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> There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medic

> There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually scale with money, but also votes in the case of old people). Medicare/Medicaid reimbursements are insufficient to support most medical practices. Tricare is for military & their families. Most active duty military are young & extremely healthy compared to the general population. Medicare/Medicaid combined are the largest single item on the federal budget. More importantly, they are still growing in costs because of an aging population, and are heading towards 30% overall of the federal budget [1] Tricare operates as an employment perk. Medicare has a cap on benefits, but is effectively mandatory for 65+, and medicaid operates as a payor of last resort, after folks have run out their lifetime benefits on medicare. However, an argument in favor of your suggestion is that the vast majority of medical resources are spent on the last 2 years of life, often for terminally ill patients with a ton of co-morbidities that are at death's door anyways. Most medical spending happens in the latter part of life [2] > 25% of Medicare’s annual spending is used by the 5% of patients during the last 12 months of their lives [3] [1] https://www.americanprogress.org/issues/economy/reports/2010/03/10/7459/the-math-is-clear/ https://www.americanprogress.org/issues/economy/reports/2010... [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/ [3] https://www.acsh.org/news/2018/09/28/true-cost-end-life-medical-care-13454 https://www.acsh.org/news/2018/09/28/true-cost-end-life-medi...

nradov 5y ago
Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries. Is there a reason that US doctors should get paid significantly more than their peers in other developed countries? https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen...
- OrvalWintermute 5y ago
  > Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Facilities rent, or mortgage Front office IT & EMR Privileging/Credentialing Practice CME/required education The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists. Perhaps you have some evidence to support your extraordinary claim? I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4] The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange. [1] https://www.reliasmedia.com/articles/147019-when-hospitals-refuse-to-see-medicaid-patients https://www.reliasmedia.com/articles/147019-when-hospitals-r... [2] https://www.investopedia.com/articles/personal-finance/100215/what-do-when-your-doctor-doesnt-take-medicare.asp https://www.investopedia.com/articles/personal-finance/10021... [3] https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280 https://www.verywellhealth.com/doctors-accept-medicare-insur... [4] https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/ https://www.hlc.org/news/more-physicians-no-longer-seeing-me...
  - toomuchtodo 5y ago
    > there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.
    - nradov 5y ago
      The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...

nradov 5y ago

Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries. Is there a reason that US doctors should get paid significantly more than their peers in other developed countries? https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen...

OrvalWintermute 5y ago
> Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Facilities rent, or mortgage Front office IT & EMR Privileging/Credentialing Practice CME/required education The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists. Perhaps you have some evidence to support your extraordinary claim? I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4] The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange. [1] https://www.reliasmedia.com/articles/147019-when-hospitals-refuse-to-see-medicaid-patients https://www.reliasmedia.com/articles/147019-when-hospitals-r... [2] https://www.investopedia.com/articles/personal-finance/100215/what-do-when-your-doctor-doesnt-take-medicare.asp https://www.investopedia.com/articles/personal-finance/10021... [3] https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280 https://www.verywellhealth.com/doctors-accept-medicare-insur... [4] https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/ https://www.hlc.org/news/more-physicians-no-longer-seeing-me...
- toomuchtodo 5y ago
  > there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.
  - nradov 5y ago
    The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...