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Establishment looks to crush liberals on Medicare for All

If Bernie's numbers are even near-correct, it will be in the best interest of our country.

This is the sort of gullible partisan ignorance that makes up a lot of the support for single payer.

Either patients can continue to line the pockets of insurance company billionaire CEOs, are they can pay the doctors and nurses.

That’s a false dichotomy and empty rhetoric.
 
I know why insurance companies oppose "Medicare for all" proposals. I don't know why hospitals do; such proposals would damn near eliminate their doubtful accounts expense.

Because Medicare pays much less for svcs that insurance companies. Medicare works, in part, because it's a supplement to a medical providers for the use of beds, buildings, equipment that are already a fixed cost expense. If Medicare payments were universal payments, the number of hospitals etc. would rapidly shrink. As it is about 30 percent of the nations doctors won't take Medicare.

So naturally, its not popular with anyone other than the "gimmie gimmie gimmie" masses.
 
It could, and no doubt there may be some clinics that have become reliant on excess margins and may not be able to recalibrate at all, and that there will be short term issues as the system adjusts, but in the end, in the long term and relative to the bigger picture, I don't see how we're overall getting to a point where we actually have compromised access and outcomes.

It's the providers with thin margins you should be especially worried about (or, for instance, the ~30% of hospitals that have negative margins today). The for-profits might weather it okay because they have lower cost structures. It's the mission-driven not-for-profits (i.e., the majority of hospitals in the United States) that offer high-margin services so they can provide important but negative margin service lines like behavioral heath that you should be concerned about.

Hospitals tend to lose money on patient care. Those that get back into the black often do so by having additional revenue sources.

A More Detailed Understanding Of Factors Associated With Hospital Profitability
Hospitals incurred small losses per adjusted discharge (a median loss of $82) from patient care services, with public hospitals and very small hospitals (those with fifty or fewer beds) having the lowest profitability. However, the median overall net income from all activities per adjusted discharge was a profit of $353, because many hospitals earned substantial profits from nonoperating activities—primarily from investments, charitable contributions (in the case of nonprofit hospitals), tuition (in the case of teaching hospitals), parking fees, and space rental. It appears that nonoperating activities allowed many hospitals that were unprofitable on the basis of operating activities to become profitable overall.

This country needs a serious discussion about the cost structure of our system and whether it's worth it to us. But "Hulk smash" does not good policy make. I would've thought people would have gotten the "let's just break stuff to see what happens" impulse out of their system two years ago.
 
Because Medicare pays much less for svcs that insurance companies. Medicare works, in part, because it's a supplement to a medical providers for the use of beds, buildings, equipment that are already a fixed cost expense. If Medicare payments were universal payments, the number of hospitals etc. would rapidly shrink. As it is about 30 percent of the nations doctors won't take Medicare.

So naturally, its not popular with anyone other than the "gimmie gimmie gimmie" masses.
  • Red:
    • Sept. 2018 --> ~22K physicians and other healthcare providers do not participate in Medicare.
    • 2015 --> There were ~827K practicing physicians in the US.
      • I don't know the extent to which that figure has changed between 2015 and now, so, for the conclusion noted in the following bullet, I've assumed the 827K figure held materially constant.
    • It is factually untrue that "about 30 percent of the nations doctors won't take Medicare." About 2.6% of physicians don't accept Medicare.
 
It's the providers with thin margins you should be especially worried about (or, for instance, the ~30% of hospitals that have negative margins today). The for-profits might weather it okay because they have lower cost structures. It's the mission-driven not-for-profits (i.e., the majority of hospitals in the United States) that offer high-margin services so they can provide important but negative margin service lines like behavioral heath that you should be concerned about.

Hospitals tend to lose money on patient care. Those that get back into the black often do so by having additional revenue sources.

A More Detailed Understanding Of Factors Associated With Hospital Profitability


This country needs a serious discussion about the cost structure of our system and whether it's worth it to us. But "Hulk smash" does not good policy make. I would've thought people would have gotten the "let's just break stuff to see what happens" impulse out of their system two years ago.

As stated in my prior post (and I'm sure probably several times thus far in our past debates), the current health system is presently based on a foundation of paying more for literally everything vs every other developed country which MFA absolutely must tackle to make the transition to SP workable. Yes, in the current environment, if you squeeze margins, and do nothing about expenses, you're going to have problems, thus any implementation of the MFA must ultimately also work to remedy the input expenses and reshape the entire present structure of income and expense.

At the very least MFA will eliminate most of the administrative expense, so that's a start, which gives us some room to pair down on the topline margins, and realize savings. Next is a comprehensive approach to reducing supplier margins (drugs, supplies, etc) to levels far more reasonable should be done; again, more margin to cut, more savings to be had. Finally, the difficult part where exceptionally high salaries have to be addressed; some student/school debt relief for physicians and other medical personnel may help smooth this over, as their salaries are in part so large to service and offset the considerable cost of their education. It's the least pleasant part of this, easily, but it has to happen, preferably over a period of years. It should be noted that even if we were to cut physician salaries considerably, by say 20%, they would still be among the very best compensated in the world, including among other wealthy nations.

None of this is tantamount to 'Hulk Smash' by the way; these are simply the hard choices that need to be done, and again, a phase in period will permit this to happen with the minimum possible disruption.
 
  • Red:
    • Sept. 2018 --> ~22K physicians and other healthcare providers do not participate in Medicare.
    • 2015 --> There were ~827K practicing physicians in the US.
      • I don't know the extent to which that figure has changed between 2015 and now, so, for the conclusion noted in the following bullet, I've assumed the 827K figure held materially constant.
    • It is factually untrue that "about 30 percent of the nations doctors won't take Medicare." About 2.6% of physicians don't accept Medicare.

While I don't accept your homebrewed number of 2.7% due to self-evident methodological flaws, you are correct that I misremembered the 30 percent figure and what it measured.

A study from Health Affairs (subscription required) found that 33 percent of doctors did not accept new Medicaid patients in 2010 and 2011.
(20 percent of Doctors won't accept new Medicare patients).

https://www.healthitoutcomes.com/doc/doctors-refuse-to-accept-medicare-patients-0001

None the less, one explanation for opposition from hospitals and doctors would be the lower rates of reimbursement, and that many providers have said they cannot survive on Medicare/Medicaid alone (e.g. Mayo Clinic) - why else would they oppose (assuming the poster who asked the question was correct that there is opposition).
 
  • Red:
    • Sept. 2018 --> ~22K physicians and other healthcare providers do not participate in Medicare.
    • 2015 --> There were ~827K practicing physicians in the US.
      • I don't know the extent to which that figure has changed between 2015 and now, so, for the conclusion noted in the following bullet, I've assumed the 827K figure held materially constant.
    • It is factually untrue that "about 30 percent of the nations doctors won't take Medicare." About 2.6% of physicians don't accept Medicare.

While I don't accept your homebrewed number of 2.7% due to self-evident methodological flaws, you are correct that I misremembered the 30 percent figure and what it measured.

(20 percent of Doctors won't accept new Medicare patients).

https://www.healthitoutcomes.com/doc/doctors-refuse-to-accept-medicare-patients-0001

None the less, one explanation for opposition from hospitals and doctors would be the lower rates of reimbursement, and that many providers have said they cannot survive on Medicare/Medicaid alone (e.g. Mayo Clinic) - why else would they oppose (assuming the poster who asked the question was correct that there is opposition).


Red:
I'm aware I can't force you to see context, reason and facts.

  • Seriously? You've summarily rejected my analysis while the data to which you refer is:
    • Not representative of the whole of the medical doctor profession, and
    • Even older than is the data I referenced. The importance of the temporal aspect of the data is readily seen in the remarks of the second above-linked article's content.
  • Please identify the methodological flaws you deem extant in my approach to arriving at 2.7%.

Blue:
Okay.


Pink:
Per the reference you cited, the 20% figure you cited pertains to family practice doctors, not doctors:
  • "...the proportion of family doctors who accepted new Medicare patients last year [2012], 81 percent, was down from 83 percent in 2010."
According to the 2015 Active Physicians in the Largest Specialties survey, family practice doctors are the most populous specialty among doctors; however, they do not form a majority (or even near it) of the M.D. profession. Using that survey's figures rather than the ones I calculated from the Statista reference source's data, there were, in 2015, some 860K doctors in the US. (That 860K figure is slightly more than the one I calculated; the 2.7% rate I calculated is an even more "generous" than is warranted.)
  • Of the 860K doctors, ~111K, 12% of all active doctors, are family practice physicians.
  • Using the 20% figure your reference source indicates for non-Medicare accepting family practice doctors, one arrives at ~22,200 family practice doctors who don't accept Medicare. That figure comports favorably with the 22K figure I cited in my above-shown post, thus supporting my earlier assertion of 2.7% and my assertion here that 2.7% is a generous estimate.
  • The preceding analysis suggests that it's largely family practice physicians who opt out of Medicare.
    • Obviously, doctors who exclusively perform non-medically-necessary procedures -- cosmetic dentistry and cosmetic plastic surgery, for example -- don't accept Medicare because Medicare won't pay for such services.


Tan:
Yes, that is the reason some doctors have cited.

From your reference article:
"Some doctors say Medicare’s reimbursement rates — as low as $58 for a 15-minute office visit — force them to see 30 or more patients a day to make ends meet. 'Family physicians have been fed up for a long time and it’s getting worse.'" (hyperlink added by me -- see also: Hours in a avg. doctor's workweek)​
Say what you want, but I'm not feeling sorry for anyone who gripes that they can't make ends meet on at least $232/hour ($1740/day/~454K/yr). That a doctor cannot "make ends meet" on $232/hr strikes me as a business model or personal financial irresponsibility problem, not a Medicare-reimbursement problem.
 
Faeries, unicorns, and pixie dust will cover the multi-trillion-dollar price tag. /s

I'd hate to be the person that has to pull all of that out of their ass.
 
It wasn't a conservative plan and they dropped the idea. That card is so over played.

Sorry but you're just wrong and won't admit that you didn't know anything about the history of the subject.
It was not only not dropped, it first became RomneyCare, then it was parlayed into the ACA.

Your stupid pride is the card that is overplayed. When you don't know something, and somebody shows you the facts, say "Thank you, I learned something", and then people will respect you more.
 
Sorry but you're just wrong and won't admit that you didn't know anything about the history of the subject.
It was not only not dropped, it first became RomneyCare, then it was parlayed into the ACA.

Your stupid pride is the card that is overplayed. When you don't know something, and somebody shows you the facts, say "Thank you, I learned something", and then people will respect you more.

I know the history of it, and you're very WRONG.
 


Red:
I'm aware I can't force you to see context, reason and facts.

  • Seriously? You've summarily rejected my analysis while the data to which you refer is:
    • Not representative of the whole of the medical doctor profession, and
    • Even older than is the data I referenced. The importance of the temporal aspect of the data is readily seen in the remarks of the second above-linked article's content.
  • Please identify the methodological flaws you deem extant in my approach to arriving at 2.7%.

Blue:
Okay.


Pink:
Per the reference you cited, the 20% figure you cited pertains to family practice doctors, not doctors:
  • "...the proportion of family doctors who accepted new Medicare patients last year [2012], 81 percent, was down from 83 percent in 2010."
According to the 2015 Active Physicians in the Largest Specialties survey, family practice doctors are the most populous specialty among doctors; however, they do not form a majority (or even near it) of the M.D. profession. Using that survey's figures rather than the ones I calculated from the Statista reference source's data, there were, in 2015, some 860K doctors in the US. (That 860K figure is slightly more than the one I calculated; the 2.7% rate I calculated is an even more "generous" than is warranted.)
  • Of the 860K doctors, ~111K, 12% of all active doctors, are family practice physicians.
  • Using the 20% figure your reference source indicates for non-Medicare accepting family practice doctors, one arrives at ~22,200 family practice doctors who don't accept Medicare. That figure comports favorably with the 22K figure I cited in my above-shown post, thus supporting my earlier assertion of 2.7% and my assertion here that 2.7% is a generous estimate.
  • The preceding analysis suggests that it's largely family practice physicians who opt out of Medicare.
    • Obviously, doctors who exclusively perform non-medically-necessary procedures -- cosmetic dentistry and cosmetic plastic surgery, for example -- don't accept Medicare because Medicare won't pay for such services.


Tan:
Yes, that is the reason some doctors have cited.

From your reference article:
"Some doctors say Medicare’s reimbursement rates — as low as $58 for a 15-minute office visit — force them to see 30 or more patients a day to make ends meet. 'Family physicians have been fed up for a long time and it’s getting worse.'" (hyperlink added by me -- see also: Hours in a avg. doctor's workweek)​
Say what you want, but I'm not feeling sorry for anyone who gripes that they can't make ends meet on at least $232/hour ($1740/day/~454K/yr). That a doctor cannot "make ends meet" on $232/hr strikes me as a business model or personal financial irresponsibility problem, not a Medicare-reimbursement problem.

Great analysis! It's still amazes me that all those Republicans who had all the Answers about healthcare during the campaign, have done NOTHING!
 
Great analysis! It's still amazes me that all those Republicans who had all the Answers about healthcare during the campaign, have done NOTHING!

[Note: Underlining is mine, Xelor's. I added it as a "surrogate" for the emboldening Media_Truth used and that got "lost" when I emboldened the whole "blue" sentence.]

Red:
Thank you.

I have to say, that analysis should never have been needed for the remark that gave rise to it is one that shouldn't ever have been made. I mean, really. It took more time to type that post than it took to obtain the data (~1.5 minutes) and to do the arithmetic (2 seconds -- ((111/860) x .2))) I presented in it. And for what? To show that a qualitative/emphatic premise (appeal) with which another member closed his "argument" doesn't hold water.

I don't even understand how folks find themselves moved to present, in public, no less, claims that cannot withstand even the most elementary of scrutiny. Just what does it take to look at the positive assertions one makes, especially quantitative ones, and ask oneself, "Am I sure this claim will be born out by the facts/data" and upon noting to oneself that the answer is anything other than "absolutely, existentially yes," either check the verity of the assertion or remove it?

I know the answer to that is "not much," but I must yet infer that whatever specific quantity it be, a ton of folks (mostly Republicans/conservatives judging by how often I encounter their factually inaccurate/unsupportable comments) deem it "too much." That any individual does deem is "too much" doesn't bother me unless the person would that their remarks be taken seriously and construes as believable by readers.



Blue:
I share in your astonishment.

There really is no excuse for the GOP's, given their having at their disposal ample information including but not limited to...
  1. the lessons learned from the O-care legislation and implementation, and
  2. "tons" of rigorous, objective and methodologically sound analysis re:
    • (a) the nation's healthcare needs,
    • (b) the nature and extent of specific lacuna between realized health outcomes and healthcare, national and infrastructural capabilities indicating such fissures are both closeable and, vis-a-vis any model of normative ethics, have no business being extant,
    • (c) the nature and extent of the polity's satisfaction and dissatisfaction, and
    • (d) the economics (positive and normative) of natural monopoly, monopolistic competition and perfect competition in healthcare,
...and having majorities in both Congressional chambers, for not having proposed a perfect-for-care-recipients healthcare solution to all that ails healthcare delivery, coverage and access in the US.
 
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