patrick.net

LeonDurham says

Do you think Americans are dumber than citizens in every other 1st world county?

Better question: Do you think American govt. officials are more corrupt than govt. officials in every other 1st world country?

Rin says

Better yet, tell me who's actually paying that $9000 bill each week. Hint, it's not the guy on dialysis, and it ain't Bernie either.

A postdoc, yes, a PhD in the biomedical sciences, earns some $42K/yr. He can perform that dialysis at ~$800/week (or $266 per treatment) and pay for his annual research budget.

That wasn't the question, I didn't ask which actual person would do the dialysis, I asked who'd funding the $9000 Medicaid payments?

MrMagic says

Also, since the bottom feeders have no skin in the game, they'll be the first ones to abuse the system, with all the FREE healthcare.

Single payer crap drives me nuts. To improve things in healthcare, it requires a bunch of different things such as the following:
- STOP ILLEGAL IMMIGRATION
- Implement the individual mandate (sorry Right wingers, it has to be done). However, revamp the qualified plans to not be so broad like what was defined in ACA.
- Tort reform to fend off ambulance chasers
- Require full transparency of prices on the Internet for all procedures, medications and services
- Remove barriers of health plans to provide insurance across state lines
- If you are on gov't subsidized health care (medicare or medicaid), you get 70s-level care. No fancy new drugs, no fancy procedures, etc. You get what you get if you don't pay for it.

MrMagic says

Better yet, tell me who's actually paying that $9000 bill each week.

Medicaid but it may be in partnership w his 3rd party Medicare advantage plan. I'm not completely sure how they break up the bill's, but the client pays nothing.

Still tho, $9000 of weekly medical Bill's when he lives in a $500 apartment? Someone is getting rich.

I get $250/year to place him into his Medicare plan.

CBOEtrader says

I have a 78 year old client who lives in a 500/month apt, but goes to kidney dialysis 3 times per week for $3000 each visit, 100% paid for by medicaid.

You tell me who's getting rich here.

You should be calling the fraud hot line immediately. What is the name of the center?

Med-cal rate for reimbursement of dialysis code Z6004 is 141.31 plus professional fees. Here is med-cal database of rates by code. https://files.medi-cal.ca.gov/pubsdoco/rates/rates_information.asp?num=26&first=V2301&last=Z9727

The base rate for medicare is 233.31. The base rate can be modified depending on many factors but only by a few percentage points. Here is the 2017 federal register for ESRD https://www.federalregister.gov/documents/2017/07/05/2017-13908/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis

MrMagic says

You're missing the point, Bernie's plan will be paid out of tax collections, the top 20% in the country pay 90% of the taxes. The bottom 50% pay virtually nothing in taxes. So in true Liberal fashion, the top 20% will be paying for the health care of the majority of the population. Also, since the bottom feeders have no skin in the game, they'll be the first ones to abuse the system, will all the FREE healthcare.

The top 20% pay 90% of federal income taxes, not all taxes.

That would be like medicare A paid out of fica tax on every worker with a cut off of 100k? That kind of no skin in the game and the top 20% paying 90%? How many abusers do you suppose will be lining up for FREE colonoscopies every day if berniecare did pass?

Relax and untwist your panties. Nothing even close to Medicare for all is ever going to get past the health care oligarchs making huge profits and doling out huge campaign contributions.

CBOEtrader says

Medicaid but it may be in partnership w his 3rd party Medicare advantage plan. I'm not completely sure how they break up the bill's, but the client pays nothing.

That doesn't make any sense. When people are dual qualified medicare is the primary and medicaid is limited to paying premiums, deductibles, and co pays not medical bills. Here are the guidelines from medicaid. https://www.medicaid.gov/medicaid/ltss/downloads/integrating-care/cost-sharing-chart.pdf

bob2356 says

When people are dual qualified medicare is the primary and medicaid is limited to paying premiums, deductibles, and co pays not medical bills.

3rd party Medicare advantage carriers take over for original medicare in all SNP's. Considering these SNP's are designed for ESRD, and losses to provider are expected to be high, I assumed the cost sharing was negotiated but dont really know the details.

bob2356 says

You should be calling the fraud hot line immediately. What is the name of the center?

I'll ask him about this, but my client most likely just doenst know the costs. He told me it was $3000 per visit. Your numbers would put him closer to $3000/month. He probably just doesnt know considering he doesnt pay the bills.

bob2356 says

Nothing even close to Medicare for all is ever going to get past the health care oligarchs

From an oligarch perspective, why? Sounds like you work in healthcare. Answer this: who is getting rich off our system? Insurance companies are paying inflated rates with often no pre-ex clauses. Even doctors are getting squeezed. Is it your medical admin ilk running off w the bag? Have hospital operators gone from being philanthropists to billionaires?

CBOEtrader says

bob2356 says

When people are dual qualified medicare is the primary and medicaid is limited to paying premiums, deductibles, and co pays not medical bills.

3rd party Medicare advantage carriers take over for original medicare in all SNP's. Considering these SNP's are designed for ESRD, and losses to provider are expected to be high, I assumed the cost sharing was negotiated but dont really know the details.

I haven't read up on SNP's but I would think medicaid rules outlined in the medicaid guide lines would still apply. There aren't any exceptions listed.

CBOEtrader says

Your numbers would put him closer to $3000/month.

The most recent number's I've seen from medicare say about 60k a year ESRD. But that's for all ESRD care, not just the dialysis.

CBOEtrader says

From an oligarch perspective, why? Sounds like you work in healthcare. Answer this: who is getting rich off our system? Insurance companies are paying inflated rates with often no pre-ex clauses. Even doctors are getting squeezed. Is it your medical admin ilk running off w the bag? Have hospital operators gone from being philanthropists to billionaires?

I worked in health care, quite a while but on the IT side as in billing/office management but not currently. Then oddly enough doing international recruitment for 4 years in Australia/NZ. Not as a recruiter, but as a liaison. Which forced me to learn a hell of a lot about medical systems around the world since explaining the differences between health systems was a part of my job. Not medical procedures. Despite what the willfully ignorant believe the training, protocols, and procedures are the same pretty much everywhere. It's the administrative and cultures that is very different. It also lets me say bullshit to the crock that US doctors are paid a lot more then anywhere else. Simply not true. I also have 3 doctors in my immediate family that give me lots of insight into the medical field whether I want to hear it or not.

Insurers are limited by LTV under ACA, which trump will eventually do away with, but still have reasonable profits. Except medicare C where LTV doesn't apply. The problem is there is no incentive to keep prices down. The more they pay out the higher profits while keeping in LTV as long as rates can keep raising. The point would be that the entire 20% of costs in the LTV doesn't exist in public systems, its taxes collected which are already collected anyway. Plus the 80% that does go out isn't all for patient care by a long shot. The average hospital or doctor spends 20-25% of what they collect on operating the billing systems. so another 16% disappears Some public health systems do have billing, but its not anything like the US systems and requires very little money to operate. That's 36% of health care dollars right up front that disappears in the private insurance system and billing both private and public.

Hospitals haven't been philanthropic since the 60's. Then 95% or better of hospitals were community non profits. Now 95% are for profit. Hospitals don't have huge profit margins, but that's deceptive. There are many revenue streams in a hospital and there is more money being made than it looks like on paper. The numbers are at least 10-12% probably higher even though on paper profits for most hospitals are in the 6-7% range. That's another 10-12% out of the system that doesn't exist in public systems.

Pharma and medical devices are off the charts. Profits of 40% aren't unusual. Drugs are 15% of health care spending. Don't bother with the costs lots for research bs. Most basic research is public funded. Pharma spends more on lobbying and advertising (neither of which exist anywhere but the US, more dollars out of health care) than on research. A good deal of pharma research is for tweaking existing patents to get another 7 years on patent. Most public systems bargain for drugs in bulk or do real cost/benefit analysis to check if a new drug has enough benefit to be worth the cost. The only large entity in the US that could bargain for drugs is medicare and medicare is prohibited from doing so by medicare d rules. Big ROI on that lobbying money.

Fee for service. Built in huge conflict of interest. As is doctors owning facilities that they can refer to. Which also ties into defensive medicine. Very few doctors actively abuse fee for service, but no one can really seriously claim that it doesn't at least shade treatment decisions. The public systems that do use fee for service almost all have strict guidelines for care.

Duplication of services/facilties. Hospitals (even non profits), labs, imaging centers, etc. etc. are businesses Businesses need to market themselves. They market themselves by setting up special services. So you might have 3 nicu's or cardiac centers in a small geographic area all less than fully utilized competing bitterly for business. These duplications is paid out of operating costs, not profits so all the wasted money is never seen. Public systems do an evaluation of what services are needed and don[t have huge amounts of expensive duplication. Really big ticket items get regionalized. When I had a cardiac mapping and ablation done in NZ there is only 1 center that does it. The health care system paid for my airfare, lodging, meals, taxi, and even airport parking Hell of a lot cheaper than a building another cardiac mapping center. No I didn't wait years while death panels decided my fate. Even though I only had nuisance rhythms that I had all my life but getting worse and was in zero danger I was taken in less than a month. If there were danger ti would have been immediate.

End of life. Only 5% of patients eat up 50% of health care. Most of them are very close to dying. Call it death panels or whatever you want but spending large sums of money to extend the life of someone elderly and already terminal by a couple months is simply insane. This is both a societal problem and a health care system problem. Americans don't accept death. Most other places have a strong hospice system that places high value on quality of life while dying not eaking out a few additional (frequently totally miserable) months from a long life. The entire health care for profit/fee for service system benefits very well financially from extending dying.

Profits,profits,profits. Every single service, medicine, procedure, supply, etc. etc.no matter how small or large has a profit built into it. Frequently cascading. Profits on top of profits. Individually they may be small, but add enough of them together and the numbers are very large.

How Is that as a start on who's running off with the bag? Yea oligarchs. The CEO's and executives in the health industry as well as the large investors can only be described that way. They are making large financial decisions and driving lawmaking for their own benefit first.

bob2356 says

The top 20% pay 90% of federal income taxes,

bob2356 says

That would be like medicare A paid out of fica tax on every worker with a cut off of 100k?

Bob, do you know the difference between "income taxes" and "payroll taxes"? Bernie's plan is to hike "income taxes" to pay for it...

Geez, the ignorance...

bob2356 says

How many abusers do you suppose will be lining up for FREE colonoscopies every day if berniecare did pass?

So, colonoscopies are the only thing people see a doctor for? I didn't know that.... amazing stuff...

bob2356 says

When people are dual qualified medicare is the primary and medicaid is limited to paying premiums, deductibles, and co pays not medical bills.

Wrong again... seems to be a pattern here.

People can be Medicaid primary and Medicare secondary... please do some research and education.

CBOEtrader says

I'll ask him about this, but my client most likely just doenst know the costs. He told me it was $3000 per visit. Your numbers would put him closer to $3000/month. He probably just doesnt know considering he doesnt pay the bills.

Exactly, Bob is just pulling things out of his netherlands again. There's all types of associated costs and facility costs added on top of the actual dialysis HCPCS. Bob needs some remedial help.

bob2356 says

I haven't read up on SNP's

Maybe you should.

bob2356 says

The most recent number's I've seen from medicare say about 60k a year ESRD. But that's for all ESRD care, not just the dialysis.

Oh Boy........ missed it by 50%...

...."Hemodialysis treatment costs an average of $89,000 per patient annually in the United States. "
https://pharm.ucsf.edu/kidney/need/statistics

I don't believe that accounts for any of the SNF costs, transportation costs, or anything else they tack on, just because they can bill for it.

Aphroman says

End of life. Only 5% of patients eat up 50% of health care. Most of them are very close to dying. Call it death panels or whatever you want but spending large sums of money to extend the life of someone elderly and already terminal by a couple months is simply insane. This is both a societal problem and a health care system problem. Americans don't accept death. Most other places have a strong hospice system that places high value on quality of life while dying not eaking out a few additional (frequently totally miserable) months from a long life. The entire health care for profit/fee for service system benefits very well financially from extending dying.

My cousins in Big Spring haven't talked to me since I told them when they came in response to my mother's passing in 1997 at 94 that I declined the attempt to revive her by the EMT after her heart had stopped. She had already made a living will and did not want any heroic efforts to revive her--to what purpose anyway. I think it was because his own mother, who was my mother's favorite niece, was treated repeatedly even after her mental faculties were long gone and it drew out her dying over several agonizing months and expense and he resented the fact I wanted to avoid that. My neighbor went through the same thing. Already advanced into mental incompetence to care for herself, when she was finally put into managed care within six months she had to have everything done for her and knew nothing. She would have medical emergencies that if left alone would have let her pass on, but instead she would be rushed to ICU where the meter would start running for every aspirin and drop of IV fluid administered--her son told me one attempt was over $75K to no avail. This went on for two years before she simply passed away in her room. Even when my mother was living, they wanted a nice payday. She had a colonoscopy in 1994 when she was 92 that was negative. When she was 93, the doctor notified her to have another colonoscopy and I put my foot down and told her to refuse, which she did. I don't think they will even administer colonoscopies anymore to people over 80 unless they have obvious symptoms--it's just a way to get more money.

Fake News Gets a Smack Down....

Democrats seize on cherry-picked claim that ‘Medicare-for-all’ would save $2 trillion.

“We know that Medicaid expansion and Medicare-for-all actually save this state and this nation $2 trillion if it were fully implemented.”
— Andrew Gillum, Democratic candidate for Florida governor, in a primary debate, Aug. 2, 2018

Gillum, the mayor of Tallahassee, was quoted in Weigel’s article as having touted, during a debate, a $2 trillion cost-savings figure that is in the report. Sanders, too, has tweeted about this $2 trillion number, sarcastically thanking the conservative Koch brothers, whose foundation has contributed to Mercatus.

That in theory would reduce the country’s overall level of health expenditures by $2 trillion from 2022 to 2031. But he makes clear that it’s a pretty unrealistic assumption.

In the fourth sentence of the report’s abstract, Blahous wrote, “It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.”

“To lend credibility to the $2 trillion savings number, one would have to argue that we can cut payments to providers by about 40 percent at the same time as increasing demand by about 11 percent,” Blahous said.

The Pinocchio Test

We don’t intend to pick on Gillum, who appears to have picked up a talking point that is circulating among Democrats. But we do want to lay down a marker because this goes too far.

All too often, politicians mischaracterize conclusions that are contained in academic or think tank studies. At the Fact Checker, we rely heavily on how a study’s author says the data should be presented. In this case, it’s clear that Blahous bent over backward to accept Sanders’s assumptions, only to find they did not add up. Democrats cannot seize on one cherry-picked fact without acknowledging the broader implications of Blahous’s research.

The verdict on the $2 Trillion Savings: Three Pinocchios

https://www.washingtonpost.com/news/fact-checker/wp/2018/08/07/democrats-seize-on-cherry-picked-claim-that-medicare-for-all-will-save-2-trillion/?utm_term=.f93f362766bd