r/FluentInFinance • u/The-Lucky-Investor • 11d ago

“Medicare for All” would save the U.S $5.1 Trillion over 10 years Discussion/ Debate

https://www.commondreams.org/news/2018/11/30/easy-pay-something-costs-less-new-study-shows-medicare-all-would-save-us-51-trillion
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u/abrandis 11d ago edited 10d ago

Exactly, everyone looks at the healthcare crisis from the perspective of the patients.

Lol , the US healthcare is built around the private equity groups , insurance industry, big hospital systems , big pharma ,labs and diagnostics imaging, medical devices ....every part is making fat profits,when you look at it from their perspective and it all makes sense. This system is working perfectly...for them...

Meanwhile 33+ other developed countries with way smaller economies can somehow offer universal healthcare. (Of course they're not perfect, but none would trade theirs for ours) .go figure...

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u/Big-Leadership1001 11d ago

The providers aren't even considered. They're more like cattle for the Beef industry - necessary but only because they don't have a product to sell without them. Healthcare is all about executive salaries at the very top and theyeven made it illegal for doctors to own a hospital so they wouldn't have to worry about providers becoming executives!

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u/JDHPH 11d ago

This always seemed so anti-competitive to me. A trained physician should be able to start up their private practice/clinic to compete for patients. Just like any other business model, serving its customer base through transparent competition.

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u/ElChuloPicante 11d ago

They can do that. What they can’t do is stand up a service to which they refer their own patients. It’s to prevent things like routing patients to higher-cost, lower-quality, or harder-to-access goods and services. We don’t want doctors submitting prescriptions exclusively to a pharmacy they own, for example.

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u/Leftieswillrule 11d ago

Tied-house laws like they have for alcohol?

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u/ElChuloPicante 11d ago

Not a bad comparison, actually, although it also helps keep the providers from defrauding payers in this case. “Hey, me, will you please perform this completely unnecessary and exorbitantly expensive procedure?” “Sure thing, me, I’d be happy to!”

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u/babybambam 11d ago

There are already laws in place about this. It's also not that they can't, it's that they can't refer you without also notifying you that they have a financial interest.

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u/AllTheyEatIsLettuce 11d ago

Cool. Do insurance sellers next. They "refer" their customers to the "networks" they alone create out of corralled and gatekept health care vendors, to the pharmacy they own and operate, that's stocked by the "PBM" they own and operate. Even they know vertical integration is the only way to ensure their survival.

But you, you just need more better retail point of sale payment processing product initialisms that run on nothing more than tax avoidance/deferment and the intentional defunding of Social Security and Medicare. No worries, though. The insurance seller owns the "benefits solution" that operates that payment processing product as well as the "bank" that's holding your funds.

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u/fiduciary420 10d ago

Americans genuinely don’t hate the rich people nearly enough for their own good.

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u/n3wsf33d 11d ago

Idk other corps are able to horizontally integrate. Seems weird. Seems like we should just be able to submit to whatever pharmacy we want vs the MD making the submission?

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u/Novel_Patience9735 10d ago

Ask your doc a paper Rx instead of electronic submission. Problem solved.

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u/ElChuloPicante 11d ago

You can, if it’s in-network, but a huge proportion of the population will just follow prescriber guidance. If a doctor says “you need ten consecutive CAT scans,” most of us don’t know any better. I certainly have zero medical degrees.

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u/n3wsf33d 10d ago edited 10d ago

I mean if I have to pay for that, I'm going to think twice. But that's also why they have utilization management at the insurance, on the payor side.

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u/ElChuloPicante 10d ago

And that’s a significant contributor to the current predominance of UM in claims adjudication. If it’s not worth you paying for, it’s questionable whether it’s worth anyone paying for.

We’ve gotten better about it, culturally, but we’re climbing out of decades of this widespread view of doctors as infallible.

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u/Odd_Comfortable_323 10d ago

Now the Insurance is infallible and you have to go to insurance court to treat a patient.

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u/n3wsf33d 10d ago

Also true. I work in UM on the hospital side. I've seen insurances pay when they shouldn't be and hospitals ask for more and higher levels of care when they shouldn't be.and vice versa

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u/Double-Inspection-72 10d ago

These things can't happen because no insurance policy would pay for it. As for your doctor owned pharmacy example insurance companies already do exactly what you were saying. Many insurance companies force you to go to particular pharmacies, that fall under their business umbrella, or face higher prices. But it's ok for them because they have big pockets to lobby the govt.

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u/dcckii 11d ago

Doesn’t United healthcare do exactly what you’re saying can’t be done by a physician? They own the doctors, the hospitals, the pharmacies, the whole shooting match. And they make billions.

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u/ElChuloPicante 11d ago

Heavy regulation and frequent audits. Costs them a fortune to remain compliant. Remember, their customers (private and gov’t) 100% will question cost upticks and do their own review of services rendered. Penalties for unmitigated FWA are astronomical. This applies to any vertically-integrated health system participant in the US.

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u/Double-Inspection-72 10d ago

I've found the insurance mole in this thread. First conjuring unrealistic examples focused on doctors being the issue. Now being concerned for the insurance companies having to undergo frequent audits?!?! Audible gasp. Maybe if all these insurance companies weren't defrauding the govt for billions through improper up-coding of their Medicare advantage plans they wouldn't undergo so many audits. Especially given these plans were sold to the government as a way to lower costs. And yes, there are bad doctors who commit fraud as well. But the scale of fraud are orders of magnitude different. And doctors also undergo audits of their billing etc, but no one is crying for them. Go report back to your insurance overlords now and tell them your job is complete.

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u/gandalf_bread 11d ago

Queue all the gp dentists that refer patients to their specialty office outside of the network

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u/ElChuloPicante 10d ago

Happens, but it’s a great way to get yourself discontinued when recontracting comes around. Networks do not much appreciate being manipulated, or having to explain to clients why their members are calling in with allegations along these lines.

The big health insurance payers are working hard to undo the (maybe well-earned) stigma of making money at any cost. The old heads-on-beds model is gone.

The Big Healthcare goons we love to hate just aren’t around anymore. They’ve all figured out it’s waaaaay better for them and their shareholders if we’re all alive and healthy. Sounds bootlicky, but it’s where the industry is now.

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u/Odd_Comfortable_323 10d ago

“We don’t want doctors submitting scripts to a pharmacy they own.”

Nope the insurance company hates competition.

https://www.nytimes.com/2024/06/21/business/prescription-drug-costs-pbm.html

The doctors will all be employees. The doctors are ONLY allowed to submit prescriptions to pharmacy’s the insurance company owns.

No more private practice.

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u/Smarktalk 10d ago

Odd. Pharmacy benefit managers certainly do this.

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u/uncle-brucie 8d ago

Except the VPs will have meetings with the docs saying-not-saying that they aren’t referring enough to their specialists despite preexisting relationships with patients or the dreadful outcomes you wouldn’t risk for your patient.