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Akkula

Why Warren and Sanders are Strongest Against Trump

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2 hours ago, NMpackalum said:

It's not really screwing things up. It should be means tested as well. There needs to be some skin in the game whether it's 1, 5 or 20 dollars for a visit. Especially for an ER visit. The big winners with Medicare for all will be the insurance companies because they will still manage the care and they have the ability to ration care based on CMS guidelines and thus have more predictable costs.  Medicaid conversely has very little restrictions. I don't know why. Insurance companies make craploads of money on government programs. People don't realize it and if I were the insurance companies, I'd stealth donate to Sanders or Warren.

Why would the insurance companies win under M4A? They don’t manage Parts A and B, and I haven’t heard of anything in Sanders’ plan mentioning Parts C or D, other then that M4A will cover prescriptions. To me this sounds like Part D will be somehow folded in to the rest of Medicare, so PBMs would just no longer exist.

It’s not clear what would happen to part C because there hasn’t really been much talk about it, so I suppose insurance companies would still be involved if Part C is still a thing. But the vast majority of people under 50 that don’t go to the doctor a lot would just take the standard Medicare plan anyway, so I’d hardly call the insurance companies a “winner” here. 
 

Or are you just assuming M4A would be altered so that insurance companies still have a large role? If Warren were to win, I think that’s a safe assumption, but with Sanders? Who the hell knows. 

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1 hour ago, SalinasSpartan said:

Why would the insurance companies win under M4A? They don’t manage Parts A and B, and I haven’t heard of anything in Sanders’ plan mentioning Parts C or D, other then that M4A will cover prescriptions. To me this sounds like Part D will be somehow folded in to the rest of Medicare, so PBMs would just no longer exist.

It’s not clear what would happen to part C because there hasn’t really been much talk about it, so I suppose insurance companies would still be involved if Part C is still a thing. But the vast majority of people under 50 that don’t go to the doctor a lot would just take the standard Medicare plan anyway, so I’d hardly call the insurance companies a “winner” here. 
 

Or are you just assuming M4A would be altered so that insurance companies still have a large role? If Warren were to win, I think that’s a safe assumption, but with Sanders? Who the hell knows. 

Medicare uses third party administrators or insurance companies to implement their care. They essentially write rules/regulations and accept claims and contract with someone to write checks to physicians, hospitals and other providers. they contract with insurers to provide medical management, prior authorizations etc...If they choose to build infrastructure to do it all themselves, it will really be a cluster and even more expensive. The most cost effective way to do it would be enroll people into a managed care Medicare plan, which doctors hate by the way. Medicare without medical management is a sure way to spend way too much money for both patients and government.

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Would like to see whatever we adopt incorporate health savings accounts to help provide “skin in the game” for patients to control costs. 

Whole Foods, and the state of Indiana have a system like this where they fund a health savings account and a high deductible insurance plan on top of that. The funds from the HSA are equal to the deductible. Patients are free to keep anything from the HSA and roll it over to the next year. 

If a patient wants to go to the ER because they have the sniffles, go for it! It’s going to come out of your HSA first. Don’t want generic drugs? Fine, you’ll be paying for it out of your HSA. 

Encourages patients to control costs and should cut down on the over utilization concerns inherent in a single payer system. High deductible plan prevents people from becoming beggared by a health emergency that every one of us will eventually face.

I’m not saying it should be a government run/funded program or not.

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35 minutes ago, NMpackalum said:

Medicare uses third party administrators or insurance companies to implement their care. They essentially write rules/regulations and accept claims and contract with someone to write checks to physicians, hospitals and other providers. they contract with insurers to provide medical management, prior authorizations etc...If they choose to build infrastructure to do it all themselves, it will really be a cluster and even more expensive. The most cost effective way to do it would be enroll people into a managed care Medicare plan, which doctors hate by the way. Medicare without medical management is a sure way to spend way too much money for both patients and government.

Unless the insurance companies are going to make more money writing rules and regulations and processing claims/Prior auths then they do right now I fail to see how they are “winners” under M4A. 

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1 hour ago, SalinasSpartan said:

Unless the insurance companies are going to make more money writing rules and regulations and processing claims/Prior auths then they do right now I fail to see how they are “winners” under M4A. 

More people sign up for Medicare Advantage plans. Capitated rates for California for instance for 2020 is $948 per month per patient. Utilize less than that, pure profit. The Feds know they won't be out more than that amount.That's 200 million potential new customers who previously had private health insurance so the Insurance plans would be happy to just change them over. They already have their demographic, medical  and utilization history.

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3 minutes ago, NMpackalum said:

More people sign up for Medicare Advantage plans. Capitated rates for California for instance for 2020 is $948 per month per patient. Utilize less than that, pure profit. The Feds know they won't be out more than that amount.That's 200 million potential new customers who previously had private health insurance so the Insurance plans would be happy to just change them over. They already have their demographic, medical  and utilization history.

Would that rate go down with so many non-old and poor people (to put it very bluntly)?

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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1 hour ago, SalinasSpartan said:

Unless the insurance companies are going to make more money writing rules and regulations and processing claims/Prior auths then they do right now I fail to see how they are “winners” under M4A. 

Maybe I'm ahead of myself. Whoever administrates MC4A will have to have the ability to contract individually with 1.1 million MDs, millions more of chiropracters, podiatrists, psychologists, 10s of thousands of hospitals, surgery centers, Urgent cares, durable medical suppliers, pharmacies, pharmacy benefit managers, home health agencies and a multitude of other beneficiaries. Not to mention credentialling, paying each of them,  reviewing and auditing charts and claims... just to start. I could go on but I won't.

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4 hours ago, NMpackalum said:

There are so many balls in the air with so many stakeholders with different goals that it would be difficult to pinpoint what should be done. There isn't one thing that can be done, many things should be done. From a physician perspective, serious meaningful Tort reform is important or we will continue to practice defensive medicine. Ironically, a government system with employed physicians have significantly lower liability risks because it's less lucrative for plaintiff attorneys to sue for frivolous cases. I keep alluding to regulatory compliance as a huge issue because of how much less productive we are which decreases access. It's a government genie that's out and not likely to be pulled back and has spawned multi tens of billion dollar industry that does very little for quality, mainly used to enhance billing and protect against audits and medicolegal liability.

Ultimately, our population is generally obese, eat and drink too much, exercise too little and would rather take a pill for their medical problems. People need to take responsibility for their health as well. Quality and  reasonable cost isn't incompatable but people need to decide what's more important. Honestly, a German style system where everyone is enrolled in a Medicare type, restricted, few frills system administrated by third party non government administrator with the ability to pay for private, more convenient benefits plan at a certain income threshhold makes sense to me. Their system also restricts ability to sue for frivolous claims as well. Physicians are happy with their income and patients are happy with their care. Access and satisfaction are superior than that of the National Health service in England, a true single payer government system, which is perpetually underfunded and understaffed.

Tough to make a dent in it. Unfortunately we don't have the political will to make meaningful changes except add more layers of administration.

It would be really cool if someone invented a system that could automatically adapt to changing market conditions and consumer demand without out someone managing it. If only such a system existed........

“Science is the belief in the ignorance of experts.”

-Richard Feynman

"When buying and selling are controlled by legislation, the first things to be bought and sold are legislators."

-P.J. O’Rourke

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Just now, happycamper said:

Would that rate go down with so many non-old and poor people (to put it very bluntly)?

If I were the government, I would offer less for sure. But it's like a bond sale, the lower it goes, the fewer bidders. For example, working age women utilize about $8500 dollars per year so the insurance companies can figure out how much they are willing to take. It is so much easier for the Insurance companies to manage as they wouldn't have to configure multiple reimbursement schedules for different hospitals, doctors, facilities. Just 1 plan. Overhead for them would decrease tremendously.

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54 minutes ago, NMpackalum said:

Maybe I'm ahead of myself. Whoever administrates MC4A will have to have the ability to contract individually with 1.1 million MDs, millions more of chiropracters, podiatrists, psychologists, 10s of thousands of hospitals, surgery centers, Urgent cares, durable medical suppliers, pharmacies, pharmacy benefit managers, home health agencies and a multitude of other beneficiaries. Not to mention credentialling, paying each of them,  reviewing and auditing charts and claims... just to start. I could go on but I won't.

If this would all be more profitable then the current system for insurance companies then M4A would already be in place. If you want to say there is a silver lining for insurance companies that they will still be able to make money, ok. But they don’t “win” with M4A, they win with Warren or Sanders losing to Trump. That means status quo for four more years which ensures the dems trotting out a corporate dem in 2024 that won’t run on M4A. 

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19 hours ago, SalinasSpartan said:

If this would all be more profitable then the current system for insurance companies then M4A would already be in place. If you want to say there is a silver lining for insurance companies that they will still be able to make money, ok. But they don’t “win” with M4A, they win with Warren or Sanders losing to Trump. That means status quo for four more years which ensures the dems trotting out a corporate dem in 2024 that won’t run on M4A. 

  • Average gross margins — the average amount by which premium income exceeds yearly claims costs for each covered person — are considered a critical benchmark for insurer financial performance. Of the three private health insurance markets, the Medicare Advantage market had the highest gross margins, with an average of $1,608 per enrollee per year.
  • The average gross margin for the MA market was about double the gross margins of the other two markets, pegged at $855 per covered person for the group market, and $779 per covered person for the individual market.

If you say so.  From the Kaiser Foundation.

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2 hours ago, NMpackalum said:
  • Average gross margins — the average amount by which premium income exceeds yearly claims costs for each covered person — are considered a critical benchmark for insurer financial performance. Of the three private health insurance markets, the Medicare Advantage market had the highest gross margins, with an average of $1,608 per enrollee per year.
  • The average gross margin for the MA market was about double the gross margins of the other two markets, pegged at $855 per covered person for the group market, and $779 per covered person for the individual market.

If you say so.  From the Kaiser Foundation.

So they are spending tons of money fighting against legislature that would make them more money?

ok

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5 hours ago, SalinasSpartan said:

So they are spending tons of money fighting against legislature that would make them more money?

ok

They're fighting the elimination of private health care insurance. You can believe unsubstantiated rhetoric or you can believe actuarial results. I've not read a single article from anyone who realizes that Medicare has no infrastructure to provide what the insurance companies provide. Do you wonder why Medicare has a reported administrative cost of 2.3% vs the industry average of 12%. Is this the rare government unicorn entity that is almost 6X more efficient than private industry?  Hardly. That is what you should be questioning. When a doctor files a claim, CMS sends the claim to a (MAC) Medicare Administrative Contractor and they provide the administrative processes to pay the claim. No medical management services, no prior authorization review, no review of medical necessity, no appeals processes, basically the most inefficient way to run things and ripe for "fraud and abuse" that we often hear about. Even CMS knows that this is inefficient so they came up with Medicare Advantage plans through private insurers to provide those processes and limit their risk. 

As far as I'm concerned, the insurers are playing this perfectly. Lobby to make sure that private insurers are still in the game and hope they expand Medicare advantage plans.

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On 11/11/2019 at 3:53 PM, renoskier said:

 

Forget that Akkula is asking, so you don't have to go down the whole "communist" hole.

Was our healthcare system just all peachy keen before the ACA? Just go back to the way it was, it was all good?

 

Our employee based health insurance is one of the stupidest, most inefficient systems, which has ever evolved. It sucks that so many resources, for both the businesses and the doctors, are spent on health insurance bullshit instead of being productive making widgets and caring for folks. 

 

This.  The complexity and red tape are the problems with the healthcare system. Having Health insurance tied to employment and some plans only offered in certain states is also stupid.  

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1 hour ago, NMpackalum said:

They're fighting the elimination of private health care insurance. You can believe unsubstantiated rhetoric or you can believe actuarial results. I've not read a single article from anyone who realizes that Medicare has no infrastructure to provide what the insurance companies provide. Do you wonder why Medicare has a reported administrative cost of 2.3% vs the industry average of 12%. Is this the rare government unicorn entity that is almost 6X more efficient than private industry?  Hardly. That is what you should be questioning. When a doctor files a claim, CMS sends the claim to a (MAC) Medicare Administrative Contractor and they provide the administrative processes to pay the claim. No medical management services, no prior authorization review, no review of medical necessity, no appeals processes, basically the most inefficient way to run things and ripe for "fraud and abuse" that we often hear about. Even CMS knows that this is inefficient so they came up with Medicare Advantage plans through private insurers to provide those processes and limit their risk. 

As far as I'm concerned, the insurers are playing this perfectly. Lobby to make sure that private insurers are still in the game and hope they expand Medicare advantage plans.

Yes, they are playing things perfectly; they are backing candidates that don’t support M4A. Which is, you know, all of them except Bernie and Warren. And even Warren now has backed off it somewhat and has only committed to doing single payer first and then promising to start pushing for M4A in 2022. 

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9 hours ago, SalinasSpartan said:

Yes, they are playing things perfectly; they are backing candidates that don’t support M4A. Which is, you know, all of them except Bernie and Warren. And even Warren now has backed off it somewhat and has only committed to doing single payer first and then promising to start pushing for M4A in 2022. 

That's fine, you're reticent to consider opinions that don't jive with your opinions and that's ok. Whoever wins the next couple elections whether Trump or Sanders/Warren/Biden will have to make significant changes to health care delivery and payment. The ball is rolling to expand Medicare. It would behoove the public if their public officials understand how health care delivery actually works and what they have to work with and not just the financing.

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4 hours ago, NMpackalum said:

That's fine, you're reticent to consider opinions that don't jive with your opinions and that's ok. Whoever wins the next couple elections whether Trump or Sanders/Warren/Biden will have to make significant changes to health care delivery and payment. The ball is rolling to expand Medicare. It would behoove the public if their public officials understand how health care delivery actually works and what they have to work with and not just the financing.

The only thing I “disagree with” is that the insurance company “wins” with M4A, as in they will profit more from it opposed to the current system. You disagree, cool. 

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16 minutes ago, SalinasSpartan said:

The only thing I “disagree with” is that the insurance company “wins” with M4A, as in they will profit more from it opposed to the current system. You disagree, cool. 

The only people that will be hurt is the patients by a M4A program.

Insurance companies will deploy their resources elsewhere.

Doctors are smart people they will make money elsewhere.

 

Patients will die because of the rationed care system.   Costs will skyrocket as they have done with every increase in government control of the medical system.

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On 11/21/2019 at 1:31 PM, SalinasSpartan said:

The only thing I “disagree with” is that the insurance company “wins” with M4A, as in they will profit more from it opposed to the current system. You disagree, cool. 

All I can say is, I was involved in a local startup HMO/PPO insurance product that included Medicaid and Medicare. We made money with Medicaid and Medicare and lost our shorts with the commercial insurance. We folded after 2 years because of the commercial losses.

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