4 ms·
Yes, it’s the last part. Medicare has set prices it will pay [0], period, and Medicare is not prone to denying procedures that a physician thinks is necessary.
by borski 3y ago
Yes, it’s the last part. Medicare has set prices it will pay [0], period, and Medicare is not prone to denying procedures that a physician thinks is necessary. This is a public socialized good.
MA plans negotiate with providers, similar to a regular commercial insurance company, for different “deals.” As you may be aware from commercial insurance, that typically means higher rates, since everyone along the line has to get paid across the providers and the insurance companies. Much higher profit motive than a socialized good.
On top of that, MA plans have an incentive to deny coverage wherever possible, because as a for-profit entity they want to make as much money as possible, not get old people healthier.
Young people have trouble fighting insurers on denials. I know this firsthand. But it’s doable, because we tend to have more energy and less cognitive impairment; I’m generalizing here, but dementia is a thing that happens to a lot of people in old age, for example.
For older people, fighting insurance companies is just about impossible. Often, this falls on their younger family members to help (ask me how I know, lol), but that implies their family or friends are willing to help. Not everyone has that.
And it shouldn’t be that way.
[0] There is a thing called Excess Charges that providers can charge, if they don’t accept the Medicare fee table, but still accept Medicare generally. They have to tell you before the service, or you are not responsible. It is also capped at 15% of the service, and is illegal in some states entirely, and capped lower in others. Some Medigap plans also cover excess charges, but they are on the more expensive end.
- pdonis 3y ago"Profit motive" is not the same as "free market". In a free market in health care, the only way to make profits would be to provide genuine services that are of value to the patients who are paying for them. In our actual system, lots of profits can be made by specializing in working the system that has been put in place by the government, to the detriment of patients. I totally agree that it shouldn't be this way. I just don't agree that the way to fix it is more socialized control by the government.
- Tagbert 3y agoA free market involves choices, information, and the ability to change choices based on that information. With health insurance the choices may be limited, you have very little information about what things cost and whether insurance will cover a given procedure. Most people are not educated well enough to be able to properly evaluate their options. You are only able to change your choice once a year. This is a free market in name only. But the impact of choosing incorrectly is very expensive.
- borski 3y agoThe US government did not invent insurance. If a company wanted to compete with an existing insurance company but do it differently, they can already do that; direct primary care offerings exist right now. Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Getting people healthier for cheaper doesn't make a healthcare company money. That is why I believe basic healthcare should be socialized. That doesn't mean we can't have private companies offering countless other medical services or additional insurance, but nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die.
- pdonis 3y ago> The US government did not invent insurance. I never claimed it did. My claim is that what we call "health insurance" in the US is not just insurance; it is a bundle of insurance (coverage for high cost unforeseen events) with other things that aren't insurance, but have to be bundled with it because the government says so. > direct primary care offerings exist right now. Yes, they do, but they are hamstrung by the fact that the US health care system disincentivizes patients from using them. If all primary care in the US was provided by such places, and patients paid the costs directly, that would be a free market, at least in primary care. But that's nothing like what we have. It's certainly nothing like what Medicare Advantage, which is the subject of this discussion, provides. > Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Not in a free market. Health care in the US before WW II was provided by private companies (or individuals like doctors with their own practices), for profit, and worked better, given the technology of the time, than what we have now. What ended that system was laws passed during WW II that fixed wages, which meant that companies could not compete for labor in a free market by offering higher wages. So companies looked around for other benefits they could offer to compete, and health care was an obvious one. And then after the war the government decided to regulate the company-provided health care instead of ending it and restoring a free market. What offers misaligned incentives is the bastardized system we have in the US, which combines the worst features of for-profit with the worst features of socialism. The for-profit part is not visible to the actual patients--as I have already pointed out upthread, patients have no idea what the services they are getting actually cost, so they have no idea whether they are worth what they cost. The socialized part is what patients see--the services available to them are determined by their health "insurance", not them--but decisions are made by third parties who have no skin in the game and suffer no consequences when they make bad decisions that cause harm to patients. > nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die. Of course not. And this would not happen in a free market. It happens because we don't have a free market in cochlear implants, we have a non-free market system with misaligned incentives, as I described above.