I know all of that. What I am saying is that their services cost 30% and of that there is profit (a lot of profit, according to what information is public). Medicare does the same service for 10%. Simple as that.
We need to make the medical profession attractive to doctors who want more than a lot of money again. Maybe offer doctors 0% interest student loans or reduced debt. Get them focused again on taking care of patients. Full healthcare coverage is going to require a lot more doctors.
Its not as simple as that. Medicare does less administration than the insurance companies do. They instead push it down to the caregivers, while additionally driving down the rates the caregivers can get for the service. They get 10% for doing pretty much NOTHING but publish schedules, process incoming patient eligibility and processing payments. There is a reason doctors have figured out how to rip of Medicare for millions. They don't have anyone that is watching out for fraud.
LIKE THE INSURANCE COMPANIES HAVE! How many stories do you hear about a doctor or a patient ripping off the insurance company for millions? Now how many stories do you hear about Drs and patients ripping off Medicare?
Like I said before, the only way we can get a handle on our healthcare cost is to take the profit out of it. Not gonna hold my breath on that one.
On the surface no doctor doesn't love what the intent of the ACA wants to do in principle. Provide healthcare to all. No physician is against that notion. But the reality of the ACA has meant that small individual practices that aren't super specialties face insolvency with the present trajectory the ACA sends them on.
To survive you have to build a large practice that incorporates specialties that are still profitable at least today. The problem is if you build a practice on that model and the ACA decides to cut the incentive/income of the specialties, then you become insolvent on a larger scale.
My g/f makes less money now than she ever did in private practice. She knew from a kid she wanted to be a doctor. She never saw herself doing anything else. The money part was not the reason why. She saw the ACAs trajectory and sold her practice while there was still a market for it. She thanks her medical GOD that she managed to pay off her student debt before that happened. Otherwise the sale proceeds would have been pretty much to pay off her debt.
So she now teaches at a Medical University. That combines patient care with teaching. Pretty much the entire patient load is ACA recipients. Its a requirement that the university hospital takes them since they receive federal funding as a teaching facility. The staff don't get a say in the matter.
Before the ACA came along, Person A, a 16 year old drug addicted girl gets pregnant and miscarries the baby at say 40 weeks. Medically speaking we are at the end of the story.
Now lets show what the ACA has done. Patient A a 16 year drug addicted girl comes in with complications from a drug related pregnancy. At 35 weeks this time. They determine the baby can be saved by implementing the advanced technology of the Neo Natal Intensive Care procedures used there. So the baby is born pre-maturely. And placed in the NICU. This cost is approx 4K for the ACA portion per day. Further we are now paying for medical care of a 16 year old who is now having complications from drug withdrawals. So she is in treatment for that. Now I'm going to throw in another one. This really actually happened. So now as it happens, a hurricane is bearing down on us. An evacuation is ordered for at risk patients. This is all the babies in the NICU and all the staff needed to run the equipment Under these circumstances we are now at $56,000 a day for each ACA patient. This particular event there were 9 of these. If they didn't evacuate them as a cost concern, they would have been subjected to sanctioning and the media showing that the poor don't get proper medical care because they are poor. So its a given that these children will be evacuated. No discussion to it.
Now lets get back to mom. She gets treated for the symptoms of drug withdrawals and is now introduced to the social support system to help insure the baby has a good start in life. At no time are the care providers allowed to counsel her on drug use, or child conception education. If they suggest birth control and she turns it down, that is the end of what the ACA allows them to do. Mom is sent home. Baby comes home after release of the NICU as a reasonable healthy baby going into an at risk home. So the ACA has now spent over $500K on Patient A and her child. But mom will be bringing that baby back for ongoing care because like any Premmie they have risk to manage. So figure they are in the system for about 2 years after they started life there.
This is in a city with a population of 190,000. This or a similar scenario happens about once a month, sometimes twice. This is just ONE aspect I am sharing. Take this example and move it to St Louis or Detroit or Seattle or New York and multiply the dollar signs accordingly.
In my state, which is no where near a 30 % drug addiction rate, the out of pocket health care premiums have risen over 200% per family member in the last 2 years. That means some employed hard working people are coming up with over 25K a year in healthcare premiums. 25K a year pays a kid college tuition they now can't afford. No way in hell will my g/f or myself tell them the story of Patient A who doesn't pay a cent into the system.
So my liberal friend. In my world, I'd prefer to have private insurance, that decides who they wish to cover based on the risk they represent and decide how to keep overall health care cost down for me. And I don't mind if they make a profit doing so. Before I am forced to pay for 23,000 examples of patient A above. The problem we all have is that if they have no healthcare, then Patient A simply comes to the emergency room, and they will be treated. Never for a minute planning on paying the bill for it. So that gets passed down to the rest of us in the form of taxes. The lesser of 2 evils I guess. But it all sucks when we have a proliferation of Patient A's
There are several programs that offer young doctors the ability to get some of the debt paid off for work provided. Some take advantage of them. Most don't. If you really want to get serious about it, the government could force them to join the military of the Peace Corp or etc for a period of time and in addition to the pay, the debt would be forgiven as part of the compensation. Nobody wants the government to force anyone to do anything, so by God make them pay the debt they have rather than biotch about it. The last time I remember talking about this topic was at a graduation ceremony. As I congratulated the new young doctor I asked him and his parents how they felt about it. The parents said, finally we don't have any more bills for him and he said, now I gotta figure out how to pay my debt off. I asked my g/f if that was a joke. She said no, the average debt payment for an MD coming out of their school is 4K a month with the average owed of 300K. If they go into a specialty multiply that. The joke passed around is MD stands for MORE DEBT!
The last thing they need to hear is Oh by the way your fee for service is going down now to make healthcare more affordable for all of America. So there is another incentive. Stop paying them less. Unless you bring their cost down. No part of the ACA does the second part.
