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If Bernie's numbers are even near-correct, it will be in the best interest of our country.
Either patients can continue to line the pockets of insurance company billionaire CEOs, are they can pay the doctors and nurses.
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.
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.
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.
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'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.
- 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.
(20 percent of Doctors won't accept new Medicare patients).A study from Health Affairs (subscription required) found that 33 percent of doctors did not accept new Medicaid patients in 2010 and 2011.
- 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).
Faeries, unicorns, and pixie dust will cover the multi-trillion-dollar price tag. /s
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.
- There Is No Shortage Of Doctors Willing To Take Medicare Patients
- Fewer doctors are opting out of Medicare
- Primary Care Physicians Accepting Medicare: A Snapshot
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:
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.)
- "...the proportion of family doctors who accepted new Medicare patients last year [2012], 81 percent, was down from 83 percent in 2010."
- 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!
[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.]
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