rest of the civilized world you might need to sacrifice a little of that. Sorry Janey but you might have to sit next to a poor person at the doctors office.

[JaneyVee]

20. Is condescendingly naive a role you're playing or...

A reality? Sit next to a poor person? I grew up poor, I had to work since Im 14, I donate my free time to community activism and helping the poor, on top of working over 50 hours a week and raising 2 little boys. You couldnt walk a day in my shoes. Find someone else to spew your sanctimonious bs to. Dont ever talk to me about "sacrifice".

[ForgoTheConsequence]

71. Wah wah wah

I don't care how much you've struggled, you're employing right wing talking points to defend denying health coverage to people. Remember what Michelle Obama said about closing the door behind you?

[JaneyVee]

72. Of course you don't care how much I've struggled.

Of course you don't.

[kristopher]

115. Show where you care about those now struggling.

All I see is someone saying "I've got mine, screw the needs of anyone else."

[virgogal]

77. Why on earth would you insult someone in that way who

was just making a general statement on Medicare?

Good lord !

[thesquanderer]

139. Our current system works well for those lucky enough to have good "employer based union healthcare."

Last edited Thu Feb 4, 2016, 11:46 AM - Edit history (1)

There is a tremendous range in the care available today.

There are people who are lucky enough to have a great employer-based plan with little in the way of deductibles, substantial copays, out-of-pocket premium payments, or long waits for care.

There are also lots of people who still have no coverage, especially in states that did not participate in the medicaid expansion.

There are also lots of people who, even with Obamacare subsidies, have deductibles and copays that keep them from using the health care they are required to pay premiums for except in catastrophic situations.

Really, the fact that the current system works great for you is a poor argument for why we shouldn't have a certain baseline of quality health care for everyone.

People with more resources will always be able to do better, but everyone is entitled to a certain base level of care that they can afford to use.

[Roy Ellefson]

17. Republican talking points

can't believe we regularly hear Republican talking points on this site.

[gollygee]

63. There aren't longer wait times

I have family living in two countries with socialized medicine. It's the same care we get. The hospitals aren't as fancy - they look like municipal buildings. Otherwise, they wait the same amount of time we do.

[JaneyVee]

66. Right, and what are the populations of those countries compared to ours?

[gollygee]

67. We have more people to take care of and more taxpayers to pay for it. N/t

[JaneyVee]

68. And not nearly enough doctors.

[gollygee]

69. So the argument against socialized health care

Is that we don't want everyone to be able to stay well and see a doctor because we're worried there might not be enough of them for both us and the unwashed masses? That's just sad.

I'm not a big capitalist but there's something to the law of supply and demand. If we have a lot of need for doctors, the country will respond to that. Kids are heavily encouraged to study engineering these days. They'll get heavily encouraged to study medicine.

[me b zola]

100. So is your arguement is that if everyone had access to healthcare then you fear you

that you will not have the same access that you have now? Or to invert that sentiment, do other people need to be denied medical care so that you can maintain your standard of living? I hope that you can take a step back and reconsider your point of view.

[Recursion]

108. If you think that's not a real issue you're fooling yourself

As disgusting as you may find that view, a lot of people hold it. A whole lot of people worry that if "their doctor" (which is a weird idea to begin with) has to start taking every Tom Dick & Harry with public insurance, they won't be able to see him.

[kristopher]

116. A lot of people?

Pretty Nonspecific number you're tossing out, isn't it?

Stoking false fear is a fucked up way to try and win a discussion like this.

[Recursion]

118. Why do you think every single plan has to have the phrase "you can keep your doctor"

nailed to it from the get-go?

[kristopher]

119. Because of the liars that keep pumping up the fear factor.

[kristopher]

117. An deliberate artificial shortage compounded by deliberate underutilization

The product of a medical industry that is joined at the hip with Wall Street.

The doctors do NOT like the present system; Wall Street and it's medical administrators do.

[polly7]

78. The longer wait times for elective surgery ....... 'possibly'.

For anything else, no. It's a myth, debunked over and over.

A larger population means more funding per person with a larger tax and purchasing base from which to draw. We only have 1/10th of your population but also take care of the poorest of the poor with equal and excellent care, have world renowned facilities specializing in procedures and treatment originally developed here, research, many, many beautiful! (not as described below) hospitals - modern, very comfortable hospitals in most rural areas .... a longer life expectancy, lower infant mortality rates, etc. etc. etc. - all with a much smaller pot.

[hill2016]

2. easy question

you get a two tier insurance system like what we have for public vs private school.

The rich will pay into a supplementary insurance scheme to have the better doctors. Some providers might move to cash only.

[stopbush]

70. That's a trend that's happening in CA from pre-ACA days.

Doctors refusing to accept any insurance at all. The patient pays cash to the doctor and then has to deal with their insurance company for reimbursement. Saves the doctor time and staffing expense that comes with dealing with insurance companies and puts the onus on the patient. If they lose patients they just raise their fees to cover the loss.

[bkkyosemite]

3. It's time they are required to accept it. I'm tired of doctors

discriminating because someone turns 65 and had Medicare.

[Ms. Yertle]

4. The reimbursement is too low

They can't cover their overhead with what they are paid under Medicare.

[bkkyosemite]

85. Medicare pays 80% of it's fee schedule then I for instance

pay another $163 for a supplement to cover what Medicare 80% does not cover. The doctors are in these elaborate buildings which causes their overhead to go way up. Enough. Their charges are outrageous to begin with and their overhead is not a wise investment. We the people deserve healthcare and the doctors need to be paid a reasonable fee. Their fees are not reasonable for the average American. Most Americans who file bankruptcy is because of medical bills.

[Ms. Yertle]

114. My dh's doc

was in private practice. He was not in any kind of fancy building. He needed to pay his staff, student loans, malpractice insurance, rent, and I'm sure his equipment didn't come from a thrift store. He did not live extravagantly.

[kristopher]

121. Under single payer - what malpractice? Also administrative staff reduced...

medical equipment and supply cost reduced...
number of patients up.

It is a new set of economics that works for us all.

[Ms. Yertle]

124. No malpractice????

Seriously? Would people no longer be compensated for doctors' screw-ups?

[kristopher]

128. What happens to our military personnel and their families when mistakes happen in care...

[polly7]

129. People here don't sue much ....... very little compared to the U.S.

partly because court awards here are puny by comparison.

Canada has a single-payer health insurance scheme that covers virtually all residents. Most physicians are in private practice and they bill the insurance plans for their services. Being in private practice, they require medical liability insurance. This is usually obtained through a professional organization. However, physicians are reimbursed for a large portion of their insurance premiums by provincial governments. Fees are lower than in the United States for a number of reasons. Two of these are that Canada’s highest courts have set limits on awards and the country’s liability laws make establishing professional negligence more difficult. Another is that the physicians’ insurance company defends lawsuits very vigorously.

Liability Insurance

Canadian physicians who are in private practice or work for hospitals are required to obtain medical liability insurance. Such insurance is available through the Canadian Medical Protective Association (CMPA). Insurance premiums or “membership fees” are based upon the type of work a physician performs and the region in which he or she practices. The three fee regions are Quebec, Ontario, and the Rest of Canada. The CMPA has published Fee Schedules.[6] Fees are not based upon a physician’s record and are not increased for a history of complaints or on account of claims paid.

Membership fees paid to the CMPA give physicians insurance coverage and a right to representation in medical malpractice lawsuits. However, provincial governments reimburse physicians for at least a portion of their membership fees. These arrangements are not generally made public. However, a recently released Memorandum of Understanding between the Ministry of Health, the Ontario Medical Association, and the CMPA reveals that physicians are currently reimbursed for about 83 percent of their membership fees.[7] It has been reported that the Ontario government paid about Can$112 million to reimburse physicians for medical malpractice fees in 2008.[8] Government officials in Ontario have explained that the purpose of the reimbursement program is to encourage physicians to practice in the province and not to move to another province or the United States where average incomes may be higher. Critics contend that because the CMPA’s fees are not based upon a physician’s record, the system does little to penalize physicians who are found to be liable for malpractice even on multiple occasions.[9] Physicians who have committed acts of malpractice may, however, be disciplined by their provincial licensing body. Discipline can range from suspensions to losses of the privilege to continue practicing medicine.

The CMPA has also been criticized for defending medical malpractice suits extremely vigorously and turning down reasonable offers to settle claims to discourage other lawsuits on a number of occasions.[10] One judge reportedly referred to the CMPA as pursuing a “scorched earth policy.”[11] In Canada, a losing party is generally required to pay about two-thirds of a successful party’s legal fees. Since the CMPA often incurs large legal expenses in defending claims, this is an additional disincentive to persons who believe that they have been injured through malpractice from bringing an action for damages.

One other feature of Canadian law that tends to discourage parties from suing physicians for malpractice is that the Supreme Court has set out guidelines that effectively cap awards for pain and suffering in all but exceptional cases. In a trilogy of decisions released in 1978, the Supreme Court established a limit of Can$100,000 on general damages for non-pecuniary losses such as pain and suffering, loss of amenities and enjoyment of life, and loss of life expectancy.[12] The Supreme Court did state that there may be extraordinary circumstances in which this amount could be exceeded, and courts have allowed the figure to be indexed for inflation so that the current suggested upper limit on awards for non-pecuniary losses is close to $300,000.[13] Nevertheless, the flexible cap on non-pecuniary losses is a major disincentive to persons considering whether they should sue a physician for malpractice and for lawyers to specialize in or seek out malpractice cases.

http://www.loc.gov/law/help/medical-malpractice-liability/canada.php


Each province regulates its medical profession through a self-governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members.

In Ontario:

Self-Regulation and the Practice of Medicine

Doctors in Ontario have been granted a degree of authority for self-regulation under provincial law. The College of Physicians and Surgeons of Ontario is the body that regulates the practice of medicine to protect and serve the public interest.

This system of self-regulation is based on the premise that the College must act first and foremost in the interest of the public. All doctors in Ontario must be members of the College in order to practise medicine. The duties of the College include:

issuing certificates of registration to doctors to allow them to practise medicine

monitoring and maintaining standards of practice through peer assessment and remediation

investigating complaints about doctors on behalf of the public, and

conducting discipline hearings when doctors may have committed an act of professional misconduct or may be incompetent.

The role of the College and its authority and powers are set out in the Regulated Health Professions Act (RHPA), the Health Professions Procedural Code under the RHPA and the Medicine Act.

http://www.cpso.on.ca/About-Us



Still, yes, we can sue - egregious malpractice suits can and do go beyond what the Supreme Court has established in its limits

[Recursion]

6. It may well be, but then you can't just gloss over that

This is would be a huge legal change, with probably some Constitutional issues to deal with.

[JaneyVee]

11. And how about the fact that....

In order to accomplish single payer we would have to collapse an entire industry which employs millions of middle class workers. So we would be starting off with healthcare in chaos and an unemployment crisis.

[enid602]

24. ACA

Clearly, a path toward making ACA a better Universal Healthcare is needed. I think Hill will soon tell us how she plans to accomplish that. It would be less wrenching to the economy, and we wouldn't have to go through the entire nightmare again.

[JaneyVee]

30. She has some on her website:

https://www.hillaryclinton.com/issues/health-care/

[Bayard]

61. Assimilated

My understanding is that those employees will have jobs in processing claims under the new system.

[kristopher]

122. Not at all.

If they don't want to work within the single payer system they don't have to, but there won't be enough cash business for hardly any of them them to survive.

[Recursion]

123. You believe there won't be enough business; I disagree

I think cash payment and private insurance would be popular, and private insurance companies would be able to cherry pick like they could before ACA.

So, we disagree.

[kristopher]

125. Disagree all you want, you are wrong.

[mythology]

10. You can't require peopl to run run a business at a loss

The reason many doctors either don't take Medicare or limit the number of Medicare patients is because they lose money on them and for the providers who do, they make it up on patients insured by others.

You can't then put everybody on the same underpaying program and expect the math to work for providers to stay in business.

[bkkyosemite]

105. The providers need to change how they do business. I'm sure if there was Medicare

for all there would be negotiations for paying doctors. But doctors have increased their charges with horrendous amounts for you to see them for 3 minutes flat. They need to not have an office that cost a huge amount, streamline their paperwork which Medicare for All would and they need to stop being so greedy.

[kristopher]

127. They don't need to participate.

But the economics will make it worth their while to participate. And most doctors will be happy with the change.

[TheBlackAdder]

79. Yeah, but PCP doctors sure love the monthly capitation fee when you don't show up!

.


This whole accepting money and not getting paid is a little weird.

Doctors get $30 or more dollars a month in capitation payments for each patient who DOESN'T show up.

Just for being a PCP.



They'll have a thousand or more patients on file, and only 5-10% might show up in a month. Then, when you see one of these doctors too many times, they chase you out of their office, because you are now cutting into their profits.

They want you well too. So they can collect a fee without providing any service.


.

[virgogal]

88. I have been on Medicare for 16 years,had some serious problems,and have

never been turned down because Medicare was my insurer.

[bkkyosemite]

104. Here where I live and in another state where I lived there

are several doctors who do not take Medicare. It is increasing all the time and getting more difficult to get a doctor.

[kristopher]

120. Single payer doesn't give them a choice - the medical industry becomes price takers.

And most doctors are fine with that - they want to practice medicine.

[mmonk]

5. Whatever entity is no longer a Medicare provider.

[Live and Learn]

7. Maybe Bernie will add free medical school to his plan.

I'm tired of us educating doctors doctors from other countries, while our populace can't even get in anyway.

[Hoyt]

8. Most docs would have to accept it, but I wouldn't want them doing a digital rectal exam when they

have to sign on. I think a bunch of older docs would retire, or cutback significantly.

[DanTex]

9. These are good questions. Whether private insurance will remain legal, and whether

healthcare providers will be able to go cash-only are important questions, and I haven't seen them answered.

If private insurance can exist over the SP, there's a very big risk that the public insurance will drop in quality and everyone will be forced to purchase private coverage again if they want decent coverage. Things could even end up being worse than Obamacare, because since the SP would take the place of Obamacare, private insurers would go back to not covering people with preexisting conditions and all that.

[JaneyVee]

12. You would think a healthcare plan would contain such info.

Cute how Bernie just glossed over that.

[Kalidurga]

14. First off it is not a plan yet.

It is a goal that is being aimed for. In order to be a plan we have to figure out what to do about your very valid concerns. But, we aren't even at that stage yet. First we have to figure out how to pay for it, how it will be implemented, and yes doctors will very likely have to be reimbursed a whole lot more.

But, to think most if any will refuse Medicare when over 90% of their patients will be using it, is kind of nutty. But, I do get your point in a way. It's most likely some will refuse, by finding a different line of work making the shortage of doctors much worse.

[JaneyVee]

18. Right, lets be serious...

Most doctors get into this field because of the salary. Without that salary incentive they'll just choose business and finance as their majors instead.

[MrChuck]

25. that's conjecture

The Hippocratic oath is not about how much salary doctors can collect.
Certainly nurses aren't in it for the money. Hospital staff etc, they aren't in it for the money.
There is job security in the sense that there will never be a time when health care becomes obsolete but to assume that "most doctors" get into medicine because of the pay is conjecture and, in my opinion, very cynical.
I think we can safely say that doctors are much closer to their staff, in terms of pay, than are the owners of the hospitals and ceo of the insurance and pharmaceutical industries.

[JaneyVee]

31. Nurses make good salary, but I agree...

Nurses more than doctors do it more as a calling while doctors do it more for salary.

[MrChuck]

36. That isn't agreement

when you reassert your point and blend it with my own.
I'm all for common ground but I'm not asserting that most doctors get into the medical field because of the pay.
We're only talking U.S. doctors anyway since every other country on the planet has doctors who get into the field in order to use their intellect and skill to heal the sick.
No one who supports SP in this country is pretending that the transition will be easy. We ARE saying that it will be worth it however.
It comes down to a fundamental understanding of what it will mean to future generations. Our struggle to enact this policy and our perseverance throughout its implementation will mean everything to future generations of Americans who will not grow up under the present system where the privileged receive the best of everything and the destitute can "get care" in emergency rooms as long as they're comfortable with being labeled as a "drain on society" or "the reason our premiums are so high."

[polly7]

81. Not here.

Doctors do get paid well, but all of them I know (I know many) are in it to do what they were trained for - trying to keep people well and caring for those that aren't.

[Armstead]

26. That's either ridiculous or scary

If you are correct, then it';s a sad commentary on the human race and we all deserve to die.

I think the truth is more that salary is certainly an incentive, but there are enough people who are also committed to the purpose of medicine that they would be satisfied with a good high income without having to make Super Bucks.

[Bayard]

65. Univ. of Louisville Med School

My ex worked for U of L for a number of years. He said if you went into the locker rooms, you didn't see posters of the Peace Corp or Doctors Without Borders, you saw posters for Mercedes and skiing vacations.

So they make a million a year instead of 3M. My heart bleeds.

[Recursion]

19. What leads you to that conclusion?

to think most if any will refuse Medicare when over 90% of their patients will be using it, is kind of nutty

How?

If doctors can make more money by saying no to Medicare For All and keeping self-funded and privately insured patients, how many would do that? I don't think it's crazy to think that Medicare For All acceptance rates might be worryingly low.

First off it is not a plan yet.

I agree. I think we deserve a plan.

[Kalidurga]

22. Do you really think doctors will turn away 90% or more of their patients?

Really? yes, that is nutty indeed.

[Recursion]

28. I don't think they'd be turning down 90% of their patients

I think a lot of people would still be willing to pay for medical care if it meant less waiting. And that becomes a vicious cycle. The more people willing to pay, the more doctors opt out, the longer the lines at the doctors that do accept it.

[restorefreedom]

34. i don't know any more than anyone here

but from hearing many of bernie's speeches, it sounds like he wants to get rid of the insurance middle man altogether. if that is the case, medicare will be the only game in town. some doctors might to start concierge practices for the wealthy, but the majority will have to deal with the m for a system

just me speculating.....

edit to add....since much of the cost of operating a practice is overhead, by cutting out ridiculius padded spending, many practices should be able to accept lower med for all payments and perhaps save money overall.

[winter is coming]

23. +1 to all of your points, and I would add:

When Kennedy made his "we will go to the moon" speech, he didn't have all the specs in his hip pocket. He established the goal as being worthy of pursuit and we set out to crack the problem. And putting a guy on the moon was something no one had ever done before, so we didn't really know whether it could be done, much less when.

Other countries already have single payer, which gives us a leg up, because we know it can be done, and we have several implementations to study and learn from. It won't be easy, but there's no reason to believe it's impossible.

[Hoyt]

55. Or docs would try to pad their income by providing more tests and treatments. Many do that now.

If Medicare is pretty much the only game in town, most docs would have to adapt or do something else. However, some folks won't be happy without the office wall aquariums, nice decor, doctors rushing through even more than they do now, more use of physician extenders than now, etc.

On the other hand, we can make more use of telephone consults for colds, flu, etc. And there are other ways to take care of people without the traditional doctor visits. But, are patients going to accept it? I would, but I wonder how many will.

And what happens when GOPers decide to fund a new war plane at expense of health care budget?

Getting everyone covered with comprehensive care is a worthy goal and one we have to pursue, but getting a financially viable system is going to take awhile and cause a lot of heart burn for providers and patients. The political realities -- GOPers in charge -- is a big impediment.

[seaglass]

73. How much did going to the moon impact every American's life? What was going to happen if we failed

to go to the moon?

They truly are nothing alike winter. There is a reason that people, including myself want details of a plan before buying into it - because it will have an effect on every person's life whether by the health care they receive or don't, what the quality and accessibility of the care will be, what the true costs of the care is - never mind all the people who will potentially lose their jobs and how long our economy will suck because of that.

I am completely for universal health care - I want the people who can't afford healthcare now to have coverage. I am willing to pay increased taxes for that to happen. For people who already have coverage but just don't like how much they are paying for it (who does?) I don't think it's worth tearing apart the economy to do it. If Bernie has a plan with detail that can allay those fears, I'm listening.

[winter is coming]

136. What's going to happen if we fail at implementing single payer? The same as

if we do nothing. We're not going to repeal the ACA and sit around hemming and hawing for years, debating the finer points of single payer, and only then implement something. Anyone who tells you that is either a liar or a fool. You're rejecting out of hand a concept that has worked in other countries, because you don't have a minutely-detailed concrete plan in front of you. I would argue that you don't need that plan to agree that single payer is a goal worth pursuing: we know it's been done in several countries and we know the ACA is not a complete solution.

What it boils down to is trust. I'm seeing nothing in Bernie's past to indicate that he's going to push for a willy-nilly implementation of single payer that will throw our economy into chaos (although it's touching to see the concern for insurance industry jobs when so many other jobs have disappeared with scarcely a shrug). He's patient, he's persistent, he tries to build coalitions, and he seeks solutions that work for the greater good. Our other choice is Hillary, who's accepted large donations from insurance and pharma corporations, which gives me zero confidence that she'll be working for a solution that benefits consumers.

[Armstead]

21. A detail that would be worked out.....

Let's say the Democrats as a party got their heads out of their butts and actually committed to the basic concept of universal expansion of social insurance , most likely a version of Medicare.

Bernie's plan should be seen as a starting point, like all campaign promises. It is one proposed basic blueprint. He would not get elected, and instantly implement it in exact form, on the day he is in office. You know that's not how it ever works.

It would be hashed out and modified. That would include issues like whether it is within a mixed system -- with private insurance available to those who choose to purchase it -- or not. That would involve answers to the questions you mention.

The rates of reimbursement would also be subject to much hashing out and adjustments. Presumably, through a combination of measures, formulas could be worked out that providers would earn enough to be profitable and earn a goodhigh income, though maybe not get super wealthy. ....And if someone is only motivated by super wealth is that someone you'd want in medicine?

First we should agree on a commitment to a concept. Then look at such possible options and issues.

[DanTex]

53. That is a fair point.

However, that also means that people asking how specifically Hillary is going to expand Obamacare are also asking the wrong question. If campaign promises are taken to be general guidelines for the direction of policy, as opposed to specific plans, then we have two competing methods for achieving universal coverage. One is single payer. The other is expanding the mandate system (along with large public insurance programs already in existence). Both have precedents in the developed world.

The question then becomes, why is the single payer route better than the ACA expansion route? Why do we need to emulate Canada rather than Holland? Would it really be that bad if we ended up with a Dutch or German style healthcare system, as opposed to a Canadian or British one?

More to the point, when Bernie talks about us being the only advanced nation without universal coverage, he's right, but that has nothing to do with single payer. Both candidates want universal coverage, the differences are only in the implementation.

[DanTex]

84. For example, here are a couple OPs asking for details on Hillary's healthcare plan.

It's a great opportunity for you to point out that campaign plans aren't about policy details, they are about setting out a general vision. That way it won't look like you are saying that only Bernie should not be pressed for policy details.

http://www.democraticunderground.com/12511129513
http://www.democraticunderground.com/12511126990

[Armstead]

95. Well, I think the problem there is the general vision

Bernie has released a plan for a model of single payer healthcare. It is not what it would be in final form, but it is a basic concept to show what type of system he is proposing and -- more important -- a philosophy and approach of social insurance rather than restricting people to private coverage.

One can peck and niggle and jiggle the details, and it would definitely be subject to all kinds of haggling and bargaining and negotiating once proposed. And it is also possible it would start with interim "compromise" steps such as a public option. And it could well end up as a mixed system, as in some otehr countries.

The difference is that Hillary has a lot of specific proposals to tweak the system, but no clear and stated goal otehr than "build on Obamacare." Which is a meaninglessness term because it can mean so many things. And she misleads oin the principle of "universal coverage." What the hell does that mean? Does it mean Universal coverage, but you still won't be able to afford it because it will continue to be under the thumb of for-profit insurance?

She also sends out mixed and conflicting messages. One day the public option is a "unicorn" that will never ever happen. The next day it is something she will "certainly consider as a subject for further discussion" which us hardly a clear communication of what she would like to do and the direction she wants to take things.

[Art_from_Ark]

27. Tell me something

You said your wife was working for the State Department there in India. Are you covered by her insurance?

[Recursion]

33. I'm eligible for it

I don't really see how our individual insurance decisions are relevant here, but yes, as a dependent I can be covered.

[Art_from_Ark]

47. It is quite relevant

If you get US government-sponsored health insurance, paid for by US taxpayers, how can you try to deny the same benefit to all Americans?

[Recursion]

48. You know it's private insurance, right?

It's insurance purchased from an insurance company by the employee.

[TubbersUK]

29. Regarding access/wait times

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

[JaneyVee]

32. Again, those countries have 1/10th of our population.

[polly7]

82. So??? nt.

[TubbersUK]

96. What issues do you see with scaleability ? n/t

[Nanjeanne]

35. The ACA isn't the same as it was when it was presented - details get worked out

This need to have every single detail defined in full is simply a way to try to knock the idea down before it gets started. Nothing that has ever been passed has been exactly as it was written down in a few pages.

THIS IS A GREAT START - about a VERY IMPORTANT ISSUE - and something that has been done by countries large and small - from Israel to Australia

What Sanders offers is a vision and a beginning that makes sense and gives people an idea of what we could do here that other countries are already doing. I have no problem with voting for that. I voted for Obama because I thought we would be getting something like this.

I am not stupid enough to believe that the ACA will be demolished while a single-payer healthcare type system was worked on. Anyone who believes that is being lied to and having fear prayed on.

I do not believe that people want choices. The only choice people want when they get sick is to get care. I find it disgusting that people are supposed to buy insurance based on how sick they "think" they may become. Or buy insurance based on "what they can afford". Does a person making $35,000 a year deserve less healthcare than a person who earns $350,000? Not in my country. I want to see this country change into a country where healthcare is a RIGHT not a PRIVILEGE. End of story.

[donco]

37. About 90% of doctors

except Medicare now.What would prevent them from accepting a younger clientele that requires less care?

[Recursion]

38. 68% of doctors accept new (EDIT) Medicaid patients

http://www.cdc.gov/nchs/data/databriefs/db195.pdf

About 90% of doctors have at least one Medicare patient, but about a third will not take new ones.

EDIT sorry, that's 68% will take new Medicaid, and 83% will accept new Medicare.

[donco]

42. I wonder if

the bureaucracy was eliminated(with Medicare proper) such as it is with Medicare advantage what that number would be?

[Recursion]

45. Me too. But I don't assume it would be better.

It might be, but I see no reason to assume that.

[TubbersUK]

74. Good point

Last edited Wed Feb 3, 2016, 01:44 PM - Edit history (1)

Around 83 - 90 % currently accept new Medicare patients

ETA: Interestingly, about the same percentage that accept private health insurance.

I can't think why they would be reluctant to embrace a younger/healthier demographic ?

http://www.cdc.gov/nchs/data/databriefs/db195.pdf

[drm604]

39. Those that don't accept it may not have a lot of customers.

It seems like there wouldn't be enough cash customers for more than a small percentage of doctors.

[Recursion]

43. Why not? Will this be making private health insurance illegal? (nt)

[drm604]

57. I don't know.

Even if it didn't, how many people would buy private insurance if they could get care that they're already paying for through taxes?

[Recursion]

58. About 10% of primary & secondary students go to private schools

Significantly more if you count charters (which are kind of a foot in both worlds, even if they're "officially" public).

More troublingly, these providers are about 25% of all schools. More lucrative students mean more individual attention to those students, which drives parents to want more "private-like" schools (hence charters).

About 25% of college students are in a private college or university, though obviously that's a little different since public ones have tuition, too.

[Motown_Johnny]

40. They go out of business.

How is that not obvious?

[Recursion]

41. Because I see no reason to think they'd go out of business

I think there would be enough people willing to pay extra to avoid the public financing system that it would be worthwhile for some providers and insurers to cater to them, and that this will lead to a cycle where more doctors seeing the private system as being more lucrative leads to more wait times on the public systems, which leads to more patients being willing to pay more to get off of it.

[Motown_Johnny]

44. Why pay for something that the government would pay for?

The taxes won't be optional.

This is like saying that people now would pay out of pocket for things that their insurance now covers. It doesn't happen.

Think whatever you want, but it doesn't make any sense.

[Recursion]

46. Why do people go to private schools? (nt)

[Motown_Johnny]

51. Are you insulting providers who accept Medicare?

The quality of private and public schools are very different. Your question assumes that the quality of health care providers within the government system would be lower than those who refuse to accept government payments.

There is nothing to base that assumption on. Are you saying that the providers who now accept Medicare are somehow inferior? If so, please provide evidence to support that statement.

[Recursion]

52. Are you insulting public schools?

Your question assumes that the quality of health care providers within the government system would be lower than those who refuse to accept government payments.

Even now providers who take Medicare and especially Medicaid patients have to do a lot of volume to make up for the lower reimbursement rate they get compared to private insurance and self-funding. This means shorter visits and less attention to each patient. (If Medicare does move off fee-for-service, that may change, incidentally, but that isn't part of the plan that people are talking about.)

And, yeah, I'm willing to bet that a provider billing privately will probably be able to offer a better experience than a provider billing publicly, based on that dynamic. And there is a non-zero number of people who will be willing to pay for that. The question is how many, and will it be enough to pull more doctors off the public system?

[Motown_Johnny]

54. Test scores prove my claim

Can you provide evidence that the quality of care provided is inferior?



http://www.daytondailynews.com/news/news/local-education/private-schools-top-public-in-average-act-sat-scor/nTtCq/

^snip^

The composite average for these private schools on the ACT was 23.6 for 2012 graduating seniors, as compared to the 21.7 average of the nine-county region’s 81 public high schools. The private school scores also topped the state (21.8) and national (21.1) averages of students at all institutions for 2012.

[Recursion]

56. They get to pick their students. Just like concierge doctors would get to pick their patients

And if you're looking for a case study of a field in which wealth disparity leads to incredibly unequal outcomes despite universal access, it's hard to find a clearer example than education.

[Motown_Johnny]

59. I didn't pick this comparison. Maybe respond to the person who did.

Oh wait, that was you.


Feel free to try again, but it should be clear by now that your argument here was an epic fail.



Again I ask, please provide evidence to support your claim that providers who accept Medicare are inferior to those who do.

[Recursion]

60. It's weird to ask me to prove a claim I'm not making (nt)

[Nye Bevan]

49. The vast majority of providers accept Medicare:

http://kff.org/medicare/issue-brief/medicare-patients-access-to-physicians-a-synthesis-of-the-evidence/

[Recursion]

50. That's "providers who have at least one Medicare patient"

Providers who will currently accept new Medicare patients is significantly lower, 68% or so.

http://www.cdc.gov/nchs/data/databriefs/db195.pdf

[TubbersUK]

62. Am I misreading - Your source says 83.7% ?

Summary
In 2013, most office-based physicians (95.3%) accepted new patients. The percentage of
physicians accepting new Medicaid patients (68.9%) was lower than the percentage accepting
new Medicare patients (83.7%) or new privately insured patients (84.7%).

[Recursion]

64. Sorry, yes, the 68% is Medicaid, vs 83% for Medicare

1 in 5 won't take new Medicare patients, one in 3 won't take new Medicaid patients.

[Nye Bevan]

75. It's 83.7% in your source,

almost identical to the percentage accepting private insurance. Bear in mind that this number is skewed lower by professionals such as psychiatrists and cosmetic plastic surgeons, who accept Medicare at a much lower rate than internists and oncologists.

[guillaumeb]

76. Your question has ignored the reality of single payer.

If every American is enrolled in Medicare for all, who will the providers treat except for Medicare patients?

It really is that simple.

[Recursion]

80. Who do private schools serve? (nt)

[guillaumeb]

86. There is no equivalence here.

Are you suggesting that there are enough rich people to set up a parallel system, a two track system of care?

If every one of the 325 million US citizens is enrolled in Medicare, providers would have to refuse to care for 322 million of US citizens, leaving the 3.25 million, the 1%, as their only patients. That would lead to an immediate oversupply of doctors and empty hospitals.

What all of these debates ignore is the fact that single payer works, and the US system does not.

[Jackie Wilson Said]

83. Medicare for all requires a complete redo of our entire system, a huge undertaking.

And as hard as it will be to do, it must be done.

[Recursion]

87. Why must it be done? Why not adopt France's system? or Germany's?

Why are you so dead set on this one particular model of financing reform?

[Jackie Wilson Said]

89. Why not outline those systems for us and I will let you know

[Recursion]

90. Gladly

In France, the government sets prices for hospitals and doctors and subsidizes about 75% of the cost of them. People either pay the rest out of pocket or buy health insurance to cover it.

In Germany, people are required to purchase insurance from regional co-ops, which negotiate prices with providers.

In both, doctors make a good deal less than they do here, and for-profit hospitals are basically unknown. Lots less is spent on end of life care, and a referral is required from your GP to see a specialist. Both have about half again as many doctors per capita as we do, and nurse practitioners, etc., can do a lot of things that only doctors can do here.

[Jackie Wilson Said]

91. So medicare for all would only be different in out of pocket costs would likely be less, so I still

like medicare for all or whatever you want to call it, single payer.

Why do you want to keep the middle person as in the Germany example?
They provide no service at all.

You see your examples would mean American doctors would have to participate and make less, the very thing you said would be an issue.

[Recursion]

93. They do provide a service: doctors can't lobby them

And can lobby the government.

Also, I don't get why people think insurance provisioning isn't a service.

[Jackie Wilson Said]

94. Insurance for profit makes no sense in healthcare. It exists solely to provide

profit for an unnecessary link.

Proof of that is Medicare itself.

Here is what I think: I think Hillary blew it and she knows it when she said "never ever gonna pass".

I think Hillary Clinton the person wants single payer, but is under tremendous pressure from the profiteers to resist it.

I think Bernie has the right idea, but will find little support in Congress for his idea at this time.

I think the only way we will get what we clearly have to have, is to take the decision out of the hands of the politicians and profiteers and put it in the hands of the people. Not sure how to do that, but once your average American sees how much better their lives will be, and it will, they will no longer allow this limbo to exist.

Or not...

[Recursion]

107. And that was the theory behind Blue Cross

That was supposed to fix it: a national network of not-for-profit insurance organizations, who since they were not tainted by the evil profit motive would provide affordable insurance to all. And, well, it wasn't really any cheaper.

[Jackie Wilson Said]

113. But that was because Blue Cross always functioned as if it was for profit with much

higher costs than Medicare.

There is no rational reason to want a middle man taking money out of your pocket when the government can set up a system to do it for far less.

Blue Cross has an ugly history.

[Vinca]

92. Providers starve.

[ljm2002]

97. The Canadian system seems like a good model...

...where doctors must accept the Medicare payment and cannot offer covered services outside of that system. Then people can buy supplemental private insurance for those services that are not covered.

That does not seem drastic to me.

As to the doctors balking at the rates, they are free to fold up their businesses. Of course it would be disastrous if large numbers of them did this -- but really, what are they going to do? Retrain for another line of work? What, exactly? Doctors are by and large smart and could retrain, but they would be throwing away years of training and monetary investment, and there are not that many better professions out there.

Any system we devise will be imperfect. The one we have is beyond imperfect, it is deeply, deeply flawed and serves to deny anything but emergency health care to a huge swath of the population, even those who are "insured" and paying through the nose for the privilege. Tinkering around the edges of it will not give us the results we need.

It never ceases to amaze me how much FUD is put forth about a Medicare for all plan, vs what we have now. The system we have now does not serve us well, and yet so many want to defend it. The flaws in ACA continue to plague us, it is overly complex and serves the medical and pharmaceutical industries and the medical insurance industry while fleecing the people for inadequate and overly expensive coverage. Time for a change. Sometimes you really do need to upset the apple cart. We can see that other countries have somehow devised serviceable systems for all of their people, and yet somehow we, the great USA, the richest and most powerful and bestest nation that ever was, cannot do it.

PFFFFFFFFFFFFT.

[Recursion]

126. I don't know anybody on DU who defends the system we have now

Can you point to that? (Or are you counting the self-evident fact that it's better now than it was before the ACA as "defense"?)

[UglyGreed]

98. May I ask if you are involved in healthcare?

I noticed you have posted many threads concerning single payer and I recall you being against providing opioids for those who suffer from chronic pain. Just wondering if these positions have anything to do with your profession.

[Recursion]

99. You recall wrongly

I recall you being against providing opioids for those who suffer from chronic pain

Nope. I expressed concern that the US uses more opioids than the entire rest of the world, and that they're killing more Americans than cocaine. No idea where you got the idea that I'm "against" people using them.

I noticed you have posted many threads concerning single payer

I have. I think it's a bad idea for the US.

[UglyGreed]

101. Well you replied to

many of my threads concerning pain medication in the past with negativity, perhaps I took them for you being against such treatments. I guess you do not want to answer my original question which is fine. BTW are you against the VA and would rather have those who served seek treatment in the private sector?

[Recursion]

102. I think the VA is one of the best things we do, and I'd much prefer expanding it to all Americans

than I would expanding single payer to all Americans while keeping private providers.

[UglyGreed]

103. OK thank you for your

reply.

[Hassin Bin Sober]

106. I keep hearing it is hard to find doctors that accept Medicare. I think that is bullshit.

I used to laugh at the letters my parents received from a couple doctors that left the medical practice my parents used our whole lives.

We had a neighborhood doctor just down the street. I went to him through my whole childhood. He was bought out by a local hospital system and the main Doctor retired.

Anyway, my parents used to get letters from two of the spin off offices BEGGING them to switch. Both of my parents were on Medicare.

I used to tease my parents - "you know you and your chronic health conditions are a cash cow for these people"

I wonder if all these "complaints" I hear about not being able to find Medicare doctors are manufactured. Like all the "frivolous lawsuit" bullshit.

[Recursion]

109. Medicaid is the bigger problem, which is the kind of broad population like M4A would be

http://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor

However, even on Medicare there are some issues, as Kaiser outlines here:

http://kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/



Kaiser seems to conclude that the concern is exaggerated but real. It is harder to find a doctor on Medicare than on private insurance, and significantly harder to find a doctor on Medicaid than on either.

[Hassin Bin Sober]

110. So basically "not being able to use Medicare" is bullshit. As I expected.

And you can't include the "not accepting patients" piece in your equation because that's true with regular insurance.

Oh I see there is supposedly a 7 percent spread. Big fucking deal. 7 percent - because they can. I suspect that would change if everybody went on Medicare.

[virgogal]

112. I'm on Medicare (16 years) and had 2 serious health issues

and some minor ones and have never been turned down.

[TubbersUK]

111. You're correct

Doctors are pretty much as likely to accept new Medicare patients as they are privately insured patients - 83.7% and 84.7 % respectively.

The figures for Medicare may actually be even more favourable in reality, given that, for instance, cosmetic specialists skew the data.

Summary
In 2013, most office-based physicians (95.3%) accepted new patients. The percentage of
physicians accepting new Medicaid patients (68.9%) was lower than the percentage accepting
new Medicare patients (83.7%) or new privately insured patients (84.7%).

http://www.cdc.gov/nchs/data/databriefs/db195.pdf

[MineralMan]

130. Acceptance of Medicare patients varies by location.

In most metropolitan areas and the suburbs surrounding them, Medicare patients are generally readily accepted or even sought after by the multi-specialty clinics that are common in those areas. In more rural areas, where such clinics are not as widespread, individual doctors in private practice are somewhat less likely to accept new Medicare patients.

The difference is in those multi-specialty clinics, compared to private solo or small group practices.

Here in the Twin Cities of MN, it's not a problem for Medicare patients. Every clinic I know of is more than happy to get new Medicare patients. Same day appointments are another perk of living in an area like this. The clinic I use has a complete range of specialists, either at the location I normally visit or at another nearby location. My clinic is also a 24-hour urgent care clinic, if I need off-hours care.

If a person lives in a rural area, however, things can be different, depending on the population and distance from some larger city. There, individual doctors in private practice may not be as eager to accept Medicare patients.

[gcomeau]

131. Then any provider that doesn't...

...suddenly finds themselves with a very small potential pool of customers.

(*If* providers are not required to accept it )

If so, how do the providers make up the lost income .

This contains an implicit assumption that we need to worry about them making it up at all. If they're massively overcharging for procedures and medications (which we know damn well the US health care system currently does) who gives a shit if they make up the loss after they're forced to start charging fair prices?

[Recursion]

133. Well, I don't, but they certainly do (nt)

[gcomeau]

137. Of course they do.

Just like the 0.1% care if they have to start paying more taxes.

And we should let that influence our policy making exactly not at all.

[Romulox]

132. Basic market forces will impel providers to accept Medicare. This is elementary. nt

[Recursion]

134. There are still private schools (nt)

[Romulox]

135. OK. Public education is nevertheless universal. nt

[azurnoir]

138. at present only about 15% of the US population is covered by MediCare

so some providers can well afford to do this , when that percentage becomes exponentially higher then refusal of care becomes very difficult