I still haven't seen: will providers be required to accept public payments under Sanders's plan?

[Recursion]

Will they be allowed to accept other forms of financing?

This is kind of (understatement) an important and fundamental question about what his plan would actually mean (it's a great or at least workable idea if the answers are "yes" and "no", and an absolutely terrible idea if they are "no" and "yes&quot . Does anybody know?

[Recursion]

1. Nobody cares enough about single payer to find this out? (nt)

[uponit7771]

2. Its not that, its the plan on its face already has tons of stumbling blocks in it and Sanders isn't

...going to address any of them just like he's not doing with his wall street reform plan.

Hell, the low hanging fruit looks suspect... you're rational question gets into what the doctors have to do ... they wont even think of touching that kind of detail.

[Recursion]

7. O'Malley's plan is very clear about what his carrot and stick are here

https://martinomalley.com/policy/health-care/

He will legally require the publication of charge masters and legally require self-financed care be billed at the Medicare rate (stick), and fund an operating grant to hospitals and practices that adopt global budgeting (carrot).

So, price transparency and parity will be required, but not direct participation in public financing (though that participation is made in many ways more attractive).

That took two paragraphs for him to set out; I don't think it's asking too much for Sanders's campaign to do something like that...

[Andy823]

8. I agree

O'Malley has come out with "real" plans, like this one, and others on all the issues that we need to address. He is the ONLY one that has put them in writing for all to read, and the only one who has taken the time to actually solve problems instead of simply throwing out promises with nothing to back them up.

[Quayblue]

11. Chargemasters depend heavily on the population served

So we still have to address public health disparities and be honest about the trends. My, our, hospital, has a high rate of admissions for cancer, addiction related chronic disease (HIV is the biggest), CHF, COPD, and so on. The area is not Rust Belt, but had blue collar jobs eliminated in the 80s, and as such, has followed that trend of every other area in this country where the lack of making a living has increased pockets of stress-related illness.

Tomorrow, I am going to look at the charge list a bit more closely than usual. I built some reports pulling data from the HIV/AIDS population, but will I am gonna pull data according to zip code as well. just to be nosey.

I can understand the publication of the list, but it means doo-doo if we don't use the data appropriately.

[Recursion]

13. And, to put it bluntly, we'd be handing those data to Paul Ryan

I've thought a lot about the possible pitfalls here, and yeah, they worry me.

[mythology]

3. I doubt it

They aren't required to take Medicaid and many either don't or only take a limited number due to the low payments. I suspect that would be a problem as well in single payer if the payments aren't adjusted.

There would be a different set of incentives as obviously if the large majority of the population is using the proposed Sanders single payer plan, doctors would have to take the patients, but would they cut appointments shorter or perhaps off load more work to nurses, physician's assistants or other things like small clinics in pharmacies.

I suspect it would also create either a secondary insurance market or a concierge service market. My guess would be the former, which would heavily cut into the suggested savings.

[Recursion]

6. Or they could charge more than Medicare pays and collect the balance from the patient

Would that be legal?

[one_voice]

12. Medicare & Medicaid reimbursements..

are really bad. Many doctors won't accept either. Another trend I've noticed is doctors going into concierge medicine/care. My family doctor made the switch at the end of last summer. I've been a patient of his for 35 years and had to make the decision as to whether I could stay with him or not.

His works like this: $1200 a year per patient, with that you get his personal cell for emergencies. He'll see you at any time if you don't feel you're able to wait until office hours. Normally you're seen the same day as you call. The service he's with has all kinds of perks, an outstanding initial physical that includes every kind of diagnostic test you can imagine at no extra charge.

You still pay your co-pay and they bill your insurance.

Doctors are finding they make more money this way. He cut his practice way down when he did this. Seems to be a trend.

I'd say both medicare & medicaid could use a huge overall.

[Recursion]

14. That's really popular in India too

Not just among the uber-rich; middle class families put doctors on a retainer (my mother in law's doctor doesn't just make housecalls; they will actually bring a portable x-ray for imaging to her house).

Many doctors won't accept either.

Yep. And once you talk about mandating it, public support drops.

[Quayblue]

4. good question

being that providers currently don't have to contract with government or commercial payers.

An issue I can foresee is balance billing,

So will/should providers be required to accept single payer payments? hm.

[Recursion]

5. And, yeah, balance billing raises a troubling question

Would it end up like higher education spending, where providers take all of the government money and then still charge whatever they can extract from the consumer?

[Quayblue]

9. Interesting this thought process leads into educational finance as well

kudos to you.

I am definitely against the student loan industry as it currently stands and am looking forward to introduction of legislation to eliminate it entirely.

Single payer is going to lead to a complete overhaul in the contractual portion of provider payment, no doubt. I read, interpret and code contracts daily, and there is so much ambiguity. We are definitely going to need language that nails down payment processes. From what I see, we have to lower health care costs in general, which is battle within itself. And then, reimburse providers accordingly.

Also, I think this is why ICD-10 was implemented..in preparation for single payer. Single payer CAN be obtained, but we truly need detailed planning. Public health professionals, doctors, lawyers, actuaries, etc. need to be in the mix.

anywho...

[Recursion]

10. I definitely agree there: it's not simply a question of adopting a different financing model

From what I see, we have to lower health care costs in general, which is battle within itself. And then, reimburse providers accordingly.

That's probably the best description of the problem I've seen; thank you.

And, yeah, I agree we need buy-in from every stakeholder in the process, including even dreaded private insurance (which, people should remember, even Canada still has, and uses to finance about 13% of their health care spending)



In particular we're going to need to get providers on board with this.