So Medicare would be a lot better if it fully reimbursed health care providers, for everyone enrolled in the system?
Not sure what you suggest here, but either way, no it is still poor.
When people paid their provider directly, that is without the intermediary, Medicare or and Insurance company, the providers did not need a several people on staff to understand codes
and do the billing Cost shifting still occurred but the freeloader was rare. The standard rate of course needed to compensate for the freeloader but like I say it was rare and the rates were low.
Medicare became the first government run systematic partial freeloader. Followed about ten years later by Medicaid. Then the insurance companies joined in with the "in network provider" system squeezing the provider from another direction. This then left those that pay their own bills and the self insured employers to be targets still standing, taking the brunt of the cost shifting.
Ah ha! a new market for the insurance companies, the self insured employers. Not to sell them insurance but to save them money by managing their plans to provide their employees coverage. Thereby saving them money by shielding them from cost shifting by the providers.
This had another undesirable effect, taking the consumer out of the loop except as being a patient. He no longer paid the bills or even knowing the amount.
In the mean time, more and more people without insurance or an employee health care become the reality for several reason (another story). So the need to cost shift become ever greater for the providers. Laws like the EMTALA act were passed which require the providers to treat those that have no means of paying. Pushing the cost the providers must charge even higher, really sticking it to those that do not have a intermediary with agreement with the provider.
So now the provider have quite a staff to manage this chaos, which doesn't help actual costs at all, trying to find ways to increase revenue. Crap what a deal, providers have to worry about revenue instead of Healthcare! Non profit hospitals slowly learn, charge the maxim for every service or procedure regardless of the actual cost. Break every thing down to the most number of codes
that will be be remebused by Medicare, Medicaid, or the Insurance company. Make sure every procedure a patient is eligible to receive is use and billed. I could expand the hell out of this section
participially from personal experience, but you can thank me later for saving you this tale.
Healthcare is now out of reach for everyone that is without a intermediary (the cash customer) that has any means, like a home, but is not rich. Homestead law in most states protected most people from losing the home, but inflation of the 70s and 80s wiped that out. In Oregon the law protects 40K of home value and that covered the bulk of homes prior to inflation, but today it is close to meaningless. Hospital can and will get a judgement to collect their cost shift bloated bills from the non payers that have means. The 40k left will probably be blown before you can recover your senses. In 2009 I think, a group in Oregon attempted to get this old Homestead protection updated via initiative. But the liberal state administration fought it at every turn and it failed to get the signatures in on time.
So if you ask, should Medicare fully reimburse providers? My answer would be, fuck no! The total system needs to be redesigned to encourage healthcare efficiently.
If you ask, should everyone be enrolled in Medicare? My answer would be, fuck no! The total system needs to be...
I see several liked your question, they can ask some too.
