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    Wednesday, November 23, 2005

    Question of the Day: From an email:

    If we had a Medicare-for-all system where the reimbursements were higher than they are today, and at least fair, would you support this over the current for-profit system with 1500 insurance companies?

    One of the arguments for a Canadian-style government run and financed healthcare system, from a physician's perspective, is just this. That the system would at least be more manageable than our current hodge-podge of insurance companies with their different rules and different reimbursement rates. It would be easier to bill, easier to collect, easier all around. And sometimes, it does seem tempting.

    But if there were only two choices - the current system vs. a Medicare-for-all system (which would be the same as the Canadian system), I'd stick with the current system - both as a patient and as a physician. For one thing, that if attached to the higher and fairer reimbursements is a mighty big if, and one that would only occur in a theoretical best of all possible worlds. The entire management culture of Medicare - and the politicians who control it - would have to change to allow better and reasonable reimbursement rates. As Medicare currently stands, reimbursement to physicians is set to automatically decrease every year by 4.4% over the next five years. By 2005, Medicare reimbursement for physicians will be 25% lower than it is today. Do you think our overhead will be 25% lower?

    This is their way of keeping costs down as the baby boomer population gets closer and closer to Medicare age. Rather than implement, say, a needs-based approach to the program, and risk angering an ever-growing and politically powerful section of the electorate, they chose a plan that would affect only the smallest demographic - doctors. And by the way, those yearly decreases in reimbursement only apply to physicians. Hospitals and other facilities are not included in the yearly automatic decrease in reimbursement. They have stronger lobbying groups.

    It's extremely frustrating to read comments from Congressmen like this:

    "I will not support simply pouring more taxpayer dollars year after year into a system that is broken," Mr. Barton said.

    As if the reason for the increase in Medicare costs is purely on the provider side. The reason Medicare costs are increasing is that there are more people on Medicare and they are living longer with chronic diseases that require medical attention. This is not going to change, no matter how little they pay doctors. And it is only going to get worse when the babyboomers hit Medicare-eligible age in five years. But no one in government is willing to address that. Instead, they actually do poor more taxpayer dollars by expanding the number of services it covers, regardless of how rich or poor the beneficiary may be.

    Our political culture would have to change drastically before a Medicare-for-all plan would work without bankrupting the nation. I'd rather bill 1500 different insurance companies than live under the tyranny of Medicare.

    posted by Sydney on 11/23/2005 07:21:00 AM 2 comments


    "As Medicare currently stands, reimbursement to physicians is set to automatically decrease every year by 4.4% over the next five years. By 2005, Medicare reimbursement for physicians will be 25% lower than it is today. Do you think our overhead will be 25% lower?"

    Well, I think that's both an accurate concern, and also your problem right there, isn't it? Your medicare system is ridiculous. You would indeed have to change a number of things. And so the initial question is unrealistic. Here's a different version: "If all patients were covered by a system in which reimbursement was paid via a single universal billing and payment system and the payments would increase over time along with the cost of living, how much of a decrease in individual reimbursements would still be fair in order to avoid the hassle of dealing with 1500 insurance companies?"

    By Anonymous Anonymous, at 7:09 PM  

    Up here in Canada, we dread the coming wave of aging baby boomers. A hybrid private-public system will ride this wave. A pure public system is like an anchor fixing us to the sea bed: we will be flooded when the wave gets higher than the anchor chain. And, since 60% of each earned dollars already goes to taxes, we cannot stretch the chain any more.

    Here, defenders of the public system (who believe in it like a religion) use the US example to scare people: it's either ours or theirs. And yours is truly scary: you pay far too much for the quality of care you get. In reality, the best systems are found in Europe, especially the scandinavian countries. Therefore, I suggest you stop looking at Canada and start looking at Danemark.

    Here is one of numerous studies comparing health care systems around the world:

    By Anonymous EM, at 1:40 PM  

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