Recent articles I have read and my own experience interviewing dozens of physicians and their staffs give a clear indication that as far as the claim and payment process goes physicians prefer Medicare over commercial insurance.
The reason is simple; Medicare asks few questions, does not employ pre-certification and follows a pay and pursue claim policy. In other words, they pay a claim and later may asks questions and that’s a big maybe. It’s also why administering claims costs less and, at least in part, why Medicare fraud is so prevalent and why it often takes years to uncover it.
Physicians see the pre-authorization process, the questioning of care and other processes employed by insurers as driven by the profit motive. That’s not accurate. Those processes all result from the growth of health care costs over the years and by the demands of employers and other plan sponsors to do something about it. In part to weed out spending money on unnecessary care; something that is well documented.
While from the physician’s point of view they are dealing with an insurer looking to save money, the fact is in many, likely most, cases that insurer is acting as an administrator for a self-funded employer plan. The insurance company has no risk based on the claims paid. It is paid a fixed fee per month per participant to manage the plan.
Medicare and certainly M4A will have to employ the techniques used by insurers, or greatly reduce allowed fees or simply use various forms of rationing to manage costs, especially if out-of-pocket costs are eliminated.