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njlauren -> RE: SCOTUS on HOBBY LOBBY and religious freedom (7/14/2014 9:11:23 PM)
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Medicare is a class example of how things can be muddled. I often hear how medicare is more efficient than private insurance, that it is cost efficient in that it negotiates cheaper rates and so forth..when in reality, medicare ends up costing us well beyond what is paid out in medicare benefits. Basically, medicare sets rates for coverage that are ridiculously low, and to make up for those payments the doctors do two things:
1)They see a lot more patients, they basically do it on a rapid assembly line, both medicare and private insurance payments
2)They make up for medicare by overbilling private insurance patients. Even with PPO services, they play all kinds of games and the insurance company doesn't give a shit, so though in a PPO you are supposed to be fully covered, they find ways to jack up the bill to private patients (some doctors have multiple tax id's, so they will bill a procedure to the patients insurance with an id that is not in the insurers network, so the patient gets covered at out of network rates..and anything not covered by the insurance comes from the patient). Doctors even in PPO's often don't like that the insurance pays, so they basically decide to bill you for what the plan doesn't pay, and just see what the insurance company tells you...so basically medicare gets doctors to cost share with the people with private insurance.
I often wonder if it would be cheaper for the government to help pay for doctor's training, in return for doctors agreeing to work in general medicine. There was an article in the NY Times that in the US, what is getting to be harder and harder is seeing a regular doctor, people often have to wait weeks and months for routine visits, which is opposite to national health systems where people have to wait for elective procedures. In the US, if you need a procedure, there is generally not much of a wait if you have insurance, which is kind of ironic. The hottest fields in medicine are things like plastic surgery, that is mostly done without insurance, because doctors can make a lot of money there, and there is an impending crisis with general practioners and the like. With specialties, doctors make money, not just from their fees, but often they own the surgical centers and diagnostic centers and such they send you to, as well. It will be ironic if someone gets sick and dies because they can't find a GP to go to or get an appointment, but could get a nose job the next day......
One of the interesting things is that there are these immediate care services opening up, including at drugstores and such, where you can see someone for routine care and checkups and such, it looks like instead of going to see a doctor in a practice, people will be seeing someone through a facility in a drugstore or in a care center that is not a private practice. Could be that seeing a practioner at a walgreen may end up being the competition in medical care people have been talking about, maybe medicine in effect can be walmartized...though how I am not certain.
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