Government

GPs to see patients in groups of 15. Being realistic is not being closed minded on Medicare for All

This may be perfectly okay in the UK, but it is an example of the types of things it takes to manage health care costs in a universal government system.

Too few doctors; too much demand for health care services? Either way the system must adjust.

Patients will be expected to see their GPs in groups of up to 15 under plans being considered by the NHS. Doctors said group consultations should become “the default” option offered by surgeries for many conditions, in an attempt to cope with growing shortages of GPs. The scheme is expected to be included in the NHS 10-year plan which is due to be published later this year. It is billed as an attempt to alleviate strain on family doctors, many of whom complain of being overworked.

Source: GPs to see patients in groups of 15

The notion that a M4A plan will make all of our health care issues, including cost, go away is very naive as is the idea of significant savings. Playing with assumptions you can reach any conclusion you desire, but more often than not reality intervenes.

When you hear promises of “free” it’s time to be concerned. When the impression is created it will be business as usual when receiving healthcare, it’s time to be concerned. When there are no specifics with regard to funding, it’s time to be concerned.

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8 replies »

  1. Too many Americans think provisions can be made for health costs, including long term care costs, etc. by asking the “wealthy” to pay more – and without disrupting the economy.

    Fifteen years ago, it was my privilege to attend a focus group conducted by Congressional direction included in the Medicare Modernization Act of 2003 – Health Care That Works for All Americans. I attended a forum in Cincinnati, Ohio. We discussed health reform in detail. One thing was abundantly clear from that discussion among everyday Americans (who took the time to show up for a discussion on a Saturday morning in downtown Cincinnati), “Americans want the best health care coverage and long term care coverage YOUR money will buy.”

    My point is simply that, like the current M4A discussion, few people know the true cost of Medicare, and even fewer would be willing to finance health care and long term care from taxes – if they knew the cost. For example, here is an estimate of the annual average cost for an individual eligible for Medicare (with an “F” plan Medicare Supplement):

    Premium:

    Part A $5,064 (premium for those who did not contribute FICA-Med)
    Part B $6,432 (Part B premium $134 * 4 * 12, general revenues fund 75% of the benefit)
    Part D $1,248 (Part D premium $26 * 4 * 12, general revenues fund 75% of the benefit)
    Supplement (F) $3,912 ($326 * 12)
    Total $16,656

    And, remember that certain structures are in place to manage the cost of services provided to Medicare beneficiaries – Diagnostic Related Groups, Resource Based Relative Value Schedules, Medicare Balance Billing Limits. Had those structure not been in place, had Medicare reimbursed providers at the same rates they charge to those who are not Medicare-eligible, the cost would be much higher. In 2017, the Medicare Payment Advisory Commission (MedPAC) reported that average commercial prices were about 28 percent higher than Medicare Fee For Service prices and that the difference has increased slightly since 2010 (Medicare Payment Advisory Commission
    2017). Importantly, defenders of Medicare assert that there is no cost shift to private insurance today. If providers can’t charge younger Americans more, they will have to further limit the number of government-insured beneficiaries. We have seen this with respect to Medicaid – where Medicare reimbursements are, on average, 39% higher than Medicaid reimbursements (varies dramatically from state to state, from a low in Rhode Island to a high in Alaska where reimbursement rates are almost the same).

    I doubt 10% of the current members of Congress can estimate the average annual cost incurred by and for Medicare beneficiaries within $1,000 a year.

    Finally, supposedly, Americans spend 18% of GDP on medical services. My economics knowledge is modest. However, I do know that GDP can be calculated in three ways, one of which is income based. GDP is about $20.4 Trillion. Disposable personal income (income after income and employment taxes) is about $15 Trillion. So, 18% of GDP would be 24% of DPI.

    How many Americans are willing to see a 24% deduction on their paycheck to pay for health coverage? And, that is without financing long term care. The bottom line is that we won’t solve the access and cost of coverage issues until we are willing to do as individuals what we are already doing as a society.

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    • I am 9 years away from Medicare. Are these the annual calculations per each medicare eligible person in the household?

      I never gave this a thought until you wrote it out. I am still trying to figure out what I am going to do for 2019.

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      • Yes. Those are total premium. The average cost beneficiaries pay is $0 for Part A hospital, $134 for Part B physician, and $26 for Part D Rx – per month, per beneficiary.

        The $326 per month is the average cost of the “F” Medicare Supplement option.

        There are lower cost options – specifically Medicare Advantage options with good value at less cost.

        My guess is that the average premium for all Medicare beneficiaries is $400 a month or so today.

        One of the positives is that Congress has taken action to dampen inflation for old folks – it has averaged 3% a year for the last 35 years.

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      • Thank you. In my mind I had $134 plus my company’s supplemental plan since those plan prices are listed as both employee and spouse. When the time comes it will be $134 * 2 plus the supplemental employee and spouse plan. In reality, my company’s rate chart does have an employee only for the supplemental plan which is amazingly exactly half, but I never looked at it until now. Heck, what’s an extra $134? At least I have 9 years to get use to the idea of paying twice as much as erroneously I thought. But at least I knew I would have to pay something. I am sure there are people who do not know until they apply for Medicare.

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  2. One more reason why M4A will fail in America. In the UK they still use open wards at NHS hospitals. In America, old hospitals are being replaced because they had two beds in a room to make it easier to comply with HIPAA laws. Many are building new hospitals with single patient rooms which also provides isolation for contagious diseases. So as the NHS moves to treat in groups, America has put up more barriers to ensure one-on-one, which as a side benefit limits cross contamination between patients.

    I am not saying which is better or right, but one has a big cost factor up front for day-to-day activities, while the other may have hidden costs during a pandemic.

    It is also funny how Americans want their privacy with their medical records but are willing to give it away to Google and Facebook, while in Europe it is the total opposite. That being said, you cannot compare America to Europe, we have different values that result in different outcomes.

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