Congressman Admits ObamaCare a Platform for Single Payer

[Bern80]

This is the question you believe any reform proposal should answer? How we can we find ways to keep spending the exact same amount of money, year after year?

What I'm saying is single payer is unlikely to address the issue prices charged by providers. There is no economic mechanism in single payer that would drive what hospitals charge down (though I suppose one could argue there is a lega, authoritarian one if government was so inclined). So if the providers are going to charge the same but the intent is to keep employers from having to pay insurance premiums for employees and for citizens costs to go down, the difference has to be made up somehow. The only way I can see to do that is either raise taxes on people or continue to borrow and add to the debt.

I'm not familiar with any single-payer proposals that involve providers retaining the tremendous power they currently have over prices. In fact, that's generally one of the primary arguments offered in favor of single payer proposals. At present, prices (i.e. reimbursement rates) are dictated by provider market power relative to payers; different payers will often be charged different reimbursement rates for a single service based on how much of the insurance market they have cornered. That isn't the case, at least with hospitals, in the only state that currently has all-payer rate-setting (i.e. common reimbursements for all payers set by the state); and in that state, they're not bent quite as far over the barrel by hospitals:

On average, Maryland hospitals charged patients 20% above the cost to treat them in 2007, compared with a national average of 182%, according to the American Hospital Association.​

If you're going to have a bilateral oligopoly, there are advantages to at least have a public entity refereeing; single-payer takes the concept further to pursue some other benefits beyond simply shifting the power to set prices away from providers.

Again other than artifical authoritarian power, what market force is going to drive provider prices down simple by makng government the single payer? It would seem to me that would give providers even more leverage because they know they are deaing with a payer that has one gigantic pool of taxpayer money and doesn't seem to care too much about going into debt to pay for things.

 

[Flopper]

Single payer is a far better system than the Obamacare, socialized medicine, or private insurance. There would be no need for the mandatory insurance requirements. Health insurance company profits and overhead, about 25% are eliminated. Businesses would no longer have the cost of providing health insurance for employees.

Really the only benefit of single payer is simplifying things. The reality is it's people saying I would rather not have to take responsibility financially for my health care. I would rather just pay a tax and have government deal with it. THAT is why our nation is getting weaker and weaker. Because more and more people simply would rather not take responsibility for themselves.

There will be very little practical savings taking some supposed bite out of insurance company profits because the FACT is insurance companies aren't that profitable in the first place. Most have single digit profit margins.

What won't change is the demand on resources and single payer does not address that. Those resources are going to cost just as much after single payer is instituted as they did before. So how exactly are the providers going to collect the same amount of money as before if the cost to people and employers is supposed to go down. Government will either have to subsidize it to make up the difference and add to the debt as a result or it will have to raise taxes on everyone to cover the costs. This will also allow providers to actually raise the price of what they charge for services. That is what happens when you subsidize something. When you set a price for a service one factor in doing so is knowing what people will pay and obviously I can charge more to whom money is less of a factor, in this case government.

I believe a single payer system in the US is very unlikely. Just as in the pass, the insurance companies will control enough congressman to insurance it's defeat.

I am not a fan of the insurance system, but don't fool yourself into thinking single payer is a better one. The country can not afford yet another entitlement program.

It sounds as if you consider the simplicity of the single payer system as a minor advantage. Actually the single payer system is a major cost saving for healthcare providers. Today, the doctor’s office will bill the primary insurance provider. What is not paid by the primary insurance is billed to the secondary insurance provider. Finally, the balance owed is billed to the patient. Since the office deals with hundreds of insurance companies with radically different manage care and point of service plans, there is a huge room for error and reprocessing. The cost of in house insurance billing personnel, insurance billing software, and write offs cost doctors 10 to 20% of the amount they bill. This pushes up the cost of healthcare for everyone. The situation is even worse with hospitals because of the complexity of billing and sizes of the bills.

Single payer systems are very simple. Everyone knows the rules. The co-pays are standard so every medical provider knows how much to collect from the patient at the time of service. The cost of losses due to non-payment and insurance billing costs would be reduced to a fraction of what they are now. This would be a big reduction in the cost of healthcare.

Eliminating the insurance company also reduces the cost of medical care. Insurance companies have an average overhead of 10% but can go as high 30%. Profits average 15%. CMS, who processes Medicare claims, handles hundreds of millions of claims each year. Their overhead is 2% and of course there are no profits.

The single payer system does not need to be an entitlement. Premiums can be determine based on cost, just as insurance companies do. Medicare and Medicaid would remain and entitlement plans. Those who can’t afford single payer insurance would be covered under Medicaid just as they are now.

Since the single payer insurance pool would be so large, covering preexisting conditions would no longer be a problem. Also those that chose not to participate at this time, would be allowed to enter the system at higher premiums based on age similar to what Medicare has done.

Lastly, businesses could get out of the healthcare business reduces their cost.

As I said, the chances of passing a single payer system are very low. For health insurance companies, it would be a fight to the death because in a single payer system, insurance companies would either be shutout or would be reduced to the role of a contractor. The healthcare insurance industry would be socialized, however the healthcare industry would not be owned or ruin by the government.

 

[Bern80]

It sounds as if you consider the simplicity of the single payer system as a minor advantage. Actually the single payer system is a major cost saving for healthcare providers.

Right off the bat I'm not sure how one can make this statement factually. Single payer isn't being used in the U.S. and there are too many other variables to make an apples to apples comparison to other countries.

Today, the doctor’s office will bill the primary insurance provider. What is not paid by the primary insurance is billed to the secondary insurance provider.

What secondary insurance provider. I don't have more than one insurance plan, do you?

Finally, the balance owed is billed to the patient. Since the office deals with hundreds of insurance companies with radically different manage care and point of service plans, there is a huge room for error and reprocessing. The cost of in house insurance billing personnel, insurance billing software, and write offs cost doctors 10 to 20% of the amount they bill. This pushes up the cost of healthcare for everyone. The situation is even worse with hospitals because of the complexity of billing and sizes of the bills.

Those are issues of course worth solving, but putting government in charge of being the single payer is just not the way to do it. That 10 to 20% added on to bills is going to get replaced by the inefficiency of government and beauracarcy.

Single payer systems are very simple. Everyone knows the rules. The co-pays are standard so every medical provider knows how much to collect from the patient at the time of service. The cost of losses due to non-payment and insurance billing costs would be reduced to a fraction of what they are now. This would be a big reduction in the cost of healthcare.

That won't be the case. Single payer is not going to change the fact that some people simply can't pay. Those losses will still exist and that expense will still be passed on to those that can.

Eliminating the insurance company also reduces the cost of medical care. Insurance companies have an average overhead of 10% but can go as high 30%. Profits average 15%. CMS, who processes Medicare claims, handles hundreds of millions of claims each year. Their overhead is 2% and of course there are no profits.

Your profit margins are overstated. The avg. insurance company would be lucky to have a profit margin in the double digits. Removing insurance companies is a good idea, but you don't understand why. The reason is because it's the introduction of a third party, ANY third party into the transaction between patient and provider. You're not going to gain much by simply replacing one third party (private insurance companies) with another third party (government).

That's the way you need to look at this. Why do we need a third party? Because we need someone else that has more money than 'we' do to cover our health care costs from time to time. That's the concept of insurance. The problem is instead of paying for the medical costs of the catastrophic and major injuries, though government has insisted that insurance companies cover in some form or other pretty much anything that may happen to us medically. THAT is what is conributing to high health care costs. The insurance companies must collect higher premiums to in the off chance they have to cover these possibly eventualities, which gives them a larger pool of money. The providers know they have a larger pool of thus know they can charge more for their services as a result

The single payer system does not need to be an entitlement. Premiums can be determine based on cost, just as insurance companies do. Medicare and Medicaid would remain and entitlement plans. Those who can’t afford single payer insurance would be covered under Medicaid just as they are now.

Since the single payer insurance pool would be so large, covering preexisting conditions would no longer be a problem. Also those that chose not to participate at this time, would be allowed to enter the system at higher premiums based on age similar to what Medicare has done.

The size of the pool is also what would allow providers to actually charge more for their services. Only now the providers get to deal with a party that cares less about cost than the insurance companies. We obviously know going into debt isn't nearly as a big a deal for government as it is for a private company.

Lastly, businesses could get out of the healthcare business reduces their cost.

As I said, the chances of passing a single payer system are very low. For health insurance companies, it would be a fight to the death because in a single payer system, insurance companies would either be shutout or would be reduced to the role of a contractor. The healthcare insurance industry would be socialized, however the healthcare industry would not be owned or ruin by the government.

I agree it would be greatly beneficial for business to not have to worry about health care as a benefit, but the citizen passing the buck to government is not the answer. There is little doubt we will see the same issues that other countries with single payer are seeing. Deficits in coverage and a gradual reduction in what government will reimburse for. If you want a the cost of something to a consumer to go down and be sustainable you can't just subsidize that cost, you have to tackle it at the source. Why the service costs what it does and how it can be reduced so the consumer doesn't have to pay as much for it. The best way to do that is for the person to take more responsibility for those costs. As simple as I can make it is providers charge what they charge because they can because a third party has entered the equation. That third party, whether it is government or private insurance company is less sensitive to cost than you are. THAT is why things cost what they cost. If you want price to go down than the the patient needs to be made more sensitive to cost. They need to be incentivised to shop for the best price and they need have more options in health care coverage.

 

[Flopper]

It sounds as if you consider the simplicity of the single payer system as a minor advantage. Actually the single payer system is a major cost saving for healthcare providers.

Right off the bat I'm not sure how one can make this statement factually. Single payer isn't being used in the U.S. and there are too many other variables to make an apples to apples comparison to other countries.

Today, the doctor’s office will bill the primary insurance provider. What is not paid by the primary insurance is billed to the secondary insurance provider.

What secondary insurance provider. I don't have more than one insurance plan, do you?




Those are issues of course worth solving, but putting government in charge of being the single payer is just not the way to do it. That 10 to 20% added on to bills is going to get replaced by the inefficiency of government and beauracarcy.




That won't be the case. Single payer is not going to change the fact that some people simply can't pay. Those losses will still exist and that expense will still be passed on to those that can.



Your profit margins are overstated. The avg. insurance company would be lucky to have a profit margin in the double digits. Removing insurance companies is a good idea, but you don't understand why. The reason is because it's the introduction of a third party, ANY third party into the transaction between patient and provider. You're not going to gain much by simply replacing one third party (private insurance companies) with another third party (government).

That's the way you need to look at this. Why do we need a third party? Because we need someone else that has more money than 'we' do to cover our health care costs from time to time. That's the concept of insurance. The problem is instead of paying for the medical costs of the catastrophic and major injuries, though government has insisted that insurance companies cover in some form or other pretty much anything that may happen to us medically. THAT is what is conributing to high health care costs. The insurance companies must collect higher premiums to in the off chance they have to cover these possibly eventualities, which gives them a larger pool of money. The providers know they have a larger pool of thus know they can charge more for their services as a result

The single payer system does not need to be an entitlement. Premiums can be determine based on cost, just as insurance companies do. Medicare and Medicaid would remain and entitlement plans. Those who can’t afford single payer insurance would be covered under Medicaid just as they are now.

Since the single payer insurance pool would be so large, covering preexisting conditions would no longer be a problem. Also those that chose not to participate at this time, would be allowed to enter the system at higher premiums based on age similar to what Medicare has done.

The size of the pool is also what would allow providers to actually charge more for their services. Only now the providers get to deal with a party that cares less about cost than the insurance companies. We obviously know going into debt isn't nearly as a big a deal for government as it is for a private company.

Lastly, businesses could get out of the healthcare business reduces their cost.

As I said, the chances of passing a single payer system are very low. For health insurance companies, it would be a fight to the death because in a single payer system, insurance companies would either be shutout or would be reduced to the role of a contractor. The healthcare insurance industry would be socialized, however the healthcare industry would not be owned or ruin by the government.

I agree it would be greatly beneficial for business to not have to worry about health care as a benefit, but the citizen passing the buck to government is not the answer. There is little doubt we will see the same issues that other countries with single payer are seeing. Deficits in coverage and a gradual reduction in what government will reimburse for. If you want a the cost of something to a consumer to go down and be sustainable you can't just subsidize that cost, you have to tackle it at the source. Why the service costs what it does and how it can be reduced so the consumer doesn't have to pay as much for it. The best way to do that is for the person to take more responsibility for those costs. As simple as I can make it is providers charge what they charge because they can because a third party has entered the equation. That third party, whether it is government or private insurance company is less sensitive to cost than you are. THAT is why things cost what they cost. If you want price to go down than the the patient needs to be made more sensitive to cost. They need to be incentivised to shop for the best price and they need have more options in health care coverage.

I’m on Medicare and have a supplemental policy, as do many if not most Medicare patients. If you carry a cancer policy or an accident policy, that’s a supplemental policy. If you are in an accident, medical payments from an auto insurance company are considered a secondary insurance. Low-income earners may be on Medicaid and also on their employers insurance. There are millions of people with secondary coverage.

You say, that the 10 to 20% added on to bills is going to get replaced by the inefficiency of government and beauracarcy. That’s not necessarily so. Everyone seems to assume the government can do nothing right and if they do it will be wasteful. Every party that is out of power preaches this and it makes great headlines. I have worked in both in the private and public sector. The truth is most government offices run very efficiently. IRS return processing runs very smoothly. CMS processes hundreds of millions of Medicare claims far more efficiently and faster than most insurance companies.

You are correct health insurance margins are not that high. They suffered as most companies have during the recession. But prior to the recession in 2007 the average margin was 10.6% and higher if you go back a few more years.

Uninsured patients and those with high deductibles are responsible for most of the medical non-payments. With a single payer system as was proposed by the administration, those who could not pay insurance premiums would be covered under Medicaid reducing the amount of write-offs.

I agree that that catastrophic insurance would lower medical costs. The problem is people don’t want this type coverage. When people get sick and go to the doctor, they want their insurance company to help them pay their $300 bill. Also a catastrophe to one person is just a normal expense to another. You might be able to easily handle a $5,000 medical bill but many people would have no way of paying it.

 

[Greenbeard]

What I'm saying is single payer is unlikely to address the issue prices charged by providers. There is no economic mechanism in single payer that would drive what hospitals charge down (though I suppose one could argue there is a lega, authoritarian one if government was so inclined).

I think this might be a first. I don't believe I've ever heard the argument that public health payers reimburse or are reimbursing too much per DRG.

Anyway, the exact nature of reimbursement depends on the design of the system. You could imagine a few different designs just springing from our current public payers' structure. You might have fee-for-service with rates set administratively or perhaps FFS with negotiated rates but I imagine both would be unlikely because providers bear no risks under FFS. Or perhaps a system in which direct reimbursement is shopped out to the private sector via capitated MCO arrangements (maybe introduce competitive bidding here), as has become popular in Medicaid and, to a lesser extent, in Medicare. Or something like the recommendation of Hsiao et al. for Vermont in which the drudgery of claims administration is shopped out to the private sector via a competitive bidding process and providers themselves are capitated, with periodic updates to capitation rates possible through negotiation between providers and a public-private board with broad stakeholder representation. Or you could look at the actual single-payer bill sitting in Congress right now, which skips past capitation right to global budgeting for providers, an arrangement that places the financial risk purely on the provider side.

Plenty of different ways to do it and very little reason to think any of them would lead to higher reimbursements per procedure (particularly since most of them explicitly distance themselves from the concept of paying per procedure). And if we need a reminder of how those prices shake out across the world, we can refer to the International Federation of Health Plans last comparative price report to see how the prices of simple scans and routine procedures not commonly associated with complications vary:

Now, if you're actually interested in the potential cost saving avenues and amounts found in single-payer arrangements--independent of reimbursement rates--I would recommend reading the Vermont report.

Again other than artifical authoritarian power, what market force is going to drive provider prices down simple by makng government the single payer? It would seem to me that would give providers even more leverage because they know they are deaing with a payer that has one gigantic pool of taxpayer money and doesn't seem to care too much about going into debt to pay for things.

Other than "artificial authoritarian power"? We're talking about negotiations between institutions--power is pretty much the whole ball of wax. In markets where providers have that "artificial" power, they get higher markups over cost. In markets where a private insurer has that power, better discounts are obtained from providers. Reimbursement setting is always a power struggle. Asking "other than the balance of power being in Side X's favor, what makes you think they'll come out on top in the negotiation?" is like asking "other than the cards in your hand, what makes you think you can win this round of poker?"

Those are issues of course worth solving, but putting government in charge of being the single payer is just not the way to do it. That 10 to 20% added on to bills is going to get replaced by the inefficiency of government and beauracarcy.

Pithy but meaningless. Inefficiency in doing what? Actual claims processing or reimbursement distribution can be done by the private sector under a single-payer system if that's desired. The significance of single-payer lies in the policy-setting function of government; concerns that the government somehow can't "do" the functions of a payer are irrelevant, as the government doesn't have to actually serve those functions under single-payer (beyond appropriate oversight of whatever private entity does carry out those functions).

The size of the pool is also what would allow providers to actually charge more for their services. Only now the providers get to deal with a party that cares less about cost than the insurance companies. We obviously know going into debt isn't nearly as a big a deal for government as it is for a private company.

Are you under the impression that the larger an insurance company is, the more it pays for a given service?

 

[mudwhistle]

What I'm saying is single payer is unlikely to address the issue prices charged by providers. There is no economic mechanism in single payer that would drive what hospitals charge down (though I suppose one could argue there is a lega, authoritarian one if government was so inclined).

I think this might be a first. I don't believe I've ever heard the argument that public health payers reimburse or are reimbursing too much per DRG.

Anyway, the exact nature of reimbursement depends on the design of the system. You could imagine a few different designs just springing from our current public payers' structure. You might have fee-for-service with rates set administratively or perhaps FFS with negotiated rates but I imagine both would be unlikely because providers bear no risks under FFS. Or perhaps a system in which direct reimbursement is shopped out to the private sector via capitated MCO arrangements (maybe introduce competitive bidding here), as has become popular in Medicaid and, to a lesser extent, in Medicare. Or something like the recommendation of Hsiao et al. for Vermont in which the drudgery of claims administration is shopped out to the private sector via a competitive bidding process and providers themselves are capitated, with periodic updates to capitation rates possible through negotiation between providers and a public-private board with broad stakeholder representation. Or you could look at the actual single-payer bill sitting in Congress right now, which skips past capitation right to global budgeting for providers, an arrangement that places the financial risk purely on the provider side.

Plenty of different ways to do it and very little reason to think any of them would lead to higher reimbursements per procedure (particularly since most of them explicitly distance themselves from the concept of paying per procedure). And if we need a reminder of how those prices shake out across the world, we can refer to the International Federation of Health Plans last comparative price report to see how the prices of simple scans and routine procedures not commonly associated with complications vary:

Now, if you're actually interested in the potential cost saving avenues and amounts found in single-payer arrangements--independent of reimbursement rates--I would recommend reading the Vermont report.

Again other than artifical authoritarian power, what market force is going to drive provider prices down simple by makng government the single payer? It would seem to me that would give providers even more leverage because they know they are deaing with a payer that has one gigantic pool of taxpayer money and doesn't seem to care too much about going into debt to pay for things.

Other than "artificial authoritarian power"? We're talking about negotiations between institutions--power is pretty much the whole ball of wax. In markets where providers have that "artificial" power, they get higher markups over cost. In markets where a private insurer has that power, better discounts are obtained from providers. Reimbursement setting is always a power struggle. Asking "other than the balance of power being in Side X's favor, what makes you think they'll come out on top in the negotiation?" is like asking "other than the cards in your hand, what makes you think you can win this round of poker?"

Those are issues of course worth solving, but putting government in charge of being the single payer is just not the way to do it. That 10 to 20% added on to bills is going to get replaced by the inefficiency of government and beauracarcy.

Pithy but meaningless. Inefficiency in doing what? Actual claims processing or reimbursement distribution can be done by the private sector under a single-payer system if that's desired. The significance of single-payer lies in the policy-setting function of government; concerns that the government somehow can't "do" the functions of a payer are irrelevant, as the government doesn't have to actually serve those functions under single-payer (beyond appropriate oversight of whatever private entity does carry out those functions).

The size of the pool is also what would allow providers to actually charge more for their services. Only now the providers get to deal with a party that cares less about cost than the insurance companies. We obviously know going into debt isn't nearly as a big a deal for government as it is for a private company.

Are you under the impression that the larger an insurance company is, the more it pays for a given service?

WTF is capitation?

Excuse me, but I've mentioned this before. You're wasting your breath unless you put all of this in layman's terms.

I understand most of what you said, but not everyone does. There is probably only a couple of people here that really know what in the heck you just said.

 

[Greenbeard]

WTF is capitation?

Excuse me, but I've mentioned this before. You're wasting your breath unless you put all of this in layman's terms.

I understand most of what you said, but not everyone does. There is probably only a couple of people here that really know what in the heck you just said.

There are different ways to pay for health care services. The most common has been paying a fee for each service provided (or, potentially, a fee for a group of services surrounding a particular diagnosis). But that has implications for the volume of services delivered because there's an incentive there to provide more services and collect more money, particularly when the fees for various services are reduced. And it reinforces the notion that we're buying health widgets and not health.

Capitation is one alternative to simply paying for each procedure. Instead it pays a flat fee for each person, often in a per-member-per-month arrangement. This has become fairly common in state Medicaid programs, where it's usually known as managed care. Under those arrangements, the state government no longer directly pays providers for each service a Medicaid beneficiary gets; instead, the state contracts with private health insurance plans--called Medicaid managed care organizations (MCOs)--to deliver care to Medicaid beneficiaries. The MCO gets a fixed amount of money each month for each enrollee (perhaps risk-adjusted to take into account whether an individual enrollee is sicker than average or needs more care) and assumes the financial risk for getting care to those enrollees. Generally the MCOs then contract with providers and sometimes find ways to shift some of that risk onto the providers.

 

[mudwhistle]

WTF is capitation?

Excuse me, but I've mentioned this before. You're wasting your breath unless you put all of this in layman's terms.

I understand most of what you said, but not everyone does. There is probably only a couple of people here that really know what in the heck you just said.

There are different ways to pay for health care services. The most common has been paying a fee for each service provided (or, potentially, a fee for a group of services surrounding a particular diagnosis). But that has implications for the volume of services delivered because there's an incentive there to provide more services and collect more money, particularly when the fees for various services are reduced. And it reinforces the notion that we're buying health widgets and not health.

Capitation is one alternative to simply paying for each procedure. Instead it pays a flat fee for each person, often in a per-member-per-month arrangement. This has become fairly common in state Medicaid programs, where it's usually known as managed care. Under those arrangements, the state government no longer directly pays providers for each service a Medicaid beneficiary gets; instead, the state contracts with private health insurance plans--called Medicaid managed care organizations (MCOs)--to deliver care to Medicaid beneficiaries. The MCO gets a fixed amount of money each month for each enrollee (perhaps risk-adjusted to take into account whether an individual enrollee is sicker than average or needs more care) and assumes the financial risk for getting care to those enrollees. Generally the MCOs then contract with providers and sometimes find ways to shift some of that risk onto the providers.

So when a provider has to take on patients without pre-conditions they're taking more of the risk. The sicker the client the more risk the provider takes instead of the state.

Guess this is intended to put the provider out of business. By that insuring that the government eventually will become the single-payer. The government shifts expenses over to the provider. Am I right?

Seems pretty cut and dried.

 

[Greenbeard]

Guess this is intended to put the provider out of business. By that insuring that the government eventually will become the single-payer. The government shifts expenses over to the provider. Am I right?

Seems pretty cut and dried.

First of all, using words correctly is important. Providers are those who actually provide health care services--these are doctors, hospitals, whatever. Payers reimburse providers for those services; there are generally insurance companies. Saying that you create a single-payer system by putting providers out of business is nonsensical.

Second, what are you talking about? Are you referring to the text you quoted about using managed care in Medicaid? Or are you talking about the broader subject of this thread, i.e. single-payer?

Either way, this comment is inane. If you're talking about Medicaid managed care, that isn't "insuring that the government eventually will become the single-payer" since Medicaid already effectively functions as a single-payer system for the categorically needy; Medicaid managed care is an attempt to control costs by letting private insurers compete for Medicaid enrollees, assume risk, and in return receive a fixed fee for each enrollee it attracts. If Medicaid MCOs all went out of business you'd be back to having...regular fee-for-service Medicaid. A government takeover of a government program!

If, on the other hand, you're talking more generally about using capitation in the context of a single-payer system: what's your point? The conceit here is that we're talking about ways a single-payer system could function. If your takeaway of a description of mechanisms by which a single-payer system could function is that those mechanisms pave the way to single-payer, I'd have to say I'm a little speechless. Uh, good catch?

By the way, capitation can be and has been associated with private payers, no public payer involvement required. See the '90s or current attempts to revive it.

 

[mudwhistle]

Guess this is intended to put the provider out of business. By that insuring that the government eventually will become the single-payer. The government shifts expenses over to the provider. Am I right?

Seems pretty cut and dried.

First of all, using words correctly is important. Providers are those who actually provide health care services--these are doctors, hospitals, whatever. Payers reimburse providers for those services; there are generally insurance companies. Saying that you create a single-payer system by putting providers out of business is nonsensical.

Second, what are you talking about? Are you referring to the text you quoted about using managed care in Medicaid? Or are you talking about the broader subject of this thread, i.e. single-payer?

Either way, this comment is inane. If you're talking about Medicaid managed care, that isn't "insuring that the government eventually will become the single-payer" since Medicaid already effectively functions as a single-payer system for the categorically needy; Medicaid managed care is an attempt to control costs by letting private insurers compete for Medicaid enrollees, assume risk, and in return receive a fixed fee for each enrollee it attracts. If Medicaid MCOs all went out of business you'd be back to having...regular fee-for-service Medicaid. A government takeover of a government program!

If, on the other hand, you're talking more generally about using capitation in the context of a single-payer system: what's your point? The conceit here is that we're talking about ways a single-payer system could function. If your takeaway of a description of mechanisms by which a single-payer system could function is that those mechanisms pave the way to single-payer, I'd have to say I'm a little speechless. Uh, good catch?

By the way, capitation can be and has been associated with private payers, no public payer involvement required. See the '90s or current attempts to revive it.

I was thinking of insurance providers.

If you're saying that the provider is the doctor that's even worse. How do you expect the doctor to stay in business if the insurer decides that he will only pay 80% of costs. Maybe if the limits on the fixed amount they pay brings it down to 50%.

How would you like to work for next to nothing?

Doctors will simply remove anyone who is under that program from their client list. Many are refusing to take Medicare or Medicaid patients now because the government will only pay a percentage and that percentage is subject to change.

Can't you see the inherent problems with this?

Actually saying that regulations that are intended to put insurance companies out of business isn't nonsensical. Requiring that 80% of your funds must go to paying benefits rather then expenses, requiring they now accept unacceptable patients by removing pre-conditions are two ways that the Affordable Health Care Bill is using to create a single-payer system.

 

[Flopper]

WTF is capitation?

Excuse me, but I've mentioned this before. You're wasting your breath unless you put all of this in layman's terms.

I understand most of what you said, but not everyone does. There is probably only a couple of people here that really know what in the heck you just said.

There are different ways to pay for health care services. The most common has been paying a fee for each service provided (or, potentially, a fee for a group of services surrounding a particular diagnosis). But that has implications for the volume of services delivered because there's an incentive there to provide more services and collect more money, particularly when the fees for various services are reduced. And it reinforces the notion that we're buying health widgets and not health.

Capitation is one alternative to simply paying for each procedure. Instead it pays a flat fee for each person, often in a per-member-per-month arrangement. This has become fairly common in state Medicaid programs, where it's usually known as managed care. Under those arrangements, the state government no longer directly pays providers for each service a Medicaid beneficiary gets; instead, the state contracts with private health insurance plans--called Medicaid managed care organizations (MCOs)--to deliver care to Medicaid beneficiaries. The MCO gets a fixed amount of money each month for each enrollee (perhaps risk-adjusted to take into account whether an individual enrollee is sicker than average or needs more care) and assumes the financial risk for getting care to those enrollees. Generally the MCOs then contract with providers and sometimes find ways to shift some of that risk onto the providers.

Yes, I think you have hit on a major problem with way healthcare services are delivered, Fee for Service. The more services the provider can sell the more money the provider makes. In most business environment the buyer is able to evaluate the service versus the cost. In most cases, this is not possible in healthcare. A person in the hospital dying of cancer and racking up hundreds of thousands of dollars in charges has little incentive to question the need for services. When the doctor says we need to repeat the CT Scan, we assume it's needed. Unfortunately, insurance companies don't do any better job in evaluating the need for service than the patient.

I think what is needed is to pay more for results not services. Do you pay the auto mechanic for trying to fix your car? I'm not saying a doctor should only be paid if he makes you well, but what I am saying we need to introduce mechanisms that focus on results. Pay hospital and doctors higher fees for successful outcomes.

 

[Old Rocks]

Yes, one can only hope for higher costs of procedures, fewer resources, and fewer coverage options.

Don't forget Death Panels™ ... lotsa Death Panels™

I think the only thing some people here forgot was to take a basic economics class.

Hmmmm....... A whole bunch of other industrial nations have single payer systems, pay 1/2 to 3/4 what we do per capita, and cover all of their citizens. They also have longer lifespans, and much lower infant mortality rates.

Sounds to me like the inefficient system here is ours.

 

[Bern80]

Don't forget Death Panels™ ... lotsa Death Panels™

I think the only thing some people here forgot was to take a basic economics class.

Hmmmm....... A whole bunch of other industrial nations have single payer systems, pay 1/2 to 3/4 what we do per capita, and cover all of their citizens. They also have longer lifespans, and much lower infant mortality rates.

Sounds to me like the inefficient system here is ours.

To remind you yet again, life expectancy has nothing to do with the quality of a health care system in an indudstrialized nation. And those same nations are going into debt as a result of their single payer systems. You myopic liberal simpletons still believe that if all you is make it cheap for people all the problems will be solved.

 

[Bern80]

WTF is capitation?

Excuse me, but I've mentioned this before. You're wasting your breath unless you put all of this in layman's terms.

I understand most of what you said, but not everyone does. There is probably only a couple of people here that really know what in the heck you just said.

There are different ways to pay for health care services. The most common has been paying a fee for each service provided (or, potentially, a fee for a group of services surrounding a particular diagnosis). But that has implications for the volume of services delivered because there's an incentive there to provide more services and collect more money, particularly when the fees for various services are reduced. And it reinforces the notion that we're buying health widgets and not health.

Capitation is one alternative to simply paying for each procedure. Instead it pays a flat fee for each person, often in a per-member-per-month arrangement. This has become fairly common in state Medicaid programs, where it's usually known as managed care. Under those arrangements, the state government no longer directly pays providers for each service a Medicaid beneficiary gets; instead, the state contracts with private health insurance plans--called Medicaid managed care organizations (MCOs)--to deliver care to Medicaid beneficiaries. The MCO gets a fixed amount of money each month for each enrollee (perhaps risk-adjusted to take into account whether an individual enrollee is sicker than average or needs more care) and assumes the financial risk for getting care to those enrollees. Generally the MCOs then contract with providers and sometimes find ways to shift some of that risk onto the providers.

Yes, I think you have hit on a major problem with way healthcare services are delivered, Fee for Service. The more services the provider can sell the more money the provider makes. In most business environment the buyer is able to evaluate the service versus the cost. In most cases, this is not possible in healthcare. A person in the hospital dying of cancer and racking up hundreds of thousands of dollars in charges has little incentive to question the need for services. When the doctor says we need to repeat the CT Scan, we assume it's needed. Unfortunately, insurance companies don't do any better job in evaluating the need for service than the patient.

I think what is needed is to pay more for results not services. Do you pay the auto mechanic for trying to fix your car? I'm not saying a doctor should only be paid if he makes you well, but what I am saying we need to introduce mechanisms that focus on results. Pay hospital and doctors higher fees for successful outcomes.

That sounds horribly complex. Why am I way off base in thinking that if we all really want a healthier less expensive system, we as individuals need to start taking MORE responsibility for our health and how our health care dollars are spent? I don't really see how capitation does that. Any solution that makes the individual less financially responsible for the costs of the specific procedures and services their health may require is a system doomed to continuing an escalation of prices for those services.

 

[Emma]

Congressman Admits ObamaCare a Platform for Single Payer

I hope so.

 

[Bern80]

Congressman Admits ObamaCare a Platform for Single Payer

I hope so.

So long as you understand that what you're hoping for is fewer health care options, increased debt, fewer resources, and a gradual reduction in what government reimburses for.

 

[RDD_1210]

Congressman Admits ObamaCare a Platform for Single Payer

I hope so.

So long as you understand that what you're hoping for is fewer health care options, increased debt, fewer resources, and a gradual reduction in what government reimburses for.

Any evidence to support your claims?

 

[Immanuel]

Congressman Admits ObamaCare a Platform for Single Payer

I hope so.

I don't.

Good to see you Emma. Where have you been?

Immie

 

[Bern80]

I hope so.

So long as you understand that what you're hoping for is fewer health care options, increased debt, fewer resources, and a gradual reduction in what government reimburses for.

Any evidence to support your claims?

The other countries like France that have forms of single payer and basic principles of economics.

 

[RDD_1210]

So long as you understand that what you're hoping for is fewer health care options, increased debt, fewer resources, and a gradual reduction in what government reimburses for.

Any evidence to support your claims?

The other countries like France that have forms of single payer and basic principles of economics.

What about France?