Leo, who decides how much to pay the health care provider? What takes the place of price competition to keep prices in-check? Is there just a nation wide standard price list that all healthcare providers have to utilize? And is there no difference between the quality of care? Seems to me that health care providers may tend to scrimp on quality and customer service to keep their bottom line profit up, if they can't compete on value (defining "value" as a combination of price and quality).
And some medical treatment isn't necessary, but may be desirable. So does the government insurance program automatically pick up the tab for treatment that may be more cosmetic in value than medical? Like a nosejob or facelift? If I wanted to get my ears "reshaped", would that be free? Would it be automatic, or would I have to "apply" for a procedure like that, and wait for some authority to approve me, hoping that they agree that my ears are so misformed that the taxpayer should pick up the tab for my ear surgery? And what if my ear surgery was not approved, would I have the opportunity to just pay for it out of my own pocket, or would it just not be an option allowed to me?
Not attacking here, just want to understand how this socialized insurance works.
Image P, I’ll address your questions in relation to Medicare because I’m covered and best aware of Medicare which I consider to be to golden standard of all insurance with regard to value for both the entire aggregate nation, Medicare covered individuals and those individuals’ families.
In my opinion it’s unfortunate that Medicare does not cover most dental procedures. I particular advocate coverage for examinations and cleaning between generally accepted and recommended durations of months, cavity and root canal tasks.
In my opinion it’s reasonable that Medicare does not cover cosmetic surgery unless the surgery remedies or significantly improves what is a grievous deformity or is of sufficient medical justification.
The maximum prices are determined by what Medicare schedule of procedures and prices will allow and those prices differ within local areas. No Health provider is required to accept Medicare patients but having accepted the patient, they must accept all Medicare's maximum prices charged to any Medicare patients.
Since I choose my doctor and can change my doctor at any time, that’s some inducement for quality care. Since almost all people over the age of 65 are covered by Medicare or Medicaid, a health provider that chose not to accept such patients would limit their elderly practice to only the very wealthiest of those patients.
Medicare or the Affordable Care Act penalizes hospitals and other facilities that release patients too early or do less than a complete job. If the patient requires additional treatment because the facility failed to properly treat or follow up their patients treatments, the facility, (not the insurance carrier which in my case is Medicare) absorbs that entire additional cost.
Opponents of limiting medical suits disregard that the medical industry would return to the industries’ disregarding the consequences of poor care because the medically ignorant public are not aware of the harm while it’s being done. Certainly Medicare’s refusal to allow the cost of such avoidable additional care would increases the difficulty of defending medical malpractice in our courts.
Medicare patients pay 1/5 of Medicare’s allowable health provider’s charges. I suspect I must be paying almost no co-payment for hospitalization because the only sizable bills that I’ve received from hospitals are for the individual doctors’ services.
Medicare is not socialized medicine; it’s a basic semi-socialized medical insurance. I and my employs together paid a total of 3% of my entire earnings toward Medicare funding. I additionally pay an annual deductable for my treatment each year and beyond that deductable I pay 1/5 of Medicare’s allowable charges as my co-payments. It’s single payment in the sense that the U.S. (CMS), Center of Medicare and Medicaid Services administers the insurance and distributes their portion of payments to health providers and facilities.
Respectfully, Supposn
