4 ms·

If you’re referring to Medicare, it does control costs through its fee schedule, but is limited in efficacy because it doesn’t cover everyone. Nevertheless, the

If you’re referring to Medicare, it does control costs through its fee schedule, but is limited in efficacy because it doesn’t cover everyone. Nevertheless, the Trump administration is currently trying to jack up how much it pays out to non-Medicare levels to prevent even this downward pressure. And of course it’s barred from negotiating drug prices for the same reasons. As to why insurance companies don’t pursue evidence-based treatment plans, it’s cheaper and easier in the US to just deny care and profit from it. Why do something more difficult, requiring additional investment, when they can just deny more claims. ACA plans already deny 1 in 5 claims.

tptacek 7y ago
Wait, Medicare covers the most expensive cohort of patients in the country, which you'll easily see in any breakdown of health costs by age. It already has responsibility and authority for prices in the most important segment of the market. Why hasn't it controlled their costs? I think your answer on evidence-based care is superficial and a little bit facile. For instance, a major component of evidence based care is in fact the denial of procedures with limited demonstrated efficacy; see, for instance, the story about cardiac stents for otherwise stable patients. If anything, both private insurance and Medicare are allowing too many of these kinds of procedures. Why?
- claudeganon 7y ago
  Hasn’t done what? Apologies, you’ll have to elaborate. Medicare fee schedules do put downward pressure on costs, which is why they’re under attack, but lack sufficient power to push down prices because they are not universal and exclude drug costs. Japan has universal price controls (and cheaper healthcare) for precisely these reasons. As to your second question, fee for service is too perverse of an incentive. What you end up with is an arms race where healthcare providers try to extract as much value as possible through as many procedures as possible and healthcare providers, in turn, try to make money by denying as much as possible (as well as pushing sick people into the government plans). The result is poor quality, expensive care, as the two factions devote more and more resources to waging this battle and less and less on creating good quality and affordable care.
  - tptacek 7y ago
    What does universality have to do with it? They already cover virtually everyone in the most expensive segments of the market. They're not controlling costs for those patients; Medicare overpays, hugely, both compared to other countries and in historical terms (costs have skyrocketed over the last 20 years). I think the burden of proof is on you for this argument. "Excluding drug costs" can't be the problem, because drugs --- no matter what their provenance --- are a small fraction of total health care costs. Your response to my second question doesn't respond to my point. I was specific. You've responded with abstractions. Can you be more specific about what you meant by evidence-based care, and Medicare's unique ability to provide it?
    - claudeganon 7y ago
      What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the ability to negotiate far better prices from healthcare suppliers. Medicare for All’s (not Medicare’s) “unique ability” is this ability to say do these things or you won’t get paid or paid as much. It’s a big part of what single payer systems do around the world to drive down costs and what allows for consistent care to prevent the development of more expensive conditions. Medicare doesn’t have this advantage because it is not “universal” in any regard and doesn’t have this leverage. The cost pressure from the ever escalating supplier-insurance war further down the chain bleeds into it, as thaumaturgy outlined. Not the very least in the form of lingering injuries and chronic illnesses in its beneficiaries that could’ve been better managed through a universal system before they came onboard. Which is related to your point about drug costs - the inability of Medicare to collectively negotiate drug prices allows them to be as ridiculous as they are in the US, which of course leads to horrible outcomes for managing care. When people can’t afford medicine, ration it, etc, their conditions worsen and become more expensive to treat. Even if the medicines themselves are not a large, direct source of upward pressure on costs, their inaccessibility creates the circumstances (and need) for more expensive care. And this happens throughout the system as people self-ration various, necessary forms of care. TLDR; Because Medicare isn’t universal coverage and it and it’s beneficiaries don’t exist in a vacuum.

tptacek 7y ago

Wait, Medicare covers the most expensive cohort of patients in the country, which you'll easily see in any breakdown of health costs by age. It already has responsibility and authority for prices in the most important segment of the market. Why hasn't it controlled their costs? I think your answer on evidence-based care is superficial and a little bit facile. For instance, a major component of evidence based care is in fact the denial of procedures with limited demonstrated efficacy; see, for instance, the story about cardiac stents for otherwise stable patients. If anything, both private insurance and Medicare are allowing too many of these kinds of procedures. Why?

claudeganon 7y ago
Hasn’t done what? Apologies, you’ll have to elaborate. Medicare fee schedules do put downward pressure on costs, which is why they’re under attack, but lack sufficient power to push down prices because they are not universal and exclude drug costs. Japan has universal price controls (and cheaper healthcare) for precisely these reasons. As to your second question, fee for service is too perverse of an incentive. What you end up with is an arms race where healthcare providers try to extract as much value as possible through as many procedures as possible and healthcare providers, in turn, try to make money by denying as much as possible (as well as pushing sick people into the government plans). The result is poor quality, expensive care, as the two factions devote more and more resources to waging this battle and less and less on creating good quality and affordable care.
- tptacek 7y ago
  What does universality have to do with it? They already cover virtually everyone in the most expensive segments of the market. They're not controlling costs for those patients; Medicare overpays, hugely, both compared to other countries and in historical terms (costs have skyrocketed over the last 20 years). I think the burden of proof is on you for this argument. "Excluding drug costs" can't be the problem, because drugs --- no matter what their provenance --- are a small fraction of total health care costs. Your response to my second question doesn't respond to my point. I was specific. You've responded with abstractions. Can you be more specific about what you meant by evidence-based care, and Medicare's unique ability to provide it?
  - claudeganon 7y ago
    What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the ability to negotiate far better prices from healthcare suppliers. Medicare for All’s (not Medicare’s) “unique ability” is this ability to say do these things or you won’t get paid or paid as much. It’s a big part of what single payer systems do around the world to drive down costs and what allows for consistent care to prevent the development of more expensive conditions. Medicare doesn’t have this advantage because it is not “universal” in any regard and doesn’t have this leverage. The cost pressure from the ever escalating supplier-insurance war further down the chain bleeds into it, as thaumaturgy outlined. Not the very least in the form of lingering injuries and chronic illnesses in its beneficiaries that could’ve been better managed through a universal system before they came onboard. Which is related to your point about drug costs - the inability of Medicare to collectively negotiate drug prices allows them to be as ridiculous as they are in the US, which of course leads to horrible outcomes for managing care. When people can’t afford medicine, ration it, etc, their conditions worsen and become more expensive to treat. Even if the medicines themselves are not a large, direct source of upward pressure on costs, their inaccessibility creates the circumstances (and need) for more expensive care. And this happens throughout the system as people self-ration various, necessary forms of care. TLDR; Because Medicare isn’t universal coverage and it and it’s beneficiaries don’t exist in a vacuum.