The factory owners want medicare for all. The cost of insuring the employees and management is wastefully inefficient.
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The Columbian Editorial 2024-0221: "Providence Health & Services, which is based in Renton, has agreed to refund nearly $21 million in medical bills paid by low-income residents in Washington, along with erasing $137 million more in outstanding debt. The move, announced this month, follows accusations from the state that Providence overcharged those patients and then used aggressive tactics is seeking to collect payment
State Attorney General Bob Ferguson says it is the largest settlement of its kind in the nation’s history. Ferguson, who is running for governor this year, also notes that it is the kind of consumer protection case his office would not have had the staffing to pursue in previous decades.
The gist: State law requires hospitals to provide financial assistance, known as charity care, to patients based on their income level. The Office of the Attorney General alleged that Providence withheld this information from patients and trained staff to not accept the answer when those patients said they could not pay. Skeptics might claim that hospitals also have bills to pay in order to provide continuing care. But as Ferguson points out: “Hospitals — especially nonprofits like Providence — get tax breaks and other benefits with the expectation that they are helping everyone have access to affordable health care. When they don’t, they’re taking advantage of the system to their benefit.”
But that is not the only method in which Providence has skewed the system in a most uncharitable fashion.
According to the Puget Sound Business Journal, Providence CEO Rod Hochman is the state’s highest-paid health care executive, receiving total compensation package of $9.5 million in 2021. In previous years, his compensation reached nearly $11 million. And in 2020, a New York Times investigation found that Providence obtained more than $500 million in government funding that was designed to help health care providers during the COVID-19 pandemic. At that time, Providence had more than $12 billion in cash reserves and earned approximately $1 billion a year in revenue from investments."
Intercst - Thank you for continuing to educate us about this important subject.
NWVillager
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Here’s another article on the lavish salaries at the “not for profit” Providence Health. I regularly get solicitations for charitable donations from Providence. Any other “charity” where dozens of executives were siphoning-off multimillion dollar salaries would be investigated for fraud.
intercst
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The Tragedy of the Commons?
Tragedy of the Commons: Examples & Solutions | HBS Online.
Communism only works in small groups where individuals can be controlled or expelled. Even kibbutzim failed.
The problem with the Healthcare Industrial Complex does not start at insurance or even at drug companies. It starts with the AgroIndustrial Food Complex. If people ate real food instead of AgroIndustrial Garbage a large part of health problems would simply disappear. These two industries benefit each other with the blessing of lobby controlled government bureaucracies. A version of Parkinson’s Laws points out that bureaucracies grow
A current form of the law is not the one to which Parkinson referred by that name in the article, but rather a mathematical equation describing the rate at which bureaucracies expand over time.
The Captain
Interesting personal observation: In the old days before I learned to eat right every two or three years I had to have new eyeglasses as my vision deteriorated. Since the change in eating habits I have not had a need for new eyeglasses. Coincidence? Maybe but I doubt it.
BTW: I’ve had practically no need to visit a doctor for close to ten years and I no longer take the eight or so medications that I was told were for life.
BTW2: Want to save on healthcare? Heal yourself by eating right.
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Oh, sure.
The Centers for Medicare and Medicaid Services data on National Health Expenditures, is at the first link below - where we see that private health insurance expenditures were “only” 1.3 trillion, while Medicare expenditures were about $944 billion and Medicaid expenditures were about $806 billion. So while most people have private insurance, most spending is done in the public programs.
Medicare reimbursement rates average around 30% less than private insurance rates, and Medicaid reimbursement rates are about 30% lower than Medicare rates. Medicare plans are also less generous than typical employer-provided private plans - they have a lower actuarial value, meaning that on the whole you get more coverage in a private plan. And finally, about 26 million people are uninsured today - roughly 10% of the nonelderly population.
So - what happens with a universal single payer system? You pick up the cost of about 26 million people who aren’t paying premiums now. You no longer have the three tiers of reimbursement rates, so no more paying Medicaid providers half and Medicare providers a third less than market rate. One rate for everyone. You have to increase the coverage of Medicare and Medicaid in order to get it up to the average level of coverage of private plans (people will crucify their politicians if their insurance coverage gets worse under M4A).
All of that extra cost dwarfs the administrative costs of private health insurance. The net cost of private health insurance is “only” about $131 billion, or just under 10% of expenditures. Providing health care to the currently uninsured would be more than $300 billion (26 million at more than $10K per); raising the reimbursement rates for Medicaid just to the level of Medicare would increase those expenditures by $240 billion, and increasing them both to private insurer levels would increase expenditures by $700 billion.
Which - again - is why the states that have tried to do this have all had to abandon the effort. Even states where single payer health coverage would be enormously popular with the electorate (like Vermont and California). Because the numbers don’t work once you pick up the tab for all the uninsured and eliminate the separate discounted pricing tiers associated with Medicare and Medicaid.
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Or reducing care. If our current system is really cheaper than Medicare for All then it’s because it fails to provide health care to everybody leading to unnecessary suffering and deaths.
So, would the “JC” add the money he is not spending on health insurance to the Prole’s paycheck, so the Proles can pay whatever tax is created to pay for unversal health insurance? Or is the “JC” thinking he can stuff that money in his own pocket?
Did “JCs” increase the Prole’s pay when they took company funded pension and retiree medical away?
Steve
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On a happy side note: it appears there are now only 10 “craphole” states now:
Pete
It is the least expensive option of ALL other options. Taxes go DOWN because EXPENSES GO DOWN. Or is that a BAD thing? LOL !!! It is also a “national security” issue. 50+% of US kids are physically unable to be in the military. Guns are useless if there is no army of soldiers to use them. Sound familiar?
Poorly done @albaby1
The pharma costs to private and public systems need negotiations. The private systems have lower cost patients. The medical equipment people are gouging. The private systems charge about twice the public systems for admin.
The medicare for all systems can safely assume doctor’s personal costs would come down. By that I mean if a doctor has three kids s/he often pays $700k during their life time on their children’s college education. Plus as much as much on their own education. Which would in a more socialized society lower those costs. What a doctor gets in earnings would decline a bit but personal costs would decline in this economy that is coming.
So yes I agree over time providers would take home relative less but it would balance out with social spending as the same.
The savings to the business community would be huge.
Productivity would also expand.
Longevity would be better across the population. There would be a sense of justice.
Sure - but you’re delivering a massive cut in compensation to maybe 10% of the workforce. The health care industry is about 16% of U.S. GDP - so if you cut it by 20%, you’re reducing U.S. GDP by more than 3%. Even if you spread that out over several years, you’re still talking about a massive negative dislocation to the economy and a lot of economic pain to everyone in the industry.
Personally, I think that’s a fantasy. What’s far more likely to happen is what we’ve seen with the defense industry and other sectors that derive enormous economic benefits from government contracts and price-setting - the health care industry ends up with massive lobbying arms and devoting a lot of money to currying politics, and governmental policy ends up protecting their rice bowl.
Again, the 17 separate “doc fix” enactments are instructive. Given the choice to cut Medicare reimbursement rates by doing nothing, Congress instead was lobbied intensely and moved to act to make sure that the government kept paying more money for Medicare services…rather than pay the political price of unhappy medical providers.
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Even if true, that doesn’t change things - both because the numbers are too small and there are still people who work for pharmaceutical and medical equipment folks.
In 2022, prescription drugs were “only” $406 billion in national health expenditures, while medical equipment (durable and non-durable) were “only” $180 billion. Call it $600 billion in total. So even if you could knock 25% off the reimbursement rates for those things, you’re still only looking at $150 billion or so - not even enough to cover half the cost of the uninsured. And again, if you cut the reimbursement rates for those companies, you’re going to inflict economic harm not just on the ‘fat cats’ and shareholders, but also everyone that works for those companies.
You absolutely can switch to a government-run single-payer system if the government is willing to take an axe to medical reimbursement rates. But it doesn’t work just by limiting that axe to just the “less popular” types of medical service providers (like Big Pharma and Big Medical Equipment) - there isn’t enough money there. And those types of cuts will be phenomenally politically unpopular, so it’s not rational to expect that it could ever happen in our political system.
So when Vermont ran the numbers, they had to scrap their system. They couldn’t make the dollars work. There just aren’t enough savings, when you actually dig into the numbers.
Vermont’s foray into publicly financed health care — in a state that in many ways offered the optimal conditions — demonstrates the extraordinary difficulty of trying to convert liberals’ dream of a more just, efficient health system into reality.
Then as now, many of the advocates shared “a belief that borders on the theological” that such a system would save money, as one analyst put it — even though no one knew what it would cost when it passed in Vermont.
That belief would prove naive. The choices Shumlin favored would essentially have doubled Vermont’s budget, raising state income taxes by up to 9.5 percent and placing an 11.5 percent payroll tax on all employers — a burden Shumlin said would pose “a risk of economic shock” — even though Vermonters would no longer pay for private health plans.
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Of that 16% of US GDP, about HALF of it is making OVERPAYMENTS to a small part of the economy. What is really happening is those overpayments are being eliminated over time. The doctors are not worried because we see what is already happening: Doctors are selling their practices to private equity/hospitals so the doctors can work “regular hours”, rather than a really hectic schedule–and taking a HUGE pay cut as a result. So the ones losing the money are the private equity groups. They are superfluous to the economy anyway, so no big deal if they disappear.
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If you believe that, I’ve got a wonderful bridge to sell you! You don’t think those private equity groups are going to push some - if not most - of those reimbursement rate cuts down onto the doctors? And nurses and administrative staff and janitorial staff and everyone else in those facilities?
As I mentioned upthread, in every Congressional district the regional hospital system is probably not the single biggest employer in the district, but is likely in the top 10 or 20. So when Congress considers slashing reimbursement rates, and the equity group that owns the hospital announces 10% cuts in compensation and/or workforce in response to those cuts, you don’t think that the political pain will be unbearable for the Congresscritters?
Nice try, but nope. Remember? Congress will have ALREADY APPROVED of the cuts because of the national contract to provide health care to everyone. Nothing prevents the private equity from screaming, but we all hear 4-month olds scream all the time when they want something. Too bad, they will NOT get what they want. Why should they? MONEY ??? ROFLMAO !!!
So? That’s what happened with Medicare. They adopted a proposal that would limit the growth of reimbursement rates to doctors. And then for the next decade and a half, every time it was going to be applied, they ended up enacting a “doc fix” that kept the rates from being cut. Because they wouldn’t endure the pain from all of the clinics and hospitals and doctors offices and diagnostic centers and everyone else calling up their Congresscritter demanding to be spared from the lower reimbursement rates.
They’re not going to do it. They either won’t adopt the cuts in the initial national contract, or they’ll just undo them before they become effective. If you think insurance companies are bad at keeping medical costs from rising, just wait until it’s politicians who are in charge of setting those rates.
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Not even close. Medicare sets it own rates to be paid. An independent bidder with a proposed AND accepted contract to deliver services for a price is NOT forcing the price on anyone. Everyone who agreed to the new rates did so with full knowledge of what they were being offered. So Congress has no valid reason to refuse such a contract. It lowers taxes, which means nobody can legitimately claim it is bad for the taxpayers.
They do have a valid reason to refuse such a contract. It will make all the people who provide medical services that live and vote in their district very unhappy. It’s the same valid reason that Congress kept passing the “doc fix” bills, even though not doing anything and allowing the already-approved cuts to take effect would have lowered taxes, too. Because the medical providers didn’t want to suffer the economic consequences that come from lowered reimbursement rates, and they made sure that Congress knew that.
And I still don’t know how you think this “national contract” is going to come into being? Congress puts out a request for bids on a national premium for health care services - and you think someone will come in with a price that’s materially below market? How would they get all those medical providers to agree to provide them with services (ie. be part of their network) at below-market rates? Congress is able to do that because they’re the government, and they already control more than half of health care spending in the country, and the bargain they strike is that if you take their lower rates you can get all-you-can eat patient supply. But how would a private insurer that doesn’t already have the monopoly be able to make this work?
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The EU has a larger population
The focus was on lifestyle under demand-side economies.
Introduction and summary. Compared with peer nations, the United States has had the highest per capita prescription drug spending for more than a decade, reaching an average of $1,432 per American in 2021.Oct 12, 2023
With EUR 615 per capita , Germany spent by far the most on pharmaceuticals among EU member states – 60% above the EU average. Belgium, France and Austria spent between 20-40% more on medicines per capita than the EU average. At the other end of the scale, Denmark and Croatia had relatively low spending levels.
Interesting note because we are shifting to a manufacturing economy.
What industry contributes most to US GDP?
U.S. share of value added to GDP 2022, by industry
In 2022, the finance, insurance, real estate, rental, and leasing industry contributed the highest amount of value to the GDP of the U.S. at 20.2 percent. The construction industry contributed around four percent of GDP in the same year.Nov 3, 2023
This is all gamed in the legislation. I would take the private sector out of it. Except for supplemental policies.
Eventually the Medicare acceptance age will be 50 years old. Then it will go down to 40 years old, rinse and repeat.
That might be temporary. I have been reading that there is a push to undo some of those states that extended it.