Posted on 11/25/2016 5:14:55 PM PST by WilliamIII
WASHINGTON — Donald J. Trump once declared that campaigning for “substantial” changes to Medicare would be a political death wish.
But with Election Day behind them, emboldened House Republicans say they will move forward on a years-old effort to shift Medicare away from its open-ended commitment to pay for medical services and toward a fixed government contribution for each beneficiary.
The idea rarely came up during Mr. Trump’s march toward the White House, but a battle over the future of Medicare could roil Washington during his first year in office, whether he wants it or not.
(Excerpt) Read more at mobile.nytimes.com ...
Trump pledged to strengthen Medicare.
What you describe as administrative costs are mostly the costs of compliance with federal regulations. Some of those regulations are well-chosen, while others are expensive vexations that serve little good purpose. Rooting out such expensive regulations is difficult and will require action by Congress.
Which is why Title 15 USC needs to be enforced on the industry!
Section 2 - “Every person who shall monopolize, or attempt to monopolize, or combine or conspire with any other person or persons, to monopolize any part of the trade or commerce among the several States, or with foreign nations, shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $100,000,000 if a corporation, or, if any other person, $1,000,000, or by imprisonment not exceeding 10 years, or by both said punishments, in the discretion of the court.”
“Just in time for my retirement.I paid into it...since I was 16...and now they’re gonna shut the door on me.”
Same here. Worked myself nearly to death and now beset with large numbers of health problems as a consequence, and that pissant P.o.S. Paul Ryan wants to fuch me.
I’m well aware the regulations, and live with them every day. The growth of administrators is in part secondary to the growth in regulations, but the growth in administrators also fuels the growth of more regulations (this is how they justify their existence). You have to break the cycle. You do that two ways. One is to alter federal law, and reduce regulations, which is what you are addressing. The other is to introduce into the system pressure to reduce administrative costs. At some point the only way to decrease the number of administrators is to put the at war with each other over who is going to survive while the money that can legally go to administrators is markedly cut back. It’s absolutely necessary.
I thought you were responsible for only 20% of the contracted charges (absent a supplement). The provider can’t charge more than the contracted rate.
We want Trump’s agenda, not the establishment Rinos.
The admistrative costs for Medicare are much lower.
Most sources estimate 2%-3%. Some much higher but I don't think anyone says they're close to the private insurance average.
A few years ago, when I had a major surgical procedure at a major university hospital, I was impressed with the cheerfulness of the employees and their attention to my care. I learned that this was due to the relentless focus of the hospital administrator and his team on the quality of patient care. I am confident though that accounting rules would book their salary and benefits as mere "administrative costs."
Since 1970, the number of administrators in health care has risen over 3000%. That’s factual, from the US board of labor statistics. If you don’t deal with that, you cannot decrease costs.
Ultimately, how well you do in the hospital is a function of how vigilant, knowledgeable, experienced, and caring your physician is - including an element of clinical insight that you can’t easily teach. It’s also a function of the vigilance of the nurses, and the efforts of those directly involved in patient care in some manner.
Having said that, most of the ‘administrative’ incursions into medicine, particularly those that have some basis in federal mandates, take caretakers away from the bedside and put them in front of computers - checking boxes and doing very general documentation that is more often than not only marginally related to the particular patients they are taking care of.
Having a caring and capable hospital administrator is a good thing, but hospitals have always had a head administrator (even those that were run by nuns - who often did a very good job). What’s different now is that the number of administrators has grown dramatically. This doesn’t lead to high quality efficient machine. It leads to increasing costs, busy work that doesn’t positively impact patient care (and often diminishes patient care), and more money going to people who don’t take care of patients.
I’m very happy your surgery went well. I’ve been a doc for a long time now, always at ‘major university hospitals’ as you put it. As part of outreach efforts, I’ve also spent time at affiliate hospitals. I’ve seen great patient care, and not so great patient care - with missed diagnoses and inappropriate treatment at both. None of those cases would have been prevented by administrators or more regulation. The administrators would have no clue about the diagnostic and therapeutic issues involved in those cases. Further, in none of those cases would the care have been flagged in any way based on the general ‘quality’ measures that are used almost universally these days. It all would fly under the radar - which it did.
All that said, I’m not talking about the administrative costs of running Medicare itself. I’m talking about the administrative costs that are built into the care at hospitals and clinics. This has nothing to do with the administrative costs at the level of the federal government in running Medicare.
What I’m talking about is the percentage of each health care dollar sent to any hospital or clinic that goes to administrative costs vs patient care at that facility. The administrative costs are ‘built in’ to the bill each patient receives. When you look at an itemized list of costs from any health care facility, these figures are not based on actual itemized costs. They are prorated, and incorporate lots of things that don’t show up on that itemized list - including the administrative costs. It doesn’t matter whether Medicare, Medicaid, or private insurance pays. The administrative costs at each hospital and clinic are what they are, independent of the payer. It’s very difficult to get administrators to cut their own numbers, unless the third party payers (no matter who they are) start demanding that the hospitals cut their administrative expenditures.
Well, to tell truth I am still waiting for final paperwork...but we have a supplemental with a deductibe so doubtful any more will be paid.
Oh! Never mind...
I know what you mean about physician vigilance as essential to patient care. A judge whom I once worked for survived an aortic aneurysm because his personal doctor -- a longtime friend -- recognized a symptom of it and got the judge hospitalized and into surgery the next day. That afforded him an extra twenty or so years of life.
In a similar manner, when I had problems with my eyesight, I suspected that I had damage to my optic nerve from an episode of shingles and went to a low vision specialist. He referred me though to another specialist. After an examination and an MRI, I was referred to a neurosurgeon at U. of Florida for removal of a benign but dangerously large pituitary adenoma.
As it was, the neurosurgeon was a well-regarded specialist in that procedure. A surgeon relative of mine in town who knows all the doctors involved later confirmed that I had lucked out due to their quick action. It was as smooth and sure a play as Tinkers to Evers to Chance.
I love it, particularly as a Cubs fan..
Shands is a great hospital, and I’m really happy everything worked out well for you. Honestly, I sometimes relate getting the right medical diagnosis to going to a mechanic. Some mechanics will find the problem, some won’t, and some don’t believe you when you tell them what your car is doing.. Being vigilant and persistent about your own health is also crucial - getting second and third opinions if necessary.
Have a great Sunday.
As a professional in this field, I have watched the death of free market medicine and the greatest medical system for decades. Finding and retaining and paying for a great clinician has never been this impossible.
The solution to the destruction of our once great medical system is to end all government involvement, period. To those who expected their lifelong contribution to the system would mean Medicare would replace their private insurance at 65, where have you been? Social security was raided long ago. You knew that baby boomers would not be funded by the system. We've been expecting bankruptcy since the 80’s and earlier.
To end all government involvement in medicine, it has been proposed that there be a cut-off age where those younger will not receive Medicare. But they will retain their own money to save for old age health costs if they so choose. This was the way our free country worked before the rise of the Welfare State. I remember because I was there. My father gave me $200 for emergency room treatment should it ever be necessary when I left home at 18. Imagine a world like that before Medicare and the end of the Gold Standard?
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