3 ms·

I admit I don't understand the mechanism - but this just sounds like they created an a flawed system that has nothing to do with nurses or patient or even healt

I admit I don't understand the mechanism - but this just sounds like they created an a flawed system that has nothing to do with nurses or patient or even health care. An improperly devised system that can be easily circumvented. It is not relevant to the subject matter of health care, it is not different than corn subsidy or whatever.

blactuary 2y ago
It's not a flawed system, it simply needs to be managed and rules need to be enforced. It may very well be true that private insurers could provide coverage for cheaper than standard Medicare. I have personally worked with health insurers who were able to outperform benchmarks by implementing care management programs, reaching out to insureds to make sure they are taking medications and getting ongoing care from their physician, etc. They can also develop close relationships with local providers, and/or have their own captive providers like the HMO model. It's not all free market dogma that there is potential for savings there, because standard Medicare is somewhat of a convoluted mess that needs modernizing. But instead of doing that, they realized that they could just pressure providers to up-code and goose the risk score and make more money. MA is relatively new. We needed many years of experience to see how the market would play out. But now we've known for a decade or so that it is clearly costing way more than it should and offering no additional benefits to justify the cost. Unfortunately we have not yet had the political will to fix it, and the handful of massive companies making bank on it will fight tooth and nail to keep the gravy train rolling. The lesson from MA is that people will figure out how to game the rules, so we need to be reactive and flexible and able to update the rules accordingly. But because health care is a complicated and personal subject, people are wary of change, and we have very little political will to fix this. This will get even harder with the recent Chevron decision, which will serve to make it even harder for CMS to fix the regulation of MA without new legislation.
marcuskane2 2y ago
> I admit I don't understand the mechanism I'll simplify it for you: The government pays health care providers for providing healthcare. It is very easy to defraud the government by billing for fake work, so fraud is common and costly. The actual details are irrelevant. There are some extra steps involved, but functionally it's the same as a nurse sending a bill that says "I treated patient X for condition Y" and the government going "Sounds good, here's some taxpayer money"

blactuary 2y ago

It's not a flawed system, it simply needs to be managed and rules need to be enforced. It may very well be true that private insurers could provide coverage for cheaper than standard Medicare. I have personally worked with health insurers who were able to outperform benchmarks by implementing care management programs, reaching out to insureds to make sure they are taking medications and getting ongoing care from their physician, etc. They can also develop close relationships with local providers, and/or have their own captive providers like the HMO model. It's not all free market dogma that there is potential for savings there, because standard Medicare is somewhat of a convoluted mess that needs modernizing. But instead of doing that, they realized that they could just pressure providers to up-code and goose the risk score and make more money. MA is relatively new. We needed many years of experience to see how the market would play out. But now we've known for a decade or so that it is clearly costing way more than it should and offering no additional benefits to justify the cost. Unfortunately we have not yet had the political will to fix it, and the handful of massive companies making bank on it will fight tooth and nail to keep the gravy train rolling. The lesson from MA is that people will figure out how to game the rules, so we need to be reactive and flexible and able to update the rules accordingly. But because health care is a complicated and personal subject, people are wary of change, and we have very little political will to fix this. This will get even harder with the recent Chevron decision, which will serve to make it even harder for CMS to fix the regulation of MA without new legislation.

marcuskane2 2y ago

> I admit I don't understand the mechanism I'll simplify it for you: The government pays health care providers for providing healthcare. It is very easy to defraud the government by billing for fake work, so fraud is common and costly. The actual details are irrelevant. There are some extra steps involved, but functionally it's the same as a nurse sending a bill that says "I treated patient X for condition Y" and the government going "Sounds good, here's some taxpayer money"