The government’s admin costs are reasonable.
After that, the government and private insurers are overpaying. They walk hand in hand on the billable. Congress has allowed this.
Tell us something we don’t already know.
As other countries have lower costs AND better outcomes (fact, not opinion–identified many times on TMF), then the US is overpaying to get worse outcomes. Time to change the dynamics of healthcare in the US in order to pay less AND get more. Hence a national contract to cover everyone at a specified per capita figure to begin lowering costs. The bigger the group, the lower costs can fall. You know, like insurance does.
These are the worst , most parasitic members of the workforce – health insurance CEOs, multi-millionaire ‘not-fot-profit’ hospital operators, Private Equity, Members of Congress taking the drug money, and Joe Manchin "leading 63 bipartisan Senators in support of Medicare Advantage.
Few Americans are going to mourn their downfall.
intercst
1 Like
No, they’re not. The people you mention are only a tiny fraction of the folks that work in the health care industry. The overwhelming majority of them are doctors, nurses, technicians, orderlies, health care aides, clerical and administrative staff, and millions of other working-class and middle-class folks who work in medical service facilities all over the country.
You can’t shrink the health care sector by any appreciable amount and not cause economic pain to those folks. Not only because they constitute the overwhelming majority of people that work in the sector, but because the people you disdain have the power to make sure that the economic pain gets disproportionately served to the ordinary people that are providing medical care. If you cut hospital reimbursement rates by 20%, you think the hospital CEO is going to eat all of that reduction? And none of it gets felt through salary cuts and layoffs to anyone else who works in that hospital?
3 Likes
Why can’t they they find work elsewhere, just like any other American who loses a job? Many will lose work anyway, as AI starts performing these tasks.
I’d like to see the National Institute of Health provide us with an AI doctor dispensing vetted medical information in competition with whatever the price gouging medical/industrial complex provides.
intercst
3 Likes
They can try, sure. But people, as a rule, generally don’t like being laid off from their jobs. They don’t like being fired. They don’t like getting pay cuts, or having their shifts cut, or getting less generous benefits. Most people don’t like it when TPTB decide that their good middle-class jobs need to go away in service of some amorphous policy objective that’s going to benefit other people, but force them to experience most of the pain of the transition.
As for AI, I wouldn’t worry too much about it just yet. I like Matt Levine’s description: AI is “extremely good at being mediocre at a lot of white collar jobs.” It can give you an output that is not especially brilliant or insightful and is probably right, though sometimes it will be very wrong. Which makes it well-suited to replace a lot of very junior people in certain job settings (like first-year lawyers or financial analysts) whose job description usually involves creating first drafts that will be reviewed and checked by more senior people - and very poorly-suited for things like medicine, where being very wrong can have disastrous consequences.
That sounds like my entire working life. Apparently, the perception is different when the “JCs” experience what the rest of us do, repeatedly?
Steve
2 Likes
No. That’s the point. The economic pain of cutting reimbursements for medical procedures is not likely to fall exclusively, or even primarily, on the “JC’s.” The folks who provide the medical services - everyone from the doctors to the nurses to the lab techs to the orderlies - will suffer economic pain if we were to try to materially shrink the size of the health care sector, or significantly slash reimbursement rates across the board. Which makes it exceptionally unlikely that Congress would actually do that under a single-payer system.
Seems some of us do not know.
The Millennials and Zs have pain now. That is why people are saying the economy is poor or bad.
Picking up the bigger ticket items would make this economy excellent for everyone.
When I went to UCONN it was 4 parts the state of CT and 1 part my family and I. Now that has flipped and it is 4 parts the student and family with 1 part being the state of CT.
Baby boomers do not deal honestly.
Doctors medical school loans and their children’s school bills can be substantially brought down. If things like that happen take home pay is relatively better and not just for the doctors.
My experience has been that the “burden” will fall disproportionately on the Proles, not the higher level people. The pump seal company cut pay in 82 or 83: Honchos got a 5% pay cut, Proles were cut 10%. The CEO explained the disparity: “we want to keep our white collar people”. Unfortunately, I did not keep the Tandy Corp proxy statements from 89-92 to see what happened to the honcho’s compensation, while they were handing out 30-40% pay cuts to store managers and salesmen.
Steve
Sure we can. Remember: There is a contract to provide services at a mutually agreed upon rate. The JC has a choice: Give up some of his/her income from that source–or have ZERO income from that source.
What would a JC do with a hospital with zero income? Sell it. To somebody with a clue about what the JC(s) do not want to do–make money. Sure, the hospital(s) could be torn down. The JC(s) will only have themselves to blame for their current/future losses. AND they would never be allowed to own/operate a business in that town/area again. All the medical staff and other personnel will find other jobs in the same/similar field(s). But you can bet anything you choose, the general public will never forget if the hospital is torn down at the direction of the JC(s) without a replacement being immediately available. then again, the city/county/ tate can always condemn the property, take it, and pay “tax value” as declared by the JC(s)–because they did honestly and properly report the value of the building and property per the tax valuation argued by their valuation experts—RIGHT? LOL !!! So a new owner can be readily found to buy the foreclosed assets and keep all the staff employed. Just the JC(s) have removed from the equation. They did that to themselves.
You still haven’t said how you think that could possibly happen. Why would the hospital (just to pick a type of medical provider) agree to a contract with a private insurer at a reimbursement rate that’s 20% (just to pick a number) below market?
Why wouldn’t the JC have a third choice - cut the salaries of his staff in order to meet the market price, rather than giving up any of his/her own income?
30k people are dying uninsured or underinsured every year.
Who is causing the pain?
Who has guaranteed income? Because the current laws guarantee the pay while businesswo/men pay taxes on changing incomes year by year.
Because the loss of so many skilled workers would mean the JC(s) could not fulfill the contract. To get the volume high enough, they would have to PAY FAR MORE to replace people who left. That, of course, implies there might NOT be an available surplus medical workforce. Which is no surprise in a post-Covid world. So the JC(s) lose their entire investment because nobody wants to work for them after they treated their former employees so poorly.
Again, I think it might help if you elaborated on how you think this contract would be formed and what it would cover.
From your earlier post, I thought that Congress would be putting out for bid a contract for insurance - that an insurer would be offering to provide universal health coverage. The insurer would quote a premium to Congress that would be 20% lower (to pick a number) than current average cost - but then that insurer would have to go out and convince health care providers to agree to provide services at a lower reimbursement rate in order to make that work.
Is that not what we’re talking about? If so, again, why couldn’t a JC cut the salaries of his staff - who aren’t going to be able to quit en masse, because every other provider would also have to be cutting their salaries in order to live under the lower reimbursement rate offered by the Master Insurer?
Well, the government is not stopping the pain, that’s for certain.
But that doesn’t change the fact that switching to single payer will end up inflicting a lot of economic pain on people that currently have insurance, or people who work in the health care industry, or some mix of both. Which is why it’s so difficult to convert to a single payer system once you’ve been running for a very long time with a non-single-payer system.
Whatever you do regarding the corrupt power games of the “Health Industry”, the crux moves for improving outcomes while cutting costs are
- Public Health Services from education and counseling to simple clinical treatments and interventions combining social and health workers
- Designing everything from hospitals and clinics for efficiency in delivery of health services networked across geographic and economic barriers
- Help people understand that a good death mostly involves stopping medical treatment before staggering abuses to body and spirit, and turning instead to lovingly saying goodbyes to people and places.
d fb
2 Likes
It would most likely be a RFP, Request for Proposal. Somebody (Who? No idea. Could be whoever thinks they can put it together). An organization that cuts out the JCs can underbid any JC proposal that includes high payments to any JC. The federal govt also can require any hospital accepting Medicare payments to belong to such a cost-saving group. Then the JC has few choices–accept lower pricing or stop accepting Medicare payments. Only private hospitals serving high-income markets can survive to operate without Medicare and other govt financial support.
1 Like
But the JC’s are in the providers - not the organizations that are submitting the bid for the insurance. If I’m trying to bid for the insurance contract, and market rate for a surgical procedure is $10K (including some JC vig), there’s no way I can come in and bid at a price of $8K. Because none of the providers will agree to that, because the providers are run by the JC’s. I can’t “cut out” the JC’s, because I have to negotiate with the JC’s for all my provider contracts. If one of the requirements for a hospital to join my network is that they have to fire their CEO…well, no one’s going to join my network, and I won’t be able to bid.
Congress wouldn’t even need the rigmarole of the RFP/contract thing, if there was actually any political will to do what you’re suggesting. Just pass a law that says that any hospital that accepts Medicare cannot charge any private patient or private insurance provider any higher fee for any medical service than the Medicare rate. Boom - 30% cost reduction, since no hospital can afford to give up Medicare. Of course, you also have - boom! - lots of hospitals going under or cutting everyone’s paychecks (not just the JC’s), because if you cut revenue by 30%, you have to find that money somewhere else. Which is why that’s never happened.
1 Like