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How are government programs a blank check? I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers
by TheCoelacanth 5y ago
How are government programs a blank check?
I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid.
- dragonwriter 5y ago> I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid. Its a whole lot more complicated than that, especially for Medicaid which is a bunch of different state programs with different rules, lots of which are exceptions from even the baseline federal rules due to waivers, and which is sometimes fee-for-service and sometimes capitated (and sometimes a mix of both for different services in the same state, and sometimes variable by geographic areas within a state.)
- s1artibartfast 5y agoIndeed, Medicare and Medicaid base their pricing on what private insurers pay. This is the problem. Instead, they should base their decision on $X/QALY (quality adjusted life years) like most of the world with socialized medicine. Just because someone with private insurance can pay 500k for a cancer treatment to extend their life 1 day, doesn't mean that it is a valuable use of tax dollars and that Medicare or Medicaid should cover that treatment.