Viewing entries tagged
Healthcare System

Behind The Headlines: Private Healthcare Plans Pay Hospitals More Than Twice The Medicare Rate

RAND Corporation analyzed the cost of hospital care across 25 states and found that hospitals, on average, charged the privately insured 2.4 times what they charge Medicare patients. A separate study by West Health found that private insurers paid California hospitals more than two times as much as Medicare paid for similar services. Private non-profit hospitals charged the most for privately insured patients.

Want Universal Healthcare? Get Serious about Cutting Fraud and Wasteful Spending

Fraud and waste is why US healthcare is so damn expensive. An estimated 10% of Medicare/Medicaid is lost to fraud. As for waste, at least 20% of US healthcare spending is unnecessary due to…Imagine if the US cut healthcare spending by a quarter. That would shave off almost a trillion dollars - enough to fund a healthcare system where everyone is covered and everyone’s paying less. All it takes is political will, including a willingness to face down the AMA.

An Alternative to Bernie Sanders' Medicare-for-All

Unfortunately, cheaper drugs and administration would not come even close to paying for Sanders’ Medicare-for-all plan. That’s because the high cost of US healthcare is driven by over-testing, over-treatment, overpriced procedures, and overpaid doctors. Check it out:

Bernie Sanders' Medicare-For-All Plan, Part I: Basic Features and Cost-Control

Most Americans support “Medicare-for-all”, at least when described very broadly as "a publicly financed, privately delivered system with all Americans enrolled and all medically necessary services covered."  But would they support Bernie Sander’s Medicare-for-all plan if well-informed of its details? Let’s look at some of those details, starting with what would be covered and how costs would be controlled. This straight from Bernie's online description

What's Wrong with US Healthcare?

Then again, Americans love their specialists – nothing soothes the soul so much as expensive displays of conspicuous compassion.

Healthcare Spending, US versus Other Developed Countries, Part VII: Recommendations

…3. Increase federal and state budgets for the detection and prosecution of fraudulent medical billing, such as upcoding. 4. Greatly expand the number of nurse practitioners working as  "full practice" primary care providers and gatekeepers, a status that allows them to work independently of a physician's clinical oversight. 5. Institute a no-fault medical malpractice system, much like the very successful one in Denmark. …

Healthcare Spending, US versus Other Developed Countries, Part VI: What Japan Can Teach US

Take MRI scans, which cost about $1500 in the US. In Japan,  the fixed price for an MRI scan is around $100 (depending on body part). Now you'd think that Japanese doctors wouldn't do that many MRIs because they couldn't make any money off them. But no - just the opposite: Japan leads the world in MRIs. What happened is that Japanese doctors asked MRI manufacturers to develop an inexpensive MRI scanner. And they got a cheap machine so they can do cheap MRI scans and still make a little profit. Sometimes the heavy hand of regulation can be a spur to innovation. …I say this as a lover of capitalism, for whom the word "corporate" elicits a sigh of gratitude.

Healthcare Spending, US versus Other Developed Countries, Part V: Administrative Costs

Between the government and private insurers, medical office personnel spend an inordinate amount of time processing bills. What is reimbursable, what is not? What type of documentation is required? What billing code should we use? How much can we charge? And that is one big reason the US spends so much on healthcare administration. Time is money.

Healthcare Spending, US versus Other Developed Countries, Part III: Drugs

Last post was about outpatient services, specifically how reimbursement rates and physician profit-sharing arrangements contribute to the cost of outpatient care in the US. This post will address the cost of pharmaceuticals…A recent JAMA study ( Papanicolas et al, 2018) found that annual per capita spending on pharmaceuticals in the US was $1443, compared to an average of $680 for ten other developed countries.

Healthcare Spending, US versus Other Developed Countries, Part II: Follow the Money

…Thus, if you want to understand why these procedures cost so much, follow the reimbursement rates. For instance, in 1997 Medicare raised reimbursement rates in certain parts of the country. On average, areas with a 2 percent increase in payment rates experienced a 3 percent increase in care provision. Physicians charge what they can, and then some.

Healthcare Spending, US versus Other Developed Countries, Part I; What Can We Learn?

Given that old people consume way more healthcare than anyone else, why do other rich countries spend so much less on healthcare than the US, when the US has comparatively fewer oldsters? Something is very wrong with this picture. What is all that money going?  … A lot is paying for outpatient care and administration, which alone account for half of US healthcare expenditures

Reducing Health Care Costs Saves Lives, Part VI

Average profit margins for insurance companies have hovered around 3% for years. That's not wasted money, though; in our current healthcare system, insurance companies play a vital role: they rein in providers who are prone to over-treat and over-test.