Medicare 4 all consequences

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ans2021 said:

I sure hope this doesn't happen here in the U.S.
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Single payer is gonna cause that? Or did you forget the US already has nurses providing solo anesthesia, practicing critical care, and doing endoscopic vein harvests and helping to sew coronary grafts?
 
I don’t think Medical for all becomes law in the next 4 years. I do see a Medicare option added to the exchanges as an option if the Dems win in November. Will Medicare 4 all eventually become law? Yes.
 
Speciality care and elective after hours and weekend cases seem to be the the real culprit of health care waste in this country. But that also helps alleviate the wait times.

how many 1st world places continue to book elective and even semi urgent cases after 3pm. Very few. How many book on weekends. Very few.
That also means no elective c section on weekends as well.

can Americans live with that plus pay equivalent to 8-9% health care taxes on top of the their 7% fica taxes on top of their 15-30% federal taxes on top of their 6-13.25% state income taxes.
 
caligas said:
I see me having 10 more good earning years, then Medicare for all in time for me to retire early without worrying about health care. Perfect.
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That was one of the considerations getting out of the .mil. I figure I wouldn’t need the health benefit for retirees as I would be getting Mcare for all. Now the job allows me to keep my Rolls Royce university plan if I retire early, which I will, and if mcare for all doesn’t go through and gets pushed back to 67, which it will. Either way I’m good.
 
The big elephant in the room:


"Overpaying" for healthcare is a problem in perspective.

Wages/payments. Pays for nurses, techs, admin, physicians. They pay taxes.

Devices/supplies. Low cost of production, high margin. Pays for R&D, wages, retirement.

Facilities. Construction jobs, maintenance jobs. Pays taxes.

Insurance middlemen. They pay their own taxes.



Destroy healthcare, and you destroy a large swath of taxbase.


Medicare for all: shifts administration from private sector to public sector unions.



It's a power and money grab by politicians, pure and simple.
 
Mikkel said:
The big elephant in the room:


"Overpaying" for healthcare is a problem in perspective.

Wages/payments. Pays for nurses, techs, admin, physicians. They pay taxes.

Devices/supplies. Low cost of production, high margin. Pays for R&D, wages, retirement.

Facilities. Construction jobs, maintenance jobs. Pays taxes.

Insurance middlemen. They pay their own taxes.



Destroy healthcare, and you destroy a large swath of taxbase.


Medicare for all: shifts administration from private sector to public sector unions.



It's a power and money grab by politicians, pure and simple.
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Yep people seem to forget that healthcare is a large part of the economy and often among the largest employers in many communities. A contraction of the healthcare sector will be terrible for the economy overall. A hospital closing down is no different than a factory or coal mine closing down. If tech, finance, energy, manufacturing, etc expands, everybody cheers. If healthcare expands, it’s a problem.
 
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The issue is if Crnas aren’t willing to work for even 150k 4 days a week no calls no weekends plus 6 weeks off. Most demand and get 180-200k 4 days a week these day’s.

how the heck is Medicare for all gonna to work for anesthesia in general.

if docs work for 150k. They gonna to work 3 days a week. Just 12 hours shifts. u will have a supply and demand problem.
 
aneftp said:
The issue is if Crnas aren’t willing to work for even 150k 4 days a week no calls no weekends plus 6 weeks off. Most demand and get 180-200k 4 days a week these day’s.

how the heck is Medicare for all gonna to work for anesthesia in general.

if docs work for 150k. They gonna to work 3 days a week. Just 12 hours shifts. u will have a supply and demand problem.
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there would be an adjustment for anesthesia conversion factor AND/OR increase in subsidies from hospitals
 
caligas said:
I see me having 10 more good earning years, then Medicare for all in time for me to retire early without worrying about health care. Perfect.
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The way the debt is headed, can argue it’s more likely you won’t have health care at all. At some point in the future, the debt will reach a point that borrowing will no longer be sustainable. Interest on the debt will be massive and require a huge part of the budget. Meaning less to spend on mandatory budget items, like your Medicare. And this is without even taking into consideration the possible ridiculous spending the socialists want.
 
aneftp said:
Speciality care and elective after hours and weekend cases seem to be the the real culprit of health care waste in this country. But that also helps alleviate the wait times.

how many 1st world places continue to book elective and even semi urgent cases after 3pm. Very few. How many book on weekends. Very few.
That also means no elective c section on weekends as well.

can Americans live with that plus pay equivalent to 8-9% health care taxes on top of the their 7% fica taxes on top of their 15-30% federal taxes on top of their 6-13.25% state income taxes.
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Malpractice, cya, etc are a major cost driver. But no one talks about tort reform
 
TikiTorches said:
Malpractice, cya, etc are a major cost driver. But no one talks about tort reform
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Lots of people talk about tort reform, they just happen to be mostly in Republican states.

Trial lawyers have a stranglehold on the Democrats. The ones guaranteed to keep their gravy train rolling with federal "healthcare reform" will always be the lawyers.
 
Mikkel said:
Lots of people talk about tort reform, they just happen to be mostly in Republican states.

Trial lawyers have a stranglehold on the Democrats. The ones guaranteed to keep their gravy train rolling with federal "healthcare reform" will always be the lawyers.
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With tort reform you will see the elimination of anesthesiologists and complete takeover by CRNA’s. Like it or not the lawyers are our best friend.....
 
BLADEMDA said:
I don’t think Medical for all becomes law in the next 4 years. I do see a Medicare option added to the exchanges as an option if the Dems win in November. Will Medicare 4 all eventually become law? Yes.
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Which specialties win in M4A???
 
Spikebd said:
Which specialties win in M4A???
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Vascular surgery...at least according to the one I worked with today. He does very well with mainly Medicare patients and says it will streamline the billing for his practice significantly. I didn’t question him more on it, but he was all for “Medicare for all.”
 
GravelRider said:
Vascular surgery...at least according to the one I worked with today. He does very well with mainly Medicare patients and says it will streamline the billing for his practice significantly. I didn’t question him more on it, but he was all for “Medicare for all.”
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Primary care probably wins as they will streamline their back office and engage in schadenfreude when orthopods and neurosurgeons take a huge pay cut and can’t getjobs because their isn’t enough operating rooms left.
 
SaltyDog said:
Eh, CA has surprisingly good tort reform and probably the highest percentage of MD only anesthesia in the country.
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Virginia is good too. Max TOTAL judgement for ALL types of damages from ALL parties is $2.4 million, which is also what coverage everyone must carry. So essentially everyone is insured for any possible judgment.
 
aneftp said:
Speciality care and elective after hours and weekend cases seem to be the the real culprit of health care waste in this country. But that also helps alleviate the wait times.

how many 1st world places continue to book elective and even semi urgent cases after 3pm. Very few. How many book on weekends. Very few.
That also means no elective c section on weekends as well.

can Americans live with that plus pay equivalent to 8-9% health care taxes on top of the their 7% fica taxes on top of their 15-30% federal taxes on top of their 6-13.25% state income taxes.
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ICUs and extreme life-saving measures seem to eat up a lot of resources too. It's an all-too-common theme: 80+ yr old with multi-organ failure medflighted from rural community hospital ($$) with either no family in sight, estranged family, or family that "believes in miracles" that demands "everything be done." So grandma sits in ICU on CVVH, going back and forth from OR for various unnecessary procedures (TAVR? balloon pump? debridement of some necrotic s***? repeat brochs, EGDs) then somehow ends up on ECMO, trach/peg'd, etc. Weeks, months later the family is convinced to pursue comfort measures and she passes with a $4 million bill that never gets paid. We fail performance metrics vs other countries because we don't ration care (one among other reasons, obv). We throw expensive meds/procedures at mets with weeks/months to live because it might give them a few more weeks/months to live (most of which will be spent in the hospital).

M4A is low-hanging fruit meant to entice the average (or below average) American into believing that our healthcare problems are an easy fix. The truth is quite the opposite as many of us know.
 
We recently finished a course of emergent radiation therapy for a kid with terminal aggressive cancer. The goal was to try to buy them a little more time and get them to their make a wish trip. Every day they got a little worse, more swolen from steroids, more sedated, etc. The trip was 2 weeks later and I’m not sure they made it. They should have gotten a big steroid pulse and gone instead of getting XRT and had a great time. I think it was a big waste all around and squandered their remaining time. If I’m like that kid was, park me on the beach with a couple bottles of $500 single malt, a handful of decadron, arrange delivery of some good pizza, and pick up the body in a few days. But it has to be on the west coast as I don’t like seeing the sunrise, I prefer watching the sunset over the ocean.
 
TikiTorches said:
I dont think they will allow that.
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I appreciate your pessimism. I'm being sincere.

I'm pessimistic in that if for some godforsaken reason we go down the path of medicare for all... and medical license contingent on participation in medicare... and outlawing private practice...

That the government would also go full ****** on the 2nd amendment and try to confiscate arms.

It's a scary future if the government goes full communo-fascist under a Bernie Sanders regime... he'd certainly try...
 
Mikkel said:
I appreciate your pessimism. I'm being sincere.

I'm pessimistic in that if for some godforsaken reason we go down the path of medicare for all... and medical license contingent on participation in medicare... and outlawing private practice...

That the government would also go full ****** on the 2nd amendment and try to confiscate arms.

It's a scary future if the government goes full communo-fascist under a Bernie Sanders regime... he'd certainly try...
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I could see all that being tried
 
sb247 said:
I could see all that being tried
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They are already doing it now slowly by making you “in-network” wheather you want to or not.

CMS already has mandatory participation in programs. Not far fetched unless you want to
Practice medicine without a license which will also probably get you arrested.

It’s basically turn docs into criminals if they don’t participate. Ofcourse everyone will go along.
 
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RadsWFA1900 said:
They are already doing it now slowly by making you “in-network” wheather you want to or not.

CMS already has mandatory participation in programs. Not far fetched unless you want to
Practice medicine without a license which will also probably get you arrested.

It’s basically turn docs into criminals if they don’t participate. Ofcourse everyone will go along.
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I’m with you on all those assessments
 
dannyboy1 said:
With tort reform you will see the elimination of anesthesiologists and complete takeover by CRNA’s. Like it or not the lawyers are our best friend.....
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Tort reform does little to improve healthcare resources utilization and costs. That is the false narrative from the right. The false narrative from the left is that M4A would save money by reducing executive and administrative costs.

The truth is that the real crisis in healthcare is one of increasing costs which in turn leads to under insurance. Increased costs are driven by 2 factors: 1) an elaborate system of rent and price control imposed by government regulation that stifle competition and market forces that would normally contain prices, and 2) rampant consumption of high-cost technology by US healthcare consumers.

The idea of rent controls is not going to be popular on this forum but occurs when Medicare sets reimbursement rates for providers and institutions that serve as a basis for other 3rd party payers. That basis is always increasing and disproportionately exposed to artificial inflation from special interests. When was the last time a physician, hospital, or pharma lobbied to cut Medicare reimbursements? Rent controls are also seen in Medicare D price setting and regulations that limit the labor pool of healthcare providers (personnel and facilities such as licensing, CONs, etc).

On the other hand price controls are seen in Medicaid and Medicare when providers can not recover the full costs of their services and must pass on those costs to patients with private insurance. This is known as cost sharing and is a big reason why those with insurance pay huge deductibles and co-pays despite massive premiums.

Consumption of expensive technology is what it is. American patients and doctors love to get expensive tests at much higher rates than other developed nations. Moreover, the rent control phenomenon is at play here too as regulations require the turnover of technology at rates not seen in other industries. For example, try to find a 64-slice CT scanner to get a cheaper rate for a patient - they don’t exists. You are always required to use that latest and most expensive technology.

So, expansion of Medicare would likely exacerbate the rent and price control market distortions, and may even worsen our technology consumption issue. I have no expectations that a reduction in administrative costs could offset those distortions.
 
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there German system has a cap on how much taxes a person pays into the system. Like we have a cap on social security taxes. (First 138k for 2020 year)

there is no way bernie system works unless he removes a health tax cap. Like many socialist want to remove the social security tax cap.
This will be real class warfare. Those elite democrats who make 1 million won’t be happy paying $100k in health care taxes.
Those elite democrats making 500k won’t be happy paying 50k in health care taxes. And trickles down to the common person making 50k who wont be happy paying 5k in health care taxes
 
Mikkel said:
I appreciate your pessimism. I'm being sincere.

I'm pessimistic in that if for some godforsaken reason we go down the path of medicare for all... and medical license contingent on participation in medicare... and outlawing private practice...

That the government would also go full ****** on the 2nd amendment and try to confiscate arms.

It's a scary future if the government goes full communo-fascist under a Bernie Sanders regime... he'd certainly try...
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I think Massachusetts already links licensing with Medicare or aid. And politicians know they won't have as much control if two tiered. So they will not allow out of network.
 
ShockIndex said:
Tort reform does little to improve healthcare resources utilization and costs. That is the false narrative from the right. The false narrative from the left is that M4A would save money by reducing executive and administrative costs.

The truth is that the real crisis in healthcare is one of increasing costs which in turn leads to under insurance. Increased costs are driven by 2 factors: 1) an elaborate system of rent and price control imposed by government regulation that stifle competition and market forces that would normally contain prices, and 2) rampant consumption of high-cost technology by US healthcare consumers.

The idea of rent controls is not going to be popular on this forum but occurs when Medicare sets reimbursement rates for providers and institutions that serve as a basis for other 3rd party payers. That basis is always increasing and disproportionately exposed to artificial inflation from special interests. When was the last time a physician, hospital, or pharma lobbied to cut Medicare reimbursements? Rent controls are also seen in Medicare D price setting and regulations that limit the labor pool of healthcare providers (personnel and facilities such as licensing, CONs, etc).

On the other hand price controls are seen in Medicaid and Medicare when providers can not recover the full costs of their services and must pass on those costs to patients with private insurance. This is known as cost sharing and is a big reason why those with insurance pay huge deductibles and co-pays despite massive premiums.

Consumption of expensive technology is what it is. American patients and doctors love to get expensive tests at much higher rates than other developed nations. Moreover, the rent control phenomenon is at play here too as regulations require the turnover of technology at rates not seen in other industries. For example, try to find a 64-slice CT scanner to get a cheaper rate for a patient - they don’t exists. You are always required to use that latest and most expensive technology.

So, expansion of Medicare would likely exacerbate the rent and price control market distortions, and may even worsen our technology consumption issue. I have no expectations that a reduction in administrative costs could offset those distortions.
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I'm not talking right or left. There is alot of cya care in medicine. There will be lowering of costs with tort reform.
 
Something that I haven't seen brought up is unionization. If the nurses, police, and firefighters can unionize, why wouldn't the docs unionize should M4A pass? If every non C-Suite dolt is an equal in the admins eyes, why not the collective bargaining and unionization by physicians en mass.
 
Zekchar said:
Something that I haven't seen brought up is unionization. If the nurses, police, and firefighters can unionize, why wouldn't the docs unionize should M4A pass? If every non C-Suite dolt is an equal in the admins eyes, why not the collective bargaining and unionization by physicians en mass.
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Anti trust legalese.
 
TikiTorches said:
I'm not talking right or left. There is alot of cya care in medicine. There will be lowering of costs with tort reform.
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Multiple states have passed tort reform. TX is probably the most studied. It hasn’t lowered costs. If anything, it may have raised costs as physicians were willing to taken on higher risk patients.


A more comprehensive “no fault” reform may help lower costs. However, a more important approach will be to retrain physician thinking from “ruling out” the unlikely to treating the most likely and accepting higher degrees of uncertainty.
 
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