(07-18-2018, 10:11 AM)mikesez Wrote:

(07-18-2018, 07:03 AM)flsprtsgod Wrote: Congress passes legislation that sets the price factors, CMS develops the fee schedule that Medicare pays, all contracts with private insurers are based on the Medicare fee schedule. Just this calendar year Congress changed the price factors twice resulting in millions of dollars of work reprocessing claims when they backdated the fee schedule updates after the fact. Here in Florida the changes resulted in a roughly 3.5% overall change in reimbursement from January 1 to March 15 that we still haven't completely worked through.

And politics is so deeply engrained in that legislative process as doctors, hospitals, insurance companies, nonprofits, health care corporations, retail stores and patient advocacy groups all lobby their [BLEEP] off to get their share of the health care dollar that the single payer model would be just as ineffective. See the Massachusetts, Tennessee, and VA plan scandals for how our government can screw it up in different ways.No, we need market based health care with fewer government friction points and reduced administrative costs, not more government control with cockamamie schemes thought up by accounting nerds who know spreadsheets better than medicine.

There's no reason to assume that a major reform of health insurance would maintain the same rules and relationships of Medicare today.

You're right that, from the perspective of individual provider organizations, Medicare reimbursement rates seem to be dictated from on high.

However those who do the "dictating" in government do not see themselves as powerful; they are very scared of losing any significant number of providers. They try to listen to the "market forces" as much as possible and err on the side of higher prices. When a large, allegedly nonprofitt hospital organization comes to them with a biased accounting presentation alleging that Medicare reimbursements are already too low, they get scared.

Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid. This rule triggers all sorts of voodoo accounting, but it also alters the playing field for negotiations between providers and insurers. The providers come to the table knowing that they will never have to accept less than Medicare pays. The private insurers at that point are just determining how much they are going to get shafted, not if.

Even as some Democrats are using "Medicare for all" as shorthand for what they hope to accomplish, it's not clear if or how their reforms would touch these types of problems, and what the impact on prices might be.

At the end of the day, medicine is not a free market activity to the user: each of us would pay any price to extend our health, and few of us have the medical knowledge to meaningfully dispute a doctor's recommendations. Robust regulations will always be needed to control prices.

That said, it is a [font=Arial Black]free market activity to the provider.[/font]  The providers have the best information about the value of their time, how many hours they want to work, and the products and services patients need. The most effective way to lower costs starts with simply having more doctors, more nursing home beds, and more hospital beds.  With higher supply, lower prices are likely.  The AMA in particular has been very effective at needlessly restricting the number of residency positions that exists, and this in turn makes it needlessly hard to get into medical school.  In Florida, the nursing home lobbyists have been very effective at blocking new nursing home construction. They don't have America's health at heart, only their own paychecks.

You got to be kidding me. The only way its a free market to a provider is to opt out of insurance completely and go direct or concierge. Theres only so many rich people around to do that with. Or do Derm, of course. In a free market the one getting the service (patient) would be the one paying the provider. That just isn't what happens in the US.

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