You miss a point, (and I am not standing up for doctors), but what is billed to the insurance companies, Medicare, Tricare and the rest, are not what is paid. Every one of them have a pricing list based on procedures, (ICD), which they use to deny payment or underpay claims.
I have dealt with this issue for years, overseas, where you need to file your own claims because the doctors/hospitals have no idea how to document a claim the way the insurance company’s claim processors want it. (I did the preparation of my own and other retiree’s claims).
I have seen the claim processor decide that cataract surgery, in an out patient facility was a fifteen minute routine office visit. That one took over four months to get it paid correctly and they still wanted to deny payment for the replacement lens because the surgeon ordered it but the patient paid for it when it was delivered for the surgical procedure.
Yes, I know that - and you're right - if you're filing the claims for yourself it's a nightmare. But that's a separate issue.
That said, this plan hands over that part of the job over to the medicare bureaucracy. They're already primed to do this... Medicare has the list of 'what they'll pay for what' and they can use that list FOR the benefit of citizens.
The $500 a year per citizen administered by Medicare almost doubles the value. It also means rip-off 'emergency rooms' can't charge $14,000 for an hour's worth of 'care'....
What sets this aside - makes it different from liberal socialism scams is the money is under the control of the citizen. It's the difference between being a 'valued customer' and a 'charity case'. Capitalism Care creates a healthy incentive as opposed to the 'Veteran Care' or Medicaid. The citizens works to keep cost down because it's HIS money. Money NOT spent will be rolled over into a Vanguard account with the citizens name on it... Young people can take the risk of 'self-insuring' knowing they're building up a hefty heath fund.
Better, corrupt government officials can't raid 'the trust fund' because there is NO TRUST FUND. The money sits in accounts owned by Citizens.
BINGO, and Tricare can change your meds without telling you. Hubby’s Whelcol went from a White tablet to a Orange 1.
My Linzess that empties the Paralyzed Colon, needed a Letter of Prior Authorization from the Gastro, he sent one in. They needed MORE info. That got sent in too, We get back a letter from Express Scripts MORE info is needed. Finally today there is a letter saying it is approved. I’ve been taking Linzess for over 2 yrs, never needed Prior Authorization.
That SIBO antibiotic generic is $1,500 for 2 weeks, it must be gotten from the base Pharmacy, which is a Old WW 2 walk in not retrofitted as Handicapped Friendly. The new Check in System that caused Chaos because NO core man was assigned to show people how to use it has been broken for 3 months now. They did add a 3rd row of Hard Plastic seats. It is designed for Walk in’s. Not wheelchairs, Oxy tanks. They remodeled the entire Exchange, but NOT the Pharmacy last year. More Spaces were assigned for Brass parking, leaving fewer for Handicapped who were DoD Mandated to use the Base Pharmacy a few years ago. Now 2 people man the counter, 1 intake, 1 hand out scripts. You call Pensacola for Refills 5 days early. Few Trust Express Scripts because they are not a good place to deal with if you use Auto Pay or Credit Cards, Use only checks after you receive your meds, IF the USPS can find the RIGHT HOUSE. Takes them 2 weeks to fill a script and 2 weeks for a Refill.
Thankfully this is a higher Military Retirement area and we all just take each others Meds over to their homes. If your med has to be refrigerated it comes in a dry ice Styrofoam box.